ChatGPT's Performance in Cardiac Arrest and Bradycardia Simulations Using the American Heart Association's Advanced Cardiovascular Life Support Guidelines: Exploratory Study

BACKGROUND

ChatGPT is the most advanced large language model to date, with prior iterations having passed medical licensing examinations, providing clinical decision support, and improved diagnostics. Although limited, past studies of ChatGPT's performance found that artificial intelligence could pass the American Heart Association's advanced cardiovascular life support (ACLS) examinations with modifications. ChatGPT's accuracy has not been studied in more complex clinical scenarios. As heart disease and cardiac arrest remain leading causes of morbidity and mortality in the United States, finding technologies that help increase adherence to ACLS algorithms, which improves survival outcomes, is critical.

OBJECTIVE

This study aims to examine the accuracy of ChatGPT in following ACLS guidelines for bradycardia and cardiac arrest.

METHODS

We evaluated the accuracy of ChatGPT's responses to 2 simulations based on the 2020 American Heart Association ACLS guidelines with 3 primary outcomes of interest: the mean individual step accuracy, the accuracy score per simulation attempt, and the accuracy score for each algorithm. For each simulation step, ChatGPT was scored for correctness (1 point) or incorrectness (0 points). Each simulation was conducted 20 times.

RESULTS

ChatGPT's median accuracy for each step was 85% (IQR 40%-100%) for cardiac arrest and 30% (IQR 13%-81%) for bradycardia. ChatGPT's median accuracy over 20 simulation attempts for cardiac arrest was 69% (IQR 67%-74%) and for bradycardia was 42% (IQR 33%-50%). We found that ChatGPT's outputs varied despite consistent input, the same actions were persistently missed, repetitive overemphasis hindered guidance, and erroneous medication information was presented.

CONCLUSIONS

This study highlights the need for consistent and reliable guidance to prevent potential medical errors and optimize the application of ChatGPT to enhance its reliability and effectiveness in clinical practice.

George Howard Darwin and the "public" interpretation of The Tides

Processes of adapting complex information for broad audiences became a pressing concern by the turn of the twentieth century. Channels of communication ranged from public lectures to printed books designed to serve a social class eager for self-improvement. Through analyzing a course of public lectures given by George Howard Darwin (1845-1912) for the Lowell Institute in Boston and the monograph he based on these, The Tides and Kindred Phenomena of the Solar System (1898), this article connects the important practices of public lecturing and book production-two aspects of knowledge dissemination that tend to be studied as separate entities. Darwin, Plumian Professor of Astronomy at the University of Cambridge and son of the famous naturalist, relied on a diverse material culture when lecturing and producing a book. Giving a new account of Darwin's scientific work through exploring his adaption of it for broader audiences, this article connects the diverse material culture Darwin employed in talks to the practice of producing a published book. The content of objects demonstrated and the lantern slides projected during Darwin's lectures evolved to form a book designed to engage broad sectors of society in Europe and the United States. Darwin's lectures were attended at full capacity, while The Tides was soon printed in numerous English editions and translated into German, Italian, Hungarian, and Spanish.

Cancer mortality in Germany-born Americans and Germans

INTRODUCTION

Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US.

METHODS

Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs).

RESULTS

Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population.

CONCLUSION

Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".

Clinical and Genetic Characterization of RDH12-Retinal Dystrophy in a South American Cohort

PURPOSE

To characterize the largest cohort of individuals with retinol dehydrogenase 12 (RDH12)-retinal dystrophy to date, and the first one from South America.

DESIGN

Retrospective multicenter international study.

SUBJECTS

Seventy-eight patients (66 families) with an inherited retinal dystrophy and biallelic variants in RDH12.

METHODS

Review of clinical notes, ophthalmic images, and molecular diagnosis.

MAIN OUTCOME MEASURES

Visual function, retinal imaging, and characteristics were evaluated and correlated.

RESULTS

Thirty-seven individuals self-identified as Latino (51%) and 34 as White (47%). Sixty-nine individuals (88%) had Leber congenital amaurosis (LCA)/early-onset severe retinal dystrophy. Macular and midperipheral atrophy were seen in all patients from 3 years of age. A novel retinal finding was a hyperautofluorescent ring in 2 young children with LCA. Thirty-nine patients (50%) had subsequent visits, with mean follow-up of 6.8 ± 7.3 (range, 0-29) years. Eight variants (21%) were previously unreported, and the most frequent variant was c.295C>A, p.Leu99Ile, present in 52 alleles of 32 probands. Individuals with LCA homozygous for p.Leu99Ile (31%) had a later age of onset, a slower rate of best-corrected visual acuity decrease, the largest percentage of patients with mild visual impairment, and were predicted to reach legal blindness at an older age than the rest of the cohort.

CONCLUSIONS

By describing the largest molecularly confirmed cohort to date, improved understanding of disease progression was possible. Our detailed characterization aims to support research and the development of novel therapies that may have the potential to reduce or prevent vision loss in individuals with RDH12-associated retinal dystrophy.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures.

American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients

BACKGROUND

About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries.

HYPOTHESIS

The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America.

METHODOLOGY

Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test.

RESULTS

This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%).

CONCLUSIONS

AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.

Causes of death among international travellers in Peru, 2017 to 2021

BACKGROUND

The wellbeing and safety of international tourists is a paramount concern for governments and stakeholders. Mortality among travellers and the causes of death serve as a significant metric of destination safety. We describe the epidemiology and causes of death among international travellers in Peru.

METHODS

Data retrieved from the Peruvian government's deaths certificates registry included all non-residents who died between January 2017 and December 2021. We analysed the national incidence and causes of death among international travellers in Peru. Causes of death were classified into non-communicable diseases (NCD), communicable diseases and injuries. We classified fatalities according to the existence of preventive measures that could be provided during the travel medicine consultation to decrease the risk.

RESULTS

We obtained records from 1514 deaths among international travellers (973 males, 64%). The incidence increased from 0.2 deaths per 10 000 travellers in 2017 to 9.9 in 2021. NCDs were the most common causes of death (n = 560, 37%), followed by communicable diseases (n = 487, 32%), and injuries (n = 321, 21%). Causes of death were unknown in 9.7% of the records. The leading causes of death in these categories were cancer, cardiovascular disease, COVID-19 and trauma. We found similar sex distribution of NCDs in travellers aged >50 years and higher rates of communicable diseases among males across all ages. Injury-associated deaths were significantly higher among males aged 18-29 years (P < 0.001) compared with other sex-age groups. We estimated that for 57.7% of deaths risk could have been decreased through pre-travel advice.

CONCLUSION

Rates of deaths among travellers to Peru increased over time. Most deaths were due to NCDs, followed by communicable diseases and injuries. Pre-travel medical optimization and effective advice focused on age-sex and destination specific risks could reduce risk among travellers. Increased awareness among travel medicine practitioners and improvement of emergency medical response systems in Peru could decrease mortality.

