Search

Prostheses are complex, ambivalent, and non-uniform objects. Even before it “exists” as a material entity, the prosthesis, and more specifically the future body-prosthesis relation, is already present in one’s amputation and rehabilitation trajectory. It is indeed integrated by healthcare professionals in amputation surgical protocols as well as during care in the pre-fitting rehabilitation phase. Not there yet, it still shapes, materially, amputees’ bodies. Likewise, while amputees wait for its arrival, the prosthesis is an object they imagine and possibly fantasise about. Then, once manufactured and materially present, prostheses become part of a long, uncertain, and ever-changing process of creating a body-prosthesis alliance. Spanning from rehabilitation to daily-life at home, this process oscillates between adaptation and dis-adaptation, embodiment and rejection, capacities and limitations, hopes and disappointments. Based on ethnographic fieldwork conducted with amputees and healthcare professionals in France, the purpose of this article is to delve into amputees’ daily experiences, in order to grasp the complexity of the alliance that is woven between amputees’ bodies and prostheses over time. More precisely, we will use the dialectic of absence and presence as a guide for our analysis, since these two notions are enlightening to understand the complex embodiment and collaboration between the amputee, his/ her body, and his/her prosthesis. They shed light on the temporalities, the spaces, and the issues of the body-prosthesis relationship in the process of embodiment and appropriation throughout the life course.

This article traces the evolution of the image of the amputated body fitted with prosthetic devices in collective and individual narratives from the early 20th century to the present day in European and North American societies. As these narratives are persistently permeated by an ableist lens and ideology, they are not devoid of socio-political issues and consequences for the people concerned. Based on these narratives, this paper proposes a socio-anthropological analysis of their historical development and their impact on representations of disability, insofar as they are a tool for transmitting social and collective values. More specifically, the aim is to question the fascination with prosthetics and the culture of the high-performance amputee body, which are vectors of ableist injunctions and ideals. The aim is also to highlight the complexity and variety of individual approaches in the face of persistent and collective normalisation over time.

Objectives: Since 2014, Staphylococcus aureus methicillin resistance has been rapidly increasing in New Caledonia and is associated with potential serious clinical repercussions. In the present study, we investigated the epidemiology of methicillin-resistant S. aureus (MRSA) in New Caledonia and the possible emergence of a particular clonal strain. Methods: An overview of the distribution of MRSA in New Caledonia in 2019 is presented. We collected and analysed 171 clinical MRSA isolates from New Caledonia medical laboratories during August and September 2019. Among this collection, 49 representative isolates were analyzed by the French National Reference Center for Staphylococci using the StaphyType DNA microarray, allowing genetic characterization of the isolates. Results: Among the 1144 S. aureus isolated over the year 2019, 442 isolates (39%) were resistant to methicillin, and 62% of these isolates were resistant to fusidic acid (FA). During the inclusion period, FA resistance rate was similar (60%). Genetic characterization evidenced CC6 as the predominant clonal complex (70%) with 26 isolates (53%) identified as CC6-MRSA-[IV+fus] (PVL+). Conclusions: These findings demonstrated a low diversity of MRSA in New Caledonia, with the dominance of a clonal complex not reported previously. The frequent fusidic acid (FA) resistance in MRSA was associated with a high prevalence of fusC gene, suggesting that FA misuse contributed to driving the selection of this clone. Our findings suggest the recommendation to stop the topical use of FA to control the emergence of this severe MRSA clone and decrease the rate of MRSA in New Caledonia.

