Varicella zoster virus ischemic optic neuropathy and subclinical temporal artery involvement
Salazar R , Russman AN , Nagel MA , Cohrs RJ , Mahalingam R , Schmid DS , Kleinschmidt-Demasters BK , Vanegmond EM , Gilden D . Arch Neurol 2011 68 (4) 517-20 OBJECTIVE: To demonstrate varicella zoster virus (VZV) infection in an asymptomatic extracranial (temporal) artery in a patient with ischemic optic neuropathy produced by VZV vasculopathy in whom the pathological changes were mistakenly identified as giant cell arteritis. DESIGN: Case report. SETTING: Teaching hospital, pathology and virology laboratory. Patient An 80-year-old man with left ophthalmic distribution zoster who developed left ischemic optic neuropathy. INTERVENTION: An ipsilateral temporal artery biopsy revealed inflammation that was mistakenly identified as giant cell arteritis. The patient was initially treated with steroids but his condition did not improve. When the diagnosis of VZV vasculopathy was confirmed virologically and the patient was treated with intravenous acyclovir, his vision improved. RESULTS: Pathological and virological studies provided proof of VZV vasculopathy in the asymptomatic temporal artery. Varicella zoster virus antigen was abundant in arterial adventitia and scattered throughout the media. With intravenous antiviral therapy, the patient's vision improved. CONCLUSION: Although in previously studied patients who died of chronic VZV vasculopathy after 10 to 12 months, VZV antigen was present exclusively in the intima, collective analyses of chronic cases and the asymptomatic VZV-infected temporal artery suggest that virus enters arteries through the adventitia and spreads transmurally to the intima. |
Investigation of an outbreak of 2009 pandemic influenza A virus (H1N1) infections among healthcare personnel in a Chicago hospital
Magill SS , Black SR , Wise ME , Kallen AJ , Lee SJ , Gardner T , Husain F , Srinivasan A , Gerber SI , Jhung M . Infect Control Hosp Epidemiol 2011 32 (6) 611-5 In May 2009, we investigated a hospital outbreak of pandemic H1N1 (pH1N1) infection among healthcare personnel (HCP). Thirteen (65%) of 20 HCP with pH1N1 infection had healthcare-associated cases, which were primarily attributed to transmission among HCP. Eleven (55%) of HCP with pH1N1 infection worked for 1 day or more after the onset of illness. Personnel working with mild illness may have contributed to transmission among HCP. |
A comparison of clinical and epidemiological characteristics of fatal human infections with H5N1 and human influenza viruses in Thailand, 2004-2006
Shinde V , Hanshaoworakul W , Simmerman JM , Narueponjirakul U , Sanasuttipun W , Kaewchana S , Areechokechai D , Ungchusak K , Fry AM . PLoS One 2011 6 (4) e14809 BACKGROUND: The National Avian Influenza Surveillance (NAIS) system detected human H5N1 cases in Thailand from 2004-2006. Using NAIS data, we identified risk factors for death among H5N1 cases and described differences between H5N1 and human (seasonal) influenza cases. METHODS AND FINDINGS: NAIS identified 11,641 suspect H5N1 cases (e.g. persons with fever and respiratory symptoms or pneumonia, and exposure to sick or dead poultry). All suspect H5N1 cases were tested with polymerase chain reaction (PCR) assays for influenza A(H5N1) and human influenza viruses. NAIS detected 25 H5N1 and 2074 human influenza cases; 17 (68%) and 22 (1%) were fatal, respectively. We collected detailed information from medical records on all H5N1 cases, all fatal human influenza cases, and a sampled subset of 230 hospitalized non-fatal human influenza cases drawn from provinces with ≥1 H5N1 case or human influenza fatality. Fatal versus non-fatal H5N1 cases were more likely to present with low white blood cell (p = 0.05), lymphocyte (p<0.02), and platelet counts (p<0.01); have elevated liver enzymes (p = 0.05); and progress to circulatory (p<0.001) and respiratory failure (p<0.001). There were no differences in age, medical conditions, or antiviral treatment between fatal and non-fatal H5N1 cases. Compared to a sample of human influenza cases, all H5N1 cases had direct exposure to sick or dead birds (60% vs. 100%, p<0.05). Fatal H5N1 and fatal human influenza cases were similar clinically except that fatal H5N1 cases more commonly: had fever (p<0.001), vomiting (p<0.01), low white blood cell counts (p<0.01), received oseltamivir (71% vs. 23%, p<.001), but less often had ≥1 chronic medical conditions (p<0.001). CONCLUSIONS: In the absence of diagnostic testing during an influenza A(H5N1) epizootic, a few epidemiologic, clinical, and laboratory findings might provide clues to help target H5N1 control efforts. Severe human influenza and H5N1 cases were clinically similar, and both would benefit from early antiviral treatment. |
Acquired skills in sexually transmitted disease prevention: partner services and tailoring interventions to populations
Hogben M , Hood J . Sex Transm Dis 2011 38 (5) 365-366 Data from the past decade and a half revealed that many people, at least in the United States and Western Europe, have used the internet as a means to seek and acquire sex partners, both for short-term and potentially long-term relationships. Early survey research and 1 meta-analysis of men who have sex with men (MSM) suggested that those who sought sex partners on the internet engaged in riskier behaviors (eg, multiple sex partners) than those who did not.1,2 One later 2006–2008 clinic-based survey has shown fewer differences between internet users and non-users in risky behaviors and infection rates, although this clinic-based survey has limited generalizability.3 Intervention services have also been distributed through the same medium, including one of the major components of sexually transmitted disease (STD) prevention programs: partner services. In this editorial, we address a study in which an STD clinic implemented and evaluated the effects of an online partner notification program.4 The results have led us to write about the role of the intervention, as well as the role of the clinic. | If people can find partners online, many of them should be able to either put a disease intervention specialist (DIS) in touch with those partners through the same medium or send an online notification message themselves. In fact, DIS have used email and other electronic methods5 to contact partners of persons infected with syphilis or HIV, whether the infection occurred with a partner met over the internet.6,7 However capable DIS may be, there are insufficient numbers of them to provide partner services to all infected people, and, in the current fiscal climate, that fact is not likely to change soon. With the index patient as the alternative medium through which partner services can be offered, it makes sense to explore how the internet might contribute to partner services intervention. |
Multiple genes contribute to the virulent phenotype observed in ferrets of an H5N1 influenza virus isolated from Thailand in 2004.
