Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage.

INTRODUCTION: In June 2015, a cholera outbreak was declared in Juba, South Sudan. In addition to standard outbreak control measures, oral cholera vaccine (OCV) was proposed. As sufficient doses to cover the at-risk population were unavailable, a campaign using half the standard dosing regimen (one-dose) targeted high-risk neighborhoods and groups including neighbors of suspected cases. Here we report the operational details of this first public health use of a single-dose regimen of OCV and illustrate the feasibility of conducting highly targeted vaccination campaigns in an urban area. METHODOLOGY/PRINCIPAL FINDINGS: Neighborhoods of the city were prioritized for vaccination based on cumulative attack rates, active transmission and local knowledge of known cholera risk factors. OCV was offered to all persons older than 12 months at 20 fixed sites and to select groups, including neighbors of cholera cases after the main campaign ('case-triggered' interventions), through mobile teams. Vaccination coverage was estimated by multi-stage surveys using spatial sampling techniques. 162,377 individuals received a single-dose of OCV in the targeted neighborhoods. In these neighborhoods vaccine coverage was 68.8% (95% Confidence Interval (CI), 64.0-73.7) and was highest among children ages 5-14 years (90.0%, 95% CI 85.7-94.3), with adult men being less likely to be vaccinated than adult women (Relative Risk 0.81, 95% CI: 0.68-0.96). In the case-triggered interventions, each lasting 1-2 days, coverage varied (range: 30-87%) with an average of 51.0% (95% CI 41.7-60.3). CONCLUSIONS/SIGNIFICANCE: Vaccine supply constraints and the complex realities where cholera outbreaks occur may warrant the use of flexible alternative vaccination strategies, including highly-targeted vaccination campaigns and single-dose regimens. We showed that such campaigns are feasible. Additional work is needed to understand how and when to use different strategies to best protect populations against epidemic cholera.

What Is Morphological Computation? On How the Body Contributes to Cognition and Control.

The contribution of the body to cognition and control in natural and artificial agents is increasingly described as "offloading computation from the brain to the body," where the body is said to perform "morphological computation." Our investigation of four characteristic cases of morphological computation in animals and robots shows that the "offloading" perspective is misleading. Actually, the contribution of body morphology to cognition and control is rarely computational, in any useful sense of the word. We thus distinguish (1) morphology that facilitates control, (2) morphology that facilitates perception, and the rare cases of (3) morphological computation proper, such as reservoir computing, where the body is actually used for computation. This result contributes to the understanding of the relation between embodiment and computation: The question for robot design and cognitive science is not whether computation is offloaded to the body, but to what extent the body facilitates cognition and control-how it contributes to the overall orchestration of intelligent behavior.

[Emergency Doctor Training for Psychiatric Emergencies: Evaluation of an Interactive Training Program]. / Notarztschulung über psychiatrische Notfälle: Evaluation eines interaktiven Fortbildungsprogramms.

Aim Emergency physicians are often confronted with psychiatric emergencies, but are not well trained for it and often feel unable to cope sufficiently with them. The aim of this investigation was to examine whether multisensoric training may improve learning effects in the training of emergency physicians with regard to psychiatric emergencies. Method Participation in a multi-modal, multi-media training program with video case histories and subsequent evaluation by questionnaire. Results 66 emergency physicians assessed their learning effects. 75 % or 73 % rated it as "rather high" or "very high". In particular, in comparison with classical training/self-study 89 % assessed the effects in learning as "rather high" or "very high" . Conclusion This training receives a high level of acceptance. Using videos, learning content may be provided more practice-related. Thus, emergency physicians are able to develop a greater understanding of psychiatric emergencies.

Trauma and stress-related disorders in German emergency physicians: the predictive role of personality factors.

Emergency medical personnel (EMP) are repeatedly exposed to traumatic and stressful events with possible consequences on their mental wellbeing. Out of the group of EMP, we chose German Emergency Physicians (EP), because they represent a distinct group within the German pre-hospital emergency services. In this group, we studied the prevalence rates of posttraumatic stress disorder (PTSD), burnout and depression. We specifically focussed on the role of personality and other factors of vulnerability. Four hundred eighty-seven German EPs answered questionnaires with scales assessing probable PTSD, burnout, depression, and personality factors. Additionally, we asked for biographic, occupational and mental health information. More than 90% of the participants reported at least one traumatic event. We found low to moderate levels of stress-related disorders with 16.8% of participants meeting the criteria for probable PTSD, 4.1% for burnout, and 3.1% for clinical depression. We identified four clusters of personalities that were related to the prevalence of PTSD and depression. The type of personality seems to be more predictive of the development of trauma and stress-related disorders than the EPs' traumatic experiences.