Vascular access hemorrhages contribute to deaths among hemodialysis patients
Ellingson KD , Palekar RS , Lucero CA , Kurkjian KM , Chai SJ , Schlossberg DS , Vincenti DM , Fink JC , Davies-Cole JO , Magri JM , Arduino MJ , Patel PR . Kidney Int 2012 82 (6) 686-92 In 2007 the Maryland Medical Examiner noted a potential cluster of fatal vascular access hemorrhages among hemodialysis patients, many of whom died outside of a health-care setting. To examine the epidemiology of fatal vascular access hemorrhages, we conducted a retrospective case review in District of Columbia, Maryland, and Virginia from January 2000 to July 2007 and a case-control study. Records from the Medical Examiner and Centers for Medicare and Medicaid Services were reviewed, from which 88 patients were identified as fatal vascular access hemorrhage cases. To assess risk factors, a subset of 20 cases from Maryland was compared to 38 controls randomly selected among hemodialysis patients who died from non-vascular access hemorrhage causes at the same Maryland facilities. Of the 88 confirmed cases, 55% hemorrhaged from arteriovenous grafts, 24% from arteriovenous fistulas, and 21% from central venous catheters. Of 82 case-patients with known location of hemorrhage, 78% occurred at home or in a nursing home. In the case-control analysis, statistically significant risk factors included the presence of an arteriovenous graft, access-related complications within 6 months of death, and hypertension; presence of a central venous catheter was significantly protective. Psychosocial factors and anticoagulant medications were not significant risk factors. Effective strategies to control vascular access hemorrhage in the home and further delineation of warning signs are needed. (Kidney International advance online publication, 13 June 2012; doi:10.1038/ki.2012.185.) |
Prevalence of diabetes and intermediate hyperglycemia among adults from the first multinational study of noncommunicable diseases in six Central American countries: the Central America Diabetes Initiative (CAMDI)
Barcelo A , Gregg EW , Gerzoff RB , Wong R , Perez Flores E , Ramirez-Zea M , Cafiero E , Altamirano L , Ascencio Rivera M , de Cosio G , de Maza MD , del Aguila R , Emanuel E , Gil E , Gough E , Jenkins V , Orellana P , Palma R , Palomo R , Pastora M , Pena R , Pineda E , Rodriguez B , Tacsan L , Thompson L , Villagra L . Diabetes Care 2012 35 (4) 738-40 OBJECTIVE: The increasing burdens of obesity and diabetes are two of the most prominent threats to the health of populations of developed and developing countries alike. The Central America Diabetes Initiative (CAMDI) is the first study to examine the prevalence of diabetes in Central America. RESEARCH DESIGN AND METHODS: The CAMDI survey was a cross-sectional survey based on a probabilistic sample of the noninstitutionalized population of five Central American populations conducted between 2003 and 2006. The total sample population was 10,822, of whom 7,234 (67%) underwent anthropometry measurement and a fasting blood glucose or 2-h oral glucose tolerance test. RESULTS: The total prevalence of diabetes was 8.5%, but was higher in Belize (12.9%) and lower in Honduras (5.4%). Of the screened population, 18.6% had impaired glucose tolerance/impaired fasting glucose. CONCLUSIONS: As this population ages, the prevalence of diabetes is likely to continue to rise in a dramatic and devastating manner. Preventive strategies must be quickly introduced. |
Prevalence of diagnosed arthritis and arthritis-attributable activity limitation among adults with and without diagnosed diabetes: United States, 2008-2010
Cheng YJ , Imperatore G , Caspersen CJ , Gregg EW , Albright AL , Helmick CG . Diabetes Care 2012 35 (8) 1686-91 OBJECTIVE: To estimate the prevalence of diagnosed arthritis among U.S. adults and the proportion of arthritis-attributable activity limitation (AAAL) among those with arthritis by diagnosed diabetes mellitus (DM) status. RESEARCH DESIGN AND METHODS: We estimated prevalences and their ratios using 2008-2010 U.S. National Health Interview Survey of noninstitutionalized U.S. adults aged ≥18 years. Respondents' arthritis and DM status were both based on whether they reported a diagnosis of these diseases. Other characteristics used for stratification or adjustment included age, sex, race/ethnicity, education level, BMI, and physical activity level. RESULTS: Among adults with DM, the unadjusted prevalences of arthritis and proportion of AAAL among adults with arthritis (national estimated cases in parentheses) were 48.1% (9.6 million) and 55.0% (5.3 million), respectively. After adjusting for other characteristics, the prevalence ratio of arthritis and of AAAL among arthritic adults with versus without DM (95% CI) were: 1.44 (1.35-1.52) and 1.21 (1.15-1.28), respectively. The prevalence of arthritis increased with age and BMI and was higher for women, non-Hispanic whites, and inactive adults compared with their counterparts both among adults with- and without DM (all P values < 0.05). Among adults with diagnosed DM and arthritis, the proportion of AAAL was associated with being obese, but was not significantly associated with age, sex, and race/ethnicity. CONCLUSION: Among U.S. adults with diagnosed DM, nearly half also have diagnosed arthritis; moreover, more than half of those with both diseases had AAAL. Arthritis can be a barrier to physical activity among adults with diagnosed DM. |
Health status of adolescent and young adult cancer survivors
Tai E , Buchanan N , Townsend J , Fairley T , Moore A , Richardson LC . Cancer 2012 118 (19) 4884-91 BACKGROUND: Adolescents and young adults (AYA) ages 15 to 29 years who are diagnosed with cancer are at risk for long-term morbidity and mortality associated with treatment of their cancer and the cancer itself. In this article, the authors describe the self-reported health status of AYA cancer survivors. METHODS: The authors examined 2009 data from the Behavioral Risk Factor Surveillance System, including demographic characteristics, risk behaviors, chronic conditions, health status, and health care access, among AYA cancer survivors compared with respondents who had no history of cancer. RESULTS: The authors identified 4054 AYA cancer survivors and 345,592 respondents who had no history of cancer. AYA cancer survivors, compared with respondents who had no history of cancer, reported a significantly higher prevalence of current smoking (26% vs 18%); obesity (31% vs 27%); chronic conditions, including cardiovascular disease (14% vs 7%), hypertension (35% vs 29%), asthma (15% vs 8%), disability (36% vs 18%), and poor mental health (20% vs 10%) and physical health (24% vs 10%); and not receiving medical care because of cost (24% vs 15%). CONCLUSIONS: AYA cancer survivors commonly reported adverse behavioral, medical, and health care access characteristics that may lead to poor long-term medical and psychosocial outcomes. Increased adherence to established follow-up guidelines may lead to improved health among AYA cancer survivors. (Cancer 2012. (c) 2012 American Cancer Society.) |
The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS
Herman WH , Edelstein SL , Ratner RE , Montez MG , Ackermann RT , Orchard TJ , Foulkes MA , Zhang P , Saudek CD , Brown MB . Diabetes Care 2012 35 (4) 723-30 OBJECTIVE: The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions. RESEARCH DESIGN AND METHODS: Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. RESULTS: Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs. $27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo. CONCLUSIONS: Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent. |
Pandemic influenza A in residential summer camps-Maine, 2009
Robinson S , Averhoff F , Kiel J , Blaisdell L , Haber M , Sites A , Copeland D . Pediatr Infect Dis J 2012 31 (6) 547-50 OBJECTIVE: The aim of this study was to evaluate the preparedness for and response of Maine summer camps to the 2009 pandemic influenza H1N1 (pH1N1). METHODS: We conducted a retrospective web-based survey of the Maine Youth Camping Foundation members at the end of the 2009 camping season. The outcome measures were responses to the pandemic including educational efforts, isolation practices and antiviral usages as well as percentage of influenza-like illness (ILI) and laboratory-confirmed influenza outbreaks among Maine residential summer camps. RESULTS: Of 107 residential camps queried, 91 (85%) responded. Although 43 (47%) of 91 camps reported cases of ILI, and 19 (21%) had outbreaks (ie, 3 or more confirmed cases of pH1N1), no respondents reported closing camps or canceling sessions. Most camps reported that they communicated with campers' families about pH1N1 and implemented control measures, including educating campers and staff about symptoms, isolating ill campers and staff, encouraging increased hand washing and hygiene practices and increasing the availability of hand sanitizers. Of the 43 camps with cases of ILI or laboratory-confirmed pH1N1, 25 (58%) used antiviral medication for treatment, and 18 (42%) used antiviral medications for prophylaxis; antiviral practices varied among camps. CONCLUSIONS: Summer camps in Maine were in general well prepared for pH1N1. Most camps followed public health guidance and implemented preventive measures. Many camps experienced ILI and outbreaks during the season, but did not report major disruptions. Camps should review their preparedness and disease control plans annually and public health authorities should keep guidance and recommendations simple and consistent. |