Maines TR , Chen LM , Belser JA , Van Hoeven N , Smith E , Donis RO , Tumpey TM , Katz JM . Virology 2011 413 (2) 226-30 Human infections with highly pathogenic H5N1 avian influenza viruses continue to occur in many parts of the world and pose a considerable public health threat. With the use of animal models, the identification of virulence determinants has been instrumental in improving our understanding of how these viruses cause severe disease in humans. Two genetically similar H5N1 viruses (A/Thailand/16/2004 and A/Thailand/SP83/2004) exhibit high or low virulence phenotypes, respectively, in multiple animal models. Reassortant viruses were generated from this virus pair and evaluated in ferrets. Each of the polymerase genes of A/Thailand/16/2004 virus individually conferred increased virulence to A/Thailand/SP83/2004 virus while the neuraminidase of the low virulence virus reduced virulence and replication efficiency of the virulent virus in ferrets unless the homologous HA was present. Our results demonstrate that H5N1 virus virulence determinants are polygenic and that there is an important correlation between polymerase adaptation, efficient replication in the host, and virulence. |
Preventing medication overdoses in young children: an opportunity for harm elimination
Budnitz DS , Salis S . Pediatrics 2011 127 (6) e1597-9 Medication overdoses in young children are an increasingly common public health problem, but it is a preventable problem that can be addressed by combining strategies. The introduction of child-resistant packaging (CRP), product reformulations, heightened parental awareness, and poison control professionals and systems have made deaths from pediatric poisonings uncommon. However, the morbidity rate from medication overdoses, measured by emergency department (ED) visits and from calls to poison control centers, has been rising.1,2 | Medications have surpassed household products (eg, cleaning agents) as the predominant cause of pediatric poisonings.3 More than 70 000 children are brought to EDs for unintentional medication overdoses annually; the peak incidence is in 2-year-olds (Fig 1). Between 2005 and 2009, ED visits for medication overdoses among children younger than 5 years rose 20%. In 2009, 1 of every 151 2-year-olds was assessed in an ED for a medication overdose. Among children younger than 5 years, 95% of these ED visits for medication overdoses were a result of unsupervised (accidental) ingestions. Fewer than 5% of ED visits were a result of errors made by a caregiver; such visits primarily involve incorrect dosing. Recognizing the significance of this problem, a new Healthy People 2020 objective calls for reversal of these morbidity trends and a reduction in ED visits by 10% by 2020.4 |
Emergency department visits for antiviral adverse events during the 2009 H1N1 influenza pandemic
Lovegrove MC , Shehab N , Hales CM , Poneleit K , Crane E , Budnitz DS . Public Health Rep 2011 126 (3) 312-7 The 2009 pandemic influenza A (H1N1) outbreak was associated with an increased use of antiviral agents and highlighted the role of population-based monitoring for related adverse drug events (ADEs). An ongoing, nationally representative emergency department-based surveillance system was used to identify and characterize ADEs during the pandemic. Active surveillance for ADEs successfully provided timely, population-based data during the pandemic. Increases in antiviral ADEs paralleled increases in prescribing. Type and severity of ADEs were similar across all seasons. |
Levels of microbial agents in floor dust during remediation of a water-damaged office building
Cho SJ , Park JH , Kreiss K , Cox-Ganser JM . Indoor Air 2011 21 (5) 417-26 We examined the effects of remediation on loads of culturable fungi in floor dust collected from a large water-damaged office building during 4 cross-sectional surveys (2002, 2004, 2005, and 2007, respectively). We created a binary remediation variable for each year for each sampled workstation using information on remediation associated with water damage obtained from building management and used generalized linear mixed-effects models. We found significantly lower levels of culturable total and hydrophilic fungi at remediated workstations than at non-remediated workstations in 2004 and 2005 after completion of major remediation. The remediation effect, however, disappeared in 2007. The fraction of hydrophilic to total fungal concentrations was lowest in 2004, increased in 2005 and was highest in 2007. Our results indicate that the 2003 remediation lowered dust indices of dampness temporarily, but remediation was incomplete, consistent with a building assessment report of water infiltration. This study demonstrates the utility of longitudinal evaluation of microbial indices during remediation of water damage in this building, in which elimination of sources of moisture was not fully addressed. Our findings indicate that the fraction of hydrophilic fungi derived from concentrations of fungal species may be a useful index for assessing the long-term effectiveness of remediation. |
Introduction to Healthy People in a Healthy Environment
Mainzer HM , Morrett DB . Public Health Rep 2011 126 1-2 This special supplement of Public Health Reports, “Healthy People in a Healthy Environment,” represents an addendum to the Centers for Disease Control and Prevention's 2009 National Environmental Public Health Conference of the same name, which drew a national audience of 1,300 to Atlanta, Georgia, from October 26–28, 2009. The meeting promoted the nation's environmental health scientific and practice capacity by enhancing the expertise of environmental health professionals, including public health and health-care professionals, academic researchers, representatives from communities and organizations, and advocacy and business groups. The conference aimed to develop and encourage innovative strategies for addressing existing and emerging issues impacting environmental public health, the discipline that focuses on the interrelationships between people and their environment, promotes human health and well-being, and fosters a safe and healthful environment. |
Development quality criteria to evaluate nontherapeutic studies of incidence, prevalence, or risk factors of chronic diseases: pilot study of new checklists
Shamliyan TA , Kane RL , Ansari MT , Raman G , Berkman ND , Grant M , Janes G , Maglione M , Moher D , Nasser M , Robinson KA , Segal JB , Tsouros S . J Clin Epidemiol 2011 64 (6) 637-57 OBJECTIVE: To develop two checklists for the quality of observational studies of incidence or risk factors of diseases. STUDY DESIGN AND SETTING: Initial development of the checklists was based on a systematic literature review. The checklists were refined after pilot trials of validity and reliability were conducted by seven experts, who tested the checklists on 10 articles. RESULTS: The checklist for studies of incidence or prevalence of chronic disease had six criteria for external validity and five for internal validity. The checklist for risk factor studies had six criteria for external validity, 13 criteria for internal validity, and two aspects of causality. A Microsoft Access database produced automated standardized reports about external and internal validities. Pilot testing demonstrated face and content validities and discrimination of reporting vs. methodological qualities. Interrater agreement was poor. The experts suggested future reliability testing of the checklists in systematic reviews with preplanned protocols, a priori consensus about research-specific quality criteria, and training of the reviewers. CONCLUSION: We propose transparent and standardized quality assessment criteria of observational studies using the developed checklists. Future testing of the checklists in systematic reviews is necessary to develop reliable tools that can be used with confidence. |
Deploying whole genome sequencing in clinical practice and public health: meeting the challenge one bin at a time.
Berg JS , Khoury MJ , Evans JP . Genet Med 2011 13 (6) 499-504 Technological advances often outpace our ability to effectively use them, a situation that certainly could pertain to modern genomics. Breathtaking advances in genetic sequencing technology have the potential to make whole genome sequencing (WGS) available for healthcare and disease prevention. However, current practices in medical genetics are not directly applicable to robust genomic analysis, and new approaches are needed which are “scalable” to this new reality. If the field merely attempts to overlay traditional medical genetic approaches to patient consent and analysis, based on a soon to be obsolete model of testing and analyzing “one-gene-at-a-time,” it threatens to stall our ability to realize the promise of genomic medicine. The informed consent process, data analysis and clinical interpretation, and return of results must be achievable within a reasonable time frame, provide results in a manner consistent with responsible clinical genetics practice, and yet still comport with the realities of modern medicine. This challenge is illustrated by recent reports suggesting that the informed consent process could require 6 hours of face-to-face discussion over the course of several sessions1 or that delivery of results would require as much as 5 hours of direct patient contact.2 Thus, new approaches, thoughtfully developed around the unique features of whole genome analysis, are required. The challenges facing the deployment of WGS in clinical practice and public health, while substantial, are not insurmountable if we learn from the way in which other complex technologies are handled in medicine and move forward in an evidence-based manner. |
Genome-wide copy number alterations in subtypes of invasive breast cancers in young white and African American women.
