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Summary: Background: Multidrug-resistant (MDR) Salmonella Infantis has disseminated worldwide, mainly linked to the consumption of poultry products. Evidence shows dissemination of this pathogen in Chile; however, studies are primarily limited to phenotypic data or involve few isolates. As human cases of Salmonella Infantis infections have substantially increased in recent years, this study aimed to characterise the genomic epidemiology and antimicrobial-resistance profiles of isolates obtained from different sources, aiming to inform effective surveillance and control measures. Methods: We sequenced 396 Salmonella Infantis genomes and analysed them with all publicly available genomes of this pathogen from Chile (440 genomes in total), representing isolates from environmental, food, animal, and human sources obtained from 2009 to 2022. Based on bioinformatic and phenotypic methods, we assessed the population structure, dissemination among different niches, and antimicrobial resistance (AMR) profiles of Salmonella Infantis in the country. Findings: The genomic and phylogenetic analyses showed that Salmonella Infantis from Chile comprised several clusters of highly related isolates dominated by sequence type 32. The HC20_343 cluster grouped an important proportion of all isolates. This was the only cluster associated with pESI-like megaplasmids, and up to 12 acquired AMR genes/mutations predicted to result in an MDR phenotype. Accordingly, antimicrobial-susceptibility testing revealed a strong concordance between the AMR genetic determinants and their matching phenotypic expression, indicating that a significant proportion of HC20_343 isolates produce extended-spectrum β-lactamases and have intermediate fluoroquinolone resistance. HC20_343 Salmonella Infantis were spread among environmental, animal, food, and human niches, showing a close relationship between isolates from different years and sources, and a low intra-source genomic diversity. Interpretation: Our findings show a widespread dissemination of MDR Salmonella Infantis from the HC20_343 cluster in Chile. The high proportion of isolates with resistance to first-line antibiotics and the evidence of active transmission between the environment, animals, food, and humans highlight the urgency of improved surveillance and control measures in the country. As HC20_343 isolates predominate in the Americas, our results suggest a high prevalence of ESBL-producing Salmonella Infantis with intermediate fluoroquinolone resistance in the continent. Funding: Partially supported by the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services as part of an award, FDU001818, with 30% percent funded by FDA/HHS; and by Agencia de Investigación y Desarrollo de Chile (ANID) through FONDECYT de Postdoctorado Folio 3230796 and Folio 3210317, FONDECYT Regular Folio 1231082, and ANID—Millennium Science Initiative Program—ICN2021_044.

Summary: In the Americas, one decade following its emergence in 2013, chikungunya virus (CHIKV) continues to spread and cause epidemics across the region. To date, 3.7 million suspected and laboratory-confirmed chikungunya cases have been reported in 50 countries or territories in the Americas. Here, we outline the current status and epidemiological aspects of chikungunya in the Americas and discuss prospects for future research and public health strategies to combat CHIKV in the region.

Summary: Background: The Americas region has the lowest (North America) and the second highest (Latin America and Caribbean) cervical cancer (CC) mortality worldwide. The lack of reliable data on screening coverage in the region hinders proper monitoring of the World Health Organization (WHO) CC elimination initiative. Methods: For this synthetic analysis, we searched data on CC screening coverage from official sources and national health surveys, supplemented with a formal WHO country consultation. Context data were obtained from official sources (income, health expenditure, inequality-adjusted human development index -IHDI-, universal health coverage, CC incidence/mortality). Country age-specific coverages for 2019 by screening interval were computed. Missing data were imputed through a multi-step algorithm. Beta-regression and Poisson-regression models were used to analyse associations between context variables, screening coverage, and CC mortality. Findings: We included data from 37 countries in the Americas. Data on coverage of HPV testing was scarce, and for many countries only Pap-smear coverage data was available. Overall, 78%, 34%, 60%, and 67% of women aged 25–65 years have been screened ever in their lifetime, and in the previous year, 3 years, and 5 years, respectively. By sub-region, 3-year coverage ranges from 48% (South America) to 72% (North America). Twenty-four countries showed screening coverage below 70%. Income and health system type were associated with screening coverage, but coverage was not associated with CC mortality. Interpretation: In the Americas region 35.1% and 56.8% of countries report 3-year and 5-year coverage over 70%, respectively. Inequalities remain a major challenge for screening programs in the region. The elimination campaign should reinforce the transition to HPV testing and strengthen surveillance systems. Funding: Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020.

