Development and validation of a multiplex real-time qPCR assay using GMP-grade reagents for leprosy diagnosis.

Leprosy is a chronic dermato-neurological disease caused by Mycobacterium leprae, an obligate intracellular bacterium. Timely detection is a challenge in leprosy diagnosis, relying on clinical examination and trained health professionals. Furthermore, adequate care and transmission control depend on early and reliable pathogen detection. Here, we describe a qPCR test for routine diagnosis of leprosy-suspected patients. The reaction simultaneously amplifies two specific Mycobacterium leprae targets (16S rRNA and RLEP), and the human 18S rRNA gene as internal control. The limit of detection was estimated to be 2.29 copies of M. leprae genome. Analytical specificity was evaluated using a panel of 20 other skin pathogenic microorganisms and Mycobacteria, showing no cross-reactivity. Intra- and inter-operator Cp variation was evaluated using dilution curves of M. leprae DNA or a synthetic gene, and no significant difference was observed between three operators in two different laboratories. The multiplex assay was evaluated using 97 patient samples with clinical and histopathological leprosy confirmation, displaying high diagnostic sensitivity (91%) and specificity (100%). Validation tests in an independent panel of 50 samples confirmed sensitivity and specificity of 97% and 98%, respectively. Importantly, assay performance remained stable for at least five months. Our results show that the newly developed multiplex qPCR effectively and specifically detects M. leprae DNA in skin samples, contributing to an efficient diagnosis that expedites the appropriate treatment.

Thinking Politically About UN Political Declarations: A Recipe for Healthier Commitments—Free of Commercial Interests Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases"

As evidence mounts that corporate actor engagement in United Nations (UN) policy-making processes leads to weaker and shallower public health commitments, greater attention is being paid to how to minimise undue interference and manage conflicts of interest (CoI). While we welcome efforts to develop normative guidance on managing such conflicts, we argue that there is the need to go further. In particular, we propose that an index be developed that would assess the health impacts of individual corporate actors, and those actors who fail to achieve a set benchmark would not have engagement privileges. We further propose the establishment of an independent panel of experts to advise on corporate actor engagement as well as on ambiguous and potentially health-harming commitments in text under negotiation in the UN. Recognising that the implementation of such measures will be contested, we recommend a number of practical steps to make their implementation more politically palatable.

Ready for the next pandemic

Penny Harrison examines ‘COVID-19: make it the last pandemic’, a recent report from the Independent Panel for Pandemic Preparedness and Response

Looking to the future: what next for the dingo?

Few animals in Australia evoke as much controversy as the dingo. There are debates about its cultural significance, what to call it, and its ecological and economic impacts. Resolving these debates requires consensus and agreement among researchers, land managers and other stakeholders. To aid this, I briefly summarise how far we have come in terms of increasing our knowledge of the ecology and behaviour of dingoes since the Royal Zoological Society of New South Wales held its first symposium on the dingo in 1999. I summarise the key debates that have arisen during this period, and then summarise some of the key recommendations made in papers that were written following the 2019 symposium. I finish with some suggestions for future dingo research, focusing on (1) how we can better understand and appropriately acknowledge the cultural significance of the dingo through research, broader consultations and appropriate representations on national, state and local pest planning committees, (2) produce taxonomic consensus through the appointment of an independent panel and future research using genome-wide DNA technology, and (3) resolving ecological and economic debates via reintroduction experiments in both conservation and managed agricultural landscapes. Without such efforts, I see a future for the dingo that continues to be steeped in controversy and debate.

The Implementation of the Action for Peacekeeping in Context

With the launching of the Action for Peacekeeping and its culmination with the Declaration of Shared Commitments in 2018, Secretary-General Antonio Guterres aimed to mobilize all partners and stakeholders to support United Nations peacekeeping, marking its seventieth anniversary and revitalizing a long process of reform which had started with previous Secretaries-General, and in its last phase by Secretary-General Ban Ki Moon. The purpose of this article is to look at the implementation of Commitment 5 of the Declaration of Shared Commitments to realize the objective of sequenced, prioritized and achievable mandates. To do so, this article looks at the process of endorsement and progressive implementation of the Declaration of Shared Commitments by the Security Council, starting with the examination of the conclusions of the High Level Independent Panel on Peacekeeping Operations (hippo report), the subsequent Secretary-General’s report under Secretary-General Ban’s tenure and the passing of the baton to Secretary-General Guterres who continued the process through the launching of the Action for Peacekeeping. The article looks at the definitions available to guide the implementation of sequenced and prioritized mandates and describes and assesses the mandate renewal process in the context of three specific field missions concentrating some of the most recent efforts of the Security Council to apply the principles of the Declaration of Shared Commitments.

Temperature-Controlled Monopolar Radiofrequency in the Treatment of Submental Skin Laxity: A Prospective Study

Background Laxity of the submental area is a common cosmetic complaint of the aging population. Objectives The objective was to determine the safety and effectiveness of a temperature-controlled minimally invasive percutaneous monopolar radiofrequency device to improve dermal laxity and achieve lift. Methods A total of 72 subjects (35–65 years old) with mild to moderate skin laxity in the submental area were included in this single-center prospective study (New Jersey, USA). All subjects received one treatment at baseline with an average subdermal temperature of 63°C. The primary endpoint was the proportion of subjects with at least a 20 mm 2 decrease in surface area at Day 90 based on 3D photography. Secondary endpoints included skin elasticity measured by a cutometer, assessment by a blinded physician panel using 2D photographs, and physician and subject-reported outcomes. Results At Day 90, 72.1% (95% confidence interval: 62.2-84.0%, P < 0.001) of subjects achieved at least a 20 mm 2 lift of the submental area. All values for skin elasticity (R2, R5, R7) showed significant improvement by 180 days as measured by cutometer. 74.2% of subjects were graded by the independent panel as “Improved” at 90 days. (62.0-84.2%, P<0.001). The treatment was well tolerated, and only one possibly related serious adverse event was reported (pharyngeal inflammation). Conclusions Treatment with temperature-controlled monopolar radiofrequency alone is a safe and effective treatment to achieve submental lift for at least six months.

Convolutional neural network-based ambient light-independent panel digit surveillance technique for infusion pumps

For effective patient therapy and improved patient safety, it is critical to administer medication accurately in accordance with doctor’s prescription. However, accidents owing to the erroneous programing of infusion pumps caused by users have been consistently reported in several documents. In this study, the authors propose a novel surveillance technique for infusion pumps to continuously monitor the variations in panel digits using a convolutional neural network model, and evaluate the performance of the implemented technique. During the experimental evaluation, 1st-step ROIs and 2nd-step ROIs were successfully extracted from the frame images regardless of the ambient lighting conditions. The final accuracies of the implemented CNN model are 99.9% for both the training (172,800 images) and validation (1080 images) dataset while the final losses for the training and validation datasets are 0.48 and 0.45 after 13th epoch, respectively. In the 24-h continuous monitoring test, the accuracy of the model for volume recognition considering all the 1440 measurements (960 for day-lighting and 480 for night-lighting) is 95.5%, whereas in day-lighting and night-lighting modes the accuracies of the model are 98.2% and 90.0%, respectively. Based on these experimental results, the proposed surveillance technique incorporating infusion pumps is expected to improve the safety of patients who need long-term treatments via infusion pumps, reducing the burden on the nurses and hospitals.