"Conscientious Guardian" vs. "Commercialized Jungle": Pharmacists and Pharmacy Design in the Postwar United States

Pharmacists and pharmacies are key drivers in the American marketplace. They serve as an endpoint of the pharmaceutical supply chain and are the dispensers of a range of consumer goods, some nonthreatening and others potentially harmful to public health. In adding pharmacies to the roster of consumerist locales in the postwar period, scholars might draw even deeper connections about the transformation of health, corporate medicine, and American economic power. To understand the interface of consumerism, corporatism, and health in postwar America, this article holds the postwar pharmacy as a key site of commodity exchange and business and positions it within the larger American firmament, paying attention to the design of pharmacies. In particular, the article will add to the knowledge about the tangible ways that medical and health care spaces are constructed, organized, and designed to best generate profits. Besides prescription medications, alcohol, tobacco, and sugar-rich products were also vital elements of the postwar pharmacy and will be featured in this article. What is more, this article focuses on a central debate between pharmacists during the postwar period about how pharmacies were shifting from the role of healer to that of a retailer - from a "conscientious guardian" to a "commercialized jungle" - in order to highlight how the public health role of pharmacies was undermined by industry pressures for profit. Based on unused corporate guides and manuals, company records, photographs, and management documents, this article will spotlight the underexplored interiority of pharmacies - the store's insides, processes of organization, and design features related to potentially habit-changing substances.

Echinorhinus brucus (Bonnaterre, 1788) in the Caribbean Sea: A recurrent visitor, or are the artisanal fisheries exploiting deeper waters?

Documentation of Echinorhinus brucus, (Bonnaterre, 1788) in the western Atlantic primarily relies on chance observations. Georeferenced records in this area remain notably scarce. This study contributes the second Venezuelan and seventh Caribbean Sea specimens, increasing the western Atlantic count to 15 individuals. All specimens gathered here were sexually mature, with a slight dominance of females. Our bramble shark record appears to be driven more by the interplay of its biology and environmental factors than being a deliberate deep-sea fishery activity, which likely occurs in the Southern Caribbean area.

The effect of El Niño and La Niña episodes on the existing niche and potential distribution of vector and host species of American Cutaneous Leishmaniasis

Leishmaniasis is a zoonotic disease transmitted to humans by a protozoan parasite through sandfly vectors and multiple vertebrate hosts. The Pan American Health Organization reported a declining trend in cases, with Brazil, Colombia, Peru, Nicaragua, and Bolivia having the most cases in 2020. There are still knowledge gaps in transmission and the parasite-host relationship. Ecological niche modeling has been used to study host-vector relationships, disease dynamics, and the impact of climate change. Understanding these aspects can aid in early surveillance and vector control strategies. The potential distribution of five host species associated with the transmission of cutaneous leishmaniasis (CL) was modeled. Occurrence data were collected for each host species, and environmental variables were used to build the models. Climatic data from El Niño, La Niña, and Neutral episodes were used to compare the predicted distributions. Additionally, the potential distributions of four vector species were compared to identify overlaps with host species. Niche analysis was conducted to evaluate changes in vector niches across episodes and to identify host-vector pairs based on niche overlap in geographic and environmental spaces. After spatial thinning, 467 records were obtained, and 1,190 candidate models were evaluated for each species. Results showed the distribution of occurrences in the environmental space, highlighting a high risk of extrapolation beyond the calibration areas. Movement-Oriented Parity analysis revealed distinct distribution patterns under different climate conditions, with areas of environmental similarity identified. Bradypus variegatus exhibited a broad potential distribution, while Dasypus novemcinctus and Didelphis marsupialis had more restricted ranges. Sylvilagus braziliensis covered most of the Neotropics. Our study provides valuable insights into ecological niches and geographic ranges of these species, contributing to the understanding of cutaneous leishmaniasis transmission dynamics.

Some Reflections on the 50th Anniversary of Hospice Care in America

This article celebrates the 50th anniversary of hospice care in America. It also offers a brief recounting of one person's reflections on some aspects of the history, achievements, and current status of American hospice care.

[Core competencies for public health teaching: regional framework for the AmericasCompetências essenciais para a docência em saúde pública: um marco regional para as Américas]

Objective

To present the Regional Core Competency Framework for Public Health (RCCFPH) and the methodology used for its development.

Methods

A participatory methodology was used for this descriptive study, using techniques such as questionnaires, discussions, pair work, extreme cases, jigsaw, data evaluation matrices, iterative reviews, and comparative analyses. The study was carried out over nine stages, bringing together experts from public health institutions and schools, as well as primary health care professionals in the Americas.

Results

The primary result is the RCCFPH, which is organized around 10 competency domains, all favoring comprehensive teaching. The primary focus is on the disciplinary domain, along with the educational domain. The remaining domains are common to the teaching of any discipline, but each competence was formulated for use within the field of public health, which is what differentiates this framework from others. It is proposed as a regional tool for use from multiple perspectives.

Conclusion

The domains and competencies encourage a new perspective on comprehensive teacher training in public health. The RCCFPH can be used as a tool to assess teaching skills and improve the quality of teaching in the Region. It can foster cooperation among educational institutions and is proposed as a facilitator for a Latin American community of practice to address new challenges in public health.

Clinical Spectrum and Outcomes of Cryptogenic Klebsiella pneumoniae Liver Abscess in the Americas: A Scoping Review

(1) Background: Cryptogenic Klebsiella pneumoniae liver abscesses are an invasive infection with or without extra hepatic involvement in the absence of hepatobiliary disease or abdominal malignancy. Most of the evidence has emanated from reports from Asia, and previous studies in the Americas have limited clinical characterization. (2) Methods: To understand this syndrome's characteristics on our continent, we conducted a scoping review to identify adult cases of idiopathic, community-acquired monomicrobial K. pneumoniae liver abscess in the Americas. (3) Results: We identified 144 cases spanning 1978-2022. Most cases were reported in males that had traveled or migrated from Southeast or East Asia with diabetes mellitus. Extrahepatic involvement and bacteremia were common, including seeding to the lungs, ocular structures, and central nervous system. Although limited by sample size, the most commonly reported genes were magA or rmpA. Concomitant percutaneous drainage and third generation cephalosporins (alone or in combination with other antibiotics) were frequently used, yet pooled fatality occurred in 9% of the reported cases. (4) Conclusions: The features of cryptogenic K. pneumoniae liver abscess in the Americas mirror those described in Asia, confirming its global dissemination. This condition is increasingly being reported in our continent and carries significant clinical impact due to its systemic invasiveness.

History of Race in America

Racial and ethnic disparities exist across a wide range of disease areas and clinical services. Becoming familiar with the history of race in America, and how it has been used to structure laws or policies that drive inequities in the social determinants of health, even today, is necessary to mitigate these disparities across medicine.

Language, Science and Globalization in the Eighteenth Century

Asia, America, and Europe have been intellectually intertwined for centuries. Several studies have been published revealing European scholars' interest in the "exotic" languages of Asia and America, as well as in ethnographic and anthropological aspects. Some scholars such as Polymath Leibniz (1646-1716), were interested in these languages in an attempt to construct a universal language, while others tried to establish language families, like the Jesuit Hervás y Panduro (1735-1809). However, all acknowledge the importance of language and the circulation of knowledge. This paper analyzes the dissemination of the compilation of eighteenth-century multilingual lexical compilations for comparative purposes as an early globalized project. These compilations were designed by European scholars and subsequently elaborated in different languages by missionaries, explorers, and scientists in the Philippines and America. Taking the correspondence and relations between botanist Mutis (1732-1808) and bureaucrats, European scientists such as polymath Humboldt (1769-1859) and Botanist Linnaeus (1707-1778) among others, and navy officers of the scientific exploration commanded by Malaspina (1754-1809) and Bustamante y Guerra (1759-1825) into consideration, I will analyze how simultaneous projects followed a unified aim, and illustrate their substantial contribution to the study of language in the late eighteenth century.