Background: Despite the increasing burden of cardiovascular diseases (CVDs), there is a shortage of vascular surgeons worldwide, with a higher scarcity in low- and middle-income countries. The objective of the present study was to report the current status of vascular surgery education and training on the American continent., Methods: Official government, postgraduate medical schools, and medical associations' websites were searched for data regarding vascular surgery training positions, programs, and pathways available in the 35 countries of the American continent., Results: There are 707 annual positions for training in vascular surgery offered by 367 training programs. Of the 35 countries in America, only 17 (48.5%) offer vascular surgery training as an independent specialty. In 1 (2.8%) country, Peru, vascular surgery is mixed with cardiothoracic surgery. There is no vascular surgery training in the remaining 17 (48.5%) countries. Brazil has the highest number of training positions, offering 292 (41.3%) positions per year, followed by the United States, with 214 (30.2%) positions per year, and Mexico, with 69 (9.7%) positions per year. The country with more positions per 1,000,000 inhabitants is Cuba (3.93), followed by Brazil (1.34) and Uruguay (0.87). Brazil, Canada, Mexico, and the United States are the only 4 countries that have vascular surgery board exams., Conclusions: This is the first report presenting a large-scale picture of vascular surgery education and training in the American continent. Brazil is the country that offers more vascular surgery training opportunities, followed by the United States and Mexico. Disseminating vascular surgery training in America is of utmost importance to help fight the CVDs pandemic the world faces., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To analyze the epidemiological profile of natural hazard-related disasters in the Americas between 2000 and 2021., Study Design: Cross-sectional study., Methods: Mean and standard deviation were used to calculate the mean rates of affected individuals, injuries, and mortality per year and per million inhabitants. The ANOVA test was applied between the calculated mean rates by type of disasters. Exponential smoothing was used to forecast the number of disasters up to the year 2026., Results: A total of 2045 natural hazard-related disasters were recorded. Of these, 81 (3.96 %) were biological, 199 (9.73 %) were climatological, 140 (6.85 %) were geophysical, 843 (41.22 %) were hydrological, and 782 (38.24 %) were meteorological. A statistically significant difference was observed between the mean injury rates per million inhabitants of natural hazard-related disasters (F = 3.40; p = 0.010). The mortality rate per million inhabitants (F = 0.43; p = 0.786) and the mean affected rate per million inhabitants (F = 0.68; p = 0.609) were not found to be statistically significant regarding the type of disaster. The results demonstrated no statistically significant decline in the mean rate of affected individuals per million inhabitants (tau = -0.086, p = 0.336), the mean mortality rate per million inhabitants (tau = -0.221, p = 0.159), and the mean rate of injuries per million inhabitants (tau = 0.169, p = 0.284)., Conclusions: Hydrological disasters had the highest mean mortality rate, biological disasters had the highest mean injury rate, and geophysical disasters had the highest mean rate of affected individuals., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Blastocystis is an intestinal protist that presents worldwide distribution, colonizes animal and human hosts, and is classified into at least 34 ribosomal subtypes (STs). Herein, we conducted an update based on studies reporting Blastocystis-positive samples obtained from diverse hosts in the Americas. We described the distribution throughout the continent by assembling maps representing the distribution of STs and the most important 18S-rRNA alleles. Thirty-nine articles from the previous study, “A summary of Blastocystis subtypes in North and South America,” and forty-one additional articles from March 2019 to March 2022 were considered. The most common subtype described was ST3, representing the highest percentage of positive samples. Other recently identified STs include ST12, ST13, and ST16 in humans, and ST10, ST14, and ST17 in animals. Novel subtypes have also been described in this continent. We assembled and updated the distribution of Blastocystis in the Americas. We hope this delivers new understandings and knowledge of this microorganism’s prevalence and genetic diversity.

Two clonal extensively-resistant S. marcescens were isolated in Peru. The presence and transferability of extended-spectrum β-lactamases and IMP, KPC, NDM, OXA-48 and VIM were determined. The concomitant presence of KPC-2 and NDM-1 was confirmed in both isolates, with KPC-2 being able to be transferred.

