A Collaborating Centre for animal health economics in the Americas.

Countries in the Americas play a vital role in global livestock and aquaculture production. With international trade of livestock and aquaculture products becoming an important source of income for countries, there has been an increased interest in using animal health economics for advocacy and allocation of resources. This article discusses the development of a new Collaborating Centre for the Economics of Animal Health and the applications of the Global Burden of Animal Diseases (GBADs) framework in the Americas region. Incentives for the increased use of economics in animal health decision-making and examples from the Americas region are examined. The article then discusses the newly formed World Organisation for Animal Health Collaborating Centre in the Americas region. Finally, it reviews two ongoing case studies that are implementing the GBADs framework in Peru and the United States of America.

Les pays des Amériques jouent un rôle crucial dans la production mondiale d'animaux d'élevage, qu'il s'agisse d'espèces terrestres ou aquatiques. Le commerce international des produits issus de l'élevage et de l'aquaculture étant désormais une source importante de revenus pour les pays, la possibilité d'utiliser les concepts de l'économie de la santé animale à des fins de plaidoyer et d'allocation des ressources suscite un intérêt croissant. Les auteurs abordent la désignation d'un nouveau Centre collaborateur pour l'économie de la santé animale ainsi que les applications du programme " Impact mondial des maladies animales " (GBADs) dans la région des Amériques. Ils examinent les avantages d'une meilleure prise en compte de l'économie dans les prises de décision en matière de santé animale, illustrés par quelques exemples concrets relevés dans la région. Ils décrivent ensuite la création du nouveau Centre collaborateur de l'Organisation mondiale de la santé animale dans la région des Amériques. Enfin, ils présentent deux études de cas menées actuellement concernant la mise en oeuvre du programme GBADs respectivement au Pérou et aux Etats-Unis d'Amérique.

Los países de las Américas desempeñan un papel fundamental en la producción ganadera y acuícola mundial. Dado que el comercio internacional de productos ganaderos y acuícolas se ha convertido en una importante fuente de ingresos para los países, el interés por utilizar la economía de la sanidad animal en favor de la promoción y la asignación de recursos ha ido en aumento. En este artículo se analiza la creación de un nuevo Centro colaborador para la economía de la sanidad animal y las aplicaciones del marco del impacto global de las enfermedades animales (GBADs) en la región de las Américas. Se examinan los incentivos para un mayor uso de la economía en la toma de decisiones sobre sanidad animal, así como ejemplos de la región. A continuación, en el artículo se presenta el recién creado Centro colaborador de la Organización Mundial de Sanidad Animal en la región de las Américas. Por último, se examinan dos estudios de casos en los que se está poniendo en práctica el marco del GBADs en Perú y los Estados Unidos de América.

Rocking block simulation based on numerical dissipation.

In this paper, a computational approach based on numerical dissipation is proposed to simulate rocking blocks. A rocking block is idealized as a solid body interacting with its foundation through a contact-based formulation. An implicit time integration scheme with numerical dissipation, set to optimally treat dissipation in contact problems, is employed. The numerical dissipation is ruled by the time step and the rocking dissipative phenomenon at impacts is accurately predicted without any damping model. A broad numerical campaign is conducted to define a regression law in analytic form for the setting of the time step, depending on the block size and aspect ratio, the contact stiffness, as well as the coefficient of restitution selected. The so-obtained regression law appears accurate and an a posteriori validation with cases not in the training dataset confirms the effectiveness of the approach. Finally, the comparison with available experimental tests highlights the approach efficacy for free rocking and harmonic loading cases (in a deterministic sense), and for earthquake-like loading cases (in a statistical sense). It is found that rocking blocks with sizes of interest for structural engineering (e.g., cultural heritage structures) can be simulated with time steps within 10-3 ÷ 10-1 s, so allowing very fast computations.

[Updated indications and contraindications in 2022 for lung transplantation in France]. / Transplantation pulmonaire en France : actualisation des indications et contre-indications en 2022.