The Genus Paronychia (Caryophyllaceae) in South America: Nomenclatural Review and Taxonomic Notes with the Description of a New Species from North Peru

All the names in Paronychia described from South America are investigated. Five names (P. arbuscula, P. brasiliana subsp. brasiliana var. pubescens, P. coquimbensis, P. hieronymi, and P. mandoniana) are lecto- or neotypified on specimens preserved at GOET, K, LP, and P. The typification of nine names, first proposed by Chaudhri in 1968 as the "holotype" are corrected according to Art. 9.10 of ICN. Three second-step typifications (Art. 9.17 of ICN) are proposed for P. camphorosmoides, P. communis, and P. hartwegiana. The following nomenclatural changes are proposed: P. arequipensis comb. et stat. nov. (basionym: P. microphylla subsp. microphylla var. arequepensis), P. compacta nom. nov. pro P. andina (Philippi non Gray; Art. 53.1 of ICN), P. jujuyensis comb. et stat. nov. (basionym: P. hieronymi subsp. hieronymi var. jujuyensis), P. compacta subsp. boliviana comb. nov. (basionym: P. andina subsp. boliviana), and P. compacta subsp. purpurea comb. nov. (basionym: P. andina subsp. purpurea). A new species (P. glabra sp. nov.) is proposed based on our examination of live plants and herbarium specimens. P. johnstonii subsp. johnstonii var. scabrida is synonymized (syn. nov.) with P. johnstonii. Finally, P. argyrocoma subsp. argyrocoma is excluded from South America since it was based on misidentified specimens (deposited at MO) of P. andina subsp. andina. A total of 30 species (43 taxa including subspecies, varieties, subvarieties, and forms) are recognized, highlighting that for some (Paronychia chilensis, P. communis, P. setigera) we provisionally accept Chaudhri's infraspecific classification, since the high phenotypic variability of these taxa is quite complicated and further investigations need to solve their taxonomy.

Paul Clairmont and his connections to American surgery

PURPOSE

To examine the life and influences of Paul Clairmont (1875-1942).

METHOD

Review and analysis of published and archival information.

RESULTS

The Clairmont family was associated with famous individuals in English literary history. Paul Clairmont himself was born, educated, and trained as a surgeon under Anton von Eiselsberg in Vienna. As a junior faculty member in 1908, he was the first general surgeon to publish a report for German readers on the remarkable progress of American surgery. Later, as Professor of Surgery in Zürich, he was a mentor to Alton Ochsner, who became a leader in the further development of surgery in the USA.

CONCLUSION

Paul Clairmont's interesting life was an important link between the classical science and practice of surgery in Europe and its continuation in America.

A comparison of clinical characteristics of psychiatric inpatients in three hospitals from Western China and America

BACKGROUND

Different countries have differences in social and cultural context and health system, which may affect the clinical characteristics of psychiatric inpatients. This study was the first to compare cross-cultural differences in the clinical characteristics of psychiatric inpatients in three hospitals from Western China and America.

METHODS

Overall, 905 and 1318 patients from three hospitals, one in America and two in Western China, respectively, were included. We used a standardised protocol and data collection procedure to record inpatients' sociodemographic and clinical characteristics.

RESULTS

Significant differences were found between hospitals from the two countries. Positive symptoms were the main reason for admission in the Chinese hospitals, while reported suicide and self-injury symptoms more frequently led to hospital admission in America. Moreover, there were more inpatients with combined substance abuse in the American hospital (97.6% vs. 1.9%, P < 0.001). The length of stay (LOS) in America was generally shorter than in China (10.5 ± 11.9 vs. 20.7 ± 13.4, P < 0.001). The dosage of antipsychotic drugs used in the American hospital was higher than in China (275.1 ± 306.9 mg vs. 238.3 ± 212.5 mg, P = 0.002). Regression analysis showed that male sex, older age, retirees, being admitted because of physical symptoms, and using higher doses of antipsychotic drugs were significantly associated with longer hospitalisation in the American hospital (P < 0.05). Comparatively, patients who were divorced, experiencing suicidal ideation, admitted involuntarily, admitted because of physical, depression, or anxiety symptoms, and using higher doses of antipsychotic drugs had longer hospitalisation in Chinese hospitals (P < 0.05).

CONCLUSION

Significant variations in clinical characteristics of inpatients were found between hospitals from Western China and America. The LOS in Chinese hospitals was significantly longer, but patients used higher doses of antipsychotic drugs in the American hospital. Admission due to physical symptoms and the use of higher dosage drugs were related to longer LOS in both countries.

First study of Seoul virus (SEOV) in urban rodents from newly urbanized areas of Gran La Plata, Argentina

Alterations of ecosystems have deep effects on the distribution of parasites. Big cities of Argentina present structural features that favor the presence of synanthropic species, acting as source of zoonotic diseases, for example in urban rodents: the Norway rat (Rattus norvegicus) and the black rat (R. rattus). One of the important zoonotic pathogens related are the RNA virus Hantavirus, with high prevalence rates in South America. The aim of this study was to explore and identify the presence of Hantavirus in urban rodents from Gran La Plata, Argentina. The presence of anti-hantavirus IgG antibodies was determined by the Enzyme-Linked Immunosorbent Assay. Six samples turned out positive for Seoul virus (SEOV, p = 14.3%). These are the first records of SEOV in urban rodents in Gran La Plata. It represents the first report in R. rattus in Argentina, and in America. This situation underscores the inequality and historical forgetfulness of a portion of society, calling for urgent action to be taken in this regard.

Review of the parasitic nematodes of marine fishes from off the American continent

The ichthyofauna of the Atlantic and Pacific coasts off the American continent is very rich. Consequently, a high biodiversity of nematodes parasitizing these vertebrates is also expected. Currently, data on nematode parasites of marine fish off the Americas are fragmented. A review of all adult nematode species reported parasitizing marine fish from off the American continent is herein presented, as well as comments on their patterns of diversity, life cycles and advances in the taxonomic and phylogenetic knowledge. A total of 209 valid species, 19 species inquirendae and 6 dubious records have been recorded, the majority from the fish taxa Eupercaria and Perciformes. The families Sciaenidae, Serranidae and Lutjanidae, as well as the tropical and temperate Atlantic waters, exhibited the highest records of parasitic nematodes. The Cucullanidae, Philometridae and Cystidicolidae were the most speciose families of nematodes, which may be related to technological advances and relatively recent efforts of taxonomists, resulting in description of new taxa and the resolution of taxonomic problems. Numerous taxonomic questions still need resolution and, even though genetic data have been important for this process, the database is very scarce. This is the first review on all currently known nematode species parasitizing marine fish off the Americas and may serve as an important basis of reference for future approaches on these organisms.

Equine Influenza Virus: An Old Known Enemy in the Americas

Equine influenza is a highly contagious disease caused by the H3N8 equine influenza virus (EIV), which is endemically distributed throughout the world. It infects equids, and interspecies transmission to dogs has been reported. The H3N8 Florida lineage, which is divided into clades 1 and 2, is the most representative lineage in the Americas. The EIV infects the respiratory system, affecting the ciliated epithelial cells and preventing the elimination of foreign bodies and substances. Certain factors related to the disease, such as an outdated vaccination plan, age, training, and close contact with other animals, favor the presentation of equine influenza. This review focuses on the molecular, pathophysiological, and epidemiological characteristics of EIV in the Americas to present updated information to achieve prevention and control of the virus. We also discuss the need for monitoring the disease, the use of vaccines, and the appropriate application of those biologicals, among other biosecurity measures that are important for the control of the virus.

