European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups.

BACKGROUND: To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups. METHODS: We conducted a subgroup analysis of adult emergency department patients with chest pain prospectively enrolled from eight US sites (January 2017 to September 2018). Patients were stratified into rule-out, observation and rule-in zones using the hs-cTnT ESC 0/1-h algorithm and classified as older (≥65 years), middle aged (46-64 years) or young (21-45 years). Patients had 0-hour and 1-hour hs-cTnT measures (Roche Diagnostics) and a History, ECG, Age, Risk factor and Troponin (HEART) score. Fisher's exact tests compared rule-out and 30-day cardiac death or MI rates between ages. NPVs with 95% CIs were calculated for the ESC 0/1-h algorithm with and without the HEART score. RESULTS: Of 1430 participants, 26.9% (385/1430) were older, 57.4% (821/1430) middle aged and 15.7% (224/1430) young. Cardiac death or MI at 30 days occurred in 12.8% (183/1430). ESC 0/1-h algorithm ruled out 35.6% (137/385) of older, 62.1% (510/821) of middle-aged and 79.9% of (179/224) young patients (p<0.001). NPV for 30-day cardiac death or MI was 97.1% (95% CI 92.7% to 99.2%) among older patients, 98.4% (95% CI 96.9% to 99.3%) in middle-aged patients and 99.4% (95% CI 96.9% to 100%) among young patients. Adding a HEART score increased NPV to 100% (95% CI 87.7% to 100%) for older, 99.2% (95% CI 97.2% to 99.9%) for middle-aged and 99.4% (95% CI 96.6% to 100%) for young patients. CONCLUSIONS: In older and middle-aged adults, the hs-cTnT ESC 0/1-h algorithm was unable to reach a 99% NPV for 30-day cardiac death or MI unless combined with a HEART score. TRIAL REGISTRATION NUMBER: NCT02984436.

Species diversity and spatial distribution of mosquitoes (Diptera: Culicidae) from La Isla Amazon Park, Napo Province, Ecuador / Diversidad de especies y distribución espacial de mosquitos (Diptera: Culicidae) del Parque Amazónico La Isla, provincia de Napo, Ecuador

Abstract Introduction: Vector-borne diseases are prevalent in the Amazon and Coastal regions of Ecuador. However, there is a scarcity of mosquito ecology studies in these areas. The most recent list of species reported for the country comprises 8 tribes, 22 genera, and 200 species. Objectives: To document the Culicidae species found in La Isla Amazon Park, Napo, Ecuador, including those with epidemiological significance; and to analyze their composition, abundance, and diversity, focusing on larval habitats during the dry and rainy periods. Methods: We evaluated different larval habitats, considering collection duration as the primary criterion. We used CDC and Shannon traps to collect adult mosquitoes during both rainy and dry periods. To assess sampling effort, we used accumulation curves and non-parametric estimators of species richness, while we employed Hill numbers to determine diversity. Additionally, we used the Berger-Parker and Pielou indices to evaluate species dominance and evenness. We conducted cluster analysis and ANOSIM tests to assess the similarity between habitats and the differences in taxonomic composition between periods. Results: We collected a total of 802 individuals from 15 species and 4 taxonomic units, 5 genera, and 4 tribes. Notably, this may be the first records of Wyeomyia felicia Dyar & Núñez Tovar and Culex derivator Dyar & Knab from Ecuador. Additionally, the presence of Culex dunni Dyar and Psorophora ferox von Humboldt (both recognized as vectors) was correlated with increased rainfall. Conclusions: The abundance of mosquitoes, including potential vector species, increased during the rainy season, indicating a higher risk of pathogen transmission. However, the relationship between rainfall amount and diversity patterns is not well-defined.