Lung transplantation (LTx) is the last-resort treatment for end-stage respiratory insufficiency, whatever its origin, and represents a steadily expanding field of endeavor. Major developments have been impelled over the years by painstaking efforts at LTx centers to improve donor and recipient selection, and multifaceted attempts have been made to meet the challenges raised by surgical management, perioperative care, and long-term medical complications. The number of procedures has increased, leading to improved post-LTx prognosis. One consequence of these multiple developments has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. With these considerations in mind, the Francophone Pulmonology Society (Société de Pneumology de Langue Française [SPLF]) has set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force has examined the most recent literature and evaluated the risk factors that continue to limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics.

In the context of lung transplant (LT), because of diagnostic difficulties, antibody-mediated rejection (AMR) remains a matter of debate. We retrospectively analyzed an LT cohort at Foch Hospital to demonstrate the impact of AMR on LT prognosis. AMR diagnosis requires association of clinical symptoms, donor-specific antibodies (DSAs), and C4d(+) staining and/or histological patterns consistent with AMR. Prospective categorization split patients into four groups: (i) DSA positive, AMR positive (DSA(pos) AMR(pos) ); (ii) DSA positive, AMR negative (DSA(pos) AMR(neg) ); (iii) DSA limited, AMR negative (DSA(Lim) ; equal to one specificity, with mean fluorescence intensity of 500-1000 once); and (iv) DSA negative, AMR negative (DSA(neg) ). AMR treatment consisted of a combination of plasmapheresis, intravenous immunoglobulin and rituximab. Among 206 transplanted patients, 10.7% were DSA(pos) AMR(pos) (n = 22), 40.3% were DSA(pos) AMR(neg) (n = 84), 6% were DSA(Lim) (n = 13) and 43% were DSA(neg) (n = 88). Analysis of acute cellular rejection at month 12 showed higher cumulative numbers (mean plus or minus standard deviation) in the DSA(pos) AMR(pos) group (2.1 ± 1.7) compared with DSA(pos) AMR(neg) (1 ± 1.2), DSA(Lim) (0.75 ± 1), and DSA(neg) (0.7 ± 1.23) groups. Multivariate analysis demonstrated AMR as a risk factor for chronic lung allograft dysfunction (hazard ratio [HR] 8.7) and graft loss (HR 7.56) for DSA(pos) AMR(pos) patients. Our results show a negative impact of AMR on LT clinical course and advocate for an early active diagnostic approach and evaluation of therapeutic strategies to improve prognosis.

[The management of lung transplantation candidates. A case series]. / Préparation des insuffisants respiratoires à la transplantation. Un état des lieux.

INTRODUCTION: Lung transplantation (LT) is associated with an increased risk of infection, cancer, chronic renal failure, cardiovascular disease and osteoporosis. Some risk factors precede transplantation and could benefit for early diagnosis and optimised care. METHODS: The incidence of comorbidities and their treatment before referral were assessed in 157 consecutive lung transplant candidates between 2008 and 2011. RESULTS: The median age was 37years [25; 51]. Fifty-six percent had a body mass index below 19kg/m(2). In the COPD group, only 50 % had undergone a pulmonary rehabilitation program in the preceding 2 years. Osteoporosis was present in 42 %, of whom 36 % were on bisphophonate therapy. Vitamin D deficiency was present in 65 %. Previously undiagnosed cardiovascular risk factors were discovered during LT assessment: hypertension in one patient, hypercholesterolemia in 6 % and diabetes in 4 %. Poor dental condition necessitating extractions were found in 41 % of patients. Protective anti-HBs antibodies levels were present in 50 % of the patients at the time of referral. CONCLUSION: The assessment and early treatment of nutritional disorders, osteoporosis and risk factors for infection as well as addressing associated cardiovascular risk factors should be optimised in the care of patients with chronic respiratory insufficiency. The potential for becoming a lung transplant candidate in the future should be kept in mind early in the global management of those patients.

[Transition of adolescents and young adults from pediatric to adult care]. / Passage des adolescents et des jeunes adultes atteints de mucoviscidose en centre adulte.