ABSTRACT An increasing number of isolations of Corynebacterium diphtheriae has been observed in recent years in the archipelago of New Caledonia. We aimed to analyze the clinical and microbiological features of samples with C. diphtheriae. All C. diphtheriae isolates identified in New Caledonia from May 2015 to May 2019 were included. For each case, a retrospective consultation of the patient files was conducted. Antimicrobial susceptibility phenotypes, tox gene and diphtheria toxin expression, biovar, and the genomic sequence were determined. Core genome multilocus sequence typing (cgMLST), 7-gene MLST, and search of genes of interest were performed from genomic assemblies. Fifty-eight isolates were included, with a median age of patients of 28 years (range: 9 days to 78 years). Cutaneous origin accounted for 51 of 58 (87.9%) isolates, and C. diphtheriae was associated with Staphylococcus aureus and/or Streptococcus pyogenes in three-quarters of cases. Half of cases came either from the main city Noumea (24%, 14/58) or from the sparsely populated island of Lifou (26%, 15/58). Six tox-positive isolates were identified, associated with recent travel to Vanuatu; 5 of these cases were linked and cgMLST confirmed recent transmission. Two cases of endocarditis in young female patients with a history of rheumatic fever involved tox-negative isolates. The 58 isolates were mostly susceptible to commonly used antibiotics. In particular, no isolate was resistant to the first-line molecules amoxicillin or erythromycin. Resistance to tetracycline was found in a genomic cluster of 17 (29%) isolates, 16 of which carried the tetO gene. There were 13 cgMLST sublineages, most of which were also observed in the neighboring country Australia. Cutaneous infections may harbor nontoxigenic C. diphtheriae isolates, which circulate largely silently in nonspecific wounds. The possible introduction of tox-positive strains from a neighboring island illustrates that diphtheria surveillance should be maintained in New Caledonia, and that immunization in neighboring islands must be improved. Genomic sequencing uncovers how genotypes circulate locally and across neighboring countries. IMPORTANCE The analysis of C. diphtheriae from the tropical archipelago of New Caledonia revealed a high genetic diversity with sublineages that may be linked to Polynesia, Australia, or metropolitan France. Genomic typing allowed confirming or excluding suspected transmission events among cases and contacts. A highly prevalent tetracycline-resistant sublineage harboring the tetO gene was uncovered. Toxigenic isolates were observed from patients returning from Vanuatu, showing the importance of improving vaccination coverage in settings where it is insufficient. This study also illustrates the importance for diphtheria surveillance of the inclusion of isolates from cutaneous sources in addition to respiratory cases, in order to provide a more complete epidemiological picture of the diversity and transmission of C. diphtheriae.

Background: Pacific Islanders are underrepresented in vaccine efficacy trials. Few studies describe their immune response to COVID-19 vaccination. Yet, this characterization is crucial to re-enforce vaccination strategies adapted to Pacific Islanders singularities. Methods and findings: We evaluated the humoral immune response of 585 adults, self-declaring as Melanesians, Europeans, Polynesians, or belonging to other communities, to the Pfizer BNT162b2 vaccine. Anti-spike and anti-nucleoprotein IgG levels, and their capacity to neutralize SARS-CoV-2 variants and to mediate antibody-dependent cellular cytotoxicity (ADCC) were assessed across communities at 1 and 3 months post-second dose or 1 and 6 months post-third dose. All sera tested contained anti-spike antibodies and 61.3% contained anti-nucleoprotein antibodies, evidencing mostly a hybrid immunity resulting from vaccination and SARS-CoV-2 infection. At 1-month postimmunization, the 4 ethnic communities exhibited no significant differences in their anti-spike IgG levels (p value = 0.17, in an univariate linear regression model), in their capacity to mediate omicron neutralization (p value = 0.59 and 0.60, in an univariate logistic regression model at 1-month after the second and third dose, respectively) and in their capacity to mediate ADCC (p value = 0.069 in a multivariate linear regression model), regardless of the infection status. Anti-spike IgG levels and functionalities of the hybrid humoral immune response remained equivalent across the 4 ethnic communities during follow-up and at 6 months post-third dose. Conclusions: Our study evidenced Pacific Islander's robust humoral immune response to Pfizer BNT162b2 vaccine, which is pivotal to re-enforce vaccination deployment in a population at risk for severe COVID-19 (clinicaltrials.gov: NCT05135585). Trial registration: This trial has been register in ClinicalTrials.gov (ID: NCT05135585). Catherine Camille Inizan and colleagues evaluate the hybrid humoral immune response to COVID-19 infection and vaccination across a variety of Pacific Islander communities, and present data on a poorly studied population. Author summary: Why was this study done?: Pacific Islanders are at risk for severe COVID-19, in part owing to lifestyle and high rate of comorbidities. In a few studies, ethnicity had no impact on antibody levels following Pfizer BNT162b2 vaccine in Pacific Islanders; in these studies, however, follow-up was reduced and no distinction was made between the different Pacific ethnic communities. Characterizing the levels and functionality of Pacific Islanders humoral immune response to Pfizer BNT162b2 vaccine is pivotal to adapt vaccination regimens to regional singularities. What did the researchers do and find?: The current study enrolled 585 participants from New Caledonia self-declaring as Melanesians, Polynesians, Europeans, or belonging to other communities. Antibody levels and their functionality were characterized at the following time points: (1) 1 and/or 3 months after a second dose of the Pfizer BNT162b2 vaccine was administered; or (2) 1 and/or 6 months after the third dose of the vaccine. Approximately 61.3% of all sera contained traces of previous SARS-CoV-2 infection; the cohort's immune response was thus mostly hybrid, resulting from both vaccination and infection. At all time points analyzed, the hybrid humoral immune response remained equivalent across the Melanesian, Polynesian, European, and other communities: anti-spike antibody levels, which mirror the strength of the immune response, but also the capacity to mediate omicron neutralization and the capacity to mediate antibody-dependent cellular cytotoxicity (ADCC) were not significantly different across communities (p values >0.05). What do these findings mean?: The lack of community effect, despite different prevalence of obesity, suggests that SARS-CoV-2 hybrid humoral response does not differ between communities. Such robust and prototypical humoral immune response to Pfizer BNT162b2 vaccine and SARS-CoV-2 in Pacific Islanders is of prime importance to foster booster doses roll-out, with the aim to better protect this understudied population which is vulnerable to severe COVID-19. Biological confirmation of ethnicity and a larger sample size in the Polynesian community would enhance the resolution of our findings. [ABSTRACT FROM AUTHOR]

