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[Editorial] The elusive end to HIV in the USA

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Underscoring the tenacious HIV epidemic in the US, the Centers for Disease Control and Prevention (CDC) report on data from the National HIV Surveillance System, Vital signs: status of human immunodeficiency virus testing, viral suppression, and HIV preexposure prophylaxis—United States, 2013–2018, was released on Dec 3, 2019. The number of new HIV infections continues to hover around 38 000 and the proportion of people with infections who have been diagnosed has increased to 86%. However, despite the availability of highly effective antiretroviral treatments, only 63% of those who are diagnosed with HIV have a suppressed viral load and 18% of the estimated 1·2 million Americans who might be indicated for PrEP (pre-exposure prophylaxis) are receiving it.

[Editorial] Italian science funding agency moves a step closer to reality

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Science funding in Italy is about to receive a boost as its previously announced new National Agency for Research (ANR) heads for a Senate vote in the 2020 budget bill. Approval by Dec 31 could mean €300 million of funding by 2022. Italy's research and development spend of about 1·3% of gross domestic product lags behind the 2·4% average of other high-income countries. The agency will be a first for Italy, which currently allots funding via individual ministries.

[Editorial] 2020: a crucial year for neglected tropical diseases

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The inaugural World Neglected Tropical Diseases Day will be marked on Jan 30, 2020. “#BeatNTDs: For good. For all” is the slogan aiming to gather support and build momentum for a decisive year of action against neglected tropical diseases (NTDs). Jan 30 is the anniversary of the 2012 London Declaration on NTDs, which did much to bring together policy makers across countries and to encourage investment to commit to control and elimination of NTDs.

[Comment] Health research in China: a call for papers

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In 2020, The Lancet will dedicate a weekly issue to document and evaluate the progress of health research in China. While we welcome submissions from China throughout the year and across all Lancet journals, we specifically invite submissions of high-quality research from China—or from research teams working on health in China—for this issue. Submissions are invited from all aspects of health science including, but not limited to, clinical medicine, public health, global health, and health policy.

[Comment] Offline: What is the point of gender equality anyway?

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Two of the great global health issues of the 21st century are the climate emergency and gender inequality. The first is an incipient mass extinction event facing the biosphere. The second is a disfiguring moral injustice that, unless addressed, will severely limit possibilities for advancing the health and wellbeing of all peoples. But while the climate crisis has recently achieved wider awareness, triggering public concern and even (admittedly inadequate) political action, gender inequality remains marginal to the central discourse of society.

[World Report] Global surge in measles should be “a wake-up call”

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Progress towards elimination of measles has reversed in recent years, and scientists call for a swift response. Ed Holt reports.

[World Report] Australia repeals medical evacuation law

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Doctors say the decision will jeopardise the health of refugees held on Manus Island and Nauru. Sophie Cousins reports.

[Perspectives] Reinventing the eye exam

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Ophthalmology has long been one the most innovative and technology-driven of the medical specialties—from the mid-19th century, when Hermann von Helmholtz and Charles Babbage competed to produce the first ophthalmoscope, to the 21st century, when smartphone cameras can be used to examine the retina. Using technologies borrowed from astronomy, such as adaptive optics and optical coherence tomography (OCT), almost every part of the eye can now be directly, non-invasively visualised. The treatment of eye disease has also been technology-driven.

[Perspectives] The age of addiction

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It used to be considered daring for addiction researchers to bring illicit drugs and alcohol together—the banned substances talked of in the same breath as the one which many societies saw as acceptable. That hesitancy is long gone, undermined in part by David Courtwright's 2001 book Forces of Habit: Drugs and the Making of the Modern World, which covered the global histories of both sets of substances along with caffeine and a nod towards licit drugs. Out in the non-historical world, researchers and commentators began to question the nature of the boundaries between substances and how they had been constructed, with some licit, others prohibited.

[Perspectives] Sorrow

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Someone says the work must be very sad—the bad news, all the deaths—too sad to weather, day to day, for a career, to not burn out. Their face wrinkles to a shape of fatigue or grand wisdom or distaste, and their voice breaks from its singsong sympathy into other notes: embarrassment, disappointment, even rage—that sorrowful events intrude in this way, here at the business of progress. That they're wider than we hold them to be, more than just aberrations turned from at life's sharp edges, the way we turn our eyes from an eclipse.

[Perspectives] How to get smarter about medical intervention

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The flow of data deluging medicine shows no sign of abating. New techniques tell us ever more about our bodies and their state of health. To the expanding galaxy of “omes”—the genome, microbiome, proteome, and so forth—we must now add a view of the transcriptome at the level of single cells: single-cell RNA sequencing uses microarray chip-based technology to identify the RNA transcripts present in every cell in a sample. This method is transforming our view of how cells acquire their fates during development, of how diverse apparently homogeneous tissues are, and of how tumours are more like structured ecosystems than chaotically proliferating rogue cells.