Nowdays adults with cystic fibrosis are no more attended in pediatric centers. Transition from pediatric to adult care centers must be anticipated. It requires the preparation of patients and families and a cooperation between both teams. Now, there are more patients and they are healthier. Adults centers caregivers have to pay particular attention to new young patients, to manage cystic fibrosis adult issues and to deal with more frequent comorbidities and severe complications. Adults centers will need better resources to maintain good quality of cares and improved life expectancy.

[Diagnostic strategy for acute respiratory failure in patients with haematological malignancy]. / Stratégie diagnostique dans l'insuffisance respiratoire aiguë des patients d'oncohématologie.

INTRODUCTION: About 15% of patients with haematological malignancy develop acute respiratory failure (ARF), necessitating admission to intensive care where their mortality is of the order of 50%. STATE OF THE ART: The prognosis of these patients is not determined by the pathological characteristics of the malignancy but by the cause of the acute respiratory failure. In effect, the need to resort to mechanical ventilation in the presence of dysfunction of other organs dominates the prognosis. Even if the use of non-invasive ventilation in these patients has reduced the need for intubation and reduced the mortality, its prolonged use in the most severely affected patients prevents the optimal diagnostic and therapeutic management. PERSPECTIVES: Fibreoptic bronchoscopy with broncho-alveolar lavage (BAL) is considered the cornerstone of aetiological diagnosis but its diagnostic effectiveness is poor, at best 50%, and this has led to increasing interest in high resolution CT scanning and regularly reawakens a transitory enthusiasm for surgical lung biopsy. Furthermore, in hypoxaemic patients, fibreoptic bronchoscopy with BAL may be the origin of the resort to mechanical ventilation, and thus increased mortality. The place of recently developed non-invasive tools is under evaluation. In effect, though the individual performance of diagnostic molecular techniques on sputum, blood, urine or naso- pharyngeal secretions has been established, the combination of these tools as an alternative to BAL has not yet been reported. CONCLUSION: This review deals with acute respiratory failure in patients with haematological malignancy. It includes a review of the recent literature and considers the current controversies, in particular the risk-benefit balance of fibreoptic bronchoscopy with BAL in severely hypoxaemic patients.

Respiratory status deterioration during G-CSF-induced neutropenia recovery.

Exacerbation of prior pulmonary involvement may occur during neutropenia recovery. Granulocyte colony-stimulating factor (G-CSF)-related pulmonary toxicity has been documented in cancer patients, and experimental models suggest a role for G-CSF in acute lung injury during neutropenia recovery. We reviewed 20 cases of noncardiac acute respiratory failure during G-CSF-induced neutropenia recovery. Half the patients had received hematopoietic stem cell transplants. All patients experienced pulmonary infiltrates during neutropenia followed by respiratory status deterioration coinciding with neutropenia recovery. Neutropenia duration was 10 (4-22) days, and time between respiratory symptoms and the first day with more than 1000 leukocytes/mm3 was 1 (-0.5 to 2) day. Of the 20 patients, 16 received invasive or noninvasive mechanical ventilation, including 14 patients with acute respiratory distress syndrome (ARDS). Five patients died, with refractory ARDS. In patients with pulmonary infiltrates during neutropenia, G-CSF-induced neutropenia recovery carries a risk of respiratory status deterioration with acute lung injury or ARDS. Clinicians must maintain a high index of suspicion for this diagnosis, which requires eliminating another cause of acute respiratory failure, G-CSF discontinuation and ICU transfer for early supportive management including diagnostic confirmation and noninvasive mechanical ventilation.

Pulmonary tuberculosis: evaluation of interferon-gamma levels as an immunological healing marker based on the response to the Bacillus Calmette-Guerin.

