A Review into the Acute Emergency Response of Operational Partnerships During the Rohingya Refugee Crisis in Cox’s Bazar

Background: The unprecedented influx of Rohingya refugees into Cox’s Bazar, Bangladesh, in 2017 led to a humanitarian emergency requiring large numbers of humanitarian workers to be deployed to the region. The World Health Organization (WHO) contributed to this effort through several well-established deployment mechanisms: the Global Outbreak Alert and Response Network (GOARN) and the Standby Partnerships (SBP). The aim of the study was to capture the views and experiences of those humanitarian workers deployed by WHO through operational partnerships between December 2017 and February 2019.Methods: A mixed methods design was used. A desktop review was conducted to describe the demographics of the humanitarian workers deployed to Cox’s Bazar and the work that was undertaken. Interviews were conducted with a subset of the respondents to elicit their views relating to their roles and contributions to the humanitarian response, challenges during their deployment and how the process could be improved. Thematic analysis was used to identify key themes.Results: We identified sixty-five deployments during the study period. Respondents’ previous experience ranged between 3 and 28 years (mean 9.7 years). The duration of deployment ranged from 8 to 278 days (mean 67 days) and there was a higher representation of workers from Western Pacific and European regions. Forty-one interviews were conducted with people who experienced all aspects of the deployment process. Key themes elicited from interviews related to staffing, the deployment process, the office environment and capacity building. Various issues raised have since been addressed, including the establishment of a sub-office structure, introduction of online training prior to deployment, and a staff wellbeing committee. Conclusions: This study identified successes and areas for improvement for deployments during emergencies. The themes and subthemes elicited can be used to inform policy and practice changes, as well as the development of performance indicators. Common findings between this study and previous literature indicate the pivotal role of staff deployments through partnership agreements during health emergency response operations and a need for continuous improvements of processes to ensure maximum effectiveness.

Measles in conflict-affected northern Syria: results from an ongoing outbreak surveillance program

Background The Syrian conflict has dramatically changed the public health landscape of Syria since its onset in March of 2011. Depleted resources, fractured health systems, and increased security risks have disrupted many routine services, including vaccinations, across several regions in Syria. Improving our understanding of infectious disease transmission in conflict-affected communities is imperative, particularly in the Syrian conflict. We utilize surveillance data from the Early Warning Alert and Response Network (EWARN) database managed by the Assistance Coordination Unit (ACU) to explore trends in the incidence of measles in conflict-affected northern Syria and analyze two consecutive epidemics in 2017 and 2018. Methods We conducted a retrospective time-series analysis of the incidence of clinically suspected cases of measles using EWARN data between January 2015 and June 2019. We compared regional and temporal trends to assess differences between geographic areas and across time. Results Between January 2015 and June 2019, there were 30,241 clinically suspected cases of measles reported, compared to 3193 cases reported across the whole country in the decade leading up to the conflict. There were 960 regional events that met the measles outbreak threshold and significant differences in the medians of measles incidence across all years (p-value < 0.001) and in each pairwise comparison of years as well as across all geographic regions (p-value < 0.001). Although most governorates faced an elevated burden of cases in every year of the study, the measles epidemics of 2017 and 2018 in the governorates of Ar-Raqqa, Deir-Ez-Zor, and Idlib accounted for over 71% of the total suspected cases over the entire study period. Conclusions The 2017 and 2018 measles epidemics were the largest since Syria eliminated the disease in 1999. The regions most affected by these outbreaks were areas of intense conflict and displacement between 2014 and 2018, including districts in Ar-Raqqa, Deir-Ez-Zor, and Idlib. The spread of measles in northern Syria serves as an indicator of low immunization coverage and limited access to care and highlights the Syrian peoples’ vulnerability to infectious diseases and vaccine preventable diseases in the setting of the current conflict.

Mathematical modelling of SigE regulatory network reveals new insights into bistability of mycobacterial stress response

Background The ability to rapidly adapt to adverse environmental conditions represents the key of success of many pathogens and, in particular, of Mycobacterium tuberculosis. Upon exposition to heat shock, antibiotics or other sources of stress, appropriate responses in terms of genes transcription and proteins activity are activated leading part of a genetically identical bacterial population to express a different phenotype, namely to develop persistence. When the stress response network is mathematically described by an ordinary differential equations model, development of persistence in the bacterial population is associated with bistability of the model, since different emerging phenotypes are represented by different stable steady states. Results In this work, we develop a mathematical model of SigE stress response network that incorporates interactions not considered in mathematical models currently available in the literature. We provide, through involved analytical computations, accurate approximations of the system’s nullclines, and exploit the obtained expressions to determine, in a reliable though computationally efficient way, the number of equilibrium points of the system. Conclusions Theoretical analysis and perturbation experiments point out the crucial role played by the degradation pathway involving RseA, the anti-sigma factor of SigE, for coexistence of two stable equilibria and the emergence of bistability. Our results also indicate that a fine control on RseA concentration is a necessary requirement in order for the system to exhibit bistability.