Healthcare for older adults in North America: challenges, successes and opportunities

Older adults in North America face similar challenges to successful ageing as other adults around the world, including an increased risk of geriatric syndromes and functional decline, limited access to healthcare professionals specialising in geriatrics and constraints on healthcare spending for Long-Term Services and Supports. Geriatrics as a specialty has long been established, along with the creation of a variety of screening tools for early identification of geriatric syndromes. Despite this, workforce shortages in all older adult care service areas have led to significant gaps in care, particularly in community settings. To address these gaps, innovative programs that expand the reach of geriatric specialists and services have been developed. Opportunities exist for further dissemination of these programs and services, as well as for expansion of an ageing capable workforce.

Dispersion routes of the main vectors of human malaria in the Americas: Genetic evidence from the mitochondrial COI gene

BACKGROUND AND OBJECTIVES

In America, of the 44 species of Anopheles, nine are main vectors of malaria and, of these, genetic information exists for seven. Hence, this study sought to know the gene flow and diversity of the seven principal vectors of malaria at the Americas level.

METHODS

For the seven species and the sequences of the mitochondrial cytochrome c oxidase I (COI) gene obtained from the GenBank and Bold System, genetic analyzes of populations and genetic structure were performed and haplotype networks and phylogenetic trees were obtained.

RESULTS

For the seven species, 1440 sequences were analyzed and 519 haplotypes were detected. The Hd and π values were higher within a continental context than by countries. Neutrality tests indicated positive and negative values with most of these being significant (p < 0.05). Phylogenetic analyses for all the species recovered three clades with no geographic pattern among them.

INTERPRETATION & CONCLUSION

Studies suggest that native species of Anopheles from the Americas have greater haplotype diversity and low genetic differentiation due to the lack of physical barriers to impede gene flow among these populations. Moreover, all the species are interconnected by roadways. This scenario complicates the epidemiological picture of malaria in the Americas.

Macroevolutionary trends and diversification dynamics in Atripliceae (Amaranthaceae s.l., Chenopodioideae): a first approach

BACKGROUND AND AIMS

Atripliceae evolved and diversified by dispersals and radiations across continents in both hemispheres, colonizing similar semi-arid, saline-alkaline environments throughout the world. Meanwhile, its species developed different life forms, photosynthetic pathways, mono- or dioecy, and different morphological features in flowers, fruiting bracteoles and seeds. In this study, we introduce a first approach to the macroevolutionary patterns and diversification dynamics of the Atripliceae to understand how time, traits, speciation, extinction and new habitats influenced the evolution of this lineage.

METHODS

We performed molecular phylogenetic analyses and clade age estimation of Atripliceae to apply time-, trait- and geographic-dependent diversification analyses and ancestral state reconstructions to explore diversification patterns within the tribe.

KEY RESULTS

Opposite diversification dynamics within the two major clades of Atripliceae, the Archiatriplex and Atriplex clades, could explain the unbalanced species richness between them; we found low mean speciation rates in the Archiatriplex clade and one shift to higher speciation rates placed in the branch of the Atriplex core. This acceleration in diversification seems to have started before the transition between C3 and C4 metabolism and before the arrival of Atriplex in the Americas, and matches the Mid-Miocene Climatic Optimum. Besides, the American species of Atriplex exhibit slightly higher net diversification rates than the Australian and Eurasian ones. While time seems not to be associated with diversification, traits such as life form, photosynthetic pathway and plant sex may have played roles as diversification drivers.

CONCLUSIONS

Traits more than time played a key role in Atripliceae diversification, and we could speculate that climate changes could have triggered speciation. The extreme arid or saline environments where Atripliceae species prevail may explain its particular evolutionary trends and trait correlations compared with other angiosperms and highlight the importance of conservation efforts needed to preserve them as genetic resources to deal with climatic changes.

Monograph of wild and cultivated chili peppers (Capsicum L., Solanaceae)

Capsicum L. (tribe Capsiceae, Solanaceae) is an American genus distributed ranging from the southern United States of America to central Argentina and Brazil. The genus includes chili peppers, bell peppers, ajíes, habaneros, jalapeños, ulupicas and pimientos, well known for their economic importance around the globe. Within the Solanaceae, the genus can be recognised by its shrubby habit, actinomorphic flowers, distinctive truncate calyx with or without appendages, anthers opening by longitudinal slits, nectaries at the base of the ovary and the variously coloured and usually pungent fruits. The highest diversity of this genus is located along the northern and central Andes. Although Capsicum has been extensively studied and great advances have been made in the understanding of its taxonomy and the relationships amongst species, there is no monographic treatment of the genus as a whole. Based on morphological and molecular evidence studied from field and herbarium specimens, we present here a comprehensive taxonomic treatment for the genus, including updated information about morphology, anatomy, karyology, phylogeny and distribution. We recognise 43 species and five varieties, including C.mirum Barboza, sp. nov. from São Paulo State, Brazil and a new combination C.muticum (Sendtn.) Barboza, comb. nov.; five of these taxa are cultivated worldwide (C.annuumL.var.annuum, C.baccatumL.var.pendulum (Willd.) Eshbaugh, C.baccatumL.var.umbilicatum (Vell.) Hunz. & Barboza, C.chinense Jacq. and C.frutescens L.). Nomenclatural revision of the 265 names attributed to chili peppers resulted in 89 new lectotypifications and five new neotypifications. Identification keys and detailed descriptions, maps and illustrations for all taxa are provided.

Piecing together the data of the U.S. marine aquaculture puzzle

Aquaculture recently became the main source of global seafood production and many countries, including the United States, see potential in marine aquaculture to sustainably fill growing demand. The U.S. supports the majority of its seafood consumption through imports, and therefore identifying bottlenecks to domestic aquaculture growth is a priority at the federal and state level. Yet, one critical aspect that appears not yet addressed is the quality and accessibility of marine aquaculture data. In this study we conducted the first multi-state synthesis and comparison of the most comprehensive suite of species, volume, and value information on U.S. marine aquaculture over time, across the 23 marine coastal states. Using publicly available data sources from the U.S. Department of Agriculture (USDA), state-level solicited data that we aggregated, and data from the National Oceanic and Atmospheric Administration (NOAA), we found strong evidence that marine aquaculture has played an increasingly important role in marine coastal states, but also uncovered numerous data gaps and discrepancies between and within these sources. In particular, we found a dearth of volumetric data and millions in missing value (USD$). We found U.S. marine aquaculture is likely much more diverse, abundant and valuable than is currently reported, but the main sources of error in any given state remain unclear. We recommend U.S. state governments adopt a standardized, digital and annual data collection program, such as the NOAA Fisheries Information Networks. Better strategic aquaculture planning, management, and research depend on accurate data, and existing digital data infrastructures provide strong opportunities for improvement.

The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.

Charles F. Ferguson, MD: America's first full time pediatric otolaryngologist

This historical review highlights the career of Charles F. Ferguson, MD for whom the annual clinical science awards bestowed by the American Society of Pediatric Otolaryngology are named. Dr. Ferguson was the first full time pediatric otolaryngologist in the United States. His career at Boston Children's Hospital spanned almost four decades. Disorders of the larynx, trachea and bronchi were his principal professional focus, with a specific expertise in bronchoesophagology. His pioneering work in pediatric airway endoscopy and the development of techniques to diagnose congenital airway malformations led to his receipt of the Chevalier Jackson Award from the American Bronchoesophagological Association, and the James Newcomb Award from the American Laryngological Society. He notably edited the first Pediatric Otolaryngology textbook in 1972. His life's work help set the foundation for the creation of the American Society of Pediatric Otolaryngology in 1984, six years following his retirement. The Charles Ferguson Clinical Science Awards were established to sustain his legacy.

