"Bacterial Meningitis in children and adolescents: an observational study based on the national surveillance system"

BACKGROUND: Bacterial meningitis is a group of life threatening infections that mostly affect children and adolescents, and may be the cause of severe neurological sequelae. Cuba has implemented massive vaccination programmes against both Neisseria meningitidis (serogroup C in 1979 and B in 1987), and Haemophilus influenzae type b (1999), two of the main causal pathogens. We described and discussed some epidemiological aspects of the current status of bacterial meningitis to learn from the Cuban experience. METHODS: A nationwide observational study on children and adolescents from 1 to 18 years old was carried out from 1998 to 2003, estimating the incidence and case-fatality rate by age group and causal pathogens, as well as the seasonality and frequency of overcrowded dormitories. The association between disease and attendance to day care centres or boarding schools was estimated by using relative risk (Chi-squared test and Fisher Exact Test). RESULTS: The overall number of cases was 1023; the incidence ranged from 3.4 to 8.5 per 100 000 population, with the higher figures in children 1–5 years old (16.8 per 100 000 population). Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis serogroup B were the main identified agents. The average case-fatality rate was 10.5% and the most lethal agents were Streptococcus pneumoniae (27%) and Haemophilus influenzae type b (10.7%). Overall percentage of cases who slept in overcrowded dormitories was 15%, reaching 30.6% in adolescents. Seasonality was only evident among meningococcal meningitis cases between September–October. The attendance to boarding high school showed an association with disease only in 1998 and 1999 (RR = 2.1; p > 0.05). CONCLUSION: The highest incidence of bacterial meningitis was observed among children from 1–5 years old. Pneumococcus was both the leading causal and the most lethal agent. Sleeping in overcrowded dormitories was more frequent among adolescents. No strong association was observed between the bacterial meningitis and attendance to day care centres or boarding schools. The incidence of bacterial meningitis in Cuba is declining after massive vaccination programmes against Neisseria meningitidis serogroup B and C and Haemophilus influenzae type b through a national immunisation program

Forces generated during stretch in the heart of the lobster Homarus americanus are anisotropic and are altered by neuromodulators

Mechanical and neurophysiological anisotropies mediate three-dimensional responses of the heart of Homarus americanus. Although hearts in vivo are loaded multi-axially by pressure, studies of invertebrate cardiac function typically use uniaxial tests. To generate whole-heart length-tension curves, stretch pyramids at constant lengthening and shortening rates were imposed uniaxially and biaxially along longitudinal and transverse axes of the beating whole heart. To determine whether neuropeptides that are known to modulate cardiac activity in H. americanus affect the active or passive components of these length-tension curves, we also performed these tests in the presence of SGRNFLRFamide (SGRN) and GYSNRNYLRFamide (GYS). In uniaxial and biaxial tests, both passive and active forces increased with stretch along both measurement axes. The increase in passive forces was anisotropic, with greater increases along the longitudinal axis. Passive forces showed hysteresis and active forces were higher during lengthening than shortening phases of the stretch pyramid. Active forces at a given length were increased by both neuropeptides. To exert these effects, neuropeptides might have acted indirectly on the muscle via their effects on the cardiac ganglion, directly on the neuromuscular junction, or directly on the muscles. Because increases in response to stretch were also seen in stimulated motor nerve-muscle preparations, at least some of the effects of the peptides are likely peripheral. Taken together, these findings suggest that flexibility in rhythmic cardiac contractions results from the amplified effects of neuropeptides interacting with the length-tension characteristics of the heart

Community acquired bacterial meningitis in Cuba: a follow up of a decade

BACKGROUND: Community acquired Bacterial Meningitis (BM) remains a serious threat to global health. Cuban surveillance system for BM allowed to characterize the main epidemiological features of this group of diseases, as well as to assess the association of some variables with mortality. Results of the BM surveillance in Cuba are presented in this paper. METHODS: A follow up of BM cases reported to the Institute "Pedro Kourí" by the National Bacterial Meningitis Surveillance System from 1998 to 2007 was completed. Incidence and case-fatality rate (CFR) were calculated. Univariate analysis and logistic regression were used to elucidate associated factors to mortality comparing death versus survival. Relative Risk (RR) or odds ratio and its 95% confidence interval (CI 95%) were estimated, using either a Chi-squared Test or Fisher's Exact Test as appropriate. A Holt-Winters model was used to assess seasonality. RESULTS: 4 798 cases of BM (4.3 per 100 000 population) were reported, with a decreasing trend of the incidence. Highest incidence was observed in infants and elderly. Overall CFR reached 24.1% affecting mostly older adults. S. pneumoniae (23.6%), N. meningitidis(8.2%) and H. influenzaetype b (6.0%) were the main causative agents. Males predominate in the incidence. Highest incidence and CFR were mainly clustered in the centre of the island. The univariate analysis did not show association between delayed medical consultation (RR = 1.20; CI = 1.07-1.35) or delayed hospitalization (RR = 0.98; CI = 0.87-1.11) and the fatal outcome. Logistic regression model showed association of categories housewife, pensioned, imprisoned, unemployed, S. peumoniae and other bacteria with mortality. Seasonality during September, January and March was observed. CONCLUSIONS: The results of the National Program for Control and Prevention of the Neurological Infectious Syndrome evidenced a reduction of the BM incidence, but not the CFR. Multivariate analysis identified an association of mortality with some societal groups as well as with S. peumoniae

