High-spatial resolution epidemic surveillance of bacterial meningitis in the African meningitis belt in Burkina Faso.

Despite improved surveillance capacities and WHO recommendations for subdistrict analysis, routine epidemic surveillance of acute bacterial meningitis in the African meningitis belt remains largely limited to the district level. We evaluated the appropriateness and performance of analyses at higher spatial resolution. We used suspected meningitis surveillance data at health centre (HC) resolution from Burkina Faso from 14 health districts spanning years 2004-2014 and analysed them using spatio-temporal statistics and generative models. An operational analysis compared epidemic signals at district and HC-level using weekly incidence thresholds. Eighty-four percent (N = 98/116) of epidemic clusters spanned only one HC-week. Spatial propagation of epidemic clusters was mostly limited to 10-30 km. During the 2004-2009 (with serogroup A meningitis) and 2010-2014 (after serogroup A elimination) period, using weekly HC-level incidence thresholds of 100 and 50 per 100,000 respectively, we found a gain in epidemic detection and timeliness in 9 (41% of total) and 10 (67%), respectively, district years with at least one HC signal. Individual meningitis epidemics expanded little in space, suggesting that a health centre level analysis is most appropriate for epidemic surveillance. Epidemic surveillance could gain in precision and timeliness by higher spatial resolution. The optimal threshold should be defined depending on the current background incidence of bacterial meningitis.

Sex influence on muscle synergies in a ballistic force-velocity test during the delayed recovery phase after a graded endurance run.

The acute and delayed phases of the functional recovery pattern after running exercise have been studied mainly in men. However, it seems that women are less fatigable and/or recover faster than men, at least when tested in isometric condition. After a 20 km graded running race, the influence of sex on the delayed phase of recovery at 2-4 days was studied using a horizontal ballistic force-velocity test. Nine female and height male recreational runners performed maximal concentric push-offs at four load levels a week before the race (PRE), 2 and 4 days (D2 and D4) later. Ground reaction forces and surface electromyographic (EMG) activity from 8 major lower limb muscles were recorded. For each session, the mechanical force-velocity-power profile (i.e. theoretical maximal values of force ( F ¯ 0), velocity ( V ¯ 0), and power ( P ¯ max)) was computed. Mean EMG activity of each recorded muscle and muscle synergies (three for both men and women) were extracted. Independently of the testing sessions, men and women differed regarding the solicitation of the bi-articular thigh muscles (medial hamstring muscles and rectus femoris). At mid-push-off, female made use of more evenly distributed lower limb muscle activities than men. No fatigue effect was found for both sexes when looking at the mean ground reaction forces. However, the force-velocity profile varied by sex throughout the recovery: only men showed a decrease of both V ¯ 0 (p < 0.05) and P ¯ max (p < 0.01) at D2 compared to PRE. Vastus medialis activity was reduced for both men and women up to D4, but only male synergies were impacted at D2: the center of activity of the first and second synergies was reached later. This study suggests that women could recover earlier in a dynamic multi-joint task and that sex-specific organization of muscle synergies may have contributed to their different recovery times after such a race.

A real-world implementation of a nationwide, long-term monitoring program to assess the impact of agrochemicals and agricultural practices on biodiversity.

Biodiversity has undergone a major decline throughout recent decades, particularly in farmland. Agricultural practices are recognized to be an important pressure on farmland biodiversity, and pesticides are suspected to be one of the main causes of this decline in biodiversity. As part of the national plan for reduction of pesticides use (Ecophyto), the French ministry of agriculture launched the 500 ENI (nonintended effects) monitoring program in 2012 in order to assess the unintended effects of agricultural practices, including pesticide use, on biodiversity represented by several taxonomic groups of interest for farmers. This long-term program monitors the biodiversity of nontargeted species (earthworms, plants, coleoptera, and birds), together with a wide range of annual data on agricultural practices (crop rotation, soil tillage, weed control, fertilizers, chemical treatments, etc.). Other parameters (e.g., landscape and climatic characteristics) are also integrated as covariates during the analyses. This monitoring program is expected to improve our understanding of the relative contribution of the different drivers of population and community trends. Here, we present the experience of setting up the 500 ENI network for this ambitious and highly complex monitoring program, as well as the type of data it collects. The issue of data quality control and some first results are discussed. With the aim of being useful to readers who would like to set up similar monitoring schemes, we also address some questions that have arisen following the first five years of the implementation phase of the program.