[Long-term care in Costa Rica: Lessons for Latin America based on international evidenceCuidados de longa duração na Costa Rica: aprendizados para a América Latina partindo de evidências internacionais]

La creciente prevalencia de dependencia funcional derivada del envejecimiento acelerado y la transformación epidemiológica hace inevitable la implementación de nuevos sistemas de cuidados de larga duración (CLD) en las Américas. En marzo del 2021, Costa Rica se convirtió en el único país de ingresos medios en la Región que ha iniciado la aplicación de un sistema nacional de este tipo. En este artículo se compara el diseño del nuevo sistema de cuidados de larga duración de Costa Rica, con los sistemas de Australia, Dinamarca, España, Estados Unidos de América, Japón y Uruguay, y se identifican enseñanzas útiles para el desarrollo de otros sistemas de CLD en la Región. Se analizan cuatro aspectos: el marco legal, el acceso y la cobertura, los tipos de servicios, y los costos y la financiación. Para ello se realizó una revisión de la bibliografía científica y de informes nacionales e internacionales entre el 1 de enero del año 2000 y el primer día de abril del año 2021. El incipiente modelo sigue las principales tendencias de la experiencia internacional. Es progresivamente universal, prioriza la atención domiciliaria, incluye herramientas tecnológicas, crea parámetros de calidad para los servicios, incorpora transferencias monetarias para familiares que se desempeñan como cuidadores, inicia servicios de respiro y desarrolla formación para personas cuidadoras. No obstante, la evidencia internacional muestra que los modelos con menor financiamiento tienen baja cobertura y poca diversidad en servicios. La escasa generosidad fiscal, la ausencia de nuevas fuentes de recursos económicos y la debilidad jurídica arriesgan la ampliación, desarrollo y sostenibilidad del nuevo modelo en las Américas.

Dr. Ignacio Fernández de Córdova (1777-1816): illustrated physician and the first American fabulist

In this paper, we have tried to integrate a biography with the greatest data that we were able to obtain about the life of the Military Physician and Surgeon Ignacio Fernández de Córdova (1777-1816). For this purpose, we undertook the task of investigating the parish archives of the State of Guanajuato and Michoacán, as well as examining the bibliography on the subject. In the same way, it was possible to determine his degree of studies and the places where he did them. We know that he was briefly a member of Hidalgo's troops, and that in his native Valladolid/Morelia he was director of the San Juan de Dios Hospital. On the other hand, in short, an incomprehensible doubt has been elucidated: Fernández de Córdova was the first fabulist in Mexico, and the first formal one in the American Continent; for the glory of the New Hispanic guild of the times of the Enlightenment.

Alien, Naturalized and Invasive Plants in China

Invasive species are a subset of naturalized species, and naturalized species are a subset of alien species. Determining the relationship among these three assemblages would be helpful in predicting and preventing biological invasion. Here, we reviewed the families, lifeforms, origins, introduction pathways and phylogenetic diversity of alien, naturalized and invasive vascular plants in China. The results show that species in the Asteraceae, Fabaceae and Poaceae families had a high dominance among alien, naturalized and invasive species. Moreover, almost all alien species in the Amaranthaceae, Solanaceae, Convolvulaceae and Euphorbiaceae families became naturalized species, and about 26.7% of the naturalized species became invasive species. Perennial herbs comprised a higher proportion of alien species than did annual herbs, though annual herbs were more suited to becoming invasive than perennial herbs. A considerable proportion (57.8%) of invasive species were introduced from America. More than half (56.5%) of alien species were introduced for their ornamental value, and half of these have become naturalized in China. Moreover, about half (55.2%) of all invasive species were introduced for their economic value (including ornamental, foraging and medicinal purposes). Invasive species were phylogenetically clustered and phylogenetically distant from alien and naturalized species, which indicates that phylogenetic differences could be helpful in becoming invasive. There is no doubt that human activity plays a significant role in biological invasion. This study suggests that when introducing alien species to a region, decision-makers should certainly consider the species' phylogeny, beyond just its fundamental characteristics.

Childhood cancer mortality trends in the Americas and Australasia: An update to 2017

BACKGROUND

Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends.

METHODS

Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries.

RESULTS

Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia.

CONCLUSIONS

Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide.

LAY SUMMARY

Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.

Comparative survival analyses among captive chimpanzees (Pan troglodytes) in America and Japan

Detailed, long-term datasets on the life histories of long-lived species such as great apes are necessary to understand their survival patterns but are relatively rare. Such information requires prolonged and consistent record-keeping over many generations, so for chimpanzees (Pan troglodytes), this equates to many decades of input. As life history variables can be altered by differences in environmental influences (whether natural or artificial), there is substantial value to being able to compare across populations. Here, we present the first comparative analysis of life history data for two ex situ chimpanzee populations residing in North America (1975–2020; n = 730) and Japan (1980–2020; n = 660). Overall, survival patterns were similar between regions, and the median life expectancy from birth is estimated at 35.7 (95% CI = [32.4–40.0]) years for females and 30.1 (27.3–34.3) years for males across both populations. Females who survive to their first birthday are estimated to survive 42.4 (40.0–46.3) years and males 35.5 (32.6–38.0) years. We found that birth type (wild-born or captive-born) did not influence survival patterns in either population, but there were differential effects of sex on longevity. In the America population, males had higher mortality rates than females, whereas in the Japan population we found no differences between the sexes. First year mortality did not differ between populations for males (18–20%), but for females it was lower in America (15%) compared to Japan (25%). Survival patterns of chimpanzees in the present study will be useful for future investigation into potential causes of regional differences and cross-species comparisons.

Systematic review with meta-analysis of the epidemiological evidence in Europe, Israel, America and Australasia on smoking and COVID-19

BACKGROUND

Previous meta-analyses related smoking to death or severe infection from coronavirus disease 2019 (COVID-19) in hospitalized patients, but considered only a few studies, did not adjust for demographics and comorbidities, and inadequately defined smoking.

AIM

To review and meta-analyse epidemiological evidence on smoking and COVID-19, considering a range of endpoints, populations and smoking definitions and the effect of adjustment.

METHODS

Studies were identified from publications in English up to 30 September, 2020 involving at least 100 individuals, carried out in Europe, Israel, America or Australasia, not restricted to those with specific other diseases, and providing information relating smoking to various COVID-related endpoints. Meta-analyses were carried out for combinations of population and endpoint, with variation studied by smoking definition, adjustment level and other factors.

