Acute muscular sarcocystosis: an international investigation among ill travelers returning from tioman island, malaysia, 2011-2012.

BACKGROUND Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. METHODS Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. RESULTS Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. CONCLUSIONS Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.

Global phylogenomic analysis of nonencapsulated Streptococcus pneumoniae reveals a deep-branching classic lineage that is distinct from multiple sporadic lineages.

The surrounding capsule of Streptococcus pneumoniae has been identified as a major virulence factor and is targeted by pneumococcal conjugate vaccines (PCV). However, nonencapsulated Streptococcus pneumoniae (Non-Ec-Sp) have also been isolated globally, mainly in carriage studies. It is unknown if Non-Ec-Sp evolve sporadically, if they have high antibiotic non-susceptiblity rates and a unique, specific gene content. Here, whole genome sequencing of 131 Non-Ec-Sp isolates sourced from 17 different locations around the world was performed. Results revealed a deep-branching classic lineage that is distinct from multiple sporadic lineages. The sporadic lineages clustered with a previously sequenced, global collection of encapsulated S. pneumoniae (Ec-Sp) isolates while the classic lineage is comprised mainly of the frequently identified multi-locus sequences types ST344 (n=39) and ST448 (n=40). All ST344 and nine ST448 isolates had high non-susceptiblity rates to β-lactams and other antimicrobials. Analysis of the accessory genome reveals that the classic Non-Ec-Sp contained an increased number of mobile elements, than Ec-Sp and sporadic Non-Ec-Sp. Performing adherence assays to human epithelial cells for selected classic and sporadic Non-Ec-Sp revealed that the presence of a integrative conjugative element (ICE) results in increased adherence to human epithelial cells (P=0.005). In contrast, sporadic Non-Ec-Sp lacking the ICE had greater growth in vitro possibly resulting in improved fitness. In conclusion, Non-Ec-Sp isolates from the classic lineage have evolved separately. They have spread globally, are well adapted to nasopharyngeal carriage and are able to coexist with Ec-Sp. Due to continued use of pneumococcal conjugate vaccines, Non-Ec-Sp may become more prevalent.

Fast parallel kriging-based stepwise uncertainty reduction with application to the identification of an excursion set

Stepwise uncertainty reduction (SUR) strategies aim at constructing a sequence of points for evaluating a function  f in such a way that the residual uncertainty about a quantity of interest progressively decreases to zero. Using such strategies in the framework of Gaussian process modeling has been shown to be efficient for estimating the volume of excursion of f above a fixed threshold. However, SUR strategies remain cumbersome to use in practice because of their high computational complexity, and the fact that they deliver a single point at each iteration. In this article we introduce several multipoint sampling criteria, allowing the selection of batches of points at which f can be evaluated in parallel. Such criteria are of particular interest when f is costly to evaluate and several CPUs are simultaneously available. We also manage to drastically reduce the computational cost of these strategies through the use of closed form formulas. We illustrate their performances in various numerical experiments, including a nuclear safety test case. Basic notions about kriging, auxiliary problems, complexity calculations, R code, and data are available online as supplementary materials.

La femme juive : sa condition légale d'après la Bible et le Talmud

par Emmanuel Weill

Assessing the sustainability of water governance systems: the sustainability wheel

We present and test a conceptual and methodological approach for interdisciplinary sustainability assessments of water governance systems based on what we call the sustainability wheel. The approach combines transparent identification of sustainability principles, their regional contextualization through sub-principles (indicators), and the scoring of these indicators through deliberative dialogue within an interdisciplinary team of researchers, taking into account their various qualitative and quantitative research results. The approach was applied to a sustainability assessment of a complex water governance system in the Swiss Alps. We conclude that the applied approach is advantageous for structuring complex and heterogeneous knowledge, gaining a holistic and comprehensive perspective on water sustainability, and communicating this perspective to stakeholders.

