Unmasking Influenza Virus Infection in Patients Attended to in the Emergency Department

Infection by the influenza virus may pass undetected in many adult patients attended to in the emergency department because its diagnosis usually relies on clinical manifestations, which can be distorted by symptoms of a preexisting disease, superposed complications or nontypical manifestations of influenza virus infection (confusing symptoms). We performed this observational, prospective study with an antigen detection test by indirect immunofluorescence assay (IFA) to estimate the presence of influenza virus infection in such patients. No confirmatory test was performed to validate a positive or negative IFA result. Then we compared those who were antigen positive to those who were negative and also analyzed those who were positive classified by age, comorbidity and clinical presentation. We also evaluated the use of medical and hospital resources and vaccination status. Posterior pharynx swab specimens from 136 consecutive adult patients, 74 women and 62 men with a mean age of 68.7 ± 17.9 (range: 18-97) years attended to in the emergency department of a university hospital in Barcelona during the 1999-2000 influenza epidemic were examined. Tested patients presented either a classical influenza syndrome, a deterioration of a previous condition or any abrupt onset of symptoms without an obvious cause. Influenza A virus antigen was detected in 99 (72.8%) of the 136 patients included in the study. Confusing symptoms were present in 86 patients with laboratoryconfirmed influenza and 40 of them lacked influenza syndrome. Prostration, aching and fever out of proportion to catarrhal symptoms (disproportionate prostration) and cough were independent predictors for this diagnosis (OR = 5.14; 95% CI: 1.98-13.35, p = 0.001 and OR = 4.40, 95% CI, 1.65-11.75, p = 0.03, respectively). Among the 99 patients who tested positive, 72 were ≥ 65 years of age. This older positive group compared to the 27 also positive < 65 (non-old) had a tendency to show symptoms mediated by cytokines less frequently: malaise was present in 76.4% of the older positive patients vs 92.6% in the non-old positive ones, p = 0.07. The equivalent percentages for muscle ache were: 56.9% vs 77.8%, p = 0.06; for dysthermia: 54.2% vs 70.4%, p = 0.08; for headache: 35.2% vs 66.7%, p = 0.005, and for disproportionate prostration: 47.2% vs 66.7%, p = 0.08. Cough was more frequent in the older positive group: 94.4% vs 77.8%, p = 0.02. Older positive patients were also hospitalized and received antibiotics more frequently than the non-old positive ones: 65.3% vs 40.7%, p = 0.03 and 81.9% vs 63.0%, p = 0.046, respectively. Hospitalization was independently correlated with the presence of complications (OR = 4.5, 95% IC 1.27-15.95, p = 0.02). Patients with the highest comorbidity, evaluated with the Charlson scale, were more inadequately vaccinated than those with moderate or low comorbidity. Influenza virus infection has a great and underestimated impact in the emergency department during influenza epidemics. High frequency of confusing symptoms, which overcome classical influenza syndrome in adult people with comorbidity, may explain this effect. Disproportionate prostration and cough are symptoms that independently predict its diagnosis in the global adult population, whereas in the elderly, fever and cough should arouse this suspicion whether or not they present classic symptoms. In our setting, individuals with high comorbidity are inadequately vaccinated

Landscape Analysis of Drone Congregation Areas of the Honey Bee, Apis mellifera

Male honey bees fly and gather at Drone Congregation Areas (DCAs), where drones and queens mate in flight. DCAs occur in places with presumably characteristic features. Using previously described landscape characteristics and observations on flight direction of drones in nearby apiaries, 36 candidate locations were chosen across the main island of Puerto Rico. At these locations, the presence or absence of DCAs was tested by lifting a helium balloon equipped with queen-sex-pheromone-impregnated bait, and visually determining the presence of high numbers of drones. Because of the wide distribution of honey bees in Puerto Rico, it was expected that most of the potential DCAs would be used as such by drones and queens from nearby colonies. Eight DCAs were found in the 36 candidate locations. Locations with and without DCAs were compared in a landscape analysis including characteristics that were described to be associated with DCAs and others. Aspect (direction of slope) and density of trails were found to be significantly associated with the presence of DCAs

Fire weather and likelihood: characterizing climate space for fire occurrence and extent in Puerto Rico

Assessing the relationships between weather patterns and the likelihood of fire occurrence in the Caribbean has not been as central to climate change research as in temperate regions, due in part to the smaller extent of individual fires. However, the cumulative effect of small frequent fires can shape large landscapes, and fire-prone ecosystems are abundant in the tropics. Climate change has the potential to greatly expand fire-prone areas to moist and wet tropical forests and grasslands that have been traditionally less fire-prone, and to extend and create more temporal variability in fire seasons. We built a machine learning random forest classifier to analyze the relationship between climatic, socio-economic, and fire history data with fire occurrence and extent for the years 2003–2011 in Puerto Rico, nearly 35,000 fires. Using classifiers based on climate measurements alone, we found that the climate space is a reliable associate, if not a predictor, of fire occurrence and extent in this environment. We found a strong relationship between occurrence and a change from average weather conditions, and between extent and severity of weather conditions. The probability that the random forest classifiers will rank a positive example higher than a negative example is 0.8–0.89 in the classifiers for deciding if a fire occurs, and 0.64–0.69 in the classifiers for deciding if the fire is greater than 5 ha. Future climate projections of extreme seasons indicate increased potential for fire occurrence with larger extents.Fil: Van Beusekom, Ashley E.. United States Department of Agriculture; Estados UnidosFil: Gould, William A.. United States Department of Agriculture; Estados UnidosFil: Monmany, Ana Carolina. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional; ArgentinaFil: Khalyani, Azad Henareh. State University of Colorado - Fort Collins; Estados UnidosFil: Quiñones, Maya. United States Department of Agriculture; Estados UnidosFil: Fain, Stephen J.. United States Department of Agriculture; Estados UnidosFil: Andrade Núñez, María José. Universidad de Puerto Rico; Puerto RicoFil: González, Grizelle. United States Department of Agriculture; Estados Unido