Preventing AIDS deaths: cryptococcal antigen screening and treatment
Klausner JD , Govender N , Oladoyinbo S , Roy M , Chiller T . Lancet Infect Dis 2012 12 (6) 431-2 We applaud the study by Rosalind Parkes-Ratanshi and colleagues,1 which showed the development of cryptococcal disease among patients with HIV/AIDS who were initially cryptococcal antigen (CrAg) negative, and the benefit of primary fluconazole prophylaxis in this population. Our group and others in South Africa have supported efforts to increase screening and treatment of severely immunocompromised HIV-infected people for CrAg by reflexive testing with a new rapid and simple US Food and Drug Administration cleared lateral flow assay (LFA) among patients with a CD4 count of less than 100 cells per μL.2, 3 In our opinion, the additional benefit of prophylaxis in those who screen CrAg negative might not be cost effective, given the large number of patients who will need to be prophylactically treated. We encourage public-health officials to consider that a CrAg screening and treatment programme alone, without an additional prophylaxis component, might be sufficient to substantially reduce cryptococcal-related morbidity and mortality. | In the study by Parkes-Ratanshi and colleagues,1 18 of 759 patients in the placebo group compared with one of 760 in the treatment group developed cryptococcal disease a mean of 7 weeks after testing CrAg negative; most were awaiting antiretroviral therapy. We suggest two actions to reduce this somewhat high incidence before adding a prophylaxis programme to already-strained public-health systems. |
Francisella novicida bacteremia after a near-drowning accident
Brett M , Doppalapudi A , Respicio-Kingry LB , Myers D , Husband B , Pollard K , Mead P , Petersen JM , Whitener CJ . J Clin Microbiol 2012 50 (8) 2826-9 We describe a rare case of Francisella novicida bacteremia following a near-drowning event in seawater. We highlight the challenges associated with laboratory identification of F. novicida and differences in the epidemiology of F. novicida and F. tularensis infections. |
HIV infection among men who have sex with men in Kampala, Uganda-a respondent driven sampling survey
Hladik W , Barker J , Ssenkusu JM , Opio A , Tappero JW , Hakim A , Serwadda D . PLoS One 2012 7 (5) e38143 BACKGROUND: Uganda's generalized HIV epidemic is well described, including an estimated adult male HIV prevalence in Kampala of 4.5%, but no data are available on the prevalence of and risk factors for HIV infection among men who have sex with men (MSM). METHODOLOGY/PRINCIPAL FINDINGS: From May 2008 to February 2009, we used respondent-driven sampling to recruit MSM ≥18 years old in Kampala who reported anal sex with another man in the previous three months. We collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. Laboratory testing included biomarkers for HIV and other sexually transmitted infections. We obtained population estimates adjusted for the non-random sampling frame using RDSAT and STATA. 300 MSM were surveyed over 11 waves; median age was 25 years (interquartile range, 21-29 years). Overall HIV prevalence was 13.7% (95% confidence interval [CI] 7.9%-20.1%), and was higher among MSM ≥25 years (22.4%) than among MSM aged 18-24 years (3.9%, odds ratio [OR] 5.69, 95% CI 2.02-16.02). In multivariate analysis, MSM ≥25 years (adjusted OR [aOR] 4.32, 95% CI 1.33-13.98) and those reporting ever having been exposed to homophobic abuse (verbal, moral, sexual, or physical abuse; aOR 5.38, 95% CI 1.95-14.79) were significantly more likely to be HIV infected. CONCLUSIONS/SIGNIFICANCE: MSM in Kampala are at substantially higher risk for HIV than the general adult male population. MSM reporting a lifetime history of homophobic abuse are at increased risk of being HIV infected. Legal challenges and stigma must be overcome to provide access to tailored HIV prevention and care services. |
CD4, viral load response and adherence among antiretroviral-naive breastfeeding women receiving triple antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV in Kisumu, Kenya
Okonji JA , Zeh C , Weidle PJ , Williamson J , Akoth B , Masaba R , Fowler MG , Thomas TK . J Acquir Immune Defic Syndr 2012 61 (2) 249-57 BACKGROUND: Health benefits and survival of an exclusively breastfed infant is dependent on the mother's health; thus the need for antiretroviral (ARV) intervention for PMTCT. Achieving maternal health benefits from these regimens requires adherence to the treatments and close monitoring. We evaluated virologic, immunologic responses and adherence among women receiving maternal triple antiretroviral prophylaxis consisting of lamivudine/zidovudine and nevirapine or nelfinavir in the Kisumu Breastfeeding Study. METHODS: We analyzed baseline demographic data, trends in CD4+ count and viral load (VL) at enrollment (32-34 weeks gestation), delivery, 14 and 24 weeks postpartum among 434 women who remained in the study at 24 weeks postpartum. Adherence rates were determined using pill counts reinforced by self-report and drug calendar. We dichotomized adherence as ≥95% versus <95%. RESULTS: Among the 434 women, 84% (n=366) had adherence ≥95%. Women with undetectable VL (<400 copies/ml) increased from 6% at baseline to 79% and women with CD4+ count <250cells/mcL decreased from 23% (100) at baseline to 5% (22) at 24 weeks postpartum. In discrete-survival model, time to achieving VL suppression was associated with baseline VL <5.0 log copies/ml, parity ≥2, and use of nelfinavir versus nevirapine-based ARV. Association between undetectable VL with duration of therapy (p<0.0001); and adherence with suppression of VL (p=0.001) was observed. CONCLUSIONS: High baseline VL and short exposure to ARVs for PMTCT are risk factors for failing to achieve undetectable VL. These findings support the new WHO guidelines for early initiation of ARV prophylaxis for PMTCT for maximal reduction of maternal VL. |
Genomic characterization of seven distinct bat coronaviruses in Kenya
Tao Y , Tang K , Shi M , Conrardy C , Li KS , Lau SK , Anderson LJ , Tong S . Virus Res 2012 167 (1) 67-73 To better understand the genetic diversity and genomic features of 41 coronaviruses (CoVs) identified from Kenya bats in 2006, seven CoVs as representatives of seven different phylogenetic groups identified from partial polymerase gene sequences, were subjected to extensive genomic sequencing. As a result, 15-16kb nucleotide sequences encoding complete RNA dependent RNA polymerase, spike, envelope, membrane, and nucleocapsid proteins plus other open reading frames (ORFs) were generated. Sequences analysis confirmed that the CoVs from Kenya bats are divergent members of Alphacoronavirus and Betacoronavirus genera. Furthermore, the CoVs BtKY22, BtKY41, and BtKY43 in Alphacoronavirus genus and BtKY24 in Betacoronavirus genus are likely representatives of 4 novel CoV species. BtKY27 and BtKY33 are members of the established bat CoV species in Alphacoronavirus genus and BtKY06 is a member of the established bat CoV species in Betacoronavirus genus. The genome organization of these seven CoVs is similar to other known CoVs from the same groups except for differences in the number of putative ORFs following the N gene. The present results confirm a significant diversity of CoVs circulating in Kenya bats. These Kenya bat CoVs are phylogenetically distant from any previously described human and animal CoVs. However, because of the examples of host switching among CoVs after relatively minor sequence changes in S1 domain of spike protein, a further surveillance in animal reservoirs and understanding the interface between host susceptibility is critical for predicting and preventing the potential threat of bat CoVs to public health. |
Detection of a novel spotted fever group Rickettsia in the gophertortoise tick
Zemtsova GE , Gleim E , Yabsley MJ , Conner LM , Mann T , Brown MD , Wendland L , Levin ML . J Med Entomol 2012 49 (3) 783-6 The gophertortoise tick, Amblyomma tuberculatum (Marx), is distributed throughout the southeastern United States, and its immature life stages have been reported to occasionally bite humans. Here we report detection of a novel spotted fever group (SFG) Rickettsia in A. tuberculatum ticks collected in the southern United States. Among questing ticks collected in Georgia, 10 pools of larvae were identified as gophertortoise ticks, A. tuberculatum. Each of these samples was positive for SFG Rickettsiae. The restriction fragment-length polymorphism profiles were identical to each other, but distinct from those of other rickettsiae previously found in Amblyomma spp. ticks. Partial genetic characterization of the novel agent was achieved by sequencing the 17 kDa, gltA, ompB, ompA, rpoB, and sca4 genes. Analysis of a concatenated tree of four genes (gltA, ompB, ompA, and sca4) demonstrates close relatedness of the detected Rickettsia to several SFG Rickettsia spp. The identical rickettsial DNA was detected in 50 and 70% of adult A. tuberculatum ticks from Mississippi and Florida, respectively. The results indicate wide distribution of a novel Rickettsia, capability for transovarial transmission, and high prevalence in tested tick populations. |
Presence, genetic variability, and potential significance of "Candidatus Midichloria mitochondrii" in the lone star tick Amblyomma americanum.
