The decline of dengue in the Americas in 2017: discussion of multiple hypotheses.

OBJECTIVE: Since the 1980s, dengue incidence has increased 30-fold. However, in 2017, there was a noticeable reduction in reported dengue incidence cases within the Americas, including severe and fatal cases. Understanding the mechanism underlying dengue's incidence and decline in the Americas is vital for public health planning. We aimed to provide plausible explanations for the decline in 2017. METHODS: An expert panel of representatives from scientific and academic institutions, Ministry of Health officials from Latin America and PAHO/WHO staff met in October 2017 to propose hypotheses. The meeting employed six moderated plenary discussions in which participants reviewed epidemiological evidence, suggested explanatory hypotheses, offered their expert opinions on each and developed a consensus. RESULTS: The expert group established that in 2017, there was a generalised decreased incidence, severity and number of deaths due to dengue in the Americas, accompanied by a reduction in reported cases of both Zika and chikungunya virus infections, with no change in distribution among age groups affected. This decline was determined to be unlikely due to changes in epidemiological surveillance systems, as similar designs of surveillance systems exist across the region. Although sudden surveillance disruption is possible at a country or regional level, it is unlikely to occur in all countries simultaneously. Retrospective modelling with epidemiological, immunological and entomological information is needed. Host or immunological factors may have influenced the decline in dengue cases at the population level through immunity; however, herd protection requires additional evidence. Uncertainty remains regarding the effect on the outcome of sequential infections of different dengue virus (DENV) types and Zika virus (ZIKV), and vice versa. Future studies were recommended that examine the epidemiological effect of prior DENV infection on Zika incidence and severity, the epidemiological effect of prior Zika virus infection on dengue incidence and severity, immune correlates based on new-generation ELISA assays, and impact of prior DENV/other arbovirus infection on ZIKV immune response in relation to number of infections and the duration of antibodies in relation to interval of protection. Follow-up studies should also investigate whether increased vector control intensification activities contributed to the decline in transmission of one or more of these arboviruses. Additionally, proposed studies should focus on the potential role of vector competence when simultaneously exposed to various arboviruses, and on entomological surveillance and its impact on circulating vector species, with a goal of applying specific measures that mitigate seasonal occurrence or outbreaks. CONCLUSIONS: Multifactorial events may have accounted for the decline in dengue seen in 2017. Differing elements might explain the reduction in dengue including elements of immunity, increased vector control, and even vector and\or viruses changes or adaptations. Most of the results of this expert consensus group meeting are hypothetical and based on limited evidence. Further studies are needed.

OBJECTIF: Depuis les années 1980, l'incidence de la dengue a été multipliée par 30. Cependant, en 2017, il y a eu une réduction notable du nombre de cas d'incidence de dengue rapportés dans les Amériques. Nous voulions fournir des explications plausibles à la baisse en 2017. MÉTHODES: Un groupe d'experts constitué de représentants d'institutions scientifiques et académiques, d'officiels des Ministères de la Santé d'Amérique Latine et de membres du personnel de l'OPS/OMS s'est réuni en octobre 2017 pour proposer et évaluer des hypothèses. RÉSULTATS: En 2017, il y a eu une baisse généralisée de l'incidence, de la sévérité et du nombre de décès dus à la dengue dans les Amériques, accompagnée d'une réduction des cas rapportés d'infections par le virus Zika et par le virus du chikungunya, sans modification dans la répartition entre les groupes d'âge affectés. Il a été déterminé que ce déclin était peu probablement dû aux changements dans les systèmes de surveillance épidémiologique, étant donné que des systèmes de surveillance similaires existaient dans toute la région. Bien que des perturbations soudaines dans la surveillance soient possibles au niveau national ou régional, il est peu probable que cela se produise simultanément dans tous les pays. Une modélisation rétrospective avec des informations épidémiologiques, immunologiques et entomologiques est nécessaire. Des facteurs liés à l'hôte ou immunologiques peuvent avoir influencé le déclin des cas de dengue au niveau de la population par le biais de l'immunité; cependant, l'évidence d'une protection conférée par l'effet du troupeau nécessite des données supplémentaires. Une incertitude subsiste quant à l'effet sur le résultat des infections séquentielles de différents types du virus de la dengue (DENV) et du virus Zika (ZIKV), et vice-versa. Les études à venir devraient examiner (1) l'effet épidémiologique d'une infection antérieure par le DENV sur l'incidence et la sévérité du virus Zika, (2) l'effet épidémiologique d'une infection antérieure par le virus Zika sur l'incidence et la sévérité de la dengue, (3) les corrélats immunitaires basés sur des tests ELISA de nouvelle génération, (4) l' impact d'une infection antérieure à DENV/autres arbovirus sur la réponse immunitaire au ZIKV en fonction du nombre d'infections et de la durée des anticorps en fonction de l'intervalle de protection, (5) si des activités d'intensification de la lutte antivectorielle ont contribué à la diminution de la transmission d'un ou plusieurs de ces arbovirus, (6) le rôle potentiel de la compétence vectorielle lorsqu'ils sont exposés simultanément à différents arbovirus, (7) la surveillance entomologique et son impact sur la circulation d'espèces de vecteurs, dans le but d'appliquer des mesures spécifiques qui réduisent l'occurrence saisonnière d'épidémies. CONCLUSIONS: Des événements multifactoriels pourraient expliquer le déclin observé de la dengue en 2017. La plupart des résultats de cette réunion du groupe de consensus d'experts sont hypothétiques, reposent sur des données limitées et requièrent des investigations supplémentaires.