Epictetus’ Discourse 3.12, entitled “On Asceticism”, is part of a tradition of Stoic treatises of the same title, including Lesson 6 by his master, Musonius Rufus. This tradition identifies philosophy with a training or exercise, distinct from the wisdom that these exercises strive to attain through putting dogmas into practice and the exercise of virtue. Epictetus introduces in this context his famous three topoi (desire, impulse, assent) seeking to limit the role of the exercise of assent reduced by contemporary philosophers to technical training in logic. He also seeks to limit the role of the ostentatious asceticism of the body, against certain tendencies of cynical asceticism, which was integrated by Musonius with his own imprint but without criticism. Even if the three topoi are proper to Epictetus, it is possible to find partial anticipations of them in the Latin Stoic tradition, reported by Cicero or endorsed by Seneca. Epictetus has an original conception of asceticism but he follows the path of this tradition and of the teaching of Musonius.

Microscale residual stress may develop during the manufacturing of Carbon Fiber-Reinforced Polymer (CFRP) composites and negatively affect apparent macroscale mechanical properties. Accordingly, accurately capturing residual stress may be essential in computational methods used for composite material design. This work presents a new data-driven methodology for the evaluation of microscale residual stress in CFRPs using fiber push-out experiments with in situ scanning electron microscopy (SEM) imaging. SEM images reveal significant through-thickness matrix sink-in deformation in resin-rich areas after nearby fibers are pushed out, which is attributed to the release of microscale process-induced residual stress. The sink-in deformation is measured experimentally, and a Finite Element Model Updating (FEMU) method is used to retrieve the associated residual stress. The finite element (FE) analysis includes simulation of the curing process, test sample machining, and fiber push-out experiment. Significant out-of-plane matrix deformation larger than 1% of the specimen thickness is reported and associated with a high level of residual stress in resin-rich areas. This work emphasizes the importance of in situ data-driven characterization for integrated computational materials engineering (ICME) and material design.