Meningococcal disease serogroup C

Despite current advances in antibiotic therapy and vaccines, meningococcal disease serogroup C (MDC) remains a serious threat to global health, particularly in countries in North and Latin America, Europe, and Asia. MDC is a leading cause of morbidity, mortality, and neurological sequelae and it is a heavy economic burden. At the individual level, despite advances in antibiotics and supportive therapies, case fatality rate remains nearly 10% and severe neurological sequelae are frequent. At the population level, prevention and control of infection is more challenging. The main approaches include health education, providing information to the public, specific treatment, chemoprophylaxis, and the use of vaccines. Plain and conjugate meningococcal C polysaccharide vaccines are considered safe, are well tolerated, and have been used successfully for over 30 years. Most high-income countries use vaccination as a part of public health strategies, and different meningococcal C vaccination schedules have proven to be effective in reducing incidence. This is particularly so with conjugate vaccines, which have been found to induce immunogenicity in infants (the age group with the highest incidence rates of disease), stimulate immunologic memory, have longer effects, not lead to hyporesponsiveness with repeated dosing, and decrease acquisition of nasopharyngeal carriage, inducing herd immunity. Antibiotics are considered a cornerstone of MDC treatment and must be administered empirically as soon as possible. The choice of which antibiotic to use should be made based on local antibiotic resistance, availability, and circulating strains. Excellent options for a 7-day course are penicillin, ampicillin, chloramphenicol, and third-generation cephalosporins (ceftriaxone and cefotaxime) intravenously, although the latter are considerably more expensive than the others. The use of steroids as adjunctive therapy for MDC is still controversial and remains a topic of debate. A combination of all of the aforementioned approaches is useful in the prevention and control of MDC, and each country should tailor its public health policy to its own particular needs and knowledge of disease burden

Tourism and the smartphone app: capabilities, emerging practice and scope in the travel domain.

Based on its advanced computing capabilities and ubiquity, the smartphone has rapidly been adopted as a tourism travel tool.With a growing number of users and a wide varietyof applications emerging, the smartphone is fundamentally altering our current use and understanding of the transport network and tourism travel. Based on a review of smartphone apps, this article evaluates the current functionalities used in the domestic tourism travel domain and highlights where the next major developments lie. Then, at a more conceptual level, the article analyses how the smartphone mediates tourism travel and the role it might play in more collaborative and dynamic travel decisions to facilitate sustainable travel. Some emerging research challenges are discussed

C-Band All-Sky Survey: A First Look at the Galaxy

We present an analysis of the diffuse emission at 5 GHz in the first quadrant of the Galactic plane using two months of preliminary intensity data taken with the C-Band All Sky Survey (C-BASS) northern instrument at the Owens Valley Radio Observatory, California. Combining C-BASS maps with ancillary data to make temperature-temperature plots we find synchrotron spectral indices of $\beta = -2.65 \pm 0.05$ between 0.408 GHz and 5 GHz and $\beta = -2.72 \pm 0.09$ between 1.420 GHz and 5 GHz for $-10^{\circ} < |b| < -4^{\circ}$, $20^{\circ} < l < 40^{\circ}$. Through the subtraction of a radio recombination line (RRL) free-free template we determine the synchrotron spectral index in the Galactic plane ($|b| < 4^{\circ}$) to be $\beta = -2.56 \pm 0.07$ between 0.408 GHz and 5 GHz, with a contribution of $53 \pm 8$ per cent from free-free emission at 5\,GHz. These results are consistent with previous low frequency measurements in the Galactic plane. By including C-BASS data in spectral fits we demonstrate the presence of anomalous microwave emission (AME) associated with the HII complexes W43, W44 and W47 near 30 GHz, at 4.4 sigma, 3.1 sigma and 2.5 sigma respectively. The CORNISH VLA 5 GHz source catalogue rules out the possibility that the excess emission detected around 30\;GHz may be due to ultra-compact HII regions. Diffuse AME was also identified at a 4 sigma level within $30^{\circ} < l < 40^{\circ}$, $-2^{\circ} < b < 2^{\circ}$ between 5 GHz and 22.8 GHz.Comment: 16 pages, 9 figures, submitted to MNRAS, referee's corrections made, awaiting for final approval for publicatio