Williams-Newkirk AJ , Rowe LA , Mixson-Hayden TR , Dasch GA . Exp Appl Acarol 2012 58 (3) 291-300 We used next generation sequencing to detect the bacterium "Candidatus Midichloria mitochondrii" for the first time in lone star ticks (Amblyomma americanum) from the eastern United States. 177 individuals and 11 tick pools from seven sites in four states were tested by pyrosequencing with barcoded 16S rRNA gene eubacterial primers targeting variable regions 5-3. Average infection prevalence was 0.15 across all surveyed populations (range 0-0.29) and only the site with the smallest sample size (n = 5) was negative. Three genotypes differing by 2.6-4.1 % in a 271 bp region of 16S rRNA gene were identified. Two variants co-occurred in sites in North Carolina and New York, but were not observed in the same tick at those sites. The third genotype was found only in Georgia. Phylogenetic analysis of this fragment indicated that the three variants are more closely related to "Candidatus Midichloria mitochondrii" genotypes from other tick species than to each other. This variation suggests that multiple independent introductions occurred in A. americanum which may provide insight into bacterial spread within its ecosystem and parasitism on this tick. Whether the presence of this bacterium affects acquisition or maintenance of other pathogens and symbionts in A. americanum or the survival, biology and evolution of the tick itself is unknown. |
Vector competence of Culex restuans (Diptera: Culicidae) from two regions of Chicago with low and high prevalence of West Nile virus human infections
Mutebi JP , Swope BN , Doyle MS , Biggerstaff BJ . J Med Entomol 2012 49 (3) 678-86 Vector competence studies for West Nile virus (WNV) were conducted for two Culex (Culex) restuans Theobald populations Edison Park (EP) and Illinois Medical District (IMD), in Chicago, IL. The aim was to determine if there were differences between mosquito populations that contributed to the observed differences in the prevalence of WNV. Percentages of orally infected, disseminated, and transmitting mosquitoes were estimated using a generalized linear mixed effects model including a random effect for family to account for anticipated within-family correlation. Analysis indicated that percentages of infected, disseminated, and transmitting mosquitoes were not significantly different between EP and IMD. The within-family correlation was 0.46 (95% CI 0.28, 0.67), indicating reasonably strong tendency for WNV titers of bodies, saliva, and legs within families to be similar. Overall, our results show that vector competence of Cx. restuans for WNV is not a contributing factor to the observed differences in WNV human cases between the EP and IMD areas of Chicago. |
Interactions among symbionts of Oropsylla spp. (Siphonoptera: Ceratophyllidae)
Jones RT , Bernhardt SA , Martin AP , Gage KL . J Med Entomol 2012 49 (3) 492-6 We used high-throughput DNA sequencing to explore bacterial communities of three species of Oropyslla fleas [Oropsylla hirsuta (Baker), Oropsylla montana (Baker), and Oropsylla tuberculata cynomuris (Jellison)] and detected seven bacterial lineages related to known insect symbionts. No significant co-occurrence patterns were detected among bacterial lineages, but relative abundance data suggest that the two most common lineages (Bartonella and Rickettsiales) interact negatively. Furthermore, presence of these two lineages significantly reduced bacterial diversity within fleas. |
Type and toxicity of pesticides sold for community vector control use in the Gambia
Murphy MW , Sanderson WT , Birch ME , Liang F , Sanyang E , Canteh M , Cook TM , Murphy SC . Epidemiol Res Int 2012 2012 1-6 OBJECTIVES: The objective of this study was to identify the types of pesticides in circulation at local markets in The Gambia and to determine the proportion of products that were sold as unlabeled pesticides. METHODS: One hundred twenty-eight samples sold as pesticides were collected from four local markets throughout The Gambia. Pesticides in the samples were identified by gas chromatography with mass spectrometry (GC/MS). FINDINGS: Of the 128 samples collected, 115 were unlabeled. Pesticide components in 111 of those unlabeled samples were identified. Approximately 28% of these samples that contained pesticides are banned or restricted in the United States, and about 16% was classified as hazardous by WHO. CONCLUSIONS: Based on results for 128 samples, a significant percentage of the pesticide products sold at local markets in The Gambia in 2005 are considered extremely hazardous. |
Use of surveillance data to estimate the effectiveness of the 7-valent conjugate pneumococcal vaccine in children less than 5 years of age over a 9 year period
De Serres G , Pilishvili T , Link-Gelles R , Reingold A , Gershman K , Petit S , Farley MM , Harrison LH , Lynfield R , Bennett NM , Baumbach J , Thomas A , Schaffner W , Beall B , Whitney C , Moore M . Vaccine 2012 30 (27) 4067-72 BACKGROUND: Case-control studies evaluating post-licensure effectiveness of conjugate vaccines can be laborious and costly. We applied an indirect cohort method to evaluate the effectiveness of seven-valent pneumococcal conjugate vaccine (PCV7) against invasive pneumococcal disease (IPD) and compared the results to the effectiveness measured using a standard case-control study conducted during the same time period. METHODS: IPD cases among children 2-59 months old were identified through the Active Bacterial Core surveillance system during 2001-2009. We used logistic regression to calculate the odds ratio of vaccination (versus no vaccination) among cases (PCV7-type IPD cases) and non-cases (non-PCV7-type IPD cases), controlling for the presence of underlying conditions. Vaccine effectiveness (VE) was calculated as one minus the adjusted odds ratio. RESULTS: Among 4225 IPD cases reported during 2001-2009, 2680 (63%) had serotype information and vaccine history. Effectiveness of ≥1 dose of PCV7 against PCV7-types was 88% (95% confidence interval (CI) 78-94%) among children with comorbid conditions and 97% (95% CI 92-98%) among healthy children. Among healthy children, VE was higher in 2001-2003 (97%, 95% CI 95-98%) compared to 2004-2009 (81%, 95% CI 64-90%). The annual estimates of VE in 2004-2009 showed great variability and wide confidence intervals due to the small number of PCV7-type cases. CONCLUSIONS: An indirect cohort design using IPD surveillance data confirms the findings of the case-control study and, therefore, appears suitable for estimating PCV7effectiveness. This method would be most useful shortly after vaccine introduction, and less useful in a setting of very high vaccine coverage and fewer vaccine-type cases. |
Innovative quality-assurance strategies for tuberculosis surveillance in the United States
Manangan LP , Tryon C , Magee E , Miramontes R . Tuberc Res Treat 2012 2012 481230 INTRODUCTION: The Centers for Disease Control and Prevention (CDC)'s National Tuberculosis Surveillance System (NTSS) is the national repository of tuberculosis (TB) data in the United States. Jurisdictions report to NTSS through the Report of Verified Case of Tuberculosis (RVCT) form that transitioned to a web-based system in 2009. MATERIALS AND METHODS: To improve RVCT data quality, CDC conducted a quality assurance (QA) needs assessment to develop QA strategies. These include QA components (case detection, data accuracy, completeness, timeliness, data security, and confidentiality); sample tools such as National TB Indicators Project (NTIP) to identify TB case reporting discrepancies; comprehensive training course; resource guide and toolkit. RESULTS AND DISCUSSION: During July-September 2011, 73 staff from 34 (57%) of 60 reporting jurisdictions participated in QA training. Participants stated usefulness of sharing jurisdictions' QA methods; 66 (93%) wrote that the QA tools will be effective for their activities. Several jurisdictions reported implementation of QA tools pertinent to their programs. Data showed >8% increase in NTSS and NTIP enrollment through Secure Access Management Services, which monitors system usage, from August 2011-February 2012. CONCLUSIONS: Despite challenges imposed by web-based surveillance systems, QA strategies can be developed with innovation and collaboration. These strategies can also be used by other disease programs to ensure high data quality. |
Clusters of sudden unexplained death associated with the mushroom, Trogia venenata, in rural Yunnan Province, China
Shi GQ , Huang WL , Zhang J , Zhao H , Shen T , Fontaine RE , Yang L , Zhao S , Lu BL , Wang YB , Ma L , Li ZX , Gao Y , Yang ZL , Zeng G . PLoS One 2012 7 (5) e35894 INTRODUCTION: Since the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006-2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms. METHODS: We established surveillance for SUD, defined as follows: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease. RESULTS: We identified 33 SUD, a 73% decline from 2002-2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata-exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test). DISCUSSION: Epidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue. |
Influence of HLA-DRB1 and HLA-DQB1 alleles on IgG antibody response to the P. vivax MSP-1, MSP-3a and MSP-9 in individuals from Brazilian endemic area.
Lima-Junior JC , Rodrigues-da-Silva RN , Banic DM , Jiang J , Singh B , Fabricio-Silva GM , Porto LC , Meyer EV , Moreno A , Rodrigues MM , Barnwell JW , Galinski MR , de Oliveira-Ferreira J . PLoS One 2012 7 (5) e36419 BACKGROUND: The antibody response generated during malaria infections is of particular interest, since the production of specific IgG antibodies is required for acquisition of clinical immunity. However, variations in antibody responses could result from genetic polymorphism of the HLA class II genes. Given the increasing focus on the development of subunit vaccines, studies of the influence of class II alleles on the immune response in ethnically diverse populations is important, prior to the implementation of vaccine trials. METHODS AND FINDINGS: In this study, we evaluated the influence of HLA-DRB1* and -DQB1* allelic groups on the naturally acquired humoral response from Brazilian Amazon individuals (n = 276) against P. vivax Merozoite Surface Protein-1 (MSP-1), MSP-3alpha and MSP-9 recombinant proteins. Our results provide information concerning these three P. vivax antigens, relevant for their role as immunogenic surface proteins and vaccine candidates. Firstly, the studied population was heterogeneous presenting 13 HLA-DRB1* and 5 DQB1* allelic groups with a higher frequency of HLA-DRB1*04 and HLA-DQB1*03. The proteins studied were broadly immunogenic in a naturally exposed population with high frequency of IgG antibodies against PvMSP1-19 (86.7%), PvMSP-3 (77%) and PvMSP-9 (76%). Moreover, HLA-DRB1*04 and HLA-DQB1*03 alleles were associated with a higher frequency of IgG immune responses against five out of nine antigens tested, while HLA-DRB1*01 was associated with a high frequency of non-responders to repetitive regions of PvMSP-9, and the DRB1*16 allelic group with the low frequency of responders to PvMSP3 full length recombinant protein. CONCLUSIONS: HLA-DRB1*04 alleles were associated with high frequency of antibody responses to five out of nine recombinant proteins tested in Rondonia State, Brazil. These features could increase the success rate of future clinical trials based on these vaccine candidates. |