Resumen Introducción: Las enfermedades vectoriales son prevalentes en las regiones amazónica y costera de Ecuador. Sin embargo, hay una escasez de estudios de ecología de mosquitos en estas áreas. En el país se ha reportado 8 tribus, 22 géneros y 200 especies. Objetivos: Documentar las especies de Culicidae encontradas en el Parque Amazónico La Isla, Napo, Ecuador, incluyendo aquellas con importancia epidemiológica; y analizar su composición, abundancia y diversidad, enfocándose en los hábitats de las larvas durante los períodos seco y lluvioso. Métodos: Evaluamos diferentes hábitats larvarios, con la duración de la recolecta como criterio. Las trampas CDC y Shannon recolectaron mosquitos adultos durante los períodos seco y lluvioso. Evaluamos la riqueza de especies con curvas de acumulación y estimadores no paramétricos, mientras que determinamos la diversidad con los números de Hill. Además, utilizamos los índices de Berger-Parker y Pielou para evaluar la dominancia y la uniformidad de las especies. Realizamos análisis de conglomerados y la prueba ANOSIM para evaluar la similitud entre hábitats y estaciones, así como las diferencias en la composición taxonómica, respectivamente. Resultados: Recolectamos un total de 802 individuos de 15 especies y 4 unidades taxonómicas, 5 géneros y 4 tribus. Este podría ser el primer registro de Wyeomyia felicia Dyar & Núñez Tovar y Culex derivator Dyar & Knab en Ecuador. Además, la presencia de Culex dunni Dyar y Psorophora ferox von Humboldt (ambos potenciales vectores) se correlacionó con el aumento de las precipitaciones. Conclusiones: El aumento de la abundancia de mosquitos durante el periodo lluvioso indica un mayor riesgo de transmisión de patógenos. Sin embargo, la relación entre la cantidad de precipitaciones y los patrones de diversidad no está bien definida.

The African mosquito-borne diseasosome: geographical patterns, range expansion and future disease emergence.

Mosquito-borne diseases (MBDs) threaten public health and food security globally. We provide the first biogeographic description of the African mosquito fauna (677 species) and the 151 mosquito-borne pathogens (MBPs) they transmit. While mosquito species richness agrees with expectations based on Africa's land surface, African arboviruses and mammalian plasmodia are more speciose than expected. Species assemblages of mosquitoes and MBPs similarly separate sub-Saharan Africa from North Africa, and those in West and Central Africa from eastern and southern Africa. Similarities between mosquitoes and MBPs in diversity and range size suggest that mosquitoes are key in delimiting the range of MBPs. With approximately 25% endemicity, approximately 50% occupying one to three countries and less than 5% occupying greater than 25 countries, the ranges of mosquitoes and MBPs are surprisingly small, suggesting that most MBPs are transmitted by a single mosquito species. Exceptionally widespread mosquito species feed on people and livestock, and most are high-altitude-windborne migrants. Likewise, widespread MBPs are transmitted among people or livestock by widespread mosquitoes, suggesting that adapting to people or livestock and to widespread mosquito species promote range expansion in MBPs. Range size may predict range expansion and emergence risk. We highlight key knowledge gaps that impede prediction and mitigation of future emergence of local and global MBDs.

Phylogenomics reveals the history of host use in mosquitoes.

Mosquitoes have profoundly affected human history and continue to threaten human health through the transmission of a diverse array of pathogens. The phylogeny of mosquitoes has remained poorly characterized due to difficulty in taxonomic sampling and limited availability of genomic data beyond the most important vector species. Here, we used phylogenomic analysis of 709 single copy ortholog groups from 256 mosquito species to produce a strongly supported phylogeny that resolves the position of the major disease vector species and the major mosquito lineages. Our analyses support an origin of mosquitoes in the early Triassic (217 MYA [highest posterior density region: 188-250 MYA]), considerably older than previous estimates. Moreover, we utilize an extensive database of host associations for mosquitoes to show that mosquitoes have shifted to feeding upon the blood of mammals numerous times, and that mosquito diversification and host-use patterns within major lineages appear to coincide in earth history both with major continental drift events and with the diversification of vertebrate classes.

The insupportable validity of mosquito subspecies (Diptera: Culicidae) and their exclusion from culicid classification.

Beginning about 80 years ago, the recognition of morphological varieties of mosquitoes was gradually replaced by the recognition of subspecies. As an examination of revisionary and detailed taxonomic studies of mosquitoes clearly shows, subspecies are untenable concepts which have been synonymized with nominotypical forms or recognized as distinct species. Thus, from our perspective, subspecies is not a functional or practical taxonomic rank. Consequently, in this study we critically assessed the taxonomic status of the 120 nominal taxa distinguished as subspecies before now to determine whether they should be recognized as separate species or synonymous names. As a result, 96 subspecies are formally elevated to specific rank, 22 are relegated to synonymy with nominotypical forms, one is considered a nomen dubium, one a species inquirenda and the names of four nominal species regarded as synonyms are revalidated. The subspecies and their new status are listed in a conspectus. The revalidated species include Anopheles argentinus (Brèthes, 1912), from synonymy with An. pseudopunctipennis Theobald, 1901c; An. peruvianus Tamayo, 1907, from synonymy with An. pseudopunctipennis as nomen dubium; Culex major Edwards, 1935, from synonymy with Cx. annulioris consimilis Newstead, 1907; and Trichoprosopon trichorryes (Dyar & Knab, 1907), from synonymy with Tr. compressum Lutz, 1905. Additionally, the type locality of Anopheles sergentii Theobald, 1907 is restricted to El Outaya, Biskra Province, Algeria. A complete list of species to be retained, added to or removed from the Encyclopedia of Life, with a few corrections, is provided.