Hierarchizing Determinants of Sick Leave: Insights From a Survey on Health and Well-being at the Workplace.

OBJECTIVE: We hierarchized a range of individual and occupational factors impacting the occurrence of very short (1-3 days), short (4 days to 1 month), or long-term (more than a month) sick leave spells. METHODS: Data were collected from a repeated cross-sectional survey conducted in the French private sector over the period 2011 to 2017. Fifty one sick leave determinants were ranked using a conditional random forest approach. RESULTS: The main determinants of long-term sick leaves were mainly health-related characteristics, such as perceived health, but also work-related covariates such as supervisor acknowledgment. On the contrary, very short-term spells were mainly defined by sociodemographic covariates. CONCLUSION: These results could be useful for devising appropriate actions to prevent against sick leave at the workplace, particularly long-term spells. Random forest approach is a promising approach for ranking correlated covariates from large datasets.

An integrative modeling approach to the age-performance relationship in mammals at the cellular scale.

Physical and cognitive performances change across lifespan. Studying cohorts of individuals in specific age ranges and athletic abilities remains essential in assessing the underlying physiological mechanisms that result in such a drop in performance. This decline is now viewed as a unique phenotypic biomarker and a hallmark of the aging process. The rates of decline are well documented for sets of traits such as running or swimming but only a limited number of studies have examined the developmental and senescent phases together. Moreover, the few attempts to do so are merely descriptive and do not include any meaningful biological features. Here we propose an averaged and deterministic model, based on cell population dynamics, replicative senescence and functionality loss. It describes the age-related change of performance in 17 time-series phenotypic traits, including human physical and cognitive skills, mouse lemur strength, greyhound and thoroughbred speed, and mouse activity. We demonstrate that the estimated age of peak performance occurs in the early part of life (20.5% ± 6.6% of the estimated lifespan) thus emphasizing the asymmetrical nature of the relationship. This model is an initial attempt to relate performance dynamics to cellular dynamics and will lead to more sophisticated models in the future.

Atmospheric Dust, Early Cases, and Localized Meningitis Epidemics in the African Meningitis Belt: An Analysis Using High Spatial Resolution Data.

BACKGROUND: Bacterial meningitis causes a high burden of disease in the African meningitis belt, with regular seasonal hyperendemicity and sporadic short, but intense, localized epidemics during the late dry season occurring at a small spatial scale [i.e., below the district level, in individual health centers (HCs)]. In addition, epidemic waves with larger geographic extent occur every 7-10 y. Although atmospheric dust load is thought to be an essential factor for hyperendemicity, its role for localized epidemics remains hypothetic. OBJECTIVES: Our goal was to evaluate the association of localized meningitis epidemics in HC catchment areas with the dust load and the occurrence of cases in the same population early in the dry season. METHODS: We compiled weekly reported cases of suspected bacterial meningitis at the HC resolution for 14 districts of Burkina Faso for the period 2004-2014. Using logistic regression, we evaluated the association of epidemic HC-weeks with atmospheric dust [approximated by the aerosol optical thickness (AOT) satellite product] and with the observation of early meningitis cases during October-December. RESULTS: Although AOT was strongly associated with epidemic HC-weeks in crude analyses across all HC-weeks during the meningitis season [odds ratio (OR) [Formula: see text]; 95% CI: 4.90, 9.50], the association was no longer apparent when controlling for calendar week (OR [Formula: see text]; 95% CI: 0.60, 1.50). The number of early meningitis cases reported during October-December was associated with epidemic HC-weeks in the same HC catchment area during January-May of the following year (OR for each additional early case [Formula: see text]; 95% CI: 1.06, 1.21). CONCLUSIONS: Spatial variations of atmospheric dust load do not seem to be a factor in the occurrence of localized meningitis epidemics, and the factor triggering them remains to be identified. The pathophysiological mechanism linking early cases to localized epidemics is not understood, but their occurrence and number of early cases could be an indicator for epidemic risk. https://doi.org/10.1289/EHP2752.