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis whose interaction with the host may lead to a cell-mediated protective immune response. The presence of interferon gamma (IFN-gamma) is related to this response. With the purpose of understanding the immunological mechanisms involved in this protection, the lymphoproliferative response, IFN-gamma and other cytokines like interleukin (IL-5, IL-10), and tumor necrosis factor alpha (TNF-alpha) were evaluated before and after the use of anti-TB drugs on 30 patients with active TB disease, 24 healthy household contacts of active TB patients, with positive purified protein derivative (PPD) skin tests (induration > 10 mm), and 34 asymptomatic individuals with negative PPD skin test results (induration < 5 mm). The positive lymphoproliferative response among peripheral blood mononuclear cells of patients showed high levels of IFN-gamma, TNF-alpha, and IL-10. No significant levels of IL-5 were detected. After treatment with rifampicina, isoniazida, and pirazinamida, only the levels of IFN-gamma increased significantly (p < 0.01). These results highlight the need for further evaluation of IFN-gamma production as a healing prognostic of patients treated.

Pulmonary tuberculosis: evaluation of interferon-gamma levels as an immunological healing marker based on the response to the Bacillus Calmette-Guerin

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis whose interaction with the host may lead to a cell-mediated protective immune response. The presence of interferon-gamma is related to this response. With the purpose of understanding the immunological mechanisms involved in this protection, the lymphoproliferative response, IFN-gamma and other cytokines like interleukin (IL-5, IL-10), and tumor necrosis factor alpha (TNF-alfa) were evaluated before and after the use of anti-TB drugs on 30 patients with active TB disease, 24 healthy household contacts of active TB patients, with positive purified protein derivative (PPD) skin tests (induration > 10 mm), and 34 asymptomatic individuals with negative PPD skin test results (induration < 5 mm). The positive lymphoproliferative response among peripheral blood mononuclear cells of patients showed high levels of IFN-gamma, TNF-alfa, and IL-10. No significant levels of IL-5 were detected. After treatment with rifampicina, isoniazida, and pirazinamida, only the levels of IFN-gamma increased significantly (p < 0.01). These results highlight the need for further evaluation of IFN-gamma production as a healing prognostic of patients treated.

Mutations in the rpoB gene of rifampicin-resistant Mycobacterium tuberculosis strains isolated in Brazil and France.

We evaluated the mutations in a 193bp of the rpoB gene by automated sequencing of rifampicin (RMP)-resistant and susceptible Mycobacterium tuberculosis strains isolated from Brazil (25 strains) and France (37 strains). In RMP-resistant strains, mutations were identified in 100% (16/16) from France and 89% (16/18) from Brazil. No mutation was detected in the 28 RMP-susceptible strains. Among RMP-resistant or RMP-susceptible strains deletion was observed. A double point mutation which had not been reported before was detected in one strain from France. Among French resistant strains mutations were found in codons 531 (31.2%), 526, 513 and 533 (18.7% each). In Brazilian strains the most common mutations were in codons 531 (72.2%), 526 (11.1%) and 513 (5.5%). The heterogeneity found in French strains may be related to the fact that most of those strains were from African or Asian patients.

Drug abuse--user accountability: is it a victimless crime?

This article examines the principles of drug-user accountability. It examines the broader concepts of accountability in terms of individual responsibility (including criminal responsibility), the actions and the consequences of such actions, in terms of the self and others. Recent and prevailing governmental and public opinions are evaluated and appropriate sanctions are examined. Medico-legal aspects and dilemmas affecting the issues of the pathology of drug addiction and the nature and degree of impairment of responsibility as part of the addictive process, are analysed. A combined approach blending effective treatment, appropriate legal sanctions and community sanctions as an ultimate process to achieve demand and supply reduction universally, is proposed.

The ethics of statutory coercion in the treatment of chemical substance abuse/dependence (addiction).

Many countries, including the Republic of South Africa, have introduced legislation providing for statutory treatment in cases of chemical substance dependence (addiction). Many more countries, including Canada and the United States of America, have made various attempts at the introduction of similar legislation in the face of an escalating drug abuse problem, only to have such legislation successfully challenged by various civil rights groups protesting about the "infringement of individual rights." This paper will examine some of the practical implications of coercive treatment of chemical addiction against the background of the principles of the rights of the individual. It will examine the feasibility of legal protection for such individual rights with simultaneous insistence on constructive treatment intervention. It will also raise many topics for discussion in terms of the role of the "helping professions", the well-worn tenet of "Am I my brother's keeper?" and the sociological poser of "the benefit of the community."