Vector-borne diseases represent a major health challenge, both because of the complexity of their control, their common zoonotic nature, or the pathology they can cause in the individual. In tropical areas, surveillance of these diseases is even more important, since the activity of vectors is usually continuous throughout the year. To develop effective prophylaxis and surveillance programs, it is important to know the identity and prevalence of these pathogens as well as their distribution in a given territory. In Guadeloupe, a French archipelago located in the Lesser Antilles of the Caribbean, no information exists about vector-borne diseases in companion animals. With this aim, blood samples were obtained from 46 owned dogs with outdoor access from five different veterinary clinics located in the two mainland islands, and the presence of DNA of the main canine vector-borne pathogens (CVBP) was investigated through diverse PCR protocols. At least one pathogen was detected in 30.4 % of the dogs. The most frequently detected CVBP was Coxiella burnetii (17.4 %), followed by Dirofilaria immitis (8.7 %), and Candidatus Mycoplasma haematoparvum, Hepatozoon canis and Rickettsia spp. (2.2 % in all cases). One dog was coinfected with Candidatus M. haematoparvum and D. immitis. All samples were negative for Anaplasma spp., Ehrlichia spp., Bartonella spp., Borrelia burgdorferi sensu lato, piroplasmids, and Leishmania spp. No significant differences in pathogen occurrence were observed between the two main islands or according to the dog's sex and age groups. This study contributes to filling a relevant gap in the knowledge of vector-borne diseases in the Caribbean., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The American continent is experiencing significant economic and industrial development driven by sustainability principles. In this context, discussions on improving energy consumption have become increasingly frequent and dynamic across various sectors of civil society, including the implementation of energy efficiency measures as advocated by the ISO 50001 energy management standard. However, there is a pressing need to investigate which socioeconomic aspects are responsible for the issuance of this certification in the Americas and how these factors relate to characteristic industrial emissions, especially particulate matter. This study aims to evaluate the socioeconomic factors influencing ISO 50001 standard issuance and how these adjusted factors correlate with particulate matter of 2.5 μm and 10 μm dimensions. To achieve this, machine learning techniques were employed, considering the complex nature and risk of data overfitting. Model fitting was performed through multiple lasso regression, and the relationship between the adjusted factors was examined through cross-correlation analysis. The analyses indicate a strong correlation of adjusted macroeconomic indicators, especially with PM 2.5 , suggesting an association with cardiorespiratory problems and methane-related origins. This work is of great relevance to academia as it proposes new concepts regarding the interaction between energy efficiency standards and particulate matter. For the industrial sector, the adjusted factors provide guidance for standard implementation while also helping to mitigate health issues. Additionally, for the government, these results can assist in formulating policies to address specific health problems related to this area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Angiostrongylus vasorum is a metastrongylid parasite infecting wild canids and domestic dogs. Its patchy distribution, high pathogenicity and taxonomical classification makes the evolutionary history of A. vasorum intriguing and important to study. First larval stages of A. vasorum were recovered from feces of two grey foxes, Urocyon cinereoargenteus, from Costa Rica. Sequencing and phylogenetic and haplotypic analyses of the ITS2, 18S and cytochrome oxidase subunit 1 (cox1) fragments were performed. Then p- and Nei´s genetic distance, nucleotide substitution rates and species delimitation analyses were conducted with cox1 data of the specimens collected herein and other Angiostrongylus spp. Cophylogenetic congruence and coevolutionary events of Angiostrongylus spp. and their hosts were evaluated using patristic and phenetic distances and maximum parsimony reconciliations. Specimens from Costa Rica clustered in a separate branch from European and Brazilian A. vasorum sequences in the phylogenetic and haplotype network analyses using the ITS2 and cox1 data. In addition, cox1 p-distance of the sequences derived from Costa Rica were up to 8.6 % different to the ones from Europe and Brazil, a finding mirrored in Nei´s genetic distance PCoA. Species delimitation analysis supported a separate group with the sequences from Costa Rica, suggesting that these worms may represent cryptic variants of A. vasorum, a new undescribed taxon or Angiocaulus raillieti, a synonym species of A. vasorum described in Brazil. Moreover, nucleotide substitution rates in A. vasorum were up to six times higher than in the congener Angiostrongylus cantonensis. This finding and the long time elapsed since the last common ancestor between both species may explain the larger diversity in A. vasorum. Finally, cophylogenetic congruence was observed between Angiostrongylus spp. and their hosts, with cospeciation events occurring at deeper taxonomic branching of host order. Altogether, our data suggest that the diversity of the genus Angiostrongylus is larger than expected, since additional species may be circulating in wild canids from the Americas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Wanderwörter are a problematic set of words in historical linguistics. They usually make up a small proportion of the total vocabulary of individual languages, and only a minority of loanwords. They are, however, found frequently in languages from across the world. There is, to our knowledge, no general synthesis of Wanderwörter patterns, causes of exceptionally high borrowing rates for particular lexical items, or estimates of their frequency across language families. Claims about the causes of their spread exist, but have not been widely tested. Nor, despite researchers’ intuitions that Wanderwörter form a distinct type of borrowing, is there a clear demonstration that Wanderwörter are, in fact, different from other loanwords in any concrete way. In the present paper, we examine the phenomenon of Wanderwörter using a standard sample of vocabulary in languages of Australia, North America and South America. The investigation presented here examines Wanderwörter in great enough detail to answer questions about the linguistic and social processes by which Wanderwörter migrate as well as the shapes and densities of the resulting networks. We show that Wanderwörter can be categorically distinguished from other borrowing. The study of Wanderwörter to date has focused on agricultural or industrialized societies; however, the phenomenon is well attested in networks of smaller languages. There are areal differences in types of Wanderwörter and the networks through which they spread. Specific categories of cultural association, including but not limited to agricultural cultivation, condition widespread borrowing. Wanderwörter are outliers in the realm of loanwords, borrowed far more frequently than typical lexical items but still a subset of a more general phenomenon. We show that the link between Wanderwörter and cultural diffusion may be a more sound basis for defining this term than the traditional definitions that invoke the loan frequency, areality, or untraceability of these terms.