Loo LW , Wang Y , Flynn EM , Lund MJ , Bowles EJ , Buist DS , Liff JM , Flagg EW , Coates RJ , Eley JW , Hsu L , Porter PL . Breast Cancer Res Treat 2011 127 (1) 297-308 Genomic copy number alterations (CNA) are common in breast cancer. Identifying characteristic CNAs associated with specific breast cancer subtypes is a critical step in defining potential mechanisms of disease initiation and progression. We used genome-wide array comparative genomic hybridization to identify distinctive CNAs in breast cancer subtypes from 259 young (diagnosed with breast cancer at <55 years) African American (AA) and Caucasian American (CA) women originally enrolled in a larger population-based study. We compared the average frequency of CNAs across the whole genome for each breast tumor subtype and found that estrogen receptor (ER)-negative tumors had a higher average frequency of genome-wide gain (P < 0.0001) and loss (P = 0.02) compared to ER-positive tumors. Triple-negative (TN) tumors had a higher average frequency of genome-wide gain (P < 0.0001) and loss (P = 0.003) than non-TN tumors. No significant difference in CNA frequency was observed between HER2-positive and -negative tumors. We also identified previously unreported recurrent CNAs (frequency >40%) for TN breast tumors at 10q, 11p, 11q, 16q, 20p, and 20q. In addition, we report CNAs that differ in frequency between TN breast tumors of AA and CA women. This is of particular relevance because TN breast cancer is associated with higher mortality and young AA women have higher rates of TN breast tumors compared to CA women. These data support the possibility that higher overall frequency of genomic alteration events as well as specific focal CNAs in TN breast tumors might contribute in part to the poor breast cancer prognosis for young AA women. |
Women's knowledge and awareness of gynecologic cancer: a multisite qualitative study in the United States
Cooper CP , Polonec L , Gelb CA . J Womens Health (Larchmt) 2011 20 (4) 517-24 BACKGROUND: U.S. women's awareness and knowledge of gynecologic cancer have not been well studied, with the exception of cervical cancer screening and risk factors. METHODS: Fifteen focus groups were conducted with women aged 40-60 years in Miami, New York City, Chicago, and Los Angeles. RESULTS: Most participants said they had heard of cervical, ovarian, and uterine cancers but were unfamiliar with vaginal and vulvar cancers. The misconception that the Pap test screens for multiple gynecologic cancers was prevalent and engendered a false sense of security in some women. An annual Pap screening interval was most familiar to participants; some mentioned a shorter screening interval for high-risk women; few mentioned an extended screening interval. A few participants thought the pelvic examination could detect a variety of conditions, including ovarian cancer. Some knew that the human papillomavirus (HPV) could cause cervical cancer, but no other risk factors for specific cancers were mentioned with any consistency. Although some recognized unexplained vaginal bleeding as a symptom of cervical cancer, participants generally were unfamiliar with gynecologic cancer symptoms. Participants reported learning about the discussion topics from a variety of sources, including the mass media. CONCLUSIONS: Participants lacked critical knowledge needed to understand their gynecologic cancer risk and seek appropriate care. Pap tests and routine examinations offer ideal opportunities to educate women about the purpose of the Pap test as well as risk factors and symptoms associated with various gynecologic cancers. The reported influence of the mass media also supports the viability of multimedia educational strategies. |
Parent attitudes about school requirements for human papillomavirus vaccine in high-risk communities of Los Angeles, CA
Robitz R , Gottlieb SL , De Rosa CJ , Guerry SL , Liddon N , Zaidi A , Walker S , Smith JS , Brewer NT , Markowitz LE . Cancer Epidemiol Biomarkers Prev 2011 20 (7) 1421-9 BACKGROUND: Human papillomavirus (HPV) immunization requirements for school entry could increase HPV vaccine uptake but are controversial. This study assessed parents' attitudes about HPV immunization requirements. METHODS: During October 2007-June 2008, we conducted telephone surveys with 484 parents of girls attending middle/high schools serving communities in Los Angeles County with elevated cervical cancer rates. RESULTS: Parents were mostly Hispanic (81%) or African-American (15%); 71% responded in Spanish. Many parents did not know if HPV vaccine works well (42%) or is unsafe (41%). Overall, 59% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea." In multivariable analysis, African-Americans and Hispanics responding in English were less likely than Hispanics responding in Spanish to agree (aOR 0.4, CI 0.2-0.8; aOR 0.1, CI 0.1-0.3, respectively). Parents were less likely to agree with these laws if they did not believe the vaccine works well (aOR 0.2, CI 0.1-0.5) but more likely to agree if they believed the vaccine is not "too new for laws like these" (aOR 4.5, CI 2.6-8.0). Agreement with laws increased to 92% when including agreement that "these laws are okay only if parents can opt out." CONCLUSIONS: In this at-risk community, over half of parents agreed with HPV immunization requirements generally, and the vast majority agreed when including opt-out provisions. Impact: Support for HPV vaccine requirements may depend on race/ethnicity and inclusion of opt-out provisions. Information about vaccine efficacy and safety may increase support and reduce uncertainty about HPV vaccine in high risk populations. |
Human papillomavirus vaccine uptake and barriers: association with perceived risk, actual risk and race/ethnicity among female students at a New York State university, 2010
Bednarczyk RA , Birkhead GS , Morse DL , Doleyres H , McNutt LA . Vaccine 2011 29 (17) 3138-43 Understanding human papillomavirus (HPV) vaccine uptake patterns is critical to improve vaccination levels. Approximately half (56%) of female undergraduate students surveyed at a large public university reported HPV vaccine series initiation, with 79% of initiators completing the three dose series. Predictors of series initiation included having a conversation with a health-care provider about the vaccine, reporting a history of sexual intercourse and receipt of the meningitis vaccine. Compared to whites, black/African-American women were 33% less likely to have initiated HPV vaccination. Common reasons for not receiving the HPV vaccine included concerns about vaccine safety and doctors' not recommending vaccination. |
Evaluation of a broadly protective Chlamydia-cholera combination vaccine candidate.
