Enabling Multicentric Participatory Disease Surveillance for Global Health Enhancement: Viewpoint on Global Flu View.

Participatory surveillance (PS) has been defined as the bidirectional process of transmitting and receiving data for action by directly engaging the target population. Often represented as self-reported symptoms directly from the public, PS can provide evidence of an emerging disease or concentration of symptoms in certain areas, potentially identifying signs of an early outbreak. The construction of sets of symptoms to represent various disease syndromes provides a mechanism for the early detection of multiple health threats. Global Flu View (GFV) is the first-ever system that merges influenza-like illness (ILI) data from more than 8 countries plus 1 region (Hong Kong) on 4 continents for global monitoring of this annual health threat. GFV provides a digital ecosystem for spatial and temporal visualization of syndromic aggregates compatible with ILI from the various systems currently participating in GFV in near real time, updated weekly. In 2018, the first prototype of a digital platform to combine data from several ILI PS programs was created. At that time, the priority was to have a digital environment that brought together different programs through an application program interface, providing a real time map of syndromic trends that could demonstrate where and when ILI was spreading in various regions of the globe. After 2 years running as an experimental model and incorporating feedback from partner programs, GFV was restructured to empower the community of public health practitioners, data scientists, and researchers by providing an open data channel among these contributors for sharing experiences across the network. GFV was redesigned to serve not only as a data hub but also as a dynamic knowledge network around participatory ILI surveillance by providing knowledge exchange among programs. Connectivity between existing PS systems enables a network of cooperation and collaboration with great potential for continuous public health impact. The exchange of knowledge within this network is not limited only to health professionals and researchers but also provides an opportunity for the general public to have an active voice in the collective construction of health settings. The focus on preparing the next generation of epidemiologists will be of great importance to scale innovative approaches like PS. GFV provides a useful example of the value of globally integrated PS data to help reduce the risks and damages of the next pandemic.

Tuberculosis screening by tuberculosis skin test or QuantiFERON-TB Gold In-Tube Assay among an immigrant population with a high prevalence of tuberculosis and BCG vaccination.

RATIONALE: Each year 1 million persons acquire permanent U.S. residency visas after tuberculosis (TB) screening. Most applicants undergo a 2-stage screening with tuberculin skin test (TST) followed by CXR only if TST-positive at > 5 mm. Due to cross reaction with bacillus Calmette-Guérin (BCG), TST may yield false positive results in BCG-vaccinated persons. Interferon gamma release assays exclude antigens found in BCG. In Vietnam, like most high TB-prevalence countries, there is universal BCG vaccination at birth. OBJECTIVES: 1. Compare the sensitivity of QuantiFERON-TB Gold In-Tube Assay (QFT) and TST for culture-positive pulmonary TB. 2. Compare the age-specific and overall prevalence of positive TST and QFT among applicants with normal and abnormal CXR. METHODS: We obtained TST and QFT results on 996 applicants with abnormal CXR, of whom 132 had TB, and 479 with normal CXR. RESULTS: The sensitivity for tuberculosis was 86.4% for QFT; 89.4%, 81.1%, and 52.3% for TST at 5, 10, and 15 mm. The estimated prevalence of positive results at age 15-19 years was 22% and 42% for QFT and TST at 10 mm, respectively. The prevalence increased thereafter by 0.7% year of age for TST and 2.1% for QFT, the latter being more consistent with the increase in TB among applicants. CONCLUSIONS: During 2-stage screening, QFT is as sensitive as TST in detecting TB with fewer requiring CXR and being diagnosed with LTBI. These data support the use of QFT over TST in this population.

Effects of creatine on isometric bench-press performance in resistance-trained humans.

PURPOSE: The purpose of this study was to investigate the effects of creatine (Cr) supplementation on force generation during an isometric bench-press in resistance-trained men. METHODS: 32 resistance-trained men were matched for peak isometric force and assigned in double-blind fashion to either a Cr or placebo group. Subjects performed an isometric bench-press test involving five maximal isometric contractions before and after 5 d of Cr (20 g.d-1 Cr + 180 g.d-1 dextrose) or placebo (200 g.d-1 dextrose). Body composition was measured before and after supplementation. Subjects completed 24-h urine collections throughout the study period; these were subsequently analyzed to provide total Cr and creatinine excretion. RESULTS: The amount of Cr retained over the supplementation period was 45 +/- 18 g (mean +/- SD), with an estimated intramuscular Cr storage of 43 (13-61) mmol x kg(-1) x dry weight muscle (median [range]). Four subjects in the Cr group were classified as "nonresponders" (< or =21 mmol x kg(-1) x dry weight muscle increase following Cr supplementation) and the remaining 17 subjects were classed as "responders" (> or =32 mmol x kg(-1) x dry weight muscle). For the Cr group, peak force and total force pre- or post-supplementation were not different from placebo. However, when the analysis was confined to the responders, both the change in peak force [Repetition 2: 59(81) N vs -26(85) N; Repetition 3: 45(59) N vs -26(64) N) and the change in total force (Repetition 1: 1471(1274) N vs 209(1517) N; Repetition 2: 1575(1254) N vs 196(1413) N; Repetition 3: 1278(1245) N vs -3(1118) N; Repetition 4: 918(935) N vs -83(1095) N] post-supplementation were significantly greater compared with the placebo group (P < 0.01). For the Cr group, estimated Cr uptake was inversely correlated with training status (r = -0.68, N = 21, P = 0.001). Cr significantly increased body weight (84.1 +/- 8.6 kg pre- vs 85.3 +/- 8.3 kg post-supplementation) and fat-free mass (71.8 +/- 6.0 kg pre- vs 72.6 +/- 6.0 kg post-supplementation), with the magnitude of increase being significantly greater in the responder group than in the placebo group. CONCLUSION: Five days of Cr supplementation increased body weight and fat-free body mass in resistance-trained men who were classified as responders. Peak force and total force during a repeated maximal isometric bench-press test were also significantly greater in the responders compared to the placebo group.