Diphtheria is a potentially devastating disease whose epidemiology remains poorly described in many settings, including Madagascar. Diphtheria vaccination is delivered in combination with pertussis and tetanus antigens and coverage of this vaccine is often used as a core measure of health system functioning. However, coverage is challenging to estimate due to the difficulty in translating numbers of doses delivered into numbers of children effectively immunised. Serology provides an alternative lens onto immunisation, but is complicated by challenges in discriminating between natural and vaccine-derived seropositivity. Here, we leverage known features of the serological profile of diphtheria to bound expectations for vaccine coverage for diphtheria, and further refine these using serology for pertussis. We measured diphtheria antibody titres in 185 children aged 6–11 months and 362 children aged 8–15 years and analysed them with pertussis antibody titres previously measured for each individual. Levels of diphtheria seronegativity varied among age groups (18.9% of children aged 6–11 months old and 11.3% of children aged 8–15 years old were seronegative) and also among the districts. We also find surprisingly elevated levels of individuals seropositive to diphtheria but not pertussis in the 6–11 month old age group suggesting that vaccination coverage or efficacy of the pertussis component of the DTP vaccine remains low or that natural infection of diphtheria may be playing a significant role in seropositivity in Madagascar.

Land equivalent ratio (LER) is a most widely used indicator of yield advantage of multi-crop farms over sole-crop farms, and usually measured using crop biomass yield per unit area. Most often, crop yields are compared between both systems using the same area. In this paper, we demonstrate that although the yield per unit area and the yield per plant are widely different, LER remains invariant. As a corollary, area time equivalent ratio and land use efficiency, derived from LER, also remain unchanged when using the two different measures of crop yields. We recommend that when the estimation of the exact land area is difficult due to complex crop planting designs, yield per plant estimate is much easier and equally valid for estimation of LER and its derivative indices.

Anaemia predicts delayed sputum conversion and mortality in tuberculosis (TB). We determined the prevalence and factors associated with anaemia among people with TB at the National Tuberculosis Treatment Centre in Uganda. People with bacteriologically confirmed TB were consecutively enrolled in a cross-sectional study between August 2017 and March 2018. Blood samples were tested for a full blood hemogram, HIV infection, and CD4+ and CD8+ T-cell counts. Anaemia was defined as a haemoglobin level of <13.0 grams per decilitre (g/dl) for males and <12.0 g/dl for females. Of 358 participants, 210 (58.7%, 95% confidence interval (CI) 53.4–63.8) had anaemia. Anaemia was associated with night sweats, a longer duration of fever, low body mass index (BMI), hyperthermia, high sputum bacillary loads, HIV co-infection, and low CD4 and CD8 counts at bivariate analysis. Factors associated with anaemia at multivariable analysis were low BMI (odds ratio (OR) 2.93, 95% CI 1.70–5.05, P < 0.001), low CD4:CD8 ratio (OR 2.54, 95% CI 1.07–6.04, P = 0.035) and microcytosis (OR 4.23, 95% CI 2.17–8.25, P < 0.001). Anaemia may be associated with the features of severe TB disease and should be considered in TB severity scores.

The phenomenon of antimicrobial resistance represents a major public health risk. The activity of integral membrane transporter proteins contributes to antimicrobial resistance in pathogenic bacteria and proton gradient-driven multidrug efflux representatives of the major facilitator superfamily (MFS) of secondary transporters are the dominant antimicrobial efflux proteins in Escherichia coli. In many, but not all, of the characterized MFS multidrug transporters, an aspartic acid residue at position D+5 of the conserved signature Motif A is essential for transport activity. The present work extends those studies to the E. coli MFS multidrug/H+ antiporter MdtM and used a combination of mutagenesis, expression studies, antimicrobial resistance assays, and transport activity measurements to reveal that a negatively charged residue at position D+5 is critical for MdtM transport function.

Innovations in medicine provide us longer and healthier life, leading lower mortality. Sooner rather than later, much greater longevity would be possible for us due to artificial intelligence advances in health care. Similarly, Advanced Driver Assistance Systems (ADAS) in highly automated vehicles may reduce or even eventually eliminate accidents by perceiving dangerous situations, which would minimize the number of accidents and lead to fewer loss claims for insurance companies. To model the survivor function capturing greater longevity as well as the number of claims reflecting less accidents in the long run, in this paper, we study a Cox process whose intensity process is piecewise-constant and decreasing. We derive its ultimate distributional properties, such as the Laplace transform of intensity integral process, the probability generating function of point process, their associated moments and cumulants, and the probability of no more claims for a given time point. In general, this simple model may be applicable in many other areas for modeling the evolution of gradually disappearing events, such as corporate defaults, dividend payments, trade arrivals, employment of a certain job type (e.g., typists) in the labor market, and release of particles. In particular, we discuss some potential applications to insurance.

We studied severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence among pregnant women in Norway by including all women who were first trimester pregnant (n = 6520), each month from December 2019 through December 2020, in the catchment region of Norway's second-largest hospital. We used sera that had been frozen stored after compulsory testing for syphilis antibodies in antenatal care. The sera were analysed with the Elecsys® Anti-SARS-CoV-2 immunoassay (Roche Diagnostics, Cobas e801). This immunoassay detects IgG/IgM against SARS-CoV-2 nucleocapsid antigen. Sera with equivocal or positive test results were retested with the Liaison® SARS-CoV-2 S1/S2 IgG (DiaSorin), which detects IgG against the spike (S)1 and S2 protein on the SARS-CoV-2 virus. In total, 98 women (adjusted prevalence 1.7%) had SARS CoV-2 antibodies. The adjusted seroprevalence increased from 0.3% (1/445) in December 2019 to 5.7% (21/418) in December 2020. Out of the 98 seropositive women, 36 (36.7%) had serological signs of current SARS-CoV-2 infection at the time of serum sampling, and the incidence remained low during the study period. This study suggests that SARS CoV-2 was present in the first half of December 2019, 6 weeks before the first case was recognised in Norway. The low occurrence of SARS-CoV-2 infection during 2020, may be explained by high compliance to extensive preventive measures implemented early in the epidemic.

The epidemic of tuberculosis has posed a serious burden in Qinghai province, it is necessary to clarify the epidemiological characteristics and spatial-temporal distribution of TB for future prevention and control measures. We used descriptive epidemiological methods and spatial statistical analysis including spatial correlation and spatial-temporal analysis in this study. Furthermore, we applied an exponential smoothing model for TB epidemiological trend forecasting. Of 43 859 TB cases, the sex ratio was 1.27:1 (M:F), and the average annual TB registered incidence was 70.00/100 000 of 2009–2019. More cases were reported in March and April, and the worst TB stricken regions were the prefectures of Golog and Yushu. High TB registered incidences were seen in males, farmers and herdsmen, Tibetans, or elderly people. 7132 cases were intractable, which were recurrent, drug resistant, or co-infected with other infections. Three likely cases clusters with significant high risk were found by spatial-temporal scan on data of 2009–2019. The exponential smoothing winters' additive model was selected as the best-fitting model to forecast monthly TB cases in the future. This research indicated that TB in Qinghai is still a serious threaten to the local residents' health. Multi-departmental collaboration and funds special for TB treatments and control are still needed, and the exponential smoothing model is promising which could be applied for forecasting of TB epidemic trend in this high-altitude province.