Calculation of the Density of States Using Discrete Variable Representation and Toeplitz Matrices

A direct and exact method for calculating the density of states for systems with localized potentials is presented. The method is based on explicit inversion of the operator $E-H$. The operator is written in the discrete variable representation of the Hamiltonian, and the Toeplitz property of the asymptotic part of the obtained {\it infinite} matrix is used. Thus, the problem is reduced to the inversion of a {\it finite} matrix

Childhood solid tumours in relation to population mixing around the time of birth

In a retrospective cohort study of 673 787 live births in the Northern Region of England, 1975 - 1994, we investigated whether a higher level of population mixing around birth was a risk factor for solid tumours, by diagnostic group (Hodgkin's disease, brain and spinal tumours, neuroblastoma, other solid tumours), diagnosed during 1975-2001 under age 15 years. Logistic regression was used to relate risk to population mixing, based on (i) all movers and (ii) incomers from outside the region. Both ward and county district level analyses were performed. There was a decreased risk of brain and spinal tumours with increasing population mixing based on incomers from outside the region (OR for trend across three categories = 0.79, 95% CI: 0.66-0.95, P = 0.01 in the ward level analysis). Although this may be because of chance, it is consistent with a role of exposure to infection and immunological response in the aetiology of these tumours. For other tumour groups, there was no consistent evidence of an association between risk and population mixing

The evolution of galaxy star formation activity in massive halos

There is now a large consensus that the current epoch of the Cosmic Star Formation History (CSFH) is dominated by low mass galaxies while the most active phase at 1<z<2 is dominated by more massive galaxies, which undergo a faster evolution. Massive galaxies tend to inhabit very massive halos such as galaxy groups and clusters. We aim to understand whether the observed "galaxy downsizing" could be interpreted as a "halo downsizing", whereas the most massive halos, and their galaxy populations, evolve more rapidly than the halos of lower mass. Thus, we study the contribution to the CSFH of galaxies inhabiting group-sized halos. This is done through the study of the evolution of the Infra-Red (IR) luminosity function of group galaxies from redshift 0 to ~1.6. We use a sample of 39 X-ray selected groups in the Extended Chandra Deep Field South (ECDFS), the Chandra Deep Field North (CDFN), and the COSMOS field, where the deepest available mid- and far-IR surveys have been conducted with Spitzer MIPS and Hersche PACS. Groups at low redshift lack the brightest, rarest, and most star forming IR-emitting galaxies observed in the field. Their IR-emitting galaxies contribute <10% of the comoving volume density of the whole IR galaxy population in the local Universe. At redshift >~1, the most IR-luminous galaxies (LIRGs and ULIRGs) are preferentially located in groups, and this is consistent with a reversal of the star-formation rate vs .density anti-correlation observed in the nearby Universe. At these redshifts, group galaxies contribute 60-80% of the CSFH, i.e. much more than at lower redshifts. Below z~1, the comoving number and SFR densities of IR-emitting galaxies in groups decline significantly faster than those of all IR-emitting galaxies. Our results are consistent with a "halo downsizing" scenario and highlight the significant role of "environment" quenching in shaping the CSFH.Comment: 14 pages, 10 figures, accepted for publication by A&

The role of massive halos in the Star Formation History of the Universe

The most striking feature of the Cosmic Star Formation History (CSFH) of the Universe is a dramatic drop of the star formation (SF) activity, since z~1. In this work we investigate if the very same process of assembly and growth of structures is one of the major drivers of the observed decline. We study the contribution to the CSFH of galaxies in halos of different masses. This is done by studying the total SFR-halo mass-redshift plane from redshift 0 to redshift z~1.6 in a sample of 57 groups and clusters by using the deepest available mid- and far-infrared surveys conducted with Spitzer MIPS and Herschel PACS and SPIRE. Our results show that low mass groups provide a 60-80% contribution to the CSFH at z~1. Such contribution declines faster than the CSFH in the last 8 billion years to less than 10% at z<0.3, where the overall SF activity is sustained by lower mass halos. More massive systems provide only a marginal contribution (<10%) at any epoch. A simplified abundance matching method shows that the large contribution of low mass groups at z~1 is due to a large fraction (>50%) of very massive, highly star forming Main Sequence galaxies. Below z~1 a quenching process must take place in massive halos to cause the observed faster suppression of their SF activity. Such process must be a slow one though, as most of the models implementing a rapid quenching of the SF activity in accreting satellites significantly underpredicts the observed SF level in massive halos at any redshift. Starvation or the transition from cold to hot accretion would provide a quenching timescale of 1 Gyrs more consistent with the observations. Our results suggest a scenario in which, due to the structure formation process, more and more galaxies experience the group environment and, thus, the associated quenching process. This leads to the progressive suppression of their SF activity shaping the CSFH below z~1.Comment: 18 pages, 21 figures, accepted for publication by A&