Chikungunya is an infection caused by the Chikungunya virus and transmitted by the bite of infected mosquito. The most common symptoms of Chikungunya virus infection are fever, joint pain or rash. Chikungunya virus outbreaks had been identified in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In late 2013, the first local transmission of Chikungunya virus in the Americas was identified in Caribbean countries and territories. Chikungunya virus disease became a nationally notifiable condition in 2015. There is a threat that Chikungunya will continue to spread to new areas in the Americas. We describe 5 patients who presented to our hospital with Chikungunya infection, shortly after returning from endemic areas. Fever and travel history to endemic areas were documented in all of our cases. Skin rash, arthralgia and contact history were also reported by these patients. Persons with suspected Chikungunya infection should be counseled to avoid mosquito bites during illness to decrease the risk of local transmission. The transmitting mosquitos are present in the US, and limiting the viral spread is essential. In this report, we describe the clinical presentation, risk factors and laboratory tests of each patient, and attempt to ensure awareness on the risk of potential spread of the disease.

Mayaro virus (MAYV) is an emergent arthropod-borne virus that causes an acute febrile illness accompanied by arthralgia, similar to chikungunya virus. Increasing urbanization of MAYV outbreaks in the Americas has led to concerns for geographic expansion and spillover. Given the potential importance of this pathogen, we sought to fill critical gaps in knowledge regarding MAYV infectivity and geographic variation. This study describes the cytopathogenicity of MAYV in human dermal fibroblasts, human skeletal muscle satellite cells, human embryonic kidney cells (HEK), peripherally derived human macrophages, and Vero cells. We found that regional differences between these viruses do not affect replication kinetics, with high titers peaking at 37 h post infection. MAYV-U, did however, cause the most cytopathic effect in a time-dependent manner. Compared to the other two prototypic isolates, MAYV-U harbors unique mutations in the E2 protein, D60G and S205F, that are likely to interact with the host cell receptor and could affect infectivity. We further demonstrate that pre-treatment of cells with interferon-β inhibited viral replication in a dose-dependent manner. Together, these findings advance our understanding of MAYV infection of human target cells and provide initial data regarding variation according to geography., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results., (Copyright © 2023. Published by Elsevier B.V.)

Zika virus is an Aedes-borne Flavivirus causing fever, arthralgia, myalgia rash, associated with Guillain–Barré syndrome and suspected to induce microcephaly in the fetus. We report here the complete coding sequence of the first characterized Caribbean Zika virus strain, isolated from a patient from Martinique in December, 2015.

Background: Women are underrepresented in hepatopancreatobiliary (HPB) surgery. We investigated whether this is a pipeline problem by looking at the percentage of women trainees presenting at Americas Hepato-Pancreato-Biliary Association (AHPBA) and then determining their ultimate career path., Methods: We extracted gender, level of training, and career path of first authors of abstracts presented at the 2007 and 2012 AHPBA conferences. Chi-square analysis and Fisher's exact test were used to examine gender trends., Results: 85 authors in 2007 and 109 in 2012 met inclusion criteria. 16.5% of presenters were female in 2007 compared to 22.9% in 2012. Just over 50% of authors went into academic medicine in 2007 (55%) and 2012 (59%) which did not differ by gender (p = 0.868 in 2007, p = 0.174 in 2012). 41.2% of first authors from 2007 to 2012 went into an HPB related field which did not differ significantly by gender (p = 0.450 for 2007, p = 0.626 for 2012)., Conclusion: Similar percentages of men and women who present at AHPBA ultimately obtain an HPB related job, however, more men than women trainees present at AHPBA. More efforts to encourage women to go into HPB surgery early may help eliminate this gender gap., (Copyright © 2020. Published by Elsevier Ltd.)