"It is good for my family's health and cooks food in a way that my heart loves": qualitative findings and implications for scaling up an improved cookstove project in rural Kenya
Person B , Loo JD , Owuor M , Ogange L , Jefferds MED , Cohen AL . Int J Environ Res Public Health 2012 9 (5) 1566-1580 The use of indoor, three-stone fire pits in resource-poor countries is a substantial burden on human health and the environment. We conducted a pilot intervention promoting the purchase and use of an improved cookstove in rural Kenya. The goals of this qualitative inquiry were to understand the motivation to purchase and use; perceived benefits and challenges of cookstove use; and the most influential promotion activities for scaling up future cookstove promotion. Purposive sampling was used to recruit 10 cookstove promoters and 30 cookstove purchasers in the Luo community. Qualitative semi-structured interviews were transcribed and a thematic analysis conducted. Women reported the need for less firewood, fuel cost savings, reduced smoke, improved cooking efficiency, reduced eye irritation, lung congestion and coughing as major benefits of the cookstove. Cost appeared to be a barrier to wider adoption. The most persuasive promotion strategies were interpersonal communication through social networks and cooking demonstrations. Despite this cost barrier, many women still considered the improved cookstove to be a great asset within their household. This inquiry provided important guidance for future cookstove implementation projects. (2012 by the authors; licensee MDPI, Basel, Switzerland.) |
An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: a supplement of new case studies
Wright MO , Hebden JN , Allen-Bridson K , Morrell GC , Horan TC . Am J Infect Control 2012 40 S32-40 The rationale for the case study series is presented, along with results of the first 5 American Journal of Infection Control-National Healthcare Safety Network case studies. Although the respondents were correct in their assessments more often than not, opportunities for improvement remain. Ten new case studies with questions are provided. Participants are provided with instructions on how to submit responses for continuing education credit through the Centers for Disease Control and Prevention. Answers with referenced explanations will be provided immediately to those who seek continuing education credit and at a later date via the online journal for those who do not. |
Patterns in influenza antiviral medication use before and during the 2009 H1N1 pandemic, Vaccine Safety Datalink Project, 2000-2010
Greene SK , Shay DK , Yin R , McCarthy NL , Baxter R , Jackson ML , Jacobsen SJ , Nordin JD , Irving SA , Naleway AL , Glanz JM , Lieu TA . Influenza Other Respir Viruses 2012 6 (6) e143-51 BACKGROUND: U.S. recommendations for using influenza antiviral medications changed in response to viral resistance (to reduce adamantane use) and during the 2009 H1N1 pandemic (to focus on protecting high-risk patients). Little information is available on clinician adherence to these recommendations. We characterized population-based outpatient antiviral medication usage, including diagnosis and testing practices, before and during the pandemic. METHODS: Eight medical care organizations in the Vaccine Safety Datalink Project provided data on influenza antiviral medication dispensings from January 2000 through June 2010. Dispensing rates were explored in relation to changes in recommendations and influenza diagnosis and laboratory testing frequencies. Factors associated with oseltamivir dispensings in pandemic versus pre-pandemic periods were identified using multivariable logistic regression. RESULTS: Antiviral use changed coincident with recommendations to avoid adamantanes in 2006, to use alternatives to oseltamivir in 2008, and to use oseltamivir during the pandemic. Of 38,019 oseltamivir dispensings during the pandemic, 31% were to patients not assigned an influenza diagnosis, and 97% were to patients not tested for influenza. Oseltamivir was more likely to be dispensed in pandemic versus pre-pandemic periods to patients <25 years old and to those with underlying conditions, including chronic pulmonary disease or pregnancy (P < 0.0001 for each factor in multivariable analysis). CONCLUSIONS: Antiviral medication usage patterns suggest that clinicians followed recommendations to change antiviral prescribing based on resistance and to focus on high-risk patients during the pandemic. Medications were commonly dispensed to patients without influenza diagnoses and tests, suggesting that antiviral dispensings may offer useful supplemental data for monitoring influenza incidence. |
2009 pandemic influenza A vaccination of pregnant women-King County, Washington State, 2009-2010
Kay MK , Koelemay KG , Kwan-Gett TS , Cadwell BL , Duchin JS . Am J Public Health 2012 102 Suppl 3 S368-74 OBJECTIVES: Our objectives were to estimate 2009 pandemic influenza A (pH1N1) vaccination coverage among pregnant women and identify associated factors. METHODS: We distributed a multimodal survey to 5341 women who gave birth between November 1, 2009, and January 31, 2010, identified by hospitals in King County, Washington State, with maternity services (n = 11). RESULTS: Of 4205 respondents, 3233 (76.9%) reported that they had received pH1N1 vaccine during pregnancy or within 2 weeks after delivery. Women whose prenatal care provider recommended vaccine had a higher vaccination prevalence than women whose provider did not (81.5% vs 29.6%; adjusted prevalence ratio = 2.1; 95% confidence interval = 1.72, 2.58). Vaccination prevalence was lower among women who had received prenatal care from a midwife only compared with women who had received care from other providers (62.9% vs 78.8%; adjusted prevalence ratio = 0.89; 95% confidence interval = 0.83, 0.96). CONCLUSIONS: Among pregnant women in King County, pH1N1 vaccination coverage was high. To improve coverage during nonpandemic seasons, influenza vaccine should be recommended routinely by prenatal care providers and vaccination provided where prenatal care is received. Barriers to midwives providing vaccination recommendations to patients should be explored. |
Cost comparison of 2 mass vaccination campaigns against influenza A H1N1 in New York City
Kansagra SM , McGinty MD , Morgenthau BM , Marquez ML , Rosselli-Fraschilla A , Zucker JR , Farley TA . Am J Public Health 2012 102 (7) 1378-83 OBJECTIVES: We estimated and compared total costs and costs per dose administered for 2 influenza A 2009 monovalent vaccine campaigns in New York City: an elementary school-located campaign targeting enrolled children aged 4 years and older, and a community-based points-of-dispensing campaign for anyone aged 4 years and older. METHODS: We determined costs from invoices or we estimated costs. We obtained vaccination data from the Citywide Immunization Registry and reports from the community points of dispensing. RESULTS: The school campaign delivered approximately 202,089 vaccines for $17.9 million and $88 per dose. The community campaign delivered 49,986 vaccines for $7.6 million and $151 per dose. At projected capacity, the school campaign could have delivered 371,827 doses at $53 each or $13 each when we excluded the value of in-kind resources. The community points of dispensing could have administered 174,000 doses at $51 each or $24 each when we excluded the value of in-kind resources. CONCLUSIONS: The school campaign delivered vaccines at a lower cost per dose than did the community campaign. Had demand been higher, both campaigns may have delivered vaccine at lower, more comparable cost per dose. |
An empirical case study of a child sexual abuse prevention initiative in Georgia
Schober DJ , Fawcett SB , Thigpen S , Curtis A , Wright R . Health Educ J 2012 71 (3) 291-298 OBJECTIVE: This empirical case study describes Prevent Child Abuse Georgia's effort to prevent child sexual abuse (CSA) by educating communities throughout the state on supporting preventive behaviour. The initiative consisted of three major components: (1) dissemination of CSA prevention messages and materials; (2) a statewide helpline that helped callers respond to the warning signs of CSA and engage in protective behaviours; and (3) a statewide education and training programme. DESIGN: An empirical case study design was used. SETTING: This prevention initiative took place across the state of Georgia. METHOD: Archival records kept by Prevent Child Abuse Georgia were reviewed to determine the outputs of this statewide effort. Additionally, the annual incidence of child sexual abuse substantiated by the Georgia Department of Human Resources (cases per 100,000 children < 18 years of age) was calculated to examine changes in the broader context of Prevent Child Abuse Georgia's statewide CSA prevention effort (from 1997-2007). RESULTS: Results show that Prevent Child Abuse Georgia provided 232,822 informational materials to Georgia residents, assisted 1,271 helpline callers to support responses to the warning signs of CSA, and trained 7,700 individuals. According to records from the Georgia Department of Human Services, from 2002-7, the incidence of child sexual abuse decreased four of the five years of the implementation period. CONCLUSION: This empirical case study describes the steps a statewide effort can take to promote the primary prevention of CSA. Prevent Child Abuse Georgia engaged in a variety of activities to educate the public, increase CSA prevention knowledge, and promote preventive behaviour. (The Author(s) 2011.) |
Improved analysis of C26:0-lysophosphatidylcholine in dried-blood spots via negative ion mode HPLC-ESI-MS/MS for X-linked adrenoleukodystrophy newborn screening.
Haynes CA , De Jesus VR . Clin Chim Acta 2012 413 1217-21 BACKGROUND: X-linked adrenoleukodystrophy (X-ALD) is the most common human peroxisomal disorder, and is caused by mutations in the peroxisomal transmembrane ALD protein (ALDP, ABCD1). The biochemical defect associated with X-ALD is an accumulation of very long-chain fatty acids (VLCFA, e.g. C24:0 and C26:0), which has been shown to result in the accumulation of C26:0-lysophosphatidylcholine (C26:0-LPC). METHODS: We describe the analysis of C26:0-LPC in dried-blood spots (DBS) using a rapid (30min) and simple extraction procedure, isocratic HPLC resolution of LPC, and structure-specific analysis via negative ion mode tandem mass spectrometry. RESULTS: In putative normal DBS specimens from newborns (N=223) C26:0-LPC was 0.09+/-0.03mcmol/l whole blood, while in peroxisomal biogenesis disorder (including X-ALD) patients (N=28) C26:0-LPC was 1.13+/-0.67mcmol/l whole blood. Both multiple reaction monitoring and a neutral loss scan (225.1Da) analysis of DBS were used to analyze LPC. CONCLUSIONS: Compared to a previous report of C26:0-LPC analysis in DBS, the method described here is simpler, faster, and more structure-specific for LPC with C26:0 acyl chains. |
Concurrent serotyping and genotyping of pneumococci by use of PCR and electrospray ionization mass spectrometry.