Le Saint-Siège et les juifs : le ghetto a Rome

par Emmanuel Rodocanachi

The dermatologists' role in managing psoriatic arthritis: results of a swiss delphi exercise intended to improve collaboration with rheumatologists.

BACKGROUND Psoriatic arthritis (PsA) substantially impacts the management of psoriatic disease. OBJECTIVE This study aimed to generate an interdisciplinary national consensus on recommendations of how PsA should be managed. METHODS Based on a systematic literature search, an interdisciplinary expert group identified important domains and went through 3 rounds of a Delphi exercise, followed by a nominal group discussion to generate specific recommendations. RESULTS A strong consensus was reached on numerous central messages regarding the impact of PsA, screening procedures, organization of the interaction between dermatologists and rheumatologists, and treatment goals. CONCLUSION These recommendations can serve as a template for similar initiatives in other countries. At the same time, they highlight the need to take into account the impact of the respective national health care system. © 2015 S. Karger AG, Basel.

Les Israélites en Roumanie

par Emmanuel Crezzulesco

A stable and reproducible human blood-brain barrier model derived from hematopoietic stem cells

The human blood brain barrier (BBB) is a selective barrier formed by human brain endothelial cells (hBECs), which is important to ensure adequate neuronal function and protect the central nervous system (CNS) from disease. The development of human in vitro BBB models is thus of utmost importance for drug discovery programs related to CNS diseases. Here, we describe a method to generate a human BBB model using cord blood-derived hematopoietic stem cells. The cells were initially differentiated into ECs followed by the induction of BBB properties by co-culture with pericytes. The brain-like endothelial cells (BLECs) express tight junctions and transporters typically observed in brain endothelium and maintain expression of most in vivo BBB properties for at least 20 days. The model is very reproducible since it can be generated from stem cells isolated from different donors and in different laboratories, and could be used to predict CNS distribution of compounds in human. Finally, we provide evidence that Wnt/β-catenin signaling pathway mediates in part the BBB inductive properties of pericytes.

Snow shielding factors for cosmogenic nuclide dating inferred from long-term neutron detector monitoring

The depth-dependent attenuation of the secondary cosmic-ray particle flux due to snow cover and its effects on production rates of cosmogenic nuclides constitutes a potential source of uncertainty for studies conducted in regions characterized by frequent seasonal snow burial. Recent experimental and numerical modelling studies have yielded new constraints on the effect of hydrogen-rich media on the production rates of cosmogenic nuclides by low- and high-energy neutrons (<10(-3) MeV and >10(2) MeV, respectively). Here we present long-term neutron-detector monitoring data from a natural setting that we use to quantify the effect of snow cover on the attenuation of fast neutrons (0.1-10 MeV), which are responsible for the production of Ne-21 from Mg and Cl-36 from K. We use data measured between July 2001 and May 2008 at seven stations located throughout the Ecrins-Pelvoux massif (French Western Alps) and its surroundings, at elevations ranging from 200 to 2500 m a.s.l. From the cosmic-ray fluxes recorded during summer, when snow is absent, we infer an apparent attenuation length of 148 g cm(-2) in the atmosphere at a latitude of similar to 45 degrees N and for altitudes ranging from similar to 200 to 2500 m a.s.l. Using snow water-equivalent (SWE) values obtained through snow-coring campaigns that overlap in time the neutron monitoring for five stations, we show that fast neutrons are much more strongly attenuated in snow than predicted by a conventional mass-shielding formulation and the attenuation length estimated in the atmosphere. We suggest that such strong attenuation results from boundary effects at the atmosphere/snow interface induced by the high efficiency of water as a neutron moderator. Finally, we propose an empirical model that allows calculating snow-shielding correction factors as a function of SWE for studies using Ne-21 and Cl-36 analyses in Mg- and K-rich minerals, respectively. This empirical model is of interest for studies with a focus on cosmic-ray exposure dating, particularly if the target rocks are made up of mafic to ultramafic units where seasonal snow-cover is a common phenomenon.