Collective effectiveness in the XV de France: selections and time matter.

The aim of this study was to quantify the impact of selections and shared selections in the rugby union. Players' names, positions, and number of selections were collected for all XV de France's games (1906-2014). Every team's percentage of renewal of workforce was calculated for backs and forwards. During the 1987-2014 period, all second row forwards (locks), halfbacks, and centres' shared selections (number of times when two players have competed together) were recreated. The Best vs. Rest method was applied to these remodelled dyads. They were analysed and compared with surrounding teammates as well as opponents. Head coaches similarly change their workforce for upcoming matches after winning or losing (around 30%), but losing teams renew significantly more positions in their line-ups. The recreated halfbacks, locks, and centres reveal a common pattern. Whether victorious or not, the 'renewed couples' victory percentage will congregate towards the XV de France's victory percentage. For all the best recreated couples, the cumulated number of selections for forwards' is always higher than the ones part of less efficient teams: 231.3 ± 80 vs. 212.9 ± 91 selections for locks' teammates (Effect sizes (ES) small, possibly positive, 54.8%). In best recreated couples, number 8's are significantly more experienced than their counterparts in less efficient pairs (ES small, likely positive, 76.3%). The XV de France's collective effectiveness relies on a balance between stability and workforce renewal, which allows the building of specific position interactions and builds on experimented forwards packs. Selections and shared selections are serious collective performance parameters associated with performance.

Detecting multi-way epistasis in family-based association studies.

The era of genome-wide association studies (GWAS) has led to the discovery of numerous genetic variants associated with disease. Better understanding of whether these or other variants interact leading to differential risk compared with individual marker effects will increase our understanding of the genetic architecture of disease, which may be investigated using the family-based study design. We present M-TDT (the multi-locus transmission disequilibrium test), a tool for detecting family-based multi-locus multi-allelic effects for qualitative or quantitative traits, extended from the original transmission disequilibrium test (TDT). Tests to handle the comparison between additive and epistatic models, lack of independence between markers and multiple offspring are described. Performance of M-TDT is compared with a multifactor dimensionality reduction (MDR) approach designed for investigating families in the hypothesis-free genome-wide setting (the multifactor dimensionality reduction pedigree disequilibrium test, MDR-PDT). Other methods derived from the TDT or MDR to investigate genetic interaction in the family-based design are also discussed. The case of three independent biallelic loci is illustrated using simulations for one- to three-locus alternative hypotheses. M-TDT identified joint-locus effects and distinguished effectively between additive and epistatic models. We showed a practical example of M-TDT based on three genes already known to be implicated in malaria susceptibility. Our findings demonstrate the value of M-TDT in a hypothesis-driven context to test for multi-way epistasis underlying common disease etiology, whereas MDR-PDT-based methods are more appropriate in a hypothesis-free genome-wide setting.

Climate change and human health: what are the research trends? A scoping review protocol.

INTRODUCTION: For 28 years, the Intergovernmental Panel on Climate Change (IPCC) has been assessing the potential risks associated with anthropogenic climate change. Although interest in climate change and health is growing, the implications arising from their interaction remain understudied. Generating a greater understanding of the health impacts of climate change could be key step in inciting some of the changes necessary to decelerate global warming. A long-term and broad overview of the existing scientific literature in the field of climate change and health is currently missing in order to ensure that all priority areas are being adequately addressed. In this paper we outline our methods to conduct a scoping review of the published peer-reviewed literature on climate change and health between 1990 and 2015. METHODS AND ANALYSIS: A detailed search strategy will be used to search the PubMed and Web of Science databases. Specific inclusion and exclusion criteria will be applied in order to capture the most relevant literature in the time frame chosen. Data will be extracted, categorised and coded to allow for statistical analysis of the results. ETHICS AND DISSEMINATION: No ethical approval was required for this study. A searchable database of climate change and health publications will be developed and a manuscript will be complied for publication and dissemination of the findings. We anticipate that this study will allow us to map the trends observed in publications over the 25-year time period in climate change and health research. It will also identify the research areas with the highest volume of publications as well as highlight the research trends in climate change and health.