RESULTS

From 96 publications, 74 studies were identified, 37 in the United States, 10 in the United Kingdom, with up to four in the other countries. Three involved over a million individuals, and 37 involved less than a thousand. Adjusted results for smoking were available in 42 studies, with adjustment not considered in 20 studies. Results were considered by endpoint. No significant effect of smoking on COVID-19 positivity was seen in the general population, but there was a reduced risk in those tested. Best-adjusted estimates for current (vs never) smoking were 0.87 (95% confidence interval: 0.52-1.47) in the general population and 0.52 (0.43-0.64) in those tested. For those hospitalized due to COVID-19, unadjusted rates were significantly increased in current smokers (1.20, 1.01-1.42) and ever smokers (1.64, 1.41-1.91), but those adjusted for comorbidities showed no increase for current (0.82, 0.52-1.30) or ever smokers (1.00, 0.76-1.32). There was little evidence to suggest that smoking was associated with intensive care admission. For those hospitalized with COVID-19, best-adjusted estimates were 0.88 (0.72-1.08) for current smokers and 1.10 (0.99-1.22) for ever smokers. In those hospitalized with COVID-19, smoking was not significantly related to subsequent mechanical ventilation, with best-adjusted estimates of 1.12 (0.60-2.09) for current smokers and 1.05 (0.88-1.25) for ever smokers. For those hospitalized with severe COVID-19, best-adjusted estimates were 0.74 (0.49-1.12) for current smokers and 1.15 (0.87-1.51) for ever smokers; few estimates were adjusted for comorbidities. While smoking was associated with increased mortality in unadjusted analyses, the association disappeared after adjustment for comorbidities. For example, in those hospitalized with COVID-19, the unadjusted estimate for ever smokers of 1.59 (1.37-1.83) reduced to 1.07 (0.82-1.38) when adjusted for comorbidities. Studies on those with severe COVID-19 showed that smoking tended to be associated with worsening of the disease. However, no estimate was adjusted, even for demographics. Estimates did not clearly vary by location or study size, and there was too little evidence to usefully study variations by age, amount smoked or years quit.

CONCLUSION

The increased COVID-19 death rate in smokers seen in unadjusted analyses disappears following adjustment for demographics and comorbidities. Among those tested, smoking is associated with lower COVID-19 infection rates.

Potential distribution of Amblyomma mixtum (Koch, 1844) in climate change scenarios in the Americas

Amblyomma mixtum is a Neotropical generalist tick of medical and veterinary importance which is widely distributed from United States of America to Ecuador. The aim of this study was to evaluate changes in the geographic projections of the ecological niche models of A. mixtum in climate change scenarios in America. We constructed a database of published scientific publications, personal collections, personal communications, and online databases. Ecological niche modelling was performed with 15 Bioclimatic variables using kuenm in R and was projected to three time periods (Last Glacial Maximum, Current and 2050) for America. Our model indicated a wide distribution for A. mixtum, with higher probability of occurrence along the Gulf of Mexico and occurring in a lesser proportion in the Pacific states, Central America, and the northern part of South America. The areas of new invasion are located mainly on the border of Mexico with Guatemala and Belize, some regions of Central America and Colombia. We conclude that the ecological niche modelling are effective tools to infer the potential distribution of A. mixtum in America, in addition to helping to propose future measures of epidemiological control and surveillance in the new potential areas of invasion.

Contribution of Research in the West Indies and Northeast Amazonia to Knowledge of the 2014-2015 Chikungunya Epidemic in the Americas

Purpose of Review

Although the chikungunya virus was discovered more than 60 years ago, it has only really been studied since the outbreak in La Reunion in 2005-2006. Ten years later, between 2014 and 2015, the chikungunya virus spread throughout the Americas, affecting millions of people. The objective of this review is to describe the contributions of research on chikungunya virus infection gained from epidemic in the West Indies and the Guiana Shield.

Recent Findings

Prevalence data were similar to those found in the Indian Ocean or Asia during epidemics. Clinically, there is now a better understanding of the typical, atypical, and severe forms. Several studies have insisted on the presence of neurological forms of chikungunya infection, such as encephalitis or Guillain-Barré syndrome. Cases of septic shock due to chikungunya virus as well as thrombotic thrombocytopenic purpura were described for the first time. Given the magnitude of the epidemic and the large number of people affected, this has led to a better description and new classifications of chikungunya virus infections in specific populations such as pregnant women, the elderly, and children. Several studies also described the behavior of populations faced with an emerging disease.

Summary

Current epidemiological data from tropical regions highlights the risk of spreading emerging diseases at higher latitudes, especially concerning arboviruses, since the vector Aedes albopictus is already established in many parts of northern countries. A better understanding of the disease and its epidemic dynamics will foster better management, the crucial importance of which was demonstrated during the COVID-19 epidemic.

Different Strokes: American Muslim Scholars Engage Media and Politics in the Woke Era

American Muslim intercommunal disunity (fitnah) is exemplified by an emic event when an editorial foray contests the inherited legacies of black Muslim icons like Malcolm X and Muhammad Ali, which exigently compels "diplomats" of different minds into engaging the digital public square with calculated strokes. The woke era's partisan identity politics asymmetrically curtail acceptable expressions of religious authority on issues of race, religion, and politics. Hence, scholars spend their social capital as political actors in these ultracrepidarian environments to different ends. This multi-year study conducted across global sites analyzes scholars with dissimilar approaches to media and political engagement amidst an environment characterized by weaponized media, polarization, and shifting goal posts. Participant observation and textual analysis impart scenes of scholars with fraught associations to administrations, funding sources, and feuding authoritarian Arab regimes getting embroiled in geopolitical hostilities. With mainstream American Muslim narratives aligned with mainstream media's liberal filter bubbles, scholars impact consensus building with varying levels of success; those negotiating compromise within spheres of legitimate contestation and consensus ad interim maintain subsisting influence. However, those that do not are expurgated and thereby cede influence.

Inferring the Potential Distribution of an Emerging Rickettsiosis in America: The Case of Rickettsia parkeri

Tick-borne rickettsioses represent a severe public health problem that has increased in recent decades by several activities that place human populations in contact with a wide range of vectors. In particular, Rickettsia parkeri, an eschar-associated spotted fever agent, represents an emerging pathogen that has been gradually identified throughout America. In the present work, we compiled an occurrence database of these bacteria, as well as its vectors, in order to identify the potential distribution of these bacteria and to detect the risk areas where this emerging pathogen may be circulating. The results show the at-risk areas to be broad regions in Central America, on the coast of Venezuela, Colombia, Ecuador, Peru, and Chile, part of Brazil and Argentina, and the greater part of Bolivia, Paraguay, and Uruguay. Particularly, in Mexico, conditions exist for widespread dissemination. Our results must be considered for the establishment of active acarological surveillance in previously unsampled areas, as well as the establishment of prevention measures for vulnerable populations and risk groups participating in outdoor activities that can place them in contact with this pathogen.

Triazole-Resistance in Environmental Aspergillus fumigatus in Latin American and African Countries

Triazole-resistance has been reported increasingly in Aspergillus fumigatus. An international expert team proposed to avoid triazole monotherapy for the initial treatment of invasive aspergillosis in regions with >10% environmental-resistance, but this prevalence is largely unknown for most American and African countries. Here, we screened 584 environmental samples (soil) from urban and rural locations in Mexico, Paraguay, and Peru in Latin America and Benin and Nigeria in Africa for triazole-resistant A. fumigatus. Samples were screened using triazole-containing agars and confirmed as triazole-resistant by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth dilution reference method. Isolates were further characterized by cyp51A sequencing and short-tandem repeat typing. Fungicide presence in samples was likewise determined. Among A. fumigatus positive samples, triazole-resistance was detected in 6.9% (7/102) of samples in Mexico, 8.3% (3/36) in Paraguay, 9.8% (6/61) in Peru, 2.2% (1/46) in Nigeria, and none in Benin. Cyp51A gene mutations were present in most of the triazole-resistant isolates (88%; 15/17). The environmentally-associated mutations TR₃₄/L98H and TR₄₆/Y121F/T289A were prevalent in Mexico and Peru, and isolates harboring these mutations were closely related. For the first time, triazole-resistant A. fumigatus was found in environmental samples in Mexico, Paraguay, Peru, and Nigeria with a prevalence of 7-10% in the Latin American countries. Our findings emphasize the need to establish triazole-resistance surveillance programs in these countries.