Massire C , Gertz RE Jr , Svoboda P , Levert K , Reed MS , Pohl J , Kreft R , Li F , White N , Ranken R , Blyn LB , Ecker DJ , Sampath R , Beall B . J Clin Microbiol 2012 50 (6) 2018-25 A pneumococcal serotyping/genotyping system (PSGS) was developed based upon targeted PCR, followed by electrospray ionization mass spectrometry and amplicon base composition analysis. Eight multiplex PCRs, 32 targeting serotype-determining capsular biosynthetic loci, and 8 targeting multilocus sequence typing (MLST) loci were employed for each of 229 highly diverse Streptococcus pneumoniae isolates. The most powerful aspect of the PSGS system was the identification of capsular serotypes accounting for the majority of invasive and carried pneumococcal strains. Altogether, 45 different serotypes or serogroups were correctly predicted among the 196 resolvable isolates, with only 2 unexpected negative results. All 33 isolates that represented 23 serotypes not included in the PSGS yielded negative serotyping results. A genotyping database was constructed using the base compositions of 65- to 100-bp sections of MLST alleles compiled within http://www.mlst.net. From this database, one or more MLST sequence types (STs) that comprised a PSGS genotype were identified. The end result of more PSGS genotypes (163) than conventional STs actually tested (155) was primarily due to amplification failures of 1 to 3 targets. In many instances, the PSGS genotype could provide resolution of single- and double-locus variants. This molecular serotyping/genotyping scheme is well suited to rapid characterization of large sets of pneumococcal isolates. |
Ultrafiltration improves ELISA and Endopep MS analysis of botulinum neurotoxin type A in drinking water
Raphael BH , Lautenschlager M , Kahler A , Pai S , Parks BA , Kalb SR , Maslanka SE , Shah S , Magnuson M , Hill V . J Microbiol Methods 2012 90 (3) 267-72 The objective of this study was to adapt and evaluate two in vitro botulinum neurotoxin (BoNT) detection methods, including the Botulinum Toxin ELISA and the Endopep MS (a mass spectrometric-based endopeptidase method), for use with drinking water samples. The method detection limits (MDL) of the ELISA and Endopep MS were 260pg/mL and 21pg/mL of BoNT/A complex toxin, respectively. Since toxin could be present in water samples at highly dilute concentrations, large volume (100-L) samples of municipal tap water from five US municipalities having distinct water compositions were dechlorinated, spiked with 5mcg BoNT/A, and subjected to tangential-flow ultrafiltration (UF) using hollow fiber dialyzers. The recovery efficiency of BoNT/A using UF and quantified by ELISA ranged from 11% to 36% while efficiencies quantified by MS ranged from 26% to 55%. BoNT/A was shown to be stable in dechlorinated municipal tap water stored at 4 degrees C for up to four weeks. In addition, toxin present in UF-concentrated water samples was also shown to be stable at 4 degrees C for up to four weeks, allowing holding of samples prior to analysis. Finally, UF was used to concentrate a level of toxin (7pg/mL) which is below the MDL for direct analysis by both ELISA and Endopep MS. Following UF, toxin was detectable in these samples using both in vitro analysis methods. These data demonstrate that UF-concentration of toxin from large volume water samples followed by use of existing analytical methods for detection of BoNT/A can be used in support of a monitoring program for contaminants in drinking water. |
Wild-type MIC distributions and epidemiological cutoff values for amphotericin B, flucytosine, and itraconazole and Candida spp. as determined by CLSI broth microdilution
Pfaller MA , Espinel-Ingroff A , Canton E , Castanheira M , Cuenca-Estrella M , Diekema DJ , Fothergill A , Fuller J , Ghannoum M , Jones RN , Lockhart SR , Martin-Mazuelos E , Melhem MS , Ostrosky-Zeichner L , Pappas P , Pelaez T , Peman J , Rex J , Szeszs MW . J Clin Microbiol 2012 50 (6) 2040-6 Clinical breakpoints (CBPs) and epidemiological cutoff values (ECVs) have been established for several Candida spp. and the newer triazoles and echinocandins but are not yet available for older antifungal agents, such as amphotericin B, flucytosine, or itraconazole. We determined species-specific ECVs for amphotericin B (AMB), flucytosine (FC) and itraconazole (ITR) for eight Candida spp. (30,221 strains) using isolates from 16 different laboratories in Brazil, Canada, Europe, and the United States, all tested by the CLSI reference microdilution method. The calculated 24- and 48-h ECVs expressed in mcg/ml (and the percentages of isolates that had MICs less than or equal to the ECV) for AMB, FC, and ITR, respectively, were 2 (99.8)/2 (99.2), 0.5 (94.2)/1 (91.4), and 0.12 (95.0)/0.12 (92.9) for C. albicans; 2 (99.6)/2 (98.7), 0.5 (98.0)/0.5 (97.5), and 2 (95.2)/4 (93.5) for C. glabrata; 2 (99.7)/2 (97.3), 0.5 (98.7)/0.5 (97.8), and 05. (99.7)/0.5 (98.5) for C. parapsilosis; 2 (99.8)/2 (99.2), 0.5 (93.0)/1 (90.5), and 0.5 (97.8)/0.5 (93.9) for C. tropicalis; 2 (99.3)/4 (100.0), 32 (99.4)/32 (99.3), and 1 (99.0)/2 (100.0) for C. krusei; 2 (100.0)/4 (100.0), 0.5 (95.3)/1 (92.9), and 0.5 (95.8)/0.5 (98.1) for C. lusitaniae; -/2 (100.0), 0.5 (98.8)/0.5 (97.7), and 0.25 (97.6)/0.25 (96.9) for C. dubliniensis; and 2 (100.0)/2 (100.0), 1 (92.7)/-, and 1 (100.0)/2 (100.0) for C. guilliermondii. In the absence of species-specific CBP values, these wild-type (WT) MIC distributions and ECVs will be useful for monitoring the emergence of reduced susceptibility to these well-established antifungal agents. |
Measurement of ambient particulate matter concentrations and particle types near agricultural burns using electron microscopy and passive samplers
Wagner J , Naik-Patel K , Wall S , Harnly M . Atmos Environ (1994) 2012 54 260-271 Computer-controlled scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to obtain ambient PM mass concentrations, elemental size distributions, morphologies, and particle types during four Bermuda grass burn events in Imperial Valley, California. Passive PM samplers were deployed to three to six locations surrounding each burn for durations of 24-120 h. Average PM(2.5) and PM(10) levels were modestly but significantly higher at locations less than 3.2 km (two miles) from the nearest burn (n = 37). During one monitored burn, higher winds caused an intense ground-level plume to envelop two samplers mounted on telephone poles very close to the field. For this event, 24-h PM(2.5) exposures downwind were up to 17 times higher than that measured upwind. Particles were classified into five distinct chemical types consistent with local area sources. Burn-related particle types, primarily submicron carbonaceous particles, contributed 95% of the PM(2.5) in the location directly impacted by the ground-level plume, compared to only 12% in the upwind location. Downwind PM(10-2.5) particles were enriched in potassium, phosphorus, chlorine, calcium, silicon, and sulfur, consistent with analyses of bulk and partially-burned Bermuda grass. The accuracy and precision of passive sampler PM measurements were all within 4 mcg m(-3), though low median values caused high percent differences for PM(2.5). The use of electron microscopy and passive sampling in this study enabled detailed PM characterizations, spatial comparisons, and rapid deployment in often dynamic sampling scenarios. (2012 Elsevier Ltd.) |
Pulmonary exposure to single-walled carbon nanotubes does not affect the early immune response against Toxoplasma gondii
Swedin L , Arrhigi R , Andersson-Willman B , Murray A , Chen Y , Karlsson MC , Kumlen Georen S , Tkach AV , Shvedova AA , Fadeel B , Barragan A , Scheynius A . Part Fibre Toxicol 2012 9 (1) 16 BACKGROUND: Single-walled carbon nanotubes (SWCNT) trigger pronounced inflammation and fibrosis in the lungs of mice following administration via pharyngeal aspiration or inhalation. Human exposure to SWCNT in an occupational setting may occur in conjunction with infections and this could yield enhanced or suppressed responses to the offending agent. Here, we studied whether the sequential exposure to SWCNT via pharyngeal aspiration and infection of mice with the ubiquitous intracellular parasite Toxoplasma gondii would impact on the immune response of the host against the parasite. METHODS: C57BL/6 mice were pre-exposed by pharyngeal administration of SWCNT (80 + 80 mug/mouse) for two consecutive days followed by intravenous injection with either 1x103 or 1x104 green fluorescence protein and luciferase-expressing T. gondii tachyzoites. The dissemination of T. gondii was monitored by in vivo bioluminescence imaging in real time for 7 days and by plaque formation. The inflammatory response was analysed in bronchoalveolar lavage (BAL) fluid, and by assessment of morphological changes and immune responses in lung and spleen. RESULTS: There were no differences in parasite distribution between mice only inoculated with T. gondii or those mice pre-exposed for 2 days to SWCNT before parasite inoculum. Lung and spleen histology and inflammation markers in BAL fluid reflected the effects of SWCNT exposure and T. gondii injection, respectively. We also noted that CD11c positive dendritic cells but not F4/80 positive macrophages retained SWCNT in the lungs 9 days after pharyngeal aspiration. However, co-localization of T. gondii with CD11c or F4/80 positive cells could not be observed in lungs or spleen. Pre-exposure to SWCNT did not affect the splenocyte response to T. gondii. CONCLUSIONS: Taken together, our data indicate that pre-exposure to SWCNT does not enhance or suppress the early immune response to T. gondii in mice. |
Citrullination of proteins: a common post-translational modification pathway induced by different nanoparticles in vitro and in vivo
Mohamed BM , Verma NK , Davies AM , McGowan A , Staunton KC , Prina-Mello A , Kelleher D , Botting CH , Causey CP , Thompson PR , Pruijn GJ , Kisin ER , Tkach AV , Shvedova AA , Volkov Y . Nanomedicine (London) 2012 7 (8) 1181-95 AIM: Rapidly expanding manufacture and use of nanomaterials emphasize the requirements for thorough assessment of health outcomes associated with novel applications. Post-translational protein modifications catalyzed by Ca(2+)-dependent peptidylargininedeiminases have been shown to trigger immune responses including autoantibody generation, a hallmark of immune complexes deposition in rheumatoid arthritis. Therefore, the aim of the study was to assess if nanoparticles are able to promote protein citrullination. MATERIALS & METHODS: Human A549 and THP-1 cells were exposed to silicon dioxide, carbon black or single-walled carbon nanotubes. C57BL/6 mice were exposed to respirable single-walled carbon nanotubes. Protein citrullination, peptidylargininedeiminases activity and target proteins were evaluated. RESULTS: The studied nanoparticles induced protein citrullination both in cultured human cells and mouse lung tissues. Citrullination occurred via the peptidylargininedeiminase-dependent mechanism. Cytokeratines 7, 8, 18 and plectins were identified as intracellular citrullination targets. CONCLUSION: Nanoparticle exposure facilitated post-translational citrullination of proteins. Original submitted 18 March 2011; Revised submitted 10 Novemeber 2011. |
Development and validation of Burkholderia pseudomallei-specific real-time PCR assays for clinical, environmental or forensic detection applications