Death by Suicide-The EMS Profession Compared to the General Public.

BACKGROUND: In 2016, nearly 45,000 deaths in the United States were attributed to suicide making this the 10th leading cause of death for all ages. National survey data suggest that among Emergency Medical Technicians (EMTs), including firefighters and Paramedics, rates of suicide are significantly higher than among the general public. EMTs face high levels of acute and chronic stress as well as high rates of depression and substance abuse, which increase their risk of suicide. OBJECTIVE/AIM: To determine the statewide Mortality Odds Ratio (MOR) of suicide completion among EMTs as compared to non-EMTs in Arizona. METHODS: We analyzed the Arizona Vital Statistics Information Management System Electronic Death Registry of all adult (≥18) deaths between January 1, 2009 and December 31, 2015. Manual review of decedent occupation was performed to identify the EMT cohort; all other deaths were included in the non-EMT cohort. Using the underlying cause of death as the outcome, we calculated the MOR of both the EMT and non-EMT cohorts. RESULTS: There were a total of 350,998 deaths during the study period with 7,838 categorized as suicide. The proportion of deaths attributed to suicide among EMTs was 5.2% (63 of 1,205 total deaths) while the percentage among non-EMTs was 2.2% (7,775/349,793) (p < 0.0001). The crude Mortality Odds Ratio for EMTs compared with non-EMTs was [cMOR 2.43; 95% CI (1.88-3.13)]. After adjusting for gender, age, race, and ethnicity, EMTs had higher odds that their death was by suicide than non-EMTs [aMOR: 1.39; 95% CI (1.06-1.82)]. CONCLUSION: In this statewide analysis, we found that EMTs had a significantly higher Mortality Odds Ratio due to suicide compared to non-EMTs. Further research is necessary to identify the underlying causes of suicide among EMTs and to develop effective prevention strategies.

One-Step Electropolymerization of a Dicyanobenzene-Carbazole-Imidazole Dye to Prepare Photoactive Redox Polymer Films.

To the best of our knowledge, this study reports the first direct electropolymerization of a dicyanobenzene-carbazole dye functionalized with an imidazole group to prepare redox- and photoactive porous organic polymer (POP) films in controlled amounts. The POP films were grown on indium-doped tin oxide (ITO) and carbon surfaces using a new monomer, 1-imidazole-2,4,6-tri(carbazol-9-yl)-3,5-dicyanobenzene (1, 3CzImIPN), through a simple one-step process. The structure and activities of the POP films were investigated as photoelectrodes for electrooxidations, as heterogeneous photocatalysts for photosynthetic olefin isomerizations, and for solid-state photoluminescence behavior tunable by lithium-ion concentrations in solution. The results demonstrate that the photoredox-POPs can be used as efficient photocatalysts, and they have potential applications in sensing.

Solid-phase synthesis and photoactivity of Ru-polypyridyl visible light chromophores bonded through carbon to semiconductor surfaces.