Background: There are many potential treatment options for patients with early stage hepatocellular carcinoma (HCC) and practice patterns vary widely. This project aimed to use a Delphi conference to generate consensus regarding the management of small resectable HCC., Methods: A base case was established with review by members of AHPBA Research Committee. The Delphi panel of experts reviewed the literature and scored clinical case statements to identify areas of agreement and disagreement. Following initial scoring, discussion was undertaken, questions were amended, and scoring was repeated. This cycle was repeated until no further likelihood of reaching consensus existed., Results: The panel achieved agreement or disagreement consensus regarding 27 statements. The overarching themes included that resection, ablation, transplantation, or any locoregional therapy as a bridge to transplant were all appropriate modalities for early or recurrent HCC. For larger lesions, consensus was reached that radiofrequency ablation and microwave ablation were not appropriate treatments., Conclusion: Using a validated system for identifying consensus, an expert panel agreed that multiple treatment modalities are appropriate for early stage HCC. These consensus guidelines are intended to help guide physicians through treatment modalities for early HCC; however, clinical decisions should continue to be made on a patient-specific basis., (Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Aim: The antibody levels against a broad spectrum of pathogens were assessed in commercial intravenous immunoglobulin (IVIG) manufactured from pooled plasma obtained from different global regions., Methods: Twenty-four IVIG commercial lots from eight manufacturers corresponding to 12 brands were analyzed. The plasma was collected in 10 countries/regions. Depending on each pathogen, antibody levels were measured using specific commercial IgG-specific enzyme immunoassay kits or by cell culture neutralization test and guinea pig skin neutralization test. A principal component analysis was performed., Results: For polio and diphtheria (reference markers of the US authorities), all IVIGs had relevant titers in accordance with reference levels. IVIGs from Canada, Australia, and the USA were positive for titers against globally distributed pathogens or those under vaccination programs in the developed world (parainfluenza, Epstein-Barr, varicella-zoster, influenza B, parvovirus B19, and measles viruses). IVIG from Taiwan and Hong Kong showed low antibody titers for these pathogens but high titers for Pseudomonas aeruginosa. IVIG from India had high titers for pathogens frequently found in developing countries (West Nile, dengue, chikungunya, and hepatitis E viruses and Streptococcus pneumoniae). IVIGs from Argentina, Spain, Israel, and Czechia showed intermediate antibody concentrations., Conclusion: The antibody profile in IVIG was greatly influenced by regional characteristics including climate, vaccination programs, and the prevalence of pathogens in the different countries and regions., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study described the population structure of M. tuberculosis complex (MTBc) strains among patients with pulmonary or lymph node tuberculosis (TB) in Northwest Ethiopia and tested the performance of culture isolation and MPT64-based speciation for Lineage 7 (L7)., Methods: Patients were recruited between April 2017 and June 2019 in North Gondar, Ethiopia. The MPT64 assay was used to confirm MTBc, and spoligotyping was used to characterize mycobacterial lineages. Line probe assay (LPA) was used to detect resistance to rifampicin and isoniazid., Results: Among 274 MTBc genotyped isolates, there were five MTBc lineages: L1-L4 and L7 were identified, with predominant East-African-Indian (L3) (53.6%) and Euro-American (L4) (40.1%) strains, and low prevalence (2.6%) of Ethiopia L7. The genotypes were similarly distributed between pulmonary and lymph node TB, and all lineages were equally isolated by culture and recognized as MTBc by the MPT64 assay. Additionally, LPA showed that 259 (94.5%) MTBc were susceptible to both rifampicin and isoniazid, and one (0.4%) was multi-drug resistant (resistant to both rifampicin and isoniazid)., Conclusion: These findings show that TB in North Gondar, Ethiopia, is mainly caused by L3 and L4 strains, with low rates of L7, confirmed as MTBc by MPT64 assay and with limited resistance to rifampicin and isoniazid., (Copyright © 2020. Published by Elsevier Ltd.)