High Levels of Diversity in Anopheles Subgenus Kerteszia Revealed by Species Delimitation Analyses.

The Anopheles subgenus Kerteszia is a poorly understood group of mosquitoes that includes several species of medical importance. Although there are currently twelve recognized species in the subgenus, previous studies have shown that this is likely to be an underestimate of species diversity. Here, we undertake a baseline study of species delimitation using the barcode region of the mtDNA COI gene to explore species diversity among a geographically and taxonomically diverse range of Kerteszia specimens. Beginning with 10 of 12 morphologically identified Kerteszia species spanning eight countries, species delimitation analyses indicated a high degree of cryptic diversity. Overall, our analyses found support for at least 28 species clusters within the subgenus Kerteszia. The most diverse taxon was Anopheles neivai, a known malaria vector, with eight species clusters. Five other species taxa showed strong signatures of species complex structure, among them Anopheles bellator, which is also considered a malaria vector. There was some evidence for species structure within An. homunculus, although the results were equivocal across delimitation analyses. The current study, therefore, suggests that species diversity within the subgenus Kerteszia has been grossly underestimated. Further work will be required to build on this molecular characterization of species diversity and will rely on genomic level approaches and additional morphological data to test these species hypotheses.

Phylogenetic analysis of the Neotropical Albitarsis Complex based on mitogenome data.

BACKGROUND: Some of the most important malaria vectors in South America belong to the Albitarsis Complex (Culicidae; Anophelinae; Anopheles). Understanding the origin, nature, and geographical distribution of species diversity in this important complex has important implications for vector incrimination, control, and management, and for modelling future responses to climate change, deforestation, and human population expansion. This study attempts to further explore species diversity and evolutionary history in the Albitarsis Complex by undertaking a characterization and phylogenetic analysis of the mitogenome of all 10 putative taxa in the Albitarsis Complex. METHODS: Mitogenome assembly and annotation allowed for feature comparison among Albitarsis Complex and Anopheles species. Selection analysis was conducted across all 13 protein-coding genes. Maximum likelihood and Bayesian inference methods were used to construct gene and species trees, respectively. Bayesian methods were also used to jointly estimate species delimitation and species trees. RESULTS: Gene composition and order were conserved across species within the complex. Unique signatures of positive selection were detected in two species-Anopheles janconnae and An. albitarsis G-which may have played a role in the recent and rapid diversification of the complex. The COI gene phylogeny does not fully recover the mitogenome phylogeny, and a multispecies coalescent-based phylogeny shows that considerable uncertainty exists through much of the mitogenome species tree. The origin of divergence in the complex dates to the Pliocene/Pleistocene boundary, and divergence within the distinct northern South American clade is estimated at approximately 1 million years ago. Neither the phylogenetic trees nor the delimitation approach rejected the 10-species hypothesis, although the analyses could not exclude the possibility that four putative species with scant a priori support (An. albitarsis G, An. albitarsis H, An. albitarsis I, and An. albitarsis J), represent population-level, rather than species-level, splits. CONCLUSION: The lack of resolution in much of the species tree and the limitations of the delimitation analysis warrant future studies on the complex using genome-wide data and the inclusion of additional specimens, particularly from two putative species, An. albitarsis I and An. albitarsis J.

Phylogenetic Network of Mitochondrial COI Gene Sequences Distinguishes 10 Taxa Within the Neotropical Albitarsis Group (Diptera: Culicidae), Confirming the Separate Species Status of Anopheles albitarsis H (Diptera: Culicidae) and Revealing a Novel Lineage, Anopheles albitarsis J.