Eko FO , Okenu DN , Singh UP , He Q , Black C , Igietseme JU . Vaccine 2011 29 (21) 3802-10 The need to simultaneously target infections with epidemiological overlap in the population with a single vaccine provides the basis for developing combination vaccines. Vibrio cholerae ghosts (rVCG) offer an attractive approach for developing vaccines against a number of human and animal pathogens. In this study, we constructed a multisubunit vaccine candidate co-expressing the serovar D-derived Porin B and polymorphic membrane protein-D proteins of Chlamydia trachomatis and evaluated its ability to simultaneously induce broad-based chlamydial immunity and elicit a vibriocidal antibody response to the Vibrio carrier envelope. Intramuscular (IM) immunization with the vaccine candidate elicited high levels of antigen-specific genital mucosal and systemic Th1 cell-mediated and humoral immune responses against heterologous serovars and strains, including serovars E-H and L. Also, in addition to the multisubunit vaccine, the single subunit constructs conferred significant cross protection against the heterologous mouse strain, Chlamydia muridarum. Furthermore, all mice immunized with rVCG vaccine constructs responded with a significant rise in vibriocidal antibody titer, the surrogate marker for protection in cholera. These findings demonstrate the ability of the multisubunit vaccine to induce cross protective chlamydial as well as vibriocidal immunity and establish the possibility of developing a broadly efficacious Chlamydia-cholera combination vaccine. |
Towards validated assays for key immunological outcomes in malaria vaccine development
Cavanagh DR , Dubois PM , Holtel A , Kisser A , Leroy O , Locke E , Moorthy VS , Remarque EJ , Shi YP . Vaccine 2011 29 (17) 3093-5 A first generation partially effective malaria vaccine, RTS, S/AS01, is scheduled to complete an ongoing Phase 3 trial in 2014. Intense efforts are underway to develop highly effective second generation malaria vaccines in accordance with the malaria vaccine technology roadmap [1]. An important aspect of this second generation development work is agreement on the key immunological outcomes for upcoming malaria vaccine trials, and agreed approaches on standardised measurement of these outcomes. | The protective mechanisms underlying immunity induced by malaria vaccines are not fully characterised and are distinct from those responsible for naturally acquired immunity. Vaccine-induced immune mechanisms are thought to differ according to life-cycle target stage for subunit vaccines. Over 30 malaria vaccine projects are under clinical evaluation or progressing towards the clinic [2]. Of these, about two-thirds have used IgG-based assays for immunogenicity, with the other third using T-cell based assays as the primary immunological readout. In most cases the immunoassays are used as a measure of immunogenicity of the vaccines as immune correlates of protection are not known. It is important to be able to accurately and reproducibly quantify whether desired immune responses have been induced. Whatever assay is used, comparison between immunogenicity of alternate formulations, adjuvants and platforms requires the availability of robust assays. “Harmonisation” of assays refers to use of consensus SOPs between networks of laboratories. “Standardization” is a further step which requires agreed-upon SOPs, reagents and equipment and implies confirmation that equivalent results will be obtained at different centers by different operators. “Validation” is a regulatory requirement for use of immunoassay data for licensure purposes and refers to a stringent quantification of assay performance including accuracy and reproducibility. |
Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008
Taylor LD , Hariri S , Sternberg M , Dunne EF , Markowitz LE . Prev Med 2011 52 (5) 398-400 OBJECTIVES: This study aims to estimate human papillomavirus (HPV) vaccine coverage by demographic and sexual behavior characteristics 1-2years after vaccine licensure in a nationally representative sample of females aged 9-59years in the United States. METHODS: In 2007-2008, a total of 2775 females aged 9-59years responded to questions on HPV vaccine receipt in the National Health and Nutrition Examination Survey (NHANES). Demographic and sexual characteristics were evaluated for select age categories in bivariate analyses after adjusting for survey design. RESULTS: Overall, 15.2% of females aged 11-26 years reported HPV vaccine initiation; vaccine initiation varied significantly by age. We found no significant difference in vaccine initiation by race or poverty level in either 11-18 or 19-26-year olds. Significantly more 19-26-year olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p=0.04). Among females aged 14-18years, vaccine initiation was higher in those who ever had sex (28.6%) compared to those who had never had sex (17.8%) (p=0.05). CONCLUSIONS: These results describe HPV vaccine initiation shortly after vaccine licensure. Vaccine initiation was highest in females aged 14-18years. Efforts should be made to increase HPV vaccine coverage for the recommended age groups. |
Comparative evaluation of automated and manual commercial DNA extraction methods for detection of Francisella tularensis DNA from suspensions and spiked swabs by real-time polymerase chain reaction.
Dauphin LA , Walker RE , Petersen JM , Bowen MD . Diagn Microbiol Infect Dis 2011 70 (3) 299-306 This study evaluated commercial automated and manual DNA extraction methods for the isolation of Francisella tularensis DNA suitable for real-time polymerase chain reaction (PCR) analysis from cell suspensions and spiked cotton, foam, and polyester swabs. Two automated methods, the MagNA Pure Compact and the QIAcube, were compared to 4 manual methods, the IT 1-2-3 DNA sample purification kit, the MasterPure Complete DNA and RNA purification kit, the QIAamp DNA blood mini kit, and the UltraClean Microbial DNA isolation kit. The methods were compared using 6 F. tularensis strains representing the 2 subspecies which cause the majority of reported cases of tularemia in humans. Cell viability testing of the DNA extracts showed that all 6 extraction methods efficiently inactivated F. tularensis at concentrations of ≤10(6) CFU/mL. Real-time PCR analysis using a multitarget 5' nuclease assay for F. tularensis revealed that the PCR sensitivity was equivalent using DNA extracted by the 2 automated methods and the manual MasterPure and QIAamp methods. These 4 methods resulted in significantly better levels of detection from bacterial suspensions and performed equivalently for spiked swab samples than the remaining 2. This study identifies optimal DNA extraction methods for processing swab specimens for the subsequent detection of F. tularensis DNA using real-time PCR assays. Furthermore, the results provide diagnostic laboratories with the option to select from 2 automated DNA extraction methods as suitable alternatives to manual methods for the isolation of DNA from F. tularensis. |
Functional analysis of the Borrelia burgdorferi bba64 gene product in murine infection via tick infestation.
Patton TG , Dietrich G , Dolan MC , Piesman J , Carroll JA , Gilmore RD Jr . PLoS One 2011 6 (5) e19536 Borrelia burgdorferi, the causative agent of Lyme borreliosis, is transmitted to humans from the bite of Ixodes spp. ticks. During the borrelial tick-to-mammal life cycle, B. burgdorferi must adapt to many environmental changes by regulating several genes, including bba64. Our laboratory recently demonstrated that the bba64 gene product is necessary for mouse infectivity when B. burgdorferi is transmitted by an infected tick bite, but not via needle inoculation. In this study we investigated the phenotypic properties of a bba64 mutant strain, including 1) replication during tick engorgement, 2) migration into the nymphal salivary glands, 3) host transmission, and 4) susceptibility to the MyD88-dependent innate immune response. Results revealed that the bba64 mutant's attenuated infectivity by tick bite was not due to a growth defect inside an actively feeding nymphal tick, or failure to invade the salivary glands. These findings suggested there was either a lack of spirochete transmission to the host dermis or increased susceptibility to the host's innate immune response. Further experiments showed the bba64 mutant was not culturable from mouse skin taken at the nymphal bite site and was unable to establish infection in MyD88-deficient mice via tick infestation. Collectively, the results of this study indicate that BBA64 functions at the salivary gland-to-host delivery interface of vector transmission and is not involved in resistance to MyD88-mediated innate immunity. |