1,10-Phenanthroline (phen) was grafted to either indium tin oxide (ITO), fluorine-doped tin oxide (FTO), or titanium dioxide (TiO2) semiconductors (SC's) by electrochemical reduction of 5-diazo-phen. The phen ligand is bonded to the semiconductor at C5, and it can be handled in air. The semiconductor-phen (SC-phen) complexes displace both CH3CN ligands from either cis-[Ru(Mebipy)2(CH3CN)2]2+ (Mebipy = 4,4'-methyl-2,2'-bipyridine), cis-[Ru(tBubipy)2(CH3CN)2]2+ (tBubipy = 4,4'-tert-butyl-2,2'-bipyridine), or cis-[Ru(pheno)(bipy)(CH3CN)2]2+ (bipy = 2,2'-bipyridine; pheno = 1,10-phenanthroline-5,6-dione) dissolved in DCM/THF (4 h, 70 °C) to form the corresponding surface-bound SC-[(phen)Ru(bipyridyl)2]2+ chromophores. The identities of the SC-[(phen)Ru(Mebipy)2]2+, SC-[(phen)Ru(tBubipy)2]2+, and SC-[(phen)Ru(pheno)(bipy)]2+ (SC = ITO, FTO or TiO2) chromophores were confirmed by X-ray photoelectron spectroscopy (XPS); inductively coupled plasma mass spectrometry (ICP-MS); UV-vis and reflectance infrared spectroscopies; and cyclic voltammetry (CV). The data were compared to analogous Ru-polypyridyl control compounds dissolved in solution. A facile ketone-amine condensation solid-phase synthesis reaction between SC-[(phen)Ru(pheno)(bipy)]2+ and [Ru(1,10-phenthroline-5,6-diamine)(bipy)2]2+ in ethanol (80 °C, 1 h) formed the dinuclear, bound chromophore SC-[(phen)(bipy)Ru(tpphz)Ru(bipy)2]4+ (tpphz = tetrapyrido[3,2-a:2',3'-c:3'',2''-h:2''',3'''-j]phenazine). Photoelectrochemical oxidation of hydroquinone and triethylamine under acidic, neutral, or basic conditions showed that the SC-chromophore photoanodes are active, and that TiO2-[(phen)Ru(Mebipy)2]2+ is the most active and stable under basic- and neutral conditions. The dinuclear chromophore SC-[(phen)(bipy)Ru(tpphz)Ru(bipy)2]4+ was most active and stable under potentiostatic conditions in acid.

Modular Construction of Photoanodes with Covalently Bonded Ru- and Ir-Polypyridyl Visible Light Chromophores.

1,10-phenanthroline is grafted to indium tin oxide (ITO) and titanium dioxide nanoparticle (TiO2) semiconductors by electroreduction of 5-diazo-1,10-phenanthroline in 0.1 M H2SO4. The lower and upper potential limits (-0.20 and 0.15 VSCE, respectively) were set to avoid reduction and oxidation of the 1,10-phenanthroline (phen) covalently grafted at C5 to the semiconductor. The resulting semiconductor-phen ligand (ITO-phen or TiO2-phen) was air stable, and was bonded to Ru- or Ir- by reaction with cis-[Ru(bpy)2(CH3CN)2]2+ (bpy = 2,2'-bipyridine) or cis-[Ir(ppy)2(CH3CN)2]+ (ppy = ortho-Cphenyl metalated 2-phenylpyridine) in CH2Cl2 and THF solvent at 50 °C. Cyclic voltammetry, X-ray photoelectron spectroscopy, solid-state UV-vis, and inductively coupled plasma-mass spectrometry all confirmed that the chromophores SC-[(phen)Ru(bpy)2]2+ and SC-[(phen)Ir(ppy)2]+ (SC = ITO or TiO2) formed in near quantitative yields by these reactions. The resulting photoanodes were active and relatively stable to photoelectrochemical oxidation of hydroquinone and triethylamine under neutral and basic conditions.

Role of alpha-actin in muscle damage of injured athletes in comparison with traditional markers.

OBJECTIVE: In order to identify a reliable marker for the early detection of muscle injuries in sports, alpha-actin protein and other markers of muscle damage were studied in sera of uninjured sportspeople and those with skeletal muscle injury. METHODS: Blood samples were obtained from 20 sportspeople with skeletal muscle injury and 48 uninjured sportspeople. Immunoassays were performed to determine cardiac troponin I (TnI), troponin T, lactate dehydrogenase and myoglobin concentrations. Western blot and densitometry were used to measure alpha-actin concentrations. Skeletal muscle damage was diagnosed according to physical examination, MRI findings and the biochemical criterion of a creatine kinase value >500 IU/l (Rosalki method, Beckman Instruments SL, Fullerton, California, USA). Results were also compared with previously obtained data on injured and uninjured non-sportspeople. RESULTS: The mean serum concentration of alpha-actin was significantly higher in sportspeople with muscle damage (10.49 microg/ml) than in uninjured sportspeople (3.99 mcirog/ml). Sera from injured sportspeople showed higher levels of alpha-actin than of troponin or myoglobin. No significant difference in TnI levels was observed between the groups. CONCLUSIONS: According to these results, alpha-actin is a new and reliable marker of skeletal muscle damage in sportspeople which can be used for the detection of muscle injury. Possible cross interference between skeletal and cardiac muscle damage can be discriminated by the combined use of alpha-actin and TnI. These data suggest that early measurement of alpha-actin in sportspeople with suspected muscle damage will allow them to receive earlier and more effective treatment and to return sooner to the practice of their sport.