[Obituary] Donald A B Lindberg

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Physician who ushered the US National Library of Medicine into the digital age. Born on Sept 21, 1933, in New York City, NY, USA, he died in Bethesda, MD, USA, on Aug 17, 2019, of injuries sustained in a fall, aged 85 years.

[Correspondence] Dengue in the Americas: Honduras' worst outbreak

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In November, 2018, the Pan American Health Organization (PAHO) alerted countries of the Americas to enhance preparedness and response efforts, including case management, laboratory diagnosis, integrated vector management, and risk communication, in preparation for a more intense dengue season.1 A World Report2 on Honduras's worst dengue outbreak in 50 years contained mischaracterised data obtained from PAHO. As of July, 2019, 2 029 342 cases of dengue had been reported in the Americas, of which 12 268 were classified as severe.

[Correspondence] The dengue epidemic in Bangladesh: risk factors and actionable items

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Dengue fever is an acute febrile viral disease transmitted by the bite of Aedes mosquitoes carrying any one of the four dengue viral serotypes. Approximately half of the world's population is at risk, especially people residing in tropical and subtropical climates such as in Bangladesh. About 390 million dengue infections are estimated to occur annually, of which a quarter of the cases (67–136 million) will manifest clinically,1 with the overall incidence of dengue having increased 30-fold over the past 50 years.

[Correspondence] The dengue epidemic and climate change in Nepal

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Climate change is affecting the incidence of dengue infections spread by two species of Aedes mosquitoes: Aedes aegypti and Aedes albopictus. The vectors of dengue and other arboviruses, including chikungunya, Zika virus, and yellow fever, depend on temperature and precipitation for their growth, survival, and feeding behaviour.1 Dengue transmission is highly sensitive to temperature, which affects generation time, the elapsed period from one cycle of vector-to-human transmission to the start of a new cycle.

[Correspondence] Vaccine-attributable severe dengue in the Philippines

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In 2016, WHO1 recommended that the dengue vaccine CYD-TDV (Dengvaxia; Pasteur, Lyon, France), the first dengue vaccine, licensed for use in adults and children aged 9 years or older, be considered for use in highly endemic regions where at least 70% of 9-year-old children had previously been infected with dengue. The Philippines was the first country to introduce Dengvaxia on a large scale in selected highly endemic regions, targeting about 1 million children aged 9–10 years. In November, 2017, an excess risk of hospitalisation for dengue and severe dengue in vaccinees who had not had a previous dengue infection at the time of vaccination was reported,2 on the basis of retrospective analyses3 of data from the Dengvaxia phase 3 trials, using a novel non-structural protein 1 (NS1) based antibody assay.

[Department of Error] Department of Error

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Skrzypczak J, Pelzer BW, Süli O. Youth activists for our health. Lancet 2019; 394: 1992—In this Correspondence, Benedict W Pelzer is affiliated with both the European Medical Students Association and the University of Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf. Orsolya Süli is affiliated with European Medical Students Association only. This correction has been made to the online version as of Dec 12, 2019.

[Clinical Picture] Gouty tophus in the quadriceps tendon: exclude malignancy

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A 69-year-old man attended our outpatient department with pain and discomfort just above both his knees. He said the problem had been troubling him for 4 months. On examination, we found swelling of the soft tissue at the end of the quadriceps tendon of his right leg (figure); the patient had a full range of movement of his knee with no weakness. The x-ray showed an ill-defined erosion of the proximal patella with calcification of the distal quadriceps tendon (figure). MRI showed that the mass was invading the proximal patella, with uptake of contrast agent at the margins extending into the quadriceps tendon without penetrating the knee joint capsule in sagittal reconstructions (figure).

[Department of Error] Department of Error

Sa, 07/12/2019 - 00:30
Brunner FJ, Waldeyer C, Ojeda F, et al. Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium. Lancet 2019; 394: 2173–83—The licence type for this Article has been changed to Gold Open Access. This correction has been made to the online version as of Dec 6, 2019, and the printed version is correct.

[Editorial] Time for honesty in the UK election

Sa, 07/12/2019 - 00:00
As the UK general election campaign reaches its climax, greater clarity on spending and ambitions for the next 5 years has suggested a thankfully renewed focus on aspects of UK society and politics beyond Brexit. The UK's National Health Service (NHS) has become a foreground issue in the campaign, with all main political parties putting NHS pledges front and centre of their manifestos. Environmental commitments, especially about climate action, have also become core policies.