We examined international regulatory developments related to the use of proteinogenic amino acids in human nutrition and concluded that the current risk-assessment practices tend to focus exclusively on setting maximum daily limits. In this brief review we argue that controlling the standards of purity and ingredient quality are the key safety issues that should be considered during risk assessment. Moreover, if maximum intake limits on amino acids are implemented, they should be defined using a well-established rationale for the health risks associated with high intakes. This would avoid setting limits that are so low that they render the dietary supplements ineffective and which, therefore, could mislead the consumer. We further suggest that there should be greater regional concordance in how the use of amino acids as ingredients is regulated and use the capacity of industry to oversee pre-competitive issues, such as standards of purity and scientific research on the safety of generic ingredients. Our arguments are based on clinical safety scientific research and oversights of amino acid purity standards conducted in the last decade by the not-for-profit international association, the International Council on Amino Acid Science., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Introduction: Regional outcomes after implantation of continuous-flow left ventricular assist devices (LVADs) have not been described. We examined differences in patient selection, survival, and adverse events across 3 geographic regions of the world: the Americas, Asia-Pacific, and Europe., Methods: Using data from The International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support registry, all adult patients implanted with a continuous-flow LVADs were included in this International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support analysis (n = 15,560), of whom, 9,988 (64%) received axial-flow devices and 5,572 (36%) received centrifugal-flow devices., Results: There were significant interregional differences in the rate of implantation of patients aged >70 years (Americas: 14%, Asia-Pacific: 1%, Europe: 5%; p < 0.0001), morbidly obese (Americas: 5%, Asia-Pacific: 1%, Europe: 1%; p < 0.0001), male (Americas: 79%, Asia-Pacific: 77%, Europe: 85%; p < 0.0001), and implanted as destination therapy (Americas: 48%, Asia-Pacific: 4%, Europe: 22%; p < 0.0001). The rates of centrifugal pump usage varied by region (Americas: 30%, Asia-Pacific: 34%, Eu: 74%; p < 0.0001). Survival rates varied by region and the type of pump flow, with survival at 12 and 48 months (axial flow vs centrifugal flow) being 82% vs 82% and 52% vs 53 in Americas; 92% vs 86% and 83% vs 74% in Asia-Pacific; and 80% vs 75% and 69% vs 53% in Europe, respectively (regional survival p < 0.0001)., Conclusion: There are marked global differences in LVAD recipient characteristics, device utilization, and post-operative care. These heterogeneities along with differences in patient management and transplantation rates may impact long-term survival. Regional differences in adverse event incidence warrant further investigation., (Copyright © 2020 International Society for Heart and Lung Transplantation. All rights reserved.)

Focusing on literature published in 2018-2020, we review inferences about: (i) how ancient DNA is contributing to clarify the peopling of the Americas and the dispersal of its first inhabitants, (ii) how the interplay between environmental diversity and culture has influenced the genetic structure and adaptation of Andean and Amazon populations, (iii) how genetics has contributed to our understanding of the Pre-Columbian Tupi expansion in Eastern South America, (iv) the subcontinental origins and dynamics of Post-Columbian admixture in the Americas, and finally, (v) episodes of adaptive natural selection in the American continent, particularly in the high altitudes of the Andes., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Canine dirofilariosis in the Americas is primarily caused by Dirofilaria immitis, a mosquito-borne filarial worm infecting dogs, which may also infect and cause disease in other mammalian hosts, including humans. Morphological and molecular evidence gathered in the past decades suggest that other Dirofilaria spp. may infect dogs in the American continent, though the actual taxonomic identity of them still needs to be elucidated. In addition, filarial worms belonging to distinct genera have also been reported in dogs in this part of the world, including Acanthocheilonema reconditum, Cercopithifilaria bainae, and Onchocerca lupi. Among these, O. lupi is a species of major clinical significance, which has been reported not only in dogs, but also in cats and humans in North America. The present article provides a current overview on canine dirofilariosis in the Americas, with notes on other filarial worms infecting dogs. It also provides some insights into outstanding research questions that should be responded to fill some of the several knowledge gaps related to this group of parasites in this continent., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Contraceptive steroids increase the ratio of cholic acid to chenodeoxycholic acid in bile. This alteration may contribute to the development of cholesterol gallstones. The objective of this study was to measure the effects of contraceptive steroids on bile acid kinetics and to relate them to changes in cholesterol metabolism. Steady-state kinetics of bile acids were measured in 15 healthy women, on and off contraceptive steroids. Cholic acid synthesis increased 30.3% (P less than 0.025) and its pool increased by 37.4% (P less than 0.025). Chenodeoxycholic acid synthesis decreased 6.4% (P = 0.08) and its pool decreased by 11.8% (P less than 0.05) during use of contraceptive steroids. The fractional turnover rates of both primary bile acids did not change. The changes in kinetics of the primary bile acids were related to alterations in biliary lipid and cholesterol metabolism, separately reported. (J. Lipid Res. 1987. 28: 828-839). During use of contraceptive steroids, total bile acid pool and total bile acid synthesis correlated directly with cholesterol synthesis, assayed in mononuclear leukocytes (r = 0.50 and r = 0.54, respectively) but not with the plasma clearance of chylomicron remnants, measured with retinyl palmitate. The data indicate that contraceptive steroids directly alter the hepatic synthesis of bile acids and suggest that newly synthesized cholesterol may be a preferred substrate for bile acid synthesis during use of contraceptive steroids.