Short-term monitoring of formaldehyde: comparison of two direct-reading instruments to a laboratory-based method
Hirst DV , Gressel MG , Flanders WD . J Occup Environ Hyg 2011 8 (6) 357-63 Airborne formaldehyde concentrations can be measured using several different techniques, including laboratory-based methods and direct-reading instruments. Two commercially available direct-reading instruments, an RKI Instruments Model FP-30 and a PPM Technology Formaldemeter htV, were compared with National Institute for Occupational Safety and Health Method 2016 in different test environments to determine if these direct-reading instruments can provide comparable results. The methods yielded the following mean concentrations for 47 samples: NIOSH Method 2016, 0.37 ppm; FP-30, 0.29 ppm; and htV, 0.34 ppm. Results from both of the direct-reading instruments were correlated with the laboratory-based method (R(2) = 0.78 for FP-30, and 0.902 for htV). Comparison of the means of the three methods showed that on average the FP-30 instrument (p < 0.001) differed statistically from NIOSH Method 2016, whereas the htV (p = 0.15) was not statistically different from the NIOSH method. Sensitivity and specificity tests demonstrated that the FP-30 had sensitivity above 60% to detect formaldehyde concentrations at all the cutoff levels tested, whereas the htV appeared to have greater sensitivity above 88% for the levels evaluated. |
Smoking status and urine cadmium above levels associated with subclinical renal effects in U.S. adults without chronic kidney disease
Mortensen ME , Wong LY , Osterloh JD . Int J Hyg Environ Health 2011 214 (4) 305-10 Tobacco smoke is a major source of adult exposure to cadmium (Cd). Urine Cd levels (CdU) above 1.0, 0.7, and 0.5mugCd/g creatinine have been associated with increased rates of microproteinuria and reduction in glomerular filtration rate. The two study objectives were to determine the prevalence and relative risk (RR) by smoking status for CdU above 1.0, 0.7, and 0.5mugCd/g creatinine in U.S. adults; and to describe geometric mean CdU by smoking status, age, and sex. NHANES 1999-2006 data for adults without chronic kidney disease were used to compute prevalence rates above the three CdU in current and former cigarette smokers, and non-smokers. RRs for smokers adjusted for age and sex were computed by logistic regression. Analysis of covariance was used to calculate geometric means of CdU adjusted for age, sex, smoking status, log urine creatinine, and interaction terms: age-smoking status and sex-smoking status. At selected ages, adjusted RR for exceeding each risk-associated CdU was highest for current smokers (3-13 times), followed by former smokers (2-3 times), compared to non-smokers. Adjusted RR for smokers increased with age and was higher in females than males. Adjusted geometric means of CdUs increased with age, were higher in females than in males regardless of smoking status, and were higher in current smokers than former smokers, who had higher levels than non-smokers at any age. Cigarette smoking greatly increases RR of exceeding renal risk-associated CdU. Former smokers retain significant risk of exceeding these levels compared to non-smokers. CdU increased with age, particularly in current smokers. |
Toxicological evaluation of lung responses after intratracheal exposure to non-dispersed titanium dioxide nanorods
Roberts JR , Chapman RS , Tirumala VR , Karim A , Chen BT , Schwegler-Berry D , Stefaniak AB , Leonard SS , Antonini JM . J Toxicol Environ Health A 2011 74 (12) 790-810 Fine- and coarse-sized titanium dioxide (TiO(2)) particles are considered to be relatively inert when inhaled. The goal of this study was to assess potential lung toxicity associated with well-characterized, non-dispersed rutile TiO(2) nanorods (10 x 40 nm). In vitro bioreactivity of TiO(2) nanorods was determined by electron spin resonance (ESR) to measure free radical production. To assess pulmonary effects in vivo, Sprague-Dawley rats were intratracheally instilled with saline, silica, or TiO(2) nanorods (10 mug, 100 mug, or 1 mg/rat). On d 1, 3, and 6 posttreatment, left lungs were preserved for microscopy and histopathology, and lung lavage was performed on right lungs. Additional rats were treated with saline or TiO(2) nanorods (100 mug or 1 mg/rat) on d 0, intratracheally inoculated with 5 x 10(5) Listeria monocytogenes on d 3, and bacterial clearance was assessed. ESR showed a significant concentration-dependent generation of hydroxyl radicals by TiO(2) nanorods in the presence and absence of macrophages; however, the hydroxyl radical signals from TiO(2) samples were low compared to silica. Rats exposed to 1 mg of TiO(2) nanorods had significantly elevated levels of lung injury, inflammation, and lavage fluid monocyte chemoattractant protein (MCP)-1 and macrophage inflammatory protein (MIP)-2 on d 1 and 3 that subsided by d 6, unlike the silica response that persisted. Immune cytokine secretion in the lung and bacterial clearance were not affected by preexposure to TiO(2) nanorods. To summarize, non-dispersed TiO(2) nanorods were found to induce radical formation and cellular oxidant production, and to generate transient and reversible pneumotoxic effects, and to not markedly alter pulmonary immune function. |
Public health approach to detection of non-O157 Shiga toxin-producing Escherichia coli: summary of two outbreaks and laboratory procedures
Schaffzin JK , Coronado F , Dumas NB , Root TP , Halse TA , Schoonmaker-Bopp DJ , Lurie MM , Nicholas D , Gerzonich B , Johnson GS , Wallace BJ , Musser KA . Epidemiol Infect 2011 140 (2) 1-7 SUMMARY: Routine laboratory testing may not detect non-O157 Shiga toxin-producing Escherichia coli (STEC) reliably. Active clinical, epidemiological, environmental health, and laboratory collaboration probably influence successful detection and study of non-O157 STEC infection. We summarized two outbreak investigations in which such coordinated efforts identified non-O157 STEC disease and led to effective control measures. Outbreak 1 involved illness associated with consuming unpasteurized apple cider from a local orchard. Public health personnel were notified by a local hospital; stool specimens from ill persons contained O111 STEC. Outbreak 2 involved bloody diarrhoea at a correctional facility. Public health personnel were notified by the facility infection control officer; O45 STEC was the implicated agent. These reports highlight the ability of non-O157 STEC to cause outbreaks and demonstrate that a coordinated effort by clinicians, infection-control practitioners, clinical diagnostic laboratorians, and public health personnel can lead to effective identification, investigation, and prevention of non-O157 STEC disease. |
High susceptibility to repeated, low-dose, vaginal SHIV exposure late in the luteal phase of the menstrual cycle of pigtail macaques
Vishwanathan SA , Guenthner PC , Lin CY , Dobard C , Sharma S , Adams DR , Otten RA , Heneine W , Hendry RM , McNicholl JM , Kersh EN . J Acquir Immune Defic Syndr 2011 57 (4) 261-4 Fluctuations in susceptibility to HIV or SHIV during the menstrual cycle are currently not fully documented. To address this, time point of infection was determined in 19 adult female pigtail macaques vaginally challenged during their undisturbed menstrual cycles with repeated, low-dose SHIVSF162P3 exposures. Eighteen macaques (95%) first displayed viremia in the follicular phase, as compared to 1 macaque (5%) in the luteal phase (p<0.0001). Due to a viral eclipse phase, we estimated a window of most frequent virus transmission between days 24-31 of the menstrual cycle, in the late luteal phase. Thus, susceptibility to vaginal SHIV infection is significantly elevated in the second half of the menstrual cycle when progesterone levels are high, and when local immunity may be low. Such susceptibility windows have been postulated before but not definitively documented. Our data support findings of higher susceptibility to HIV in women during progesterone-dominated periods including pregnancy and contraceptive use. |
Histopathologic diagnosis of fungal infections in the 21st century