Characterization of the major bacterial-fungal populations colonizing dandruff scalps in Shanghai, China, shows microbial disequilibrium.

Dandruff is a scalp disorder characterized by the formation of flaky white-yellowish scales due to an altered proliferation and differentiation status; a disrupted barrier function; a decrease in the level of hydration and of natural moisturizing factors (NMF) in the scalp, with a persistent and relapsing inflammatory condition. It was recently reported that an imbalance between bacterial and fungal species colonizing the scalp of French volunteers was associated with dandruff condition. The purpose of the present study was to analyze the major bacterial and fungal species present on the scalp surface of Chinese volunteers and to investigate possible region-related variation in the microbiota linked to dandruff condition. The data obtained from the Chinese populations were highly similar to those obtained in France, confirming that dandruff scalps are associated with a higher incidence of Malassezia restricta and Staphylococcal sp. The ratios of Malassezia to Propionibacterium and Propionibacterium to Staphylococcus were also significantly higher in the dandruff volunteers as compared to normal volunteers, suggesting that equilibrium between the major bacterial and fungal taxa found on the normal scalps is perturbed in the dandruff scalps. The main difference between the French and Shanghai subjects was in their Staphylococcal biota. The results obtained in China and in France suggest that targeting one particular Malassezia sp. by antifungals instead of using large spectrum antifungals and rebalancing the dandruff scalp microbiota could be common approach to improve dandruff condition in the two countries.

Drug sales data analysis for outbreak detection of infectious diseases: a systematic literature review.

BACKGROUND: This systematic literature review aimed to summarize evidence for the added value of drug sales data analysis for the surveillance of infectious diseases. METHODS: A search for relevant publications was conducted in Pubmed, Embase, Scopus, Cochrane Library, African Index Medicus and Lilacs databases. Retrieved studies were evaluated in terms of objectives, diseases studied, data sources, methodologies and performance for real-time surveillance. Most studies compared drug sales data to reference surveillance data using correlation measurements or indicators of outbreak detection performance (sensitivity, specificity, timeliness of the detection). RESULTS: We screened 3266 articles and included 27 in the review. Most studies focused on acute respiratory and gastroenteritis infections. Nineteen studies retrospectively compared drug sales data to reference clinical data, and significant correlations were observed in 17 of them. Four studies found that over-the-counter drug sales preceded clinical data in terms of incidence increase. Five studies developed and evaluated statistical algorithms for selecting drug groups to monitor specific diseases. Another three studies developed models to predict incidence increase from drug sales. CONCLUSIONS: Drug sales data analyses appear to be a useful tool for surveillance of gastrointestinal and respiratory disease, and OTC drugs have the potential for early outbreak detection. Their utility remains to be investigated for other diseases, in particular those poorly surveyed.

Surveillance of gastrointestinal disease in France using drug sales data.

Drug sales data have increasingly been used for disease surveillance during recent years. Our objective was to assess the value of drug sales data as an operational early detection tool for gastroenteritis epidemics at national and regional level in France. For the period 2008-2013, we compared temporal trends of drug sales for the treatment of gastroenteritis with trends of cases reported by a Sentinel Network of general practitioners. We benchmarked detection models to select the one with the best sensitivity, false alert proportion and timeliness, and developed a prospective framework to assess the operational performance of the system. Drug sales data allowed the detection of seasonal gastrointestinal epidemics occurring in winter with a distinction between prescribed and non-prescribed drugs. Sales of non-prescribed drugs allowed epidemic detection on average 2.25 weeks earlier than Sentinel data. These results confirm the value of drug sales data for real-time monitoring of gastroenteritis epidemic activity.

Dandruff is associated with disequilibrium in the proportion of the major bacterial and fungal populations colonizing the scalp.

The bacterial and fungal communities associated with dandruff were investigated using culture-independent methodologies in the French subjects. The major bacterial and fungal species inhabiting the scalp subject's were identified by cloning and sequencing of the conserved ribosomal unit regions (16S for bacterial and 28S-ITS for fungal) and were further quantified by quantitative PCR. The two main bacterial species found on the scalp surface were Propionibacterium acnes and Staphylococcus epidermidis, while Malassezia restricta was the main fungal inhabitant. Dandruff was correlated with a higher incidence of M. restricta and S. epidermidis and a lower incidence of P. acnes compared to the control population (p<0.05). These results suggested for the first time using molecular methods, that dandruff is linked to the balance between bacteria and fungi of the host scalp surface.