We describe an ancestry-informative autosomal SNP multiplex designed to be a small-scale, flexible panel that can complement uniparental markers in assessing the American variability (i.e. pre-Colombian) found in contemporary indigenous American populations. This study centered on choosing SNPs with the specific characteristics of: 1) extreme allele frequency differences between indigenous Americans and the African, European and East Asian population groups that contribute to present-day population variation in the Americas; 2) high informativeness-for-assignment I n values; and 3) well-spaced genomic distribution and chromosomal separation from existing small-scale forensic ancestry marker sets. The resulting capillary electrophoresis SNaPshot single base extension test was named: PIMA (Population Informative Multiplex for the Americas), comprising 26 autosomal SNPs, a single X-chromosome SNP plus the amelogenin sex marker adapted for SNaPshot. PIMA complements the established 34plex forensic ancestry panel to provide a powerful and simple tool for the analysis of American populations, including those with admixed histories, commonly encountered in America. Comparing the results obtained with the combined marker panels of PIMA and 34plex to SNP data from a much larger ancestry panel allowed us to gauge their relative efficiency. PIMA+34plex gives equivalent power to the 314-SNP 'LACE' genomic ancestry control panel, while requiring a much smaller genotyping effort. The ancestry profiles and genetic structure of 22 populations spread across the American continent were estimated using PIMA+34plex data, and those estimates were contrasted with information provided by uniparental markers (mtDNA and Y-chromosome loci) for a small set of admixed individuals from Venezuela. Our results indicate that an American genetic component is efficiently detected in contemporary American populations using a small set of ancestry informative SNPs, and these co-ancestry estimates are consistent with the known history and demography of the Americas. The small scale and high population differentiation power of PIMA, particularly when combined with 34plex, provides a practical and powerful tool for genetic studies of American populations as well as forensic DNA analyses., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: The aim of this cross-sectional study was to describe the results of a systematic serological screening programme for strongyloidiasis., Methods: A prospective serological screening programme for strongyloidiasis was performed between 2009 and 2014 for all immigrant patients attending the Tropical Medicine Unit. Three formalin-ether concentrated stool samples and an ELISA for anti-Strongyloides stercoralis antibodies were used as screening tools., Results: Of 659 patients screened, 79 (12%) were positive for S. stercoralis regardless of the diagnostic method used. The prevalence of infection was 42.9% in East African patients, 16.3% in Central African patients, 10.9% in those from South America, and 10% in the case of West Africa. Univariate analysis showed that infection by S. stercoralis was significantly more frequent in patients from Central Africa (p=0.026; OR 1.72, 95% CI 1.03-2.85) and East Africa (p<0.001; OR 5.88, 95% CI 1.75-19.32). Taking West Africa as the reference (as the area of lowest prevalence among the positive prevalence areas), the statistical analysis showed that the risk of infection was higher in East Africa (p=0.001; OR 6.750, 95% CI 2.127-21.423) and Central Africa (p=0.065; OR 1.747, 95% CI 0.965-3.163)., Conclusions: Due to the potential complications of strongyloidiasis infection, we recommend that immigrant patients from developing countries be routinely screened for S. stercoralis, especially those from East Africa. A serological test is a highly appropriate screening tool., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: While death due to Zika virus (ZIKV) infection has been described, reports of fatal cases have been infrequent and no systematic reviews on the subject have been published., Methods: A systematic review of the literature in four databases was performed to assess fatal outcomes of postnatal ZIKV infection and the available evidence that links ZIKV infection to death., Results: Three hundred and eleven articles were retrieved; 20 of them were epidemiological reports from surveillance agencies and ministries of health. After screening by abstract and title, 59 articles were selected for full-text assessment. Of these, 35 were excluded (with reasons) and 24 were finally included for qualitative analysis. A total of 51 reported deaths associated with ZIKV infection in nine countries were identified. The majority of cases (56.9%) were not related to Guillain-Barré syndrome. Cases from three countries accounted for 67.6% of the deaths. ZIKV infection was laboratory-confirmed in the majority of cases (64.7%)., Discussion: ZIKV was not considered to be a dangerous, and much less a lethal pathogen, until very recently. However, an increasing number of fatalities have been published in the literature since the first death was reported in 2016. Additional research is needed to elucidate factors that may mediate the pathogenesis of severe, atypical, and fatal disease., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required., Objectives: The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation., Methods: Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics., Results: The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24-2.09)., Conclusions: Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs., (Copyright © American Society for Nutrition 2019.)