HLA-G in Mayas from Yucatan: An evolutionary approach

HLA-G allele frequencies were studied in Yucatán (Mexico) Maya Amerindians by a direct exon DNA sequencing technique. It is described that Mayas are probably one of the first populations together with Olmecs that populated Meso America and that important HLA genetic differences between Mexican and Guatemalan Mayas support that Maya languages were imposed to several neighbouring Amerindian groups. HLA-G*01:01:02, HLA-G*01:01:01 and HLA-G*01:04:01 are the most frequent alleles in this population. It is remarkable that HLA-G*01:05N allele was not found in the population in accordance with similar results found in another Amerindians. Also, protein allele HLA-G*01:04 frequency is found not to differ to those found in another far or close living Amerindians in contrast to other World populations. It seems that while high HLA-G*01:05N frequency is found in Iran and Middle East populations, probably where this allele appeared within an ancestral HLA-A*19 group of alleles haplotype and it is maintained by unknown evolutionary forces, Amerindians do not have a high frequency because a founder effect or because required natural evolutionary forces do not exist in America. Finally, we believe useful to study HLA-G evolution for its physiopathology understanding in addition to the many papers on statistics on HLA-G and in vitro models that are yearly published.

Key Factors That Enable the Pandemic Potential of RNA Viruses and Inter-Species Transmission: A Systematic Review

Viruses play a primary role as etiological agents of pandemics worldwide. Although there has been progress in identifying the molecular features of both viruses and hosts, the extent of the impact these and other factors have that contribute to interspecies transmission and their relationship with the emergence of diseases are poorly understood. The objective of this review was to analyze the factors related to the characteristics inherent to RNA viruses accountable for pandemics in the last 20 years which facilitate infection, promote interspecies jump, and assist in the generation of zoonotic infections with pandemic potential. The search resulted in 48 research articles that met the inclusion criteria. Changes adopted by RNA viruses are influenced by environmental and host-related factors, which define their ability to adapt. Population density, host distribution, migration patterns, and the loss of natural habitats, among others, have been associated as factors in the virus-host interaction. This review also included a critical analysis of the Latin American context, considering its diverse and unique social, cultural, and biodiversity characteristics. The scarcity of scientific information is striking, thus, a call to local institutions and governments to invest more resources and efforts to the study of these factors in the region is key.

Detection of Dermacentor andersoni (Acari: Ixodidae) in Brazil on a Human Traveler Returning from the United States

Only one previous record of an exotic tick on a Brazilian traveler has been reported. Here, we report the detection of Dermacentor andersoni (Stiles) in Brazil while attached to a human traveler returning from the United States. This report is the fifth record of D. andersoni as an exotic tick, and the second record of an exotic tick on a South American traveler.

Endemic and Other Dimorphic Mycoses in The Americas

Endemic fungi are thermally dimorphic fungi that have a limited geographic range and can cause both primary disease and opportunistic infections. The Americas are home to more genera of endemic fungi than anywhere else on earth. These include Coccidioides, Histoplasma, Blastomyces, Paracoccidioides, and Sporothrix. Endemic fungi are found across the Americas and the Caribbean, from Blastomyces gilchristi, which extends into the northeast corners of North America, to Histoplasma capsulatum, which occurs all the way down in the southern regions of South America and into the Caribbean Islands. Symptoms of endemic fungal infection, when present, mimic those of many other diseases and are often diagnosed only after initial treatment for a bacterial or viral disease has failed. Endemic fungi place a significant medical burden on the populations they affect, especially in immunocompromised individuals and in resource-limited settings. This review summarizes the ecology, geographical range, epidemiology, and disease forms of the endemic fungi found in the Americas. An emphasis is placed on new and proposed taxonomic changes, including the assignment of new species names in Histoplasma, Blastomyces, and Paracoccidioides.

The US Public's Perception of the Threat of COVID-19 During the Rapid Spread of the COVID-19 Outbreak: Cross-Sectional Survey Study

BACKGROUND

The rapid spread of the COVID-19 pandemic in the United States has made people uncertain about their perceptions of the threat of COVID-19 and COVID-19 response measures. To mount an effective response to this epidemic, it is necessary to understand the public's perceptions, behaviors, and attitudes.

OBJECTIVE

We aimed to test the hypothesis that people's perceptions of the threat of COVID-19 influence their attitudes and behaviors.

METHODS

This study used an open dataset of web-based questionnaires about COVID-19. The questionnaires were provided by Nexoid United Kingdom. We selected the results of a questionnaire on COVID-19-related behaviors, attitudes, and perceptions among the US public. The questionnaire was conducted from March 29 to April 20, 2020. A total of 24,547 people who lived in the United States took part in the survey.

RESULTS

In this study, the average self-assessed probability of contracting COVID-19 was 33.2%, and 49.9% (12,244/24,547) of the respondents thought that their chances of contracting COVID-19 were less than 30%. The self-assessed probability of contracting COVID-19 among women was 1.35 times that of males. A 5% increase in perceived infection risk was significantly associated with being 1.02 times (OR 1.02, 95% CI 1.02-1.02; P<.001) more likely to report having close contact with >10 people, and being 1.01 times (OR 1.01, 95% CI 1.01-1.01; P<.001) more likely to report that cohabitants disagreed with taking steps to reduce the risk of contracting COVID-19. However, there was no significant association between participants who lived with more than 5 cohabitants or less than 5 cohabitants (P=.85). Generally, participants who lived in states with 1001-10,000 COVID-19 cases, were aged 20-40 years, were obese, smoked, drank alcohol, never used drugs, and had no underlying medical conditions were more likely to be in close contact with >10 people. Most participants (21,017/24,547, 85.6%) agreed with washing their hands and maintaining social distancing, but only 20.2% (4958/24,547) of participants often wore masks. Additionally, male participants and participants aged <20 years typically disagreed with washing their hands, maintaining social distancing, and wearing masks.

CONCLUSIONS

This survey is the first attempt to describe the determinants of the US public's perception of the threat of COVID-19 on a large scale. The self-assessed probability of contracting COVID-19 differed significantly based on the respondents' genders, states of residence, ages, body mass indices, smoking habits, alcohol consumption habits, drug use habits, underlying medical conditions, environments, and behaviors. These findings can be used as references by public health policy makers and health care workers who want to identify populations that need to be educated on COVID-19 prevention and health.

Bluetongue virus in South America: current status based on phylogenetic analysis

Bluetongue (BT) is an insect-borne disease affecting domestic and wild ruminants. Bluetongue virus (BTV) is the causative agent of the BT disease. BT outbreaks have been widely recorded worldwide. However, in the South American subcontinent, accurate information about the disease and molecular epidemiology is still lacking because little effort has been made to cover the region. This study comprises an exhaustive phylogenetic analysis including all BTV sequences available in databases and reports new Argentinean sequences for Seg 8 and Seg 9. Maximum-likelihood phylogenetic analyses were conducted for Seg 2, Seg 3, Seg 6, Seg 7, Seg 8, Seg 9 and Seg 10. Throughout the study, wide circulation and genetic continuity along the American continent were detected. Also, reassortment events are reported, and the historical virus introduction path into and through South America is suggested.

Why are Asian countries outperforming the Western world in controlling COVID-19 pandemic?