The Neotropical Albitarsis Group is a complex assemblage of essentially isomorphic species which currently comprises eight recognized species-five formally described (Anopheles albitarsis Lynch-Arribalzaga, An. deaneorum Rosa-Freitas, An. janconnae Wilkerson and Sallum, An. marajoara Galvao and Damasceno, An. oryzalimnetes Wilkerson and Motoki) and three molecularly assigned (An. albitarsis F, G & I)-and one mitochondrial lineage (An. albitarsis H). To further explore species recognition within this important group, 658 base pairs of the mitochondrial DNA cytochrome oxidase subunit I (COI) were analyzed from 988 specimens from South America. We conducted statistical parsimony network analysis, generated estimates of haplotype, nucleotide, genetic differentiation, divergence time, and tested the effect of isolation by distance (IBD). Ten clusters were identified, which confirmed the validity of the eight previously determined species, and confirmed the specific status of the previous mitochondrial lineage An. albitarsis H. High levels of diversity were highlighted in two samples from Pará (= An. albitarsis J), which needs further exploration through additional sampling, but which may indicate another cryptic species. The highest intra-specific nucleotide diversity was observed in An. deaneorum, and the lowest in An. marajoara. Significant correlation between genetic and geographical distance was observed only in An. oryzalimnetes and An. albitarsis F. Divergence time within the Albitarsis Group was estimated at 0.58-2.25 Mya, during the Pleistocene. The COI barcode region was considered an effective marker for species recognition within the Albitarsis Group and a network approach was an analytical method to discriminate among species of this group.

Molecular species delimitation reveals high diversity in the mosquito Anopheles tessellatus Theobald, 1901 (Diptera, Culicidae) across its range.

Anopheles tessellatus is a potentially important vector found across South, East and Southeast Asia. While it was formerly considered a formidable vector of human Plasmodium and filarial parasites in the Maldives, and of lesser importance as a vector of human Plasmodium in Sri Lanka and parts of Indonesia, it is currently of little or unknown health importance in many other parts of its range. This study describes the genetic diversity and evolutionary relationships among An. tessellatus populations in nine Asian countries at the COI gene using maximum-likelihood and Bayesian phylogenetic inference tree and cluster-based species delimitation approaches. These analyses reveal exceptional levels of genetic diversity in An. tessellatus populations across its known range, and identify up to six putative species in the newly determined Tessellatus Complex. The existence of such cryptic diversity has potentially important consequences for vector management and disease control. Differences in the ecologies and life histories among these species may have considerable impact on vectorial capacity and may go some way towards explaining why An. tessellatus s.l. has such varying degrees of public health importance across its range.

Identification key to the Anopheles mosquitoes of South America (Diptera: Culicidae). III. Male genitalia.

BACKGROUND: Accurate identification of the species of Anopheles Meigen, 1818 requires careful examination of all life stages. However, morphological characters, especially those of the females and fourth-instar larvae, show some degree of polymorphism and overlap among members of species complexes, and sometimes even within progenies. Characters of the male genitalia are structural and allow accurate identification of the majority of species, excluding only those in the Albitarsis Complex. In this key, based on the morphology of the male genitalia, traditionally used important characters are exploited together with additional characters that allow robust identification of male Anopheles mosquitoes in South America. METHODS: Morphological characters of the male genitalia of South American species of the genus Anopheles were examined and employed to construct a comprehensive, illustrated identification key. For those species for which specimens were not available, illustrations were based on published illustrations. Photographs of key characters of the genitalia were obtained using a digital Canon Eos T3i attached to a light Diaplan Leitz microscope. The program Helicon Focus was used to build single in-focus images by stacking multiple images of the same structure. RESULTS: An illustrated key to South American species of Anopheles based on the morphology of the male genitalia is presented, together with a glossary of morphological terms. The male genitalia of type-specimens of previously poorly documented species were also examined and included in the key, e.g. Anopheles (Anopheles) tibiamaculatus (Neiva, 1906) which has a unique quadrangular-shaped aedeagus with an apical opening. CONCLUSIONS: Male genitalia of South American species of Anopheles possess robust characters that can be exploited for accurate species identification. Distortion that can occur during the dissection and mounting process can obstruct accurate identification; this is most evident with inadvertent damage or destruction of unique features and interferes with correctly assigning shapes of the features of the ventral claspette. In some species, the shape, and anatomical details of the aedeagus also need to be examined for species identification. For members of the Myzorhynchella Series, both ventral and dorsal claspettes possess multiple characteristics that are herein used as reliable characters for species identification.