Guarner J , Brandt ME . Clin Microbiol Rev 2011 24 (2) 247-80 SUMMARY: Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs. |
Adverse events post smallpox-vaccination: insights from tail scarification infection in mice with Vaccinia virus
Mota BE , Gallardo-Romero N , Trindade G , Keckler MS , Karem K , Carroll D , Campos MA , Vieira LQ , da Fonseca FG , Ferreira PC , Bonjardim CA , Damon IK , Kroon EG . PLoS One 2011 6 (4) e18924 Adverse events upon smallpox vaccination with fully-replicative strains of Vaccinia virus (VACV) comprise an array of clinical manifestations that occur primarily in immunocompromised patients leading to significant host morbidity/mortality. The expansion of immune-suppressed populations and the possible release of Variola virus as a bioterrorist act have given rise to concerns over vaccination complications should more widespread vaccination be reinitiated. Our goal was to evaluate the components of the host immune system that are sufficient to prevent morbidity/mortality in a murine model of tail scarification, which mimics immunological and clinical features of smallpox vaccination in humans. Infection of C57BL/6 wild-type mice led to a strictly localized infection, with complete viral clearance by day 28 p.i. On the other hand, infection of T and B-cell deficient mice (Rag1(-/-)) produced a severe disease, with uncontrolled viral replication at the inoculation site and dissemination to internal organs. Infection of B-cell deficient animals (microMT) produced no mortality. However, viral clearance in microMT animals was delayed compared to WT animals, with detectable viral titers in tail and internal organs late in infection. Treatment of Rag1(-/-) with rabbit hyperimmune anti-vaccinia serum had a subtle effect on the morbidity/mortality of this strain, but it was effective in reduce viral titers in ovaries. Finally, NUDE athymic mice showed a similar outcome of infection as Rag1(-/-), and passive transfer of WT T cells to Rag1(-/-) animals proved fully effective in preventing morbidity/mortality. These results strongly suggest that both T and B cells are important in the immune response to primary VACV infection in mice, and that T-cells are required to control the infection at the inoculation site and providing help for B-cells to produce antibodies, which help to prevent viral dissemination. These insights might prove helpful to better identify individuals with higher risk of complications after infection with poxvirus. |
AFAP1L1 is a novel adaptor protein of the AFAP family that interacts with cortactin and localizes to invadosomes
Snyder BN , Cho YJ , Qian Y , Coad JE , Flynn DC , Cunnick JM . Eur J Cell Biol 2011 90 (5) 376-389 The actin-filament associated protein (AFAP) family of adaptor proteins consists of three members: AFAP1, AFAP1L1, and AFAP1L2/XB130 with AFAP1 being the best described as a cSrc binding partner and actin cross-linking protein. A homology search of AFAP1 recently identified AFAP1L1 which has a similar sequence, domain structure and cellular localization; however, based upon sequence variations, AFAP1L1 is hypothesized to have unique functions that are distinct from AFAP1. While AFAP1 has the ability to bind to the SH3 domain of the nonreceptor tyrosine kinase cSrc via an N-terminal SH3 binding motif, it was unable to bind cortactin. However, the SH3 binding motif of AFAP1L1 was more efficient at interacting with the SH3 domain of cortactin and not cSrc. AFAP1L1 was shown by fluorescence microscopy to decorate actin filaments and move to punctate actin structures and colocalize with cortactin, consistent with localization to invadosomes. Upon overexpression in A7r5 cells, AFAP1L1 had the ability to induce podosome formation and move to podosomes without stimulation. Immunohistochemical analysis of AFAP1L1 in human tissues shows differential expression when contrasted with AFAP1 with localization of AFAP1L1 to unique sites in muscle and the dentate nucleus of the brain where AFAP1 was not detectable. We hypothesize AFAP1L1 may play a similar role to AFAP1 in affecting changes in actin filaments and bridging interactions with binding partners, but we hypothesize that AFAP1L1 may forge unique protein interactions in which AFAP1 is less efficient, and these interactions may allow AFAP1L1 to affect invadosome formation. (C) 2011 Elsevier GmbH. All rights reserved. |
A comparison of in vitro susceptibility of Candida species from cases of invasive candidiasis in solid organ and stem cell transplant recipients: TRANSNET 2001-2006
Lockhart SR , Wagner D , Iqbal N , Pappas PG , Andes DR , Kauffman CA , Brumble LM , Hadley S , Walker R , Ito JI , Baddley JW , Chiller T , Park BJ . J Clin Microbiol 2011 49 (7) 2404-10 Invasive fungal infections (IFI) are a major cause of morbidity and mortality among both solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Candida is the most common cause of IFI in SOT recipients and the second most common cause of IFI in HSCT recipients. We determined antifungal susceptibilities to fluconazole, voriconazole, itraconazole, posaconazole, amphotericin B, and caspofungin for 383 invasive Candida spp. isolates from SOT and HSCT recipients enrolled in the Transplant-Associated Infection Surveillance Network, and correlated these results to clinical data. Fluconazole resistance in C. albicans, C. tropicalis and C. parapsilosis isolates was low (1%) but the high percentage of C. glabrata and C. krusei isolates within this group of patients increased the overall percentage of fluconazole resistance to 16%. Overall voriconazole resistance was 3% but was 8% among C. glabrata isolates. On multivariable analysis, among HSCTs fluconazole non-susceptibility was independently associated with C. glabrata, non-Hodgkin's lymphoma, CMV antigenemia, diabetes active at the time of the IFI, and any prior amphotericin B; among SOTs, fluconazole non-susceptibility was independently associated with any fluconazole use in the three months prior to the IFI, C. glabrata, ganciclovir use in three months prior to the IFI, diabetes acquired since the transplant, and gender. With the exception of breakthrough isolates during prophylaxis, routine antifungal susceptibility testing of Candida isolates from this patient population is not routinely recommended. |
CXCL4 and CXCL10 predict risk of fatal cerebral malaria
Wilson NO , Jain V , Roberts CE , Lucchi N , Joel PK , Singh MP , Nagpal AC , Dash AP , Udhayakumar V , Singh N , Stiles JK . Dis Markers 2011 30 (1) 39-49 Plasmodium falciparum in a subset of patients can lead to a diffuse encephalopathy known as cerebral malaria (CM). Despite treatment, mortality caused by CM can be as high as 30% while 10% of survivors of the disease may experience short- and long-term neurological complications. The pathogenesis of CM involves alterations in cytokine and chemokine expression, local inflammation, vascular injury and repair processes. These diverse factors have limited the rate of discovery of prognostic predictors of fatal CM. Identification of reliable early predictors of CM severity will enable clinicians to adjust this risk with appropriate management of CM. Recent studies revealed that elevated levels of CXCL10 expression in cerebrospinal fluid and peripheral blood plasma independently predicted severe and fatal CM. CXCR3, a promiscuous receptor of CXCL10, plays an important role in pathogenesis of mouse model of CM. In this study the role of corresponding CXCR3 ligands (CXCL11, CXCL10, CXCL9 & CXCL4) in fatal or severe CM was evaluated by comparing their levels in 16 healthy control (HC), 26 mild malaria (MM), 26 cerebral malaria survivors (CMS) and 12 non-survivors (CMNS) using enzyme linked immunosorbent assay (ELISA). Levels of CXCL4 and CXCL10 were significantly elevated in CMNS patients (p < 0.05) when compared with HC, MM and CMS. Elevated plasma levels of CXCL10 and CXCL4 were tightly associated with CM mortality. Receiver Operating Characteristic (ROC) curve analysis revealed that CXCL4 and CXCL10 can discriminate CMNS from MM (p < 0.0001) and CMS (p <0.0001) with an area under the curve (AUC)=1. These results suggest that CXCL4 and CXCL10 play a prominent role in pathogenesis of CM associated death and may be used as functional or surrogate biomarkers for predicting CM severity. |
Design and assessment of a real time reverse transcription-PCR method to genotype single-stranded RNA male-specific coliphages (family Leviviridae)