COVID-19 already caused more than 1,260,000 deaths around the world. However, mortality rates are not equal amongst the different countries. Mortality rates are ranging from less than 1 death per million in Taiwan, Vietnam and Thailand to 1,112 deaths per million in Belgium. In the present article, we report a striking difference in mean per million mortality between Asian and European countries (2.7 vs 197 deaths per million population, p < 0.001). In addition, we confirmed that the later a specific country was hit by the epidemic, the milder the impact on mortality during the first 50 days was. We analyzed several factors that may have contributed to this discrepancy including population age, previous experience of epidemics in the modern era, social acceptance of physical distancing and face masks, percentage of active smokers and lastly genetic prothrombotic mutations.

Systematics and geographical distribution of Galba species, a group of cryptic and worldwide freshwater snails

Cryptic species can present a significant challenge to the application of systematic and biogeographic principles, especially if they are invasive or transmit parasites or pathogens. Detecting cryptic species requires a pluralistic approach in which molecular markers facilitate the detection of coherent taxonomic units that can then be analyzed using various traits (e.g., internal morphology) and crosses. In asexual or self-fertilizing species, the latter criteria are of limited use. We studied a group of cryptic freshwater snails (genus Galba) from the family Lymnaeidae that have invaded almost all continents, reproducing mainly by self-fertilization and transmitting liver flukes to humans and livestock. We aim to clarify the systematics, distribution, and phylogeny of these species with an integrative approach that includes morphology, molecular markers, wide-scale sampling across America, and data retrieved from GenBank (to include Old World samples). Our phylogenetic analysis suggests that the genus Galba originated ca. 22 Myr ago and today comprises six species or species complexes. Four of them show an elongated-shell cryptic phenotype and exhibit wide variation in their genetic diversity, geographic distribution, and invasiveness. The remaining two species have more geographically restricted distributions and exhibit a globose-shell cryptic phenotype, most likely phylogenetically derived from the elongated one. We emphasize that no Galba species should be identified without molecular markers. We also discuss several hypotheses that can explain the origin of cryptic species in Galba, such as convergence and morphological stasis.

Disproportionate extinction of South American mammals drove the asymmetry of the Great American Biotic Interchange

The biological interchange between North and South America associated with the formation of the Isthmus of Panama is key to defining current gradients of species diversity. A major gap in our understanding of the interchange is its asymmetry, where mammals of North American origin attained higher diversity in South America than vice versa. The prevailing view is that this asymmetry resulted from higher origination of immigrant mammals in South America. In contrast, we find that asymmetry results from high extinction of native mammals in South America, which reduced the diversity of native mammals available to disperse northwards. These results shed light on the legacy of the biotic interchange to understand the current patterns of species diversity across the Americas.

The interchange between the previously disconnected faunas of North and South America was a massive experiment in biological invasion. A major gap in our understanding of this invasion is why there was a drastic increase in the proportion of mammals of North American origin found in South America. Four nonmutually exclusive mechanisms may explain this asymmetry: 1) Higher dispersal rate of North American mammals toward the south, 2) higher origination of North American immigrants in South America, 3) higher extinction of mammals with South American origin, and 4) similar dispersal rate but a larger pool of native taxa in North versus South America. We test among these mechanisms by analyzing ∼20,000 fossil occurrences with Bayesian methods to infer dispersal and diversification rates and taxonomic selectivity of immigrants. We find no differences in the dispersal and origination rates of immigrants. In contrast, native South American mammals show higher extinction. We also find that two clades with North American origin (Carnivora and Artiodactyla) had significantly more immigrants in South America than other clades. Altogether, the asymmetry of the interchange was not due to higher origination of immigrants in South America as previously suggested, but resulted from higher extinction of native taxa in southern South America. These results from one of the greatest biological invasions highlight how biogeographic processes and biotic interactions can shape continental diversity.

The global epidemiology of Brucella infections in terrestrial wildlife: A meta-analysis

Brucellosis is a widespread zoonotic disease with serious consequences on human and animal health. Brucella infections were reported in many terrestrial wild animals, from subtropical and temperate regions to arctic regions. In many areas, the epidemiology of brucellosis in wildlife is closely associated with the occurrence of the disease in livestock. Some wild species may contribute to the re-introduction of Brucella infections in livestock (spillback), even in officially brucellosis-free (OBF) regions. Through meta-regression analysis, this study draws a global picture of the prevalence of Brucella spp. in terrestrial wild animals, trying to determine most affected subgroups as well as preferential sampling and screening methods. For this purpose, a literature search was carried out among publications published from 1983 to 2019. Different subgroups were compared according to animal species, feeding, gender, age as well as the method used for sampling and for brucellosis diagnostic. To determine heterogeneity of studies, chi-squared test was used and a random-effects model (REM) estimated the pooled prevalence among subgroups. A total of 68 publications, comprising 229 data reports/studies, were selected. The most-reported Brucella species in wildlife was Brucella abortus, and the highest prevalence rate was found in American bison, Bison bison (39.9%) followed by Alpine ibex, Capra ibex (33%). Serology was the most widely applied diagnostic approach (66%), while PCR appeared to be highly sensitive (36.62% of positive results). The gender of animals showed no significant association with the prevalence of brucellosis (p > .05). Blood samples and visceral organs constituted the great majority of specimen used for the detection of Brucella spp., while lymph nodes showed a high prevalence of positive samples (94.6%). The present study provides insight into the global epidemiology and enzootic potential of brucellosis in wild terrestrial animals worldwide, aiming at helping the appropriate authorities to strengthen prevention, surveillance and control strategies.

Measles outbreak: preliminary report on a case series of the first 8,070 suspected cases, Manaus, Amazonas state, Brazil, February to November 2018

We report an ongoing measles outbreak in Manaus, Amazonas state, Brazil. As at 3 November 2018, 1,631 cases were confirmed corresponding to an incidence of 75.3 per 100,000 inhabitants; all five sanitary districts presented confirmed cases. Reintroduction of measles virus in Manaus is likely related to the current outbreak in Venezuela and due to recent decline in measles vaccine coverage. Given the current scenario, prevention and control measures should target individuals aged 15–29 years.

Phytosociological Study, Diversity and Conservation Status of the Cloud Forest in the Dominican Republic

The study of the forest in rainy environments of the Dominican Republic reveals the presence of four types of vegetation formations, clearly differentiated from each other in terms of their floristic and biogeographical composition, and also significantly different from the rainforests of Cuba. This leads us to propose two new alliances and four plant associations located in northern mountain areas exposed to moisture-laden winds from the Atlantic: All. Rondeletio ochraceae-Clusion roseae (Ass. Cyatheo furfuracei-Prestoetum motanae; Ass. Ormosio krugii-Prestoetum montanae); and All. Rondeletio ochraceae-Didymopanion tremuli (Ass. Hyeronimo montanae-Magnolietum pallescentis; Hyeronimo dominguensis-Magnolietum hamorii). We pay special attention to the description of cloud forest types, since they have a high rate of endemic species, and therefore there are endemic habitats, which need special protective actions. Therefore, we apply the Shannon diversity index to characteristic, companion, non-endemic, and endemic species. As result, the association Ormosio krugii-Prestoetum montanae has a Shannon_T = 2.4 and a value of Shannon_E = 0, whereas the other 3 associations have a better conservation status with Shannon values in all cases > 0: This is due to a worse conservation status of the Eastern Cordillera, in comparison with the Central Cordillera and Sierra de Bhaoruco. Due to human activity, some areas are very poorly conserved, as evidenced by the diversity index and the presence of endemic tree and plant elements. The worst conserved in terms of the relationship between characteristic plants vegetation (cloud forest) in areas with high rainfall are in the Dominican Republic, along with its floristic diversity and state of conservation. This study has made it possible to significantly increase the botanical knowledge of this important habitat.