Price EP , Dale JL , Cook JM , Sarovich DS , Seymour ML , Ginther JL , Kaufman EL , Beckstrom-Sternberg SM , Mayo M , Kaestli M , Glass MB , Gee JE , Wuthiekanun V , Warner JM , Baker A , Foster JT , Tan P , Tuanyok A , Limmathurotsakul D , Peacock SJ , Currie BJ , Wagner DM , Keim P , Pearson T . PLoS One 2012 7 (5) e37723 The bacterium Burkholderia pseudomallei causes melioidosis, a rare but serious illness that can be fatal if untreated or misdiagnosed. Species-specific PCR assays provide a technically simple method for differentiating B. pseudomallei from near-neighbor species. However, substantial genetic diversity and high levels of recombination within this species reduce the likelihood that molecular signatures will differentiate all B. pseudomallei from other Burkholderiaceae. Currently available molecular assays for B. pseudomallei detection lack rigorous validation across large in silico datasets and isolate collections to test for specificity, and none have been subjected to stringent quality control criteria (accuracy, precision, selectivity, limit of quantitation (LoQ), limit of detection (LoD), linearity, ruggedness and robustness) to determine their suitability for environmental, clinical or forensic investigations. In this study, we developed two novel B. pseudomallei specific assays, 122018 and 266152, using a dual-probe approach to differentiate B. pseudomallei from B. thailandensis, B. oklahomensis and B. thailandensis-like species; other species failed to amplify. Species specificity was validated across a large DNA panel (>2,300 samples) comprising Burkholderia spp. and non-Burkholderia bacterial and fungal species of clinical and environmental relevance. Comparison of assay specificity to two previously published B. pseudomallei-specific assays, BurkDiff and TTS1, demonstrated comparable performance of all assays, providing between 99.7 and 100% specificity against our isolate panel. Last, we subjected 122018 and 266152 to rigorous quality control analyses, thus providing quantitative limits of assay performance. Using B. pseudomallei as a model, our study provides a framework for comprehensive quantitative validation of molecular assays and provides additional, highly validated B. pseudomallei assays for the scientific research community. |
Using maternally reported data to investigate the association between early childhood infection and autism spectrum disorder: the importance of data source
Atladottir HO , Henriksen TB , Schendel DE , Parner ET . Paediatr Perinat Epidemiol 2012 26 (4) 373-85 BACKGROUND: Childhood infections have been found to be associated with autism spectrum disorder (ASD) in previous studies using hospital data or medical records to identify infections. We aimed to replicate these findings using maternal reports of childhood infection. METHODS: We used the Danish National Birth Cohort consisting of 92,583 live singletons born from 1997 to 2003 in Denmark. ASD diagnoses were retrieved from the Danish Psychiatric Central Register, and a total of 945 children from the cohort were diagnosed with ASD. Data were analysed using Cox proportional hazards regression. We studied the association between ASD and maternal reports of infectious disease in the child from birth to 19 months. Furthermore, we performed secondary analyses using hospital registers to investigate the association between ASD and hospital contact in general as well as hospital contact for various infections. RESULTS: We did not find a general association between maternal reports of infectious illness and ASD. However, hospital contact for all causes was associated with an increased risk for an ASD diagnosis. Danish children with ASD do not appear to have a general pattern of illness from infection in early life, but do have more contact with medical specialists for infections and other indications compared with the general population. CONCULSION: Hospital data should be used cautiously when studying the co-morbidity of ASD; if the increased rate of hospital contact overall for children with ASD is not considered, then misleading interpretations might be made of observed associations between specific diseases and ASD. |
Evaluation of criteria for the detection of fires in underground conveyor belt haulageways
Litton CD , Perera IE . Fire Saf J 2012 51 110-119 Large-scale experiments were conducted in an above-ground gallery to simulate typical fires that develop along conveyor belt transport systems within underground coal mines. In the experiments, electrical strip heaters, imbedded ~5 cm below the top surface of a large mass of coal rubble, were used to ignite the coal, producing an open flame. The flaming coal mass subsequently ignited 1.83-m-wide conveyor belts located approximately 0.30 m above the coal surface. Gas samples were drawn through an averaging probe located approximately 20 m downstream of the coal for continuous measurement of CO, CO2, and O2 as the fire progressed through the stages of smoldering coal, flaming coal, and flaming conveyor belt. Also located approximately 20 m from the fire origin and approximately 0.5 m below the roof of the gallery were two commercially available smoke detectors, a light obscuration meter, and a sampling probe for measurement of total mass concentration of smoke particles. Located upstream of the fire origin and also along the wall of the gallery at approximately 14 m and 5 m upstream were two video cameras capable of both smoke and flame detection. During the experiments, alarm times of the smoke detectors and video cameras were measured while the smoke obscuration and total smoke mass were continually measured. Twelve large-scale experiments were conducted using three different types of fire-resistant conveyor belts and four air velocities for each belt. The air velocities spanned the range from 1.0 m/s to 6.9 m/s. The results of these experiments are compared to previous large-scale results obtained using a smaller fire gallery and much narrower (1.07-m) conveyor belts to determine if the fire detection criteria previously developed remained valid for the wider conveyor belts. Although some differences between these and the previous experiments did occur, the results, in general, compare very favorably. Differences are duly noted and their impact on fire detection discussed. |
Analyses of geological and hydrodynamic controls on methane emissions experienced in a Lower Kittanning coal mine
Karacan CÖ , Goodman GVR . Int J Coal Geol 2012 98 110-127 This paper presents a study assessing potential factors and migration paths of methane emissions experienced in a room-and-pillar mine in Lower Kittanning coal, Indiana County, Pennsylvania. Methane emissions were not excessive at idle mining areas, but significant methane was measured during coal mining and loading. Although methane concentrations in the mine did not exceed 1% limit during operation due to the presence of adequate dilution airflow, the source of methane and its migration into the mine was still a concern. In the course of this study, structural and depositional properties of the area were evaluated to assess complexity and sealing capacity of roof rocks. Composition, gas content, and permeability of Lower Kittanning coal, results of flotation tests, and geochemistry of groundwater obtained from observation boreholes were studied to understand the properties of coal and potential effects of old abandoned mines within the same area. These data were combined with the data obtained from exploration boreholes, such as depths, elevations, thicknesses, ash content, and heat value of coal. Univariate statistical and principal component analyses (PCA), as well as geostatistical simulations and co-simulations, were performed on various spatial attributes to reveal interrelationships and to establish area-wide distributions. These studies helped in analyzing groundwater quality and determining gas-in-place (GIP) of the Lower Kittanning seam. Furthermore, groundwater level and head on the Lower Kittanning coal were modeled and flow gradients within the study area were examined. Modeling results were interpreted with the structural geology of the Allegheny Group of formations above the Lower Kittanning coal to understand the potential source of gas and its migration paths. Analyses suggested that the source of methane was likely the overlying seams such as the Middle and Upper Kittanning coals and Freeport seams of the Allegheny Group. Simulated groundwater water elevations, gradients of groundwater flow, and the presence of recharge and discharge locations at very close proximity to the mine indicated that methane likely was carried with groundwater towards the mine entries. Existing fractures within the overlying strata and their orientation due to the geologic conditions of the area, and activation of slickensides between shale and sandstones due to differential compaction during mining, were interpreted as the potential flow paths. |
Design optimization of a portable thermophoretic precipitator nanoparticle sampler
Miller A , Marinos A , Wendel C , King G , Bugarski A . Aerosol Sci Technol 2012 46 (8) 897-904 Researchers at the National Institute for Occupational Safety and Health (NIOSH) are developing methods for characterizing diesel particulate matter in mines. Introduction of novel engine and exhaust after treatment technologies in underground mines is changing the nature of diesel emissions, and metrics alternative to the traditional mass-based measurements are being investigated with respect to their ability to capture changes in the properties of diesel aerosols. The emphasis is given to metrics based on measurement of number and surface area concentrations, but analysis of collected particles using electron microscopy (EM) is also employed for detailed particle characterization. To collect samples for EM analysis at remote workplaces, including mining and manufacturing facilities, NIOSH is developing portable particle samplers capable of collecting airborne nano-scale particles. This paper describes the design, construction, and testing of a prototype thermophoretic precipitator (TP) particle sampler optimized for collection of particles in the size range of 1-300 nm. The device comprises heated and cooled metal plates separated by a 0.8 mm channel through which aerosol is drawn by a pump. It weighs about 2 kg, has a total footprint of 27 x 22 cm, and the collection plate size is approximately 4 x 8 cm. Low power consumption and enhanced portability were achieved by using moderate flow rates (50-150 cm(3)/min) and temperature gradients (10-50 K/mm with Delta T between 8 K and 40 K). The collection efficiency of the prototype, measured with a condensation particle counter using laboratory-generated polydisperse submicrometer NaCl aerosols, ranged from 14-99%, depending on temperature gradient and flow rate. Analysis of transmission electron microscopy images of samples collected with the TP confirmed that the size distributions of collected particles determined using EM are in good agreement with those determined using a Fast Mobility Particle Sizer. |
Nutritional factors and hypospadias risks
Carmichael SL , Ma C , Feldkamp ML , Munger RG , Olney RS , Botto LD , Shaw GM , Correa A . Paediatr Perinat Epidemiol 2012 26 (4) 353-60 BACKGROUND: We examined whether hypospadias was associated with several aspects of the diet, including intake of animal products, intake of several nutrients and food groups related to a vegetarian diet and oestrogen metabolism, and diet quality. METHODS: The study included deliveries from 1997 to 2005 that were part of the National Birth Defects Prevention Study. Diet was assessed by food frequency questionnaire during maternal telephone interviews, and two diet quality indices were developed based on existing indices. Analyses included 1250 cases with second- or third-degree hypospadias (urethra opened at the penile shaft, scrotum or perineum) and 3118 male, liveborn, non-malformed controls. All odds ratios (OR) and 95% confidence intervals [CI] were estimated from logistic regression models that included several potential confounders, including energy intake. RESULTS: Intake of animal products was not associated with hypospadias; for example, the adjusted OR for any vs. no intake of meat was 1.0 [95% CI 0.6, 1.6]. Frequency of intake of meat or other animal products was also not associated with hypospadias, nor was intake of iron or several nutrients that are potentially related to oestrogen metabolism. Diet quality was also not associated with hypospadias; the OR for diet quality in the highest vs. lowest quartile for the two diet quality indices were 1.0 [95% CI 0.6, 1.6] and 0.9 [95% CI 0.7, 1.1]. CONCLUSION: This large study does not support an association of a vegetarian diet or worse diet quality with hypospadias. |
Estimation of trends in serum and RBC folate in the U.S. population from pre- to postfortification using assay-adjusted data from the NHANES 1988-2010