Wing size and parity as markers of cohort demography for potential Anopheles (Culicidae: Diptera) malaria vectors in the Republic of Korea.

Wing lengths of parous (P) and nulliparous (NP) PCR-identified female Anopheles belenrae, An. kleini, An. pullus, and An. sinensis were determined from weekly trap collections at Camp Humphreys (CH), Ganghwa Island (GH), and Warrior Base (WB), Republic of Korea (ROK) during Jun-Oct, 2009. Wing length was greatest at the beginning and end of the study period. Wing length of NPs tended to be less than that of Ps before the period of maximum greening (Jul-Aug) but greater thereafter. Larger specimens tended to be Ps, and weekly wing length of Ps appeared less variable than NPs, possibly due to selection. A bimodal wing length frequency distribution of An. sinensis suggested two forms comprising small- (≤4.5 mm, SW) and large-winged females (>4.5 mm, LW). LW comprised the majority of peaks in abundance, however %SW, while still a minority, often increased during these times suggesting a density-dependent effect. At WB and GH, a two to three-week periodicity in %SW was obvious for An. sinensis and An. kleini. Analyses of weather station and satellite data showed that smaller-winged An. sinensis were associated with warmer, more humid, and greener times of the year. SW and LW specimens possibly result from agricultural practices that are common across large areas; regular synchronous peaks of SW and LW were observed from different sites. Peaks in SW Ps followed peaks in NPs in a 'ripple effect' one to two weeks apart, suggesting that wing length combined with parity could be used to follow the emergence and survival of mosquito cohorts.

Identification keys to the Anopheles mosquitoes of South America (Diptera: Culicidae). IV. Adult females.

BACKGROUND: Morphological identification of adult females of described species of the genus Anopheles Meigen, 1818 in South America is problematic, but necessary due to their differing roles in the transmission of human malaria. The increase in the number of species complexes uncovered by molecular taxonomy challenges accurate identification using morphology. In addition, the majority of newly discovered species have not been formally described and in some cases the identities of the nominotypical species of species complexes have not been resolved. Here, we provide an up-to-date key to identify Neotropical Anopheles species using female external morphology and employing traditionally used and new characters. METHODS: Morphological characters of the females of South American species of the genus Anopheles were examined and employed to construct a species/group identification key. Photographs of key characters were obtained using a digital Canon Eos T3i, attached to a microscope. The program Helicon Focus was used to build single in-focus images by stacking multiple images of the same structure. RESULTS: A morphological identification key to the adult females of species of the genus Anopheles described in South America is presented. Definitions and illustrations of the key characters are provided to facilitate use of key. CONCLUSIONS: Identification of species of the genus Anopheles based on female morphology is challenging because some key characters can be variable and overlapping among species. In addition, the majority of key characters are linked to color and shape of scales, their distribution on the head, scutum, abdomen, maxillary palpi, labium and legs, and pattern of pale and dark scales on dorsal and ventral surfaces of the wing veins. Thus, it is understandable that a specimen needs to be in good condition to be accurately identified. Morphologically similar species, such as those of the Konderi, Oswaldoi, Nuneztovari, Benarrochi and Albitarsis Complexes, and the Triannulatus and Strodei Groups, among others, cannot be accurately identified using characters included in the key. Further investigation will be required to exploit morphological characteristics for identification of members of those complexes, with formal description of new species.

Identification keys to the Anopheles mosquitoes of South America (Diptera: Culicidae). II. Fourth-instar larvae.

BACKGROUND: Accurate species identification of South American anophelines using morphological characters of the fourth-instar larva is problematic, because of the lack of up-to-date identification keys. In addition, taxonomic studies, employing scanning electron microscopy of the eggs and DNA sequence data, have uncovered multiple complexes of morphologically similar species, and resulted in the resurrection of other species from synonymy, mainly in the subgenus Nyssorhynchus. Consequently, the identification keys urgently need to be updated to provide accurate morphological tools to identify fourth-instar larvae of all valid species and species complexes. METHODS: Morphological characters of the fourth-instar larvae of South American species of the genus Anopheles were examined and employed to elaborate a fully illustrated identification key. For species for which no specimens were available, illustrations were based on published literature records. RESULTS: A fully illustrated key to the fourth-instar larvae of South American species of the genus Anopheles (Diptera: Culicidae) is presented. Definitions of the morphological terms used in the key are provided and illustrated. CONCLUSIONS: Morphological identification of South American Anopheles species based on the fourth-instar larvae has been updated. Characters of the spiracular apparatus were determined useful for the identification of morphologically similar species, in the Strodei Group and some taxa in the Myzorhynchella Section. The single versus branched abdominal seta 6-IV used to differentiate Myzorhynchella species from other Nyssorhynchus species was shown to be variable in Myzorhynchella species. Also, the abdominal setae 1-IV,V of Anopheles atacamensis and Anopheles pictipennis were shown to be slightly serrate at the edges. Recognition of this character is important to avoid inaccurate identification of these species as members of the subgenus Anopheles.