Friedman SD , Cooper EM , Calci KR , Genthner FJ . J Virol Methods 2011 173 (2) 196-202 A real-time, reverse transcription-PCR (RT-qPCR) assay was developed to differentiate the four genogroups of male-specific ssRNA coliphages (FRNA) (family Leviviridae). As FRNA display a trend of source-specificity (human sewage or animal waste) at the genogroup level, this assay provides a tool to help identify the origin of fecal contamination. Primers and probes were designed using complete genomic sequences from 29 FRNA phages. The final selection of primer/probe sets were based on (i) ability to amplify a single, specific product, (ii) genogroup specificity, (iii) lack of cross-reactivity, and (iv) experimental reproducibility and sensitivity over a range of target concentrations. Assay time was reduced by using heat-released viral RNA rather than purified RNA. For quality assurance, a custom RNA molecule was employed as an internal, non-competitive control. The usefulness of this method to identify sources of fecal contamination was tested on a total of 49 FRNA phages isolated from various warm-blooded animals, sewage and combined sewage overflow. FRNA phages from animal wastes were genotyped as 86% I, 4% III Q-like and 9% IV. Two sewage isolates typed to genogroup I and combined sewage overflow isolates genotyped as 40% II and 52% III. Primer specificity designed from this comprehensive sequence database may better discriminate FRNA from different sources. |
Discrimination of haptens from prohaptens using the metabolically deficient Cpr(low/low) mouse
Chipinda I , Blachere FM , Anderson SE , Siegel PD . Toxicol Appl Pharmacol 2011 252 (3) 268-72 The murine local lymph node assay (LLNA) is a validated, well accepted method for identification of chemical contact allergens. Both direct acting haptens and prohaptens (requiring metabolic activation) can be identified, but not differentiated by this assay. This study was used to assess the utility of a pan microsomal metabolic deficient mouse to distinguish between direct acting haptens and prohaptens in the LLNA. Hapten and prohapten induced cell proliferation was compared in C57BL/6J (B6) wild type (WT) versus homozygous (HO) knockout mice with a hypomorphic NADPH-Cytochrome P450 Reductase (CPR) gene (termed Cpr(low/low)) resulting in low CPR enzyme activity. Mice were dosed with known prohaptens; benzo(a)pyrene (BaP), carvone oxime (COx) and paracetamol (PCM) and haptens; oxazolone (OX), 4-ethoxymethylene-2-phenyl-2-oxazolin-5-one (EtOX), and N-acetylbenzoquinoneimine (NABQI) in this study. Skin microsomes from the WT, HO and heterozygous (HT) Cpr(low/low) mice were compared and evaluated for CPR activity. Lymphocyte proliferative responses to BaP, COx and PCM were significantly abrogated by 36.4%, 45.2% and 50.8%, respectively; in Cpr(low/low) knock out (KO) mice versus WT mice; while the lymphocyte proliferative responses to the direct acting haptens OX, EtOX and NABQI were comparable. CPR activity, determined as Units/mg protein, was determined to be significantly lower in the Cpr(low/low) mice compared to the WT. Results of the present study suggest potential utility of the Cpr(low/low) mice in the LLNA to differentiate prohaptens from direct acting haptens. |
Dual testing algorithm of BED-CEIA and AxSYM avidity index assays performs best in identifying recent HIV infection in a sample of Rwandan sex workers
Braunstein SL , Nash D , Kim AA , Ford K , Mwambarangwe L , Ingabire CM , Vyankandondera J , van de Wijgert JH . PLoS One 2011 6 (4) e18402 BACKGROUND: To assess the performance of BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays in estimating HIV incidence among female sex workers (FSW) in Kigali, Rwanda. METHODOLOGY AND FINDINGS: Eight hundred FSW of unknown HIV status were HIV tested; HIV-positive women had BED and Ax-AI testing at baseline and ≥12 months later to estimate assay false-recent rates (FRR). STARHS-based HIV incidence was estimated using the McWalter/Welte formula, and adjusted with locally derived FRR and CD4 results. HIV incidence and local assay window periods were estimated from a prospective cohort of FSW. At baseline, 190 HIV-positive women were BED and Ax-AI tested; 23 were classified as recent infection (RI). Assay FRR with 95% confidence intervals were: 3.6% (1.2-8.1) (BED); 10.6% (6.1-17.0) (Ax-AI); and 2.1% (0.4-6.1) (BED/Ax-AI combined). After FRR-adjustment, incidence estimates by BED, Ax-AI, and BED/Ax-AI were: 5.5/100 person-years (95% CI 2.2-8.7); 7.7 (3.2-12.3); and 4.4 (1.4-7.3). After CD4-adjustment, BED, Ax-AI, and BED/Ax-AI incidence estimates were: 5.6 (2.6-8.6); 9.7 (5.0-14.4); and 4.7 (2.0-7.5). HIV incidence rates in the first and second 6 months of the cohort were 4.6 (1.6-7.7) and 2.2 (0.1-4.4). CONCLUSIONS: Adjusted incidence estimates by BED/Ax-AI combined were similar to incidence in the first 6 months of the cohort. Furthermore, false-recent rate on the combined BED/Ax-AI algorithm was low and substantially lower than for either assay alone. Improved assay specificity with time since seroconversion suggests that specificity would be higher in population-based testing where more individuals have long-term infection. |
Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008
Osterman MJ , Martin JA . Natl Vital Stat Rep 2011 59 (5) 1-13, 16 OBJECTIVES: This report presents 2008 data on receipt of epidural and spinal anesthesia as collected on the 2003 U.S. Standard Certificate of Live Birth. The purpose of this report is to describe the characteristics of women giving birth and the circumstances of births in which epidural or spinal anesthesia is used to relieve the pain of labor for vaginal deliveries. METHODS: Descriptive statistics are presented on births occurring in 2008 to residents of 27 states that had implemented the 2003 U.S. Standard Certificate of Live Birth as of January 1, 2008. Analyses are limited to singleton births in vaginal deliveries that occurred in the 27-state reporting area only and are not generalizable to the United States as a whole. RESULTS: Overall, 61 percent of women who had a singleton birth in a vaginal delivery in the 27 states in 2008 received epidural or spinal anesthesia; non-Hispanic white women received epidural or spinal anesthesia more often (69 percent) than other racial groups. Among Hispanic origin groups, Puerto Rican women were most likely to receive epidural or spinal anesthesia (68 percent). Levels of treatment with epidural or spinal anesthesia decreased by advancing age of mother. Levels increased with increasing maternal educational attainment. Early initiation of prenatal care increased the likelihood of epidural or spinal anesthesia receipt, as did attendance at birth by a physician. Use of epidural or spinal anesthesia was more common in vaginal deliveries assisted by forceps (84 percent) or vacuum extraction (77 percent) than in spontaneous vaginal deliveries (60 percent). Use of epidural or spinal anesthesia was less likely when infants were born prior to 34 weeks of gestation or weighed less than 1,500 grams. Women with chronic and gestational diabetes were more likely to receive an epidural or spinal anesthesia than women with no pregnancy risk factors. Precipitous labor (less than 3 hours) was associated with decreased epidural or spinal anesthesia receipt. longer second stage of labor, and fetal distress (compared with women who receive opiates intravenously or by injection) (1,5,6). Severe headache, maternal hypotension, maternal fever, and urinary retention have also been associated with epidural/spinal anesthesia receipt (5). This report examines the relationship between epidural/spinal anesthesia receipt and selected characteristics of the mother and of labor among vaginal deliveries in the 27-state reporting area as reported on the 2003 U.S. Standard Certificate of Live Birth. |
Occupational sensitization to soy allergens in workers at a processing facility
