Syndromic approach to arboviral diagnostics for global travelers as a basis for infectious disease surveillance

Background Arboviruses have overlapping geographical distributions and can cause symptoms that coincide with more common infections. Therefore, arbovirus infections are often neglected by travel diagnostics. Here, we assessed the potential of syndrome-based approaches for diagnosis and surveillance of neglected arboviral diseases in returning travelers. Method To map the patients high at risk of missed clinical arboviral infections we compared the quantity of all arboviral diagnostic requests by physicians in the Netherlands, from 2009 through 2013, with a literature-based assessment of the travelers’ likely exposure to an arbovirus. Results 2153 patients, with travel and clinical history were evaluated. The diagnostic assay for dengue virus (DENV) was the most commonly requested (86%). Of travelers returning from Southeast Asia with symptoms compatible with chikungunya virus (CHIKV), only 55% were tested. For travelers in Europe, arbovirus diagnostics were rarely requested. Over all, diagnostics for most arboviruses were requested only on severe clinical presentation. Conclusion Travel destination and syndrome were used inconsistently for triage of diagnostics, likely resulting in vast under-diagnosis of arboviral infections of public health significance. This study shows the need for more awareness among physicians and standardization of syndromic diagnostic algorithms

Rotational aesthetics: Michael Bay and contemporary cinema’s machine movement

Digital imaging technologies enable a mastery of the visual that in recent mainstream cinema frequently manifests as certain kinds of spatial reach, orientation and motion. In such a context Michael Bay’s Transformers franchise can be framed as a digital re-tooling of a familiar fantasy of vehicular propulsion, US car culture writ large in digitally crafted spectacles of diegetic speed, the vehicular chase film ‘2.0’. Movement is central to these films, calling up Scott Bukatman’s observation that in spectacular visual media ‘movement has become more than a tool of bodily knowledge; it has become an end in itself’ (2003: 125). Not all movements and not all instances of vehicular propulsion are the same however. How might we evaluate what is at stake in a film’s assertion of movement as an end in itself, and the form that assertion takes, its articulations of diegetic velocity, corporeality, and spatial penetration? Deploying an attentiveness towards the specificity of aesthetic detail and affective impact in Bay’s delineation of movement, this essay suggests that the franchise poses questions about the relationship of human movement to machine movement that exceed their narrative basis. Identifying a persistent rotational trope in the franchise that in its audio-visual articulation combines oddly anachronistic elements (evoking the mechanical rather than the digital), the article argues that the films prioritise certain fantasies of transformation and spatial penetration, and certain modes of corporeality, as one response to contemporary debates about digital technologisation, sustainable energy, and cinematic spectacle. In this way the franchise also represents a particular moment in a more widely discernible preoccupation in contemporary cinema with what we might call a ‘rotational aesthetics’ of action, a machine movement made possible by the digital, but which invokes earlier histories and fantasies of animation, propulsion, mechanization and mechanization to particular ends.