Abstract Background In 2017, New Caledonia experienced an outbreak of severe dengue causing high hospital burden (4379 cases, 416 hospital admissions, 15 deaths). We decided to build a local operational model predictive of dengue severity, which was needed to ease the healthcare circuit. Methods We retrospectively analyzed clinical and biological parameters associated with severe dengue in the cohort of patients hospitalized at the Territorial Hospital between January and July 2017 with confirmed dengue, in order to elaborate a comprehensive patient’s score. Patients were compared in univariate and multivariate analyses. Predictive models for severity were built using a descending step-wise method. Results Out of 383 included patients, 130 (34%) developed severe dengue and 13 (3.4%) died. Major risk factors identified in univariate analysis were: age, comorbidities, presence of at least one alert sign, platelets count 10 N, and previous dengue infection. Severity was not influenced by the infecting dengue serotype nor by previous Zika infection. Two models to predict dengue severity were built according to sex. Best models for females and males had respectively a median Area Under the Curve = 0.80 and 0.88, a sensitivity = 84.5 and 84.5%, a specificity = 78.6 and 95.5%, a positive predictive value = 63.3 and 92.9%, a negative predictive value = 92.8 and 91.3%. Models were secondarily validated on 130 patients hospitalized for dengue in 2018. Conclusion We built robust and efficient models to calculate a bedside score able to predict dengue severity in our setting. We propose the spreadsheet for dengue severity score calculations to health practitioners facing dengue outbreaks of enhanced severity in order to improve patients’ medical management and hospitalization flow.

The increase in carbapenem-resistant Enterobacterales (CRE) is mostly driven by the spread of carbapenemase-producing (CP) strains. In New Caledonia, the majority of carbapenemases found are IMP-type carbapenemases that are difficult to detect on routine selective media. In this study, a culture-based method with ertapenem selection is proposed to distinguish non-CRE, non-CP-CRE, and CP-CRE from samples with very high bacterial loads. Firstly, assays were carried out with phenotypically well-characterized β-lactam-resistant Enterobacterales isolates. Then, this approach was applied to clinical and environmental samples. Presumptive CP-CRE isolates were finally identified, and the presence of a carbapenemase was assessed. In a collection of 27 phenotypically well-characterized β-lactam-resistant Enterobacterales, an ertapenem concentration of 0.5 µg·mL−1 allowed distinguishing CRE from non-CRE. A concentration of 4 µg·mL−1 allowed distinguishing CP-CRE from non-CP-CRE after nine hours of incubation. These methods allowed isolating 18 CP-CRE from hospital effluents, including the first detection of a KPC in New Caledonia. All these elements show that this cost-effective strategy to distinguish β-lactam-resistant Enterobacterales provides fast and reliable results. This could be applied in the Pacific islands or other resource-limited settings, where limited data are available.

The port-Hamiltonian system approach is intended to be an innovative and unifying way of modeling multiphysics systems, by expressing all of them as systems of conservation laws. Indeed, the increasing developments in recent years allow finding better control and coupling strategies. This work aimed to apply such an approach to Naghdi–Reissner’s five-kinematic-field shell model in linear elasticity, while including often-neglected higher-order intrinsic geometric coupling effects, therefore preparing the theoretical background required for the coupling (or interconnection) with an acoustic fluid model and the different types of interactions that can arise among them. The model derived thusly can be used for controller design in a wide variety of applications such as inflatable space structures, launcher tank vibration damping, payload vibration protection using smart materials, and many other related applications.

Compared to the previous 2013–2014 outbreak, dengue 2016–2017 outbreak in New Caledonia was characterized by an increased number of severe forms associated with hepatic presentations. In this study, we assessed the virological factors associated with this enhanced severity. Whole-genome sequences were retrieved from dengue virus (DENV)-1 strains collected in 2013–2014 and from severe and non-severe patients in 2016–2017. Fitness, hepatic tropism and cytopathogenicity of DENV 2016–2017 strains were compared to those of 2013–2014 strains using replication kinetics in the human hepatic cell line HuH7. Whole-genome sequencing identified four amino acid substitutions specific to 2016–2017 strains and absent from 2013–2014 strains. Three of these mutations occurred in predicted T cell epitopes, among which one was also a B cell epitope. Strains retrieved from severe forms did not exhibit specific genetic features. DENV strains from 2016–2017 exhibited a trend towards reduced replicative fitness and cytopathogenicity in vitro compared to strains from 2013–2014. Overall, the 2016–2017 dengue outbreak in New Caledonia was associated with a viral genetic evolution which had limited impact on DENV hepatic tropism and cytopathogenicity. These mutations, however, may have modified DENV strains antigenicity, altering the anti-DENV immune response in some patients, in turn favoring the development of severe forms.Trial registration: ClinicalTrials.gov identifier: NCT04615364.