Green BJ , Cummings KJ , Rittenour WR , Hettick JM , Bledsoe TA , Blachere FM , Siegel PD , Gaughan DM , Kullman GJ , Kreiss K , Cox-Ganser J , Beezhold DH . Clin Exp Allergy 2011 41 (7) 1022-30 BACKGROUND: Exposure to soy antigens has been associated with asthma in community outbreaks and in some workplaces. Recently, 135 soy flake processing workers (SPWs) in a Tennessee facility were evaluated for immune reactivity to soy. Allergic sensitization to soy was common and was five times more prevalent than in health care worker controls (HCWs) with no known soy exposure. OBJECTIVE: To characterize sensitization to soy allergens in SPWs. Methods Sera that were positive to soy ImmunoCAP (n=27) were tested in IgE immunoblots. Wild-type (WT) and transgenic (TG) antigens were sequenced using nanoscale Ultra-Performance Liquid Chromatography Tandem Mass Spectrometry (nanoUPLC MS/MS). IgE reactivity towards 5-enolpyruvylshikimate-3-phosphate synthase (CP4-EPSP), a protein found in TG soy, was additionally investigated. De-identified sera from 50 HCWs were used as a control. Results Immunoblotting of WT and TG soy flake extracts revealed IgE against multiple soy antigens with reactivity towards 48, 54, and 62 kDa bands being the most common. The prominent proteins that bound SPW IgE were identified by nanoUPLC MS/MS analysis to be the high molecular weight soybean storage proteins, beta-conglycinin (Gly m 5), and Glycinin (Gly m 6). No specific IgE reactivity could be detected to lower molecular weight soy allergens, Gly m 1 and Gly m 2, in soybean hull (SH) extracts. IgE reactivity was comparable between WT and TG extracts; however, IgE antibodies to CP4-EPSP could not be detected. CONCLUSIONS AND CLINICAL RELEVANCE: SPWs with specific IgE to soy reacted most commonly with higher molecular weight soybean storage proteins compared with the lower molecular weight SH allergens identified in community asthma studies. IgE reactivity was comparable between WT and TG soy extracts, while no IgE reactivity to CP4-EPSP was observed. High molecular weight soybean storage allergens, Gly m 5 and Gly m 6, may be respiratory sensitizers in occupational exposed SPWs. |
Anti-triatomine saliva immunoassays for the evaluation of impregnated netting trials against Chagas disease transmission
Schwarz A , Juarez JA , Richards J , Rath B , Machaca VQ , Castro YE , Malaga ES , Levy K , Gilman RH , Bern C , Verastegui M , Levy MZ . Int J Parasitol 2011 41 (6) 591-4 Insecticide-impregnated nets can kill triatomine bugs, but it remains unclear whether they can protect against Chagas disease transmission. In a field trial in Quequena, Peru, sentinel guinea pigs placed in intervention enclosures covered by deltamethrin-treated nets showed significantly lower antibody responses to saliva of Triatoma infestans compared with animals placed in pre-existing control enclosures. Our results strongly suggest that insecticide-treated nets prevent triatomine bites and can thereby protect against infection with Trypanosoma cruzi. Anti-salivary immunoassays are powerful new tools to evaluate intervention strategies against Chagas disease. |
Hospital staff perceptions of a legislative mandate for methicillin-resistant Staphylococcus aureus screening
Wise ME , Weber SG , Schneider A , Stojcevski M , France AM , Schaefer MK , Lin MY , Kallen AJ , Cochran RL . Infect Control Hosp Epidemiol 2011 32 (6) 573-8 OBJECTIVE: In August 2007, Illinois passed legislation mandating methicillin-resistant Staphylococcus aureus (MRSA) admission screening for intensive care unit patients. We assessed hospital staff perceptions of the implementation of this law. DESIGN: Mixed-methods evaluation using structured focus groups and questionnaires. SETTING: Eight Chicago-area hospitals. PARTICIPANTS: Three strata of staff (leadership, midlevel, and frontline) at each hospital. Methods. All participants completed a questionnaire and participated in a focus group. Focus group transcripts were thematically coded and analyzed. The proportion of staff agreeing with statements about MRSA and the legislation was compared across staff types. RESULTS: Overall, 126 hospital staff participated in 23 focus groups. Fifty-six percent of participants agreed that the legislation had a positive effect at their facility; frontline staff were more likely to agree than midlevel and leadership staff ([Formula: see text]). Perceived benefits of the legislation included increased awareness of MRSA among staff and better knowledge of the epidemiology of MRSA colonization. Perceived negative consequences included the psychosocial effect of screening and contact precautions on patients and increased use of resources. Most participants (59%) would choose to continue the activities associated with the legislation but advised facilities in states considering similar legislation to educate staff and patients about MRSA screening and to draft clear implementation plans. CONCLUSION: Staff from Chicago-area hospitals perceived that mandatory MRSA screening legislation resulted in some benefits but highlighted implementation challenges. States considering similar initiatives might minimize these challenges by optimizing messaging to patients and healthcare staff, drafting implementation plans, and developing program evaluation strategies. |
Allocating funds for HIV/AIDS: a descriptive study of KwaDukuza, South Africa
Lasry A , Carter MW , Zaric GS . Health Policy Plan 2011 26 (1) 33-42 OBJECTIVE: through a descriptive study, we determined the factors that influence the decision-making process for allocating funds to HIV/AIDS prevention and treatment programmes, and the extent to which formal decision tools are used in the municipality of KwaDukuza, South Africa. METHODS: we conducted 35 key informant interviews in KwaDukuza. The interview questions addressed specific resource allocation issues while allowing respondents to speak openly about the complexities of the HIV/AIDS resource allocation process. RESULTS: donors have a large influence on the decision-making process for HIV/AIDS resource allocation. However, advocacy groups, governmental bodies and local communities also play an important role. Political power, culture and ethics are among a set of intangible factors that have a strong influence on HIV/AIDS resource allocation. Formal methods, including needs assessment, best practice approaches, epidemiologic modelling and cost-effectiveness analysis are sometimes used to support the HIV/AIDS resource allocation process. Historical spending patterns are an important consideration in future HIV/AIDS allocation strategies. CONCLUSIONS: several factors and groups influence resource allocation in KwaDukuza. Although formal economic and epidemiologic information is sometimes used, in most cases other factors are more important for resource allocation decision-making. These other factors should be considered in any attempts to improve the resource allocation processes. |
Adoptive parents' suspicion of preadoption abuse of their adopted children and the use of support services
Ward BW . Child Care Health Dev 2011 38 (2) 175-85 BACKGROUND: Adopted children have a higher risk of developmental, mental, behavioural and social problems compared with non-adopted children, and their use of postadoption support services is of interest. Little attention has been given to the impact of preadoption abuse on the use of these services, and therefore this study examines whether or not adoptive parents' suspicion of preadoption abuse has a significant impact on the use of support services by adopted children. METHODS: Data from the National Survey of Adoptive Parents, a US nationally representative survey of adopted children, were used to examine parents' suspicion of preadoption abuse and its effects on the use of postadoption support services by children aged 6-17 years (n= 1411). Statistical analyses were used to examine the relationship between suspected abuse and the use of support services while controlling for characteristics of the adopted child and adoptive parents/household. RESULTS: Seven out of 10 adopted children have used some form of support service, and a larger percentage of 6- to 12-year-old children suspected of experiencing preadoption abuse used a support service compared with children not suspected of experiencing abuse. Significant relationships existed between various types of suspected preadoption abuse and the use of different types of postadoption support services. These relationships may go unaccounted for when only examining if any preadoption abuse occurred, or if any support service was used. CONCLUSIONS: The type of preadoption abuse suspected appears to play a modest role in predicting the type of postadoption support services used by an adopted child. Giving further attention to understanding the relationship between different types of preadoption abuse and types of postadoption support services may help better understand the problems and difficulties experienced by adopted children. |
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