In 1973, analysis of the mummified remains of a young boy dated to 700AD and from the Late Nasca period (Peru) identified (i) chronic Pott's disease, leading to loss of lower body mobility, and (ii) acute miliary tuberculosis, affecting most organs and the immediate cause of death (Allison et al., 1973). This report was the first to establish, beyond dispute, the presence of tuberculosis in the Americas before the arrival of Europeans. Here, we revisit the 'Nasca Boy' from a bioarchaeology of care perspective. Contextualising the original study's results within what is known of contemporary lifeways, we apply the bioarchaeology of care methodology in considering the Nasca Boy's experience of living with tuberculosis; the type of care he required and how this may have evolved over a period of deteriorating health; and what such caregiving may suggest both about social organisation within his community and some of the more everyday aspects of Nasca existence. Up to now, the bioarchaeology of care approach has been employed almost exclusively with skeletal evidence; in this analysis of the Nasca Boy's remains, and in the accompanying wider-ranging discussion, we illustrate the potential of preserved soft tissue evidence to contribute to research into disability and care in the past. Although this report functions as a stand-alone case study, to obtain maximum benefit it should be read in conjunction with the Introduction to the special International Journal of Paleopathology issue on 'mummy studies and the bioarchaeology of care' (Nystrom and Tilley, 2018)., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Management of asymptomatic small well-differentiated (panNET) <2 cm remains controversial. A consensus conference was held on this topic. The impact of attending the conference and participating in the audience response survey on surgeon's clinical approach to pancreatic neuroendocrine tumors was assessed., Methods: Audience members were surveyed using a smartphone real-time response system at the beginning and end of the conference., Results: The majority of 75 attendees underwent fellowship training, and 30% had >10 years experience as attending surgeons. Previously published consensus statements on the topic were considered insufficient to guide surgical practice by 82% of attendees, and over 96% desired additional data. After review of the data, consensus statements, and decision-making process, a significant number of participants changed their opinions regarding indications for tissue biopsy (p = 0.001), size thresholds for excision (p = 0.002), and regional lymph node dissection (p = 0.002) independent of whether a consensus was reached by the content-expert panel., Conclusions: This represented the first Delphi process consensus on the topic, and the survey confirmed the topic as well-chosen and timely. Attendees changed opinions on management of panNET regardless of whether formal consensus was reached. Therefore, statements of consensus combined with presentation of literature and live discussion served to impact attendees' approach to this disease., (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. All rights reserved.)

Background: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs., Methods: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement. Results of the survey were discussed after each round of review. This cycle was repeated until no further likelihood of reaching consensus existed., Results: Twenty-two case statements related to surgical indications, preoperative biopsy, extent of resection, type of surgery, and tumor location were scored. Using a pre-defined definition of consensus, the panel achieved consensus on the following: i) resection is not recommended for <1 cm lesions; ii) resection is recommended for lesions greater than 2 cm; iii) lymph node dissection is recommended for radiographically-suspicious nodes with splenectomy for distal lesions; iv) tumor enucleation and central pancreatectomy are acceptable when technically feasible. No consensus was reached regarding issues of preoperative biopsy or 1-2 cm tumors., Conclusions: Using a structured, validated system for identifying consensus, an expert panel identified areas of agreement regarding critical management decisions for patients with PNET. Issues without consensus warrant additional clinical investigation., (Copyright © 2018. Published by Elsevier Ltd.)