Identification keys to the Anopheles mosquitoes of South America (Diptera: Culicidae). I. Introduction.

BACKGROUND: The worldwide genus Anopheles Meigen, 1918 is the only genus containing species evolved as vectors of human and simian malaria. Morbidity and mortality caused by Plasmodium Marchiafava & Celli, 1885 is tremendous, which has made these parasites and their vectors the objects of intense research aimed at mosquito identification, malaria control and elimination. DNA tools make the identification of Anopheles species both easier and more difficult. Easier in that putative species can nearly always be separated based on DNA data; more difficult in that attaching a scientific name to a species is often problematic because morphological characters are often difficult to interpret or even see; and DNA technology might not be available and affordable. Added to this are the many species that are either not yet recognized or are similar to, or identical with, named species. The first step in solving Anopheles identification problem is to attach a morphology-based formal or informal name to a specimen. These names are hypotheses to be tested with further morphological observations and/or DNA evidence. The overarching objective is to be able to communicate about a given species under study. In South America, morphological identification which is the first step in the above process is often difficult because of lack of taxonomic expertise and/or inadequate identification keys, written for local fauna, containing the most consequential species, or obviously, do not include species described subsequent to key publication. METHODS: Holotypes and paratypes and other specimens deposited in the Coleção Entomológica de Referência, Faculdade de Saúde Pública (FSP-USP), Museo de Entomología, Universidad del Valle (MUSENUV) and the US National Mosquito Collection, Smithsonian Institution (USNMC) were examined and employed to illustrate the identification keys for female, male and fourth-instar larvae of Anopheles. RESULTS: We presented, in four concurrent parts, introduction and three keys to aid the identification of South American Anopheles based on the morphology of the larvae, male genitalia and adult females, with the former two keys fully illustrated. CONCLUSIONS: Taxonomic information and identification keys for species of the genus Anopheles are updated. The need for further morphology-based studies and description of new species are reinforced.

Seasonal dynamics of Anopheles species at three locations in the Republic of Korea.

Weekly changes in adult Anopheles species were monitored at Camp Humphreys (CH), Ganghwa Island (GH), and Warrior Base (WB), from May-October, 2009-2010 to explore the relationship between Plasmodium vivax development and vector dynamics in the Republic of Korea (ROK). Adult females were trapped and dissected to determine parity for estimating longevity, mortality, and birthrate. A degree-day (DD) method was used to estimate the extrinsic incubation period (EIP) of P. vivax and duration of the gonotrophic cycle and other life stages. Anopheles sinensis was the predominant species, with satellite data showing peak abundance occurring after the period of maximum greenness. Abundance peaks were location dependent, comprised nulliparous and parous females, and timing could not be fully explained by DD estimation. Parity showed synchronicity between locations and years and was highest for September and lowest during maximum greenness. Mosquito longevity was predicted to exceed the EIP (when malaria transmission is possible) during weeks 29, 31, 34, and near the end of the season. Area-wide changes in parity suggest a common cause; information on local larval habitat and agricultural practices may explain location-specific effects. DD estimates of EIP and parity could be used to predict when conditions are suitable for P. vivax transmission.

The Opioid Epidemic in the United States.

There is an epidemic of opioid abuse. This article discusses the history of opioid use. Abusers of opioids are at great risk of harm. There have been increasing legislative efforts to curb this abuse and we present a review of the current state of these laws. Naloxone has made a profound impact in the care of these patients if they present for medical care early enough. This paper discusses naloxone pharmacodynamics, its use in the medical setting, and how its use is now being expanded to include nontraditional providers with take home naloxone programs.

Elevation of Pseudoskusea, Rusticoidus and Protomacleaya to valid subgenera in the mosquito genus Aedes based on taxon naming criteria recently applied to other members of the Tribe Aedini (Diptera: Culicidae).