Pfeiffer CM , Hughes JP , Lacher DA , Bailey RL , Berry RJ , Zhang M , Yetley EA , Rader JI , Sempos CT , Johnson CL . J Nutr 2012 142 (5) 886-93 The NHANES has monitored folate status of the U.S. population from prefortification (1988-1994) to postfortification (1999-2010) by measuring serum and RBC folate concentrations. The Bio-Rad radioassay (BR) was used from 1988 to 2006, and the microbiologic assay (MBA) was used from 2007 to 2010. The MBA produces higher concentrations than the BR and is considered to be more accurate. Thus, to bridge assay differences and to examine folate trends over time, we adjusted the BR results to be comparable to the MBA results. Postfortification, assay-adjusted serum and RBC folate concentrations were 2.5 times and 1.5 times prefortification concentrations, respectively, and showed a significant linear trend (P < 0.001) to slightly lower concentrations during 1999-2010. The postfortification prevalence of low serum (<10 nmol/L) or RBC (<340 nmol/L) folate concentrations was ≤ 1%, regardless of demographic subgroup, compared with 24% for serum folate and 3.5% for RBC folate prefortification, with substantial variation among demographic subgroups. The central 95% reference intervals for serum and RBC folate varied by demographic subgroup during both pre- and postfortification periods. Age and dietary supplement use had the greatest effects on prevalence estimates of low folate concentrations during the prefortification period. In summary, the MBA-equivalent blood folate concentrations in the U.S. population showed first a sharp increase from pre- to postfortification, then showed a slight decrease (17% for serum and 12% for RBC folate) during the 12-y postfortification period. The MBA-equivalent pre- and postfortification reference concentrations will inform countries that plan folic acid fortification or that need to evaluate its impact. |
Risk assessment: closing the exposure gap
Heidel DS , Ripple SD . Synergist (Akron) 2012 23 (4) 22-23 In January 2011, over 107,000 chemicals were manufactured within or imported into the European Union in quantities exceeding 1,000 tons. Chemical manufacturers and importers were required by EU's Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) legislation to register these chemicals with the EU. By 2018, REACH registration requirements will be extended to all chemicals manufactured or imported in quantities greater than 1 ton. A similar number of chemcials are likely handled in the United States and can cause adverse health effects if exposures are nto controlled below the associated occupational exposure limit (OEL). |
Risk assessment's new era, part 1: challenges for industrial hygiene
Dotson GS , Rossner A , Maier A , Boelter FW . Synergist (Akron) 2012 23 (4) 24-26 Risk is an inherent aspect of our lives. Whether the topic is the nation's dietary habits, community air pollution or chemical exposures in the workplace, risk analysis is an integral part of the conversation. | Risk analysis is the combined activities of assessing, managing and communicating human health risks. Interest in understanding risk from chemical exposures and other stressors has led to the formalization of health risk assessment as an applied public health science. Numerous seminal reports from the National Academies of Science (NAS) have highlighted the framework for risk assessment and risk management, as well as key changes within the practice of risk analysis. | The profession of industrial hygiene has evolved to reflect the changes in health risk assessment methodology and practice. Traditional industrial hygiene practice−the anticipation, recognition, evaluation and control of occupational and environmental hazards and risks–parallels key aspects of health risk assessment. Thus, industrial hygienists have a strong history as leading practitioners of all aspects of risk analysis–health risk assessment, risk management and risk communication–within the occupational environment. |
Risk assessment's new era, part 2: evolving methods and future directions
Williams PRD , Dotson GS , Maier A . Synergist (Akron) 2012 23 (5) 46-48 For more than three decades, health practitioners and regulatory agencies have used risk assessment methods to characterize health risks. Risk assessment is the process of determining the likelihood and severity of health risk to an individual or population from exposure to a chemical or other stressor. Evolving methods and advances in science and technology offer several opportunities for improving risk assessment and its application to occupational settings. |
Safety culture and exposure to blood and body fluids among paramedics
Boal WL , Leiss JK . Prehosp Emerg Care 2012 16 (3) 418 Mr. Weaver and colleagues report an investigation of the association between emergency medical services (EMS) workplace safety culture scores and patient or provider safety outcomes.Citation1 They indicate that there were no previous studies of occupational safety culture and adverse events among EMS personnel. However, several articles from the National Study to Prevent Blood Exposure in ParamedicsCitation2 touched upon safety culture and exposures to blood among paramedics and support the general findings of Weaver et al. that EMS worker perceptions of workplace safety culture are associated with provider safety outcomes. | The National Study to Prevent Blood Exposure in Paramedics was a nationally representative survey of paramedics conducted in 2002–2003. For each of five routes of exposure, paramedics were asked how many times in the previous 12 months they had had contact with blood. They were also asked whether they had reported the exposure to their employer. The survey also asked about provision and use of safety devices and personal protective equipment (PPE). Two questions using a yes/no/don't know format were included as indicators of management emphasis on workplace safety culture. These were: “If you did not follow Universal/Standard Precautions, would your supervisor speak to you about it?” and “Is following safety procedures part of your job evaluation?” |
Worker satisfaction with personal flotation devices (PFDS) in the fishing industry: evaluations in actual use
Lucas D , Lincoln J , Somervell P , Teske T . Appl Ergon 2012 43 (4) 747-752 The purpose of this study was to determine which type of commercially available PFD resulted in the highest satisfaction among workers in the fishing industry. Fishing industry workers on four types of vessels wore and evaluated six different PFDs during their fishing seasons. Linear regression was used to test the differences in mean satisfaction scores, adjusting for clustered observations on vessels. The data were stratified by vessel type to determine the differences in PFD satisfaction within each vessel type. PFD D had the highest mean satisfaction score, but satisfaction with particular PFDs varied depending on the vessel type. Although the common objections by workers to wearing PFDs are that they are bulky and uncomfortable, some of the PFDs that were evaluated in this study received high scores for comfort and satisfaction. Given the availability of PFDs that are comfortable to wear while working, fishing vessel owners and operators should consider implementing policies mandating the use of PFDs on deck. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). |
Preface to the special section on occupational fall prevention and protection
Hsiao HW , Armstrong TJ . Hum Factors 2012 54 (3) 301-302 University of MichiganFalls represent a serious hazard to workers in many industries. Workers who perform tasks at elevation—such as structural metalworking, roof assembly and repair, tree trimming, and green energy construction—are at risk of falls from heights, with frequently serious or even fatal consequences. Many more workers, in nearly every industry, are subject to falls to floors, walkways, or ground surfaces; these falls, characterized as “fall on the same level” by U.S. statistical reporting agencies, are responsible for well over 15% of nonfatal injuries that result in days away from work (U.S. Department of Labor, 2011). | The most recent report on injuries, illnesses and fatalities by the U.S. Bureau of Labor Statistics (BLS) shows that there were about 293,990 slip-and-fall-related nonfatal occupational injuries involving days away from work in 2010, which accounted for about a quarter of all occupational injuries in the year (U.S. Department of Labor, 2011). BLS also reported 645 fall-related fatalities for calendar year 2009, which accounted for 14.2% of overall occupational fatality cases. The health services and wholesale and retail industries experienced the highest frequency of nonfatal fall injuries, and the construction industry continued to suffer the highest rate of fall-related fatalities. Health care support, building cleaning and maintenance, transportation and material moving, and construction and extraction occupations were particularly at risk of falls to floors or ground surfaces. Workers’ compensation and medical costs associated with occupational fall incidents have been estimated at approximately $70 billion annually in the United Sates (National Safety Council, 2002). Many countries are facing the same challenges as the United States in preventing slip-and-fall injury problems in the workplace. |
The epidemiology of slips, trips, and falls in a helicopter manufacturing plant
Amandus H , Bell J , Tiesman H , Biddle E . Hum Factors 2012 54 (3) 387-395 OBJECTIVE: The purpose of this evaluation was to evaluate the causes and costs of slips, trips, and falls (STFs) in a helicopter manufacturing plant. BACKGROUND: STFs are a significant portion of the total industry injury burden. METHODS: For this study, 4,070 helicopter plant workers who were employed from January 1, 2004, through February 28, 2008, were enrolled. Company records on workers' compensation claims, occupational health first report of injury, and payroll records on hours worked were collected. Cause and source of all injuries, including STFs, were coded for analysis. RESULTS: During the 4-year study period, there were 2,378 injuries and 226 STFs (46 falls [20%] to a lower level, 117 [52%] falls on the same level, 41 [18%] from loss of balance without a fall, and 22 [10%] from other events). Of the 226 STFs, 123 falls to the same level were caused by slippery substances (52), objects on floor (43), and surface hazards (28), and they cost $1,543,946. Falls to lower levels primarily involved access to stands to and from aircraft and falling off large machines. CONCLUSION: More than half of the STF injury claims likely could have been prevented by housekeeping and maintenance, and this cost saving could reasonably offset a considerable portion of the cost of prevention. Training and stand modifications could be considered to prevent falls from elevation from stands, machines, and aircraft. APPLICATION: Recommendations for STF prevention are discussed. |
Estimation of internal exposure to uranium with uncertainty from urinalysis data using the InDEP computer code
Anderson JL , Apostoaei AI , Thomas BA . Radiat Prot Dosimetry 2012 153 (1) 64-73 The National Institute for Occupational Safety and Health (NIOSH) is currently studying mortality in a cohort of 6409 workers at a former uranium processing facility. As part of this study, over 220,000 urine samples were used to reconstruct organ doses due to internal exposure to uranium. Most of the available computational programs designed for analysis of bioassay data handle a single case at a time, and thus require a significant outlay of time and resources for the exposure assessment of a large cohort. NIOSH is currently supporting the development of a computer program, InDEP (Internal Dose Evaluation Program), to facilitate internal radiation exposure assessment as part of epidemiological studies of both uranium- and plutonium-exposed cohorts. A novel feature of InDEP is its batch processing capability which allows for the evaluation of multiple study subjects simultaneously. InDEP analyses bioassay data and derives intakes and organ doses with uncertainty estimates using least-squares regression techniques or using the Bayes' Theorem as applied to internal dosimetry (Bayesian method). This paper describes the application of the current version of InDEP to formulate assumptions about the characteristics of exposure at the study facility that were used in a detailed retrospective intake and organ dose assessment of the cohort. |