Presencia y distribución espacial de Simulium sp. (Díptera: Simuliidae) en dos provincias de Angola / Presence and spatial distribution of Simuliumsp.(Diptera: Simuliidae) in two provinces of Angola

En el oeste de África los miembros del complejo Simulium damnosum son los vectores de la oncocercosis. El objetivo es obtener datos sobre la presencia y distribución de simúlidos en dos provincias de Angola. El trabajo se realizó en las provincias de Huambo y Bié donde se muestrearon 24 cuerpos de agua entre julio y agosto, 2015. Todos los sitios se localizaron por encima de una altitud de 1 000 m y solo tres resultaron negativos a la presencia de simúlidos. Estos resultados constituyen los primeros que se obtienen sobre la presencia y distribución espacial de Simulium sp. en Angola de gran importancia, pues la superposición de los mapas de distribución de la infección humana y los vectores permiten localizar áreas con peligro de transmisión(AU)

In West Africa Simuliumdamnosum complex members are the main vectors of onchocerciasis. The objective of this paper was to collect data on the presence and spatial distribution of black flies in two provinces of Angola. The research work was conducted in Huambo and Bié provinces where 24 water bodies were sampled between July and August 2015. All the studied sites were located above 1 000 m of altitude and only three of them were found to be negative for the presence of black flies. These were the first results obtained on the presence and spatial distribution of Simulium sp. in Angola and are of great importance because overlapping the distribution maps of human infection and of vectors allows finding the areas at risk of transmission(AU)

Pulsed ultrasounds accelerate healing of rib fractures in an experimental animal model: an effective new thoracic therapy?

OBJECTIVES: Rib fractures are a frequent traumatic injury associated with a relatively high morbidity. Currently, the treatment of rib fractures is symptomatic. Since it has been reported that pulsed ultrasounds accelerates repair of limb fractures, we hypothesized that the application of pulsed ultrasounds will modify the course of healing in an animal model of rib fracture. METHODS: We studied 136 male Sprague-Dawley rats. Animals were randomly assigned to different groups of doses (none, 50, 100, and 250 mW/cm(2) of intensity for 3 minutes per day) and durations (2, 10, 20, and 28 days) of treatment with pulsed ultrasounds. In every subgroup, we analyzed radiologic and histologic changes in the bone callus. In addition, we examined changes in gene expression of relevant genes involved in wound repair in both control and treated animals. RESULTS: Histologic and radiologic consolidation was significantly increased by pulsed ultrasound treatment when applied for more than 10 days. The application of 50 mW/cm(2) was the most effective dose. Only the 100 and 250 mW/cm(2) doses were able to significantly increase messenger RNA expression of insulin-like growth factor 1, suppressor of cytokine signaling-2 and -3, and vascular endothelial growth factor and decrease monocyte chemoattractant protein-1 and collagen type II-alpha 1. CONCLUSIONS: Our findings indicate that pulsed ultrasound accelerates the consolidation of rib fractures. This study is the first to show that pulsed ultrasound promotes the healing of rib fractures. From a translational point of view, this easy, cheap technique could serve as an effective new therapeutic modality in patients with rib fractures.

La mediación en el sistema español de justicia penal de menores / Mediation in the Spanish juvenile criminal justice system / A mediação no sistema espanhol da justiça penal dos menores

El trabajo aborda la situación de la mediación en el sistema penal de menores en España. Tras analizar el papel que se otorga por las directrices internacionales a esta medida desjudicializadora, se efectúa un análisis de la regulación contenida en el art. 19 de la Ley Orgánica 5/2000, de 12 de enero, reguladora de la responsabilidad penal de los menores, tanto desde un punto de vista jurídico como práctico, destacando como principal problema la diversa implantación de la mediación en las distintas Comunidades Autónomas

This work approaches the present situation of mediation in juvenile criminal justice in Spain. Upon having analyzed the role conferred by international outlines on this dejudicializing measure, an analysis is offered of the regulation contained in article 19 of Organic Act (“Ley Orgánica”) 5/2000 of 12th January, whereby minors’ criminal liability is regulated in both juridical and practical terms, by highlighting as a major problem the diverse implementation of mediation in the different Autonomous Communities

O trabalho aborda a situação da mediação no sistema penal dos menores na Espanha. Após ter analisado o papel que é concedido pelas diretrizes internacionais a esta medida desjudicializadora, realiza-se uma análise do regulamento contido no artigo 19 da lei orgânica 5/2000, 12 de janeiro, reguladora da responsabilidade criminal dos menores, tanto quanto de um ponto de vista legal como prático, e destaca como o problema principal a implantação diversa da mediação nas diferentes Comunidades Autônomas