Brain Networks Detectable by fMRI during On-Line Self Report of Hallucinations in Schizophrenia

An analysis of an internationally shared functional magnetic resonance imaging (fMRI) data involving healthy participants and schizophrenia patients extracted brain networks involved in listening to radio speech and capture hallucination experiences. A multidimensional analysis technique demonstrated that for radio-speech sound files, a brain network matching known auditory perception networks emerged, and importantly, displayed speech-duration-dependent hemodynamic responses (HDRs), confirming fMRI detection of these speech events. In the hallucination-capture data, although a sensorimotor (response) network emerged, it did not show hallucination-duration-dependent HDRs. We conclude that although fMRI retrieved the brain network involved in generating the motor responses indicating the start and end of an experienced hallucination, the hallucination event itself was not detected. Previous reports on brain networks detected by fMRI during hallucination capture is reviewed in this context.

Diagnostic Yield of Screening for SARS-CoV-2 among Patients Admitted for Alternate Diagnoses

Objectives: To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19, and identify risk factors for positive tests. Design: Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry Setting: 30 acute care hospitals across Canada Participants: Patients hospitalized for non-COVID-19 related diagnoses who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 1, and December 29, 2020 Main outcome: Positive nucleic acid amplification test (NAAT) for SARS-CoV-2 Outcome measure: Diagnostic yield Results: We enrolled 15,690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% - 0.92%). Factors associated with a positive test included presence of a fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases. Conclusions: Universal screening of hospitalized patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence.

A plastidial retrograde-signal potentiates biosynthesis of systemic stress response activators

Plants employ an array of intricate and hierarchical signaling cascades to perceive and transduce informational cues to synchronize and tailor adaptive responses. Systemic stress response (SSR) is a recognized complex signaling and response network quintessential to plant's local and distal responses to environmental triggers, however, the identity of the initiating signals has remained fragmented. Here, we show that both biotic (aphids and viral pathogens) and abiotic (high light and wounding) stresses induce accumulation of the plastidial-retrograde-signaling metabolite, methylerythritol cyclodiphosphate (MEcPP), leading to reduction of the phytohormone, auxin, and the subsequent decreased expression of the phosphatase, PP2C.D1. This enables phosphorylation of mitogen-activated protein kinases (MAPK3/6), and the consequential induction of the downstream events ultimately resulting in biosynthesis of the two SSR priming metabolites, pipecolic- and N-hydroxy-pipecolic acid. This work identifies plastids as the initiation site, and the plastidial retrograde-signal, MEcPP as the initiator of a multi-component signaling cascade potentiating the biosynthesis of SSR activators, in response to biotic and abiotic triggers.

Common and distinct neurofunctional representations of core and social disgust in the brain: An ALE meta-analysis and MACM characterization

ABSTRACTDisgust represents a multifaceted defensive-avoidance response. On the behavioral level, the response includes withdrawal and a disgust-specific facial expression. While both serve the avoidance of pathogens the latter additionally transmits social-communicative information. Given that common and distinct brain representation of the primary defensive-avoidance response (core disgust) and encoding of the social-communicative signal (social disgust) remain debated we employed neuroimaging meta-analyses to (1) determine brain systems generally engaged in disgust processing, and (2) segregate common and distinct brain systems for core and social disgust. Disgust processing, in general, engaged a bilateral network encompassing the insula, amygdala, occipital and prefrontal regions. Core disgust evoked stronger reactivity in left-lateralized threat detection and defensive response network including amygdala, occipital and frontal regions while social disgust engaged a right-lateralized superior temporal-frontal network engaged in social cognition. Anterior insula, inferior frontal and fusiform regions were commonly engaged during core and social disgust suggesting a common neural basis. We demonstrate a common and separable neural basis of primary disgust responses and encoding of associated social-communicative signals.