Quantitative assessment of preventive behaviors in France during the Fukushima nuclear crisis.

BACKGROUND: The Fukushima nuclear disaster has generated worldwide concern on the risk of exposure to nuclear radiations. In Europe, health authorities had to issue statements about the lack of usefulness of iodine based preventive treatments within their borders. However a lack of confidence in official messages has developed in various European countries due to recent perceived failures in managing public health crises. The lay population preventive behaviors in this context are largely unknown. Consequently, to examine the effects of public health crisis on lay behaviors leading to pharmaceuticals purchases, we studied the sales of iodine-based products in France before, during and after the crisis. METHODS: We focused our study on 58 iodine-based drugs available with and without a physician prescription. Our data came from a stratified sample of 3004 pharmacies in metropolitan France. Our study period was from January 2010 to April 2012, with a focus on March-April 2011. We differentiated sales of drugs prescribed by physicians from sales of drugs obtained without a prescription. We used a CUSUM method to detect abnormal increases in sales activity and cross-correlations to assess shifts in sales timing. RESULTS: Sales of iodine-based nutritional complements, and later sales of iodine-based homeopathic remedies, substantially increased (up to 3-fold) during a period of 20 days. Their temporal patterns were correlated to specific events during the crisis. Prescriptions for iodine-based homeopathy increased (up to 35% of all sales). Iodine pills, strictly regulated by health authorities, have also been sold but on a very small scale. CONCLUSION: These results indicate uncontrolled preventive behaviors resulting in the potentially unjustifiable consumption of available drugs. They have implications in public policy, and demonstrate the usefulness of drug sales surveillance for instantaneous evaluation of population behavior during a global crisis.

A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial.

OBJECTIVES: To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%. DESIGN: A cluster randomized study was carried out over a 5-month period. SETTINGS AND PARTICIPANTS: Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs). INTERVENTION: The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders. MEASUREMENTS: The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497). RESULTS: Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89-1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87-1.12]; P = .86]) analysis. CONCLUSION: Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results.

A new measure of classifier performance for gene expression data.

One of the major aims of many microarray experiments is to build discriminatory diagnosis and prognosis models. A large number of supervised methods have been proposed in literature for microarray-based classification for this purpose. Model evaluation and comparison is a critical issue and, the most of the time, is based on the classification cost. This classification cost is based on the costs of false positives and false negative, that are generally unknown in diagnostics problems. This uncertainty may highly impact the evaluation and comparison of the classifiers. We propose a new measure of classifier performance that takes account of the uncertainty of the error. We represent the available knowledge about the costs by a distribution function defined on the ratio of the costs. The performance of a classifier is therefore computed over the set of all possible costs weighted by their probability distribution. Our method is tested on both artificial and real microarray data sets. We show that the performance of classifiers is very depending of the ratio of the classification costs. In many cases, the best classifier can be identified by our new measure whereas the classic error measures fail.

Taxon influence index: assessing taxon-induced incongruities in phylogenetic inference.

Understanding the evolutionary history of species is at the core of molecular evolution and is done using several inference methods. The critical issue is to quantify the uncertainty of the inference. The posterior probabilities in Bayesian phylogenetic inference and the bootstrap values in frequentist approaches measure the variability of the estimates due to the sampling of sites from genes and the sampling of genes from genomes. However, they do not measure the uncertainty due to taxon sampling. Taxa that experienced molecular homoplasy, recent selection, a spur of evolution, and so forth may disrupt the inference and cause incongruences in the estimated phylogeny. We define a taxon influence index to assess the influence of each taxon on the phylogeny. We found that although most taxa have a weak influence on the phylogeny, a small fraction of influential taxa strongly alter it even in clades only loosely related to them. We conclude that highly influential taxa should be given special attention and sampling them more thoroughly can lead to more dependable phylogenies.