Text

IntroductionEosinophilic meningitis is a rare form of meningitis with sequelae or death occurring in approximately 2-3% of cases. The most frequent etiological agent is the parasite Angiostrongylus cantonensis. The aim of this study was to characterize New Caledonian cases and to assess the extent to which of A. cantonensis was involved.Material and methodsWe performed a retrospective study of all cases of eosinophilic meningitis (EM) admitted to the Territorial Hospital of New Caledonia, from 2004 to 2019. We performed a descriptive and a multivariate analysis to identify association of variables with severe and fatal cases (or cases with sequelae).ConclusionAngiostrongyliasis was confirmed as being responsible for 17 of the 92 reported EM cases in New Caledonia from 2004 to 2019 with most being young adults and non-walking infants, and with two peaks of incidence one during the dry season and one during the rainy season. Considering the high incidence and regularity of cases, the potential reservoirs should be identified to target prevention campaigns.

Dengue virus infection is endemic in New Caledonia, with outbreaks occurring every year. We evaluated the Biosynex® Dengue NS1 antigen rapid diagnostic test (RDT) for the early diagnosis of dengue in patients attending a local hospital in northern New Caledonia. Samples collected from patients suspected of dengue infection were tested with RDT at the local laboratory, and then sent to the reference laboratory for confirmation with real-time RT-PCR. A total of 472 samples were included during the study period. RT-PCR yielded a positive result in 154 samples (32.6%). The sensitivity and specificity of the NS1 antigen RDT were 79.9% and 96.2%, respectively. The performance of the RDT varied by the time of sampling and dengue virus serotype. In conclusion, Biosynex® Dengue NS1 antigen RDT showed a sensitivity and a specificity in the upper range usually reported for this type of test. Several factors can lead to a suboptimal sensitivity, and negative samples with suggestive clinical features should be retested with reference methods.

With over one million cases worldwide annually and a high fatality in symptomatic forms, human leptospirosis is a growing public health concern for the most vulnerable populations, especially in the context of global warming and unplanned urbanization. Although the Asia-Pacific region is particularly affected, accurate epidemiological data are often lacking. We conducted an eleven-year retrospective laboratory-based epidemiological survey of human leptospirosis in New Caledonia. From 2006 to 2016, 904 cases were laboratory-confirmed, including 29 fatalities, corresponding to an average annual incidence of 30.6/100,000 and a case fatality rate of 3.2%. Over the period, there was a major shift from indirect serological diagnosis by MAT to direct diagnosis by real-time PCR, a more specific and sensitive test when performed early in the course of the disease. The systematic implementation of genotyping informed on the variety of the infective strains involved, with a predominance of serogroups Icterohaemorrhagiae and Pyrogenes. The epidemiological pattern showed a marked seasonality with an annual peak in March-April. Interestingly, the seasonal peak in children of school age was significantly earlier and corresponded to school holidays, suggesting that attending school from February on could protect children from environment-borne leptospirosis.

Zika virus, an arbovirus responsible for major outbreaks, can cause serious health issues, such as neurological diseases. In the present study, different types of samples (serum, saliva, and urine), collected in 2015–2016 in New Caledonia and French Guiana from 53 patients presenting symptoms and clinical signs triggered by arbovirus infections, were analyzed using a recently developed, and in-house validated, 4-plex RT-qPCR TaqMan method for simultaneous detection and discrimination of the Zika and Chikungunya viruses. Subsequently, statistical analyses were performed in order to potentially establish recommendations regarding the choice of samples type to use for an efficient and early stage Zika infection diagnosis. On this basis, the use of only urine samples presented the highest probability to detect viral RNA from Zika virus. Moreover, such a probability was improved using both urine and saliva samples. Consequently, the added value of non-invasive samples, associated with a higher acceptance level for collection among patients, instead of serum samples, for the detection of Zika infections was illustrated.