BACKGROUND: Pseudoskusea, Rusticoidus and Protomacleaya were well-recognized, morphologically distinct subgenera within the genus Aedes prior to a series of taxonomic changes over the past 15 years by Reinert, Harbach and Kitching, when they were recognized as subgenera of the genus Ochlerotatus. In our recent effort to stabilize the Tribe Aedini, we synonymized these subgenera and associated species back into the genus Aedes, but incorrectly assigned them as putative informal groups, instead of reinstating them to subgenera. CONCLUSION: Here we formally elevate three traditionally recognized subgenera (Pseudoskusea, Rusticoidus and Protomacleaya) within the genus Aedes.

Malaria vectors in South America: current and future scenarios.

BACKGROUND: Malaria remains a significant public health issue in South America. Future climate change may influence the distribution of the disease, which is dependent on the distribution of those Anopheles mosquitoes competent to transmit Plasmodium falciparum. Herein, predictive niche models of the habitat suitability for P. falciparum, the current primary vector Anopheles darlingi and nine other known and/or potential vector species of the Neotropical Albitarsis Complex, were used to document the current situation and project future scenarios under climate changes in South America in 2070. METHODS: To build each ecological niche model, we employed topography, climate and biome, and the currently defined distribution of P. falciparum, An. darlingi and nine species comprising the Albitarsis Complex in South America. Current and future (i.e., 2070) distributions were forecast by projecting the fitted ecological niche model onto the current environmental situation and two scenarios of simulated climate change. Statistical analyses were performed between the parasite and each vector in both the present and future scenarios to address potential vector roles in the dynamics of malaria transmission. RESULTS: Current distributions of malaria vector species were associated with that of P. falciparum, confirming their role in transmission, especially An. darlingi, An. marajoara and An. deaneorum. Projected climate changes included higher temperatures, lower water availability and biome modifications. Regardless of future scenarios considered, the geographic distribution of P. falciparum was exacerbated in 2070 South America, with the distribution of the pathogen covering 35-46% of the continent. As the current primary vector An. darlingi showed low tolerance for drier environments, the projected climate change would significantly reduce suitable habitat, impacting both its distribution and abundance. Conversely, climate generalist members of the Albitarsis Complex showed significant spatial and temporal expansion potential in 2070, and we conclude these species will become more important in the dynamics of malaria transmission in South America. CONCLUSIONS: Our data suggest that climate and landscape effects will elevate the importance of members of the Albitarsis Complex in malaria transmission in South America in 2070, highlighting the need for further studies addressing the bionomics, ecology and behaviours of the species comprising the Albitarsis Complex.

Making Mosquito Taxonomy Useful: A Stable Classification of Tribe Aedini that Balances Utility with Current Knowledge of Evolutionary Relationships.

The tribe Aedini (Family Culicidae) contains approximately one-quarter of the known species of mosquitoes, including vectors of deadly or debilitating disease agents. This tribe contains the genus Aedes, which is one of the three most familiar genera of mosquitoes. During the past decade, Aedini has been the focus of a series of extensive morphology-based phylogenetic studies published by Reinert, Harbach, and Kitching (RH&K). Those authors created 74 new, elevated or resurrected genera from what had been the single genus Aedes, almost tripling the number of genera in the entire family Culicidae. The proposed classification is based on subjective assessments of the "number and nature of the characters that support the branches" subtending particular monophyletic groups in the results of cladistic analyses of a large set of morphological characters of representative species. To gauge the stability of RH&K's generic groupings we reanalyzed their data with unweighted parsimony jackknife and maximum-parsimony analyses, with and without ordering 14 of the characters as in RH&K. We found that their phylogeny was largely weakly supported and their taxonomic rankings failed priority and other useful taxon-naming criteria. Consequently, we propose simplified aedine generic designations that 1) restore a classification system that is useful for the operational community; 2) enhance the ability of taxonomists to accurately place new species into genera; 3) maintain the progress toward a natural classification based on monophyletic groups of species; and 4) correct the current classification system that is subject to instability as new species are described and existing species more thoroughly defined. We do not challenge the phylogenetic hypotheses generated by the above-mentioned series of morphological studies. However, we reduce the ranks of the genera and subgenera of RH&K to subgenera or informal species groups, respectively, to preserve stability as new data become available.