Functional levels of floor surface roughness for the prevention of slips and falls: clean-and-dry and soapsuds-covered wet surfaces
Kim IJ , Hsiao H , Simeonov P . Appl Ergon 2012 44 (1) 58-64 Literature has shown a general trend that slip resistance performance improves with floor surface roughness. However, whether slip resistance properties are linearly correlated with surface topographies of the floors or what roughness levels are required for effective slip resistance performance still remain to be answered. This pilot study aimed to investigate slip resistance properties and identify functional levels of floor surface roughness for practical design applications in reducing the risk of slip and fall incidents. A theory model was proposed to characterize functional levels of surface roughness of floor surfaces by introducing a new concept of three distinctive zones. A series of dynamic friction tests were conducted using 3 shoes and 9 floor specimens under clean-and-dry as well as soapsuds-covered slippery wet environments. The results showed that all the tested floor-shoe combinations provided sufficient slip resistances performance under the clean-and-dry condition. A significant effect of floor type (surface roughness) on dynamic friction coefficient (DFC) was found in the soapsuds-covered wet condition. As compared to the surface roughness effects, the shoe-type effects were relatively small. Under the soapsuds-covered wet condition, floors with 50 mum in Ra roughness scale seemed to represent an upper bound in the functional range of floor surface roughness for slip resistance because further increase of surface roughness provided no additional benefit. A lower bound of the functional range for slip resistance under the soapsuds-covered wet condition was estimated from the requirement of DFC > 0.4 at Ra congruent with 17 mum. Findings from this study may have potential safety implications in the floor surface design for reducing slip and fall hazards. |
Impact of harness fit on suspension tolerance
Hsiao HW , Turner N , Whisler R , Zwiener J . Hum Factors 2012 54 (3) 346-357 OBJECTIVE: This study investigated the effect of body size and shape and harness fit on suspension tolerance time. BACKGROUND: Fall victims may develop suspension trauma, a potentially fatal reduction of return blood flow from legs to the heart and brain, after a successfully arrested fall if they are not rescued quickly or the harness does not fit them well. METHOD: For this study, 20 men and 17 women with construction experience were suspended from the dorsal D-ring of a full-body fall-arrest harness. Their suspension tolerance time, physical characteristics, and harness fit levels were assessed. RESULTS: Body characteristics (i.e., weight, stature, upper- and lower-torso depths) were associated with decreased suspension tolerance time (r = -.36 similar to -.45, p <= .03). In addition, harness fit affected suspension tolerance time; workers with a torso angle of suspension greater than 35 degrees, a thigh strap angle greater than 50 degrees, or a poorly fitting harness size had shorter suspension tolerance time (mean differences = 14, 11, and 9.8 min, respectively, p <= .05). CONCLUSION: Body size and harness fit were predictors of suspension tolerance time. Selecting well-fit harnesses and establishing a 9-min rescue plan are suggested to ensure that no more than 5% of workers would experience suspension trauma. APPLICATIONS: The study provides a basis for harness designers, standards writers, and manufacturers to improve harness configurations and testing requirements for better worker protection against suspension trauma. |
Increased lung cancer mortality among chrysotile asbestos textile workers is more strongly associated with exposure to long thin fibres
Loomis D , Dement JM , Elliott L , Richardson D , Kuempel ED , Stayner L . Occup Environ Med 2012 69 (8) 564-8 BACKGROUND: Animal data and physical models suggest that the carcinogenicity of asbestos fibres is related to their size and shape. OBJECTIVES: To investigate the influence of fibre length and diameter on lung cancer risk in workers at asbestos textile mills in North Carolina and South Carolina, USA.METHODS: Men and women (n=6136) who worked ≥30 days in production and were employed between 1940 and 1973 were enumerated and followed for vital status through 2003. A matrix of fibre size-specific exposure estimates was constructed using determinations of fibre numbers and dimensions through analysis of 160 historical dust samples by transmission electron microscopy. Associations of lung cancer mortality with metrics of fibre exposure were estimated by Poisson regression with adjustment for age, sex, race and calendar year. RESULTS: Exposure to fibres throughout the range of length and diameter was significantly associated with increased risk of lung cancer. Models for fibres >5 mum long and <0.25 mum in diameter provided the best fit to the data, while fibres 5-10 mum long and <0.25 mum in diameter were associated most strongly with lung cancer mortality (log rate about 4% per IQR, p<0.001). When indicators of mean fibre length and diameter were modelled simultaneously, lung cancer risk increased as fibre length increased and diameter decreased. CONCLUSIONS: The findings support the hypothesis that the occurrence of lung cancer is associated most strongly with exposure to long thin asbestos fibres. The relationship of cancer risk and fibre dimensions should be examined in cohorts exposed to other types of fibres. |
A comparison of the Interactive Systems Framework (ISF) for Dissemination and Implementation and the CDC Division of HIV/AIDS Prevention's Research-to-Practice model for behavioral interventions
Collins CB Jr , Edwards AE , Jones PL , Kay L , Cox PJ , Puddy RW . Am J Community Psychol 2012 50 518-29 Translating evidence-based HIV/STD prevention interventions and research findings into applicable HIV prevention practice has become an important challenge for the fields of community psychology and public health due to evidence-based interventions and evidence-based practice being given higher priority and endorsement by federal, state, and local health department funders. The Interactive Systems Framework (ISF) for Dissemination and Implementation and the Division of HIV/AIDS Prevention (DHAP) Research-to-Practice model both address this challenge. The DHAP model and the ISF are each presented with a brief history and an introduction of their features from synthesis of research findings through translation into intervention materials to implementation by prevention providers. This paper describes why the ISF and the DHAP model were developed and the similarities and differences between them. Specific examples of the use of the models to translate research to practice and the subsequent implications for support of each model are provided. The paper concludes that the ISF and the DHAP model are truly complementary with some unique differences, while both contribute substantially to addressing the gap between identifying effective programs and ensuring their widespread adoption in the field. |
Putting public health into practice: a model for assessing the relationship between local health departments and practicing physicians
Parton HB , Perlman SE , Koppaka R , Greene CM . Am J Public Health 2012 102 Suppl 3 S333-5 The New York City (NYC) Department of Health and Mental Hygiene (Health Department) surveyed practicing NYC physicians to quantify Health Department resource use. Although the Health Department successfully reaches most physicians, and information is valued in practice, knowledge of several key resources was low. Findings suggested 3 recommendations for all local health departments seeking to enhance engagement with practicing physicians: (1) capitalize on physician interest, (2) engage physicians early and often, and (3) make interaction with the health department easy. Also, older physicians may require targeted outreach. |
Integrating public health-oriented e-learning into graduate medical education
Hemans-Henry C , Greene CM , Koppaka R . Am J Public Health 2012 102 Suppl 3 S353-6 OBJECTIVES: In fall 2008, the New York City Department of Health and Mental Hygiene collaborated with Albert Einstein College of Medicine residency program directors to assess the effectiveness of an e-learning course on accurate death certificate completion among resident physicians. METHODS: We invited postgraduate year 1 and 2 (PGY1 and PGY2) residents (n = 227) to participate and administered a pretest, e-learning module, posttest, and course evaluation to PGY1 residents; PGY2 residents completed a pretest and survey only. RESULTS: In all, 142 residents (63%) participated. The average pretest scores for PGY2 residents (61%) and PGY1 residents (59%) were not significantly different. The PGY1 residents' average test score increased significantly after taking the e-learning module (59% vs 72%; P < .01). The participants rated course length, delivery method, and utility highly. CONCLUSIONS: Results suggest that e-learning can effectively integrate public health-oriented training into clinical residency programs. |
Are we there yet? Seizing the moment to integrate medicine and public health
Scutchfield FD , Michener JL , Thacker SB . Am J Public Health 2012 102 Suppl 3 S312-6 Multiple promising but unsustainable attempts have been made to maintain programs integrating primary care and public health since the middle of the last century. During the 1960s, social justice movements expanded access to primary care and began to integrate primary care with public health concepts both to meet community needs for medical care and to begin to address the social determinants of health. Two decades later, the managed care movement offered opportunities for integration of primary care and public health as many employers and government payers attempted to control health costs and bring disease prevention strategies in line with payment mechanisms. Today, we again have the opportunity to align primary care with public health to improve the community's health. |
Moment density estimation for positive random variables
Mnatsakanov RM , Ruymgaart FH . Statistics 2012 46 (2) 215-230 An unknown moment-determinate cumulative distribution function or its density function can be recovered from corresponding moments and estimated from the empirical moments. This method of estimating an unknown density is natural in certain inverse estimation models like multiplicative censoring or biased sampling when the moments of unobserved distribution can be estimated via the transformed moments of the observed distribution. In this paper, we introduce a new nonparametric estimator of a probability density function defined on the positive real line, motivated by the above. Some fundamental properties of proposed estimator are studied. The comparison with traditional kernel density estimator is discussed. |
An efficient statistical algorithm for a temporal scan statistic applied to vaccine safety analyses
McClure DL , Xu S , Weintraub E , Glanz JM . Vaccine 2012 30 (27) 3986-91 In the US, the Vaccine Safety Datalink (VSD) project, sponsored by the Centers for Disease Control and Prevention, conducts near-real-time, population-based, active surveillance for vaccine safety. One of the steps in analyzing signals, if there are enough cases, is to apply temporal scan statistics. The purpose is to determine if the cases clustered in time within an overall a priori defined post-vaccination observation interval. We presented a relatively efficient and accurate algorithm for the purely temporal scan statistic as applied to vaccine safety investigations. It only needs SAS/BASE((R)) software, and the algorithm is simple enough to be programmed in another software languages. Our present work is focused on incorporating the temporal scan statistic algorithm within our previous approach for finding an optimal risk window for studies of vaccine safety. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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- Immunity and Immunization
- Injury and Violence
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