Philadelphia telemedicine glaucoma detection and follow-up study: Methods and screening results
Hark LA , Katz LJ , Myers JS , Waisbourd M , Johnson D , Pizzi LT , Leiby BE , Fudemberg SJ , Mantravadi AV , Henderer JD , Zhan T , Molineaux J , Doyle V , Divers M , Burns C , Murchison AP , Reber S , Resende A , Bui TDV , Lee J , Crews JE , Saaddine JB , Lee PP , Pasquale LR , Haller JA . Am J Ophthalmol 2017 181 114-124 PURPOSE: To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN: Screening program results for a prospective, randomized clinical trial. MATERIALS AND METHODS: Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; Caucasian individuals over age 65 years; any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a non-mydriatic, auto-focus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICarerebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS: From 4/1/15, to 2/6/17, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve; 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy; and 68 (7.5%) had other retinal abnormalities. CONCLUSION: An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology. |
Impact of pregnancy on observed sex disparities among adults hospitalized with laboratory-confirmed influenza, FluSurv-NET, 2010-2012
Kline K , Hadler JL , Yousey-Hindes K , Niccolai L , Kirley PD , Miller L , Anderson EJ , Monroe ML , Bohm SR , Lynfield R , Bargsten M , Zansky SM , Lung K , Thomas AR , Brady D , Schaffner W , Reed G , Garg S . Influenza Other Respir Viruses 2017 11 (5) 404-411 INTRODUCTION: Previous FluSurv-NET studies found that adult females had a higher incidence of influenza-associated hospitalizations than males. To identify groups of women at higher risk than men, we analyzed data from 14 FluSurv-NET sites that conducted population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 78 US counties. METHODS: We analyzed 6292 laboratory-confirmed, geocodable (96%) adult cases collected by FluSurv-NET during the 2010-12 influenza seasons. We used 2010 US Census and 2008-2012 American Community Survey data to calculate overall age-adjusted and age group-specific female:male incidence rate ratios (IRR) by race/ethnicity and census tract-level poverty. We used national 2010 pregnancy rates to estimate denominators for pregnant women aged 18-49. We calculated male:female IRRs excluding them and IRRs for pregnant:non-pregnant women. RESULTS: Overall, 55% of laboratory-confirmed influenza cases were female. Female:male IRRs were highest for females aged 18-49 of high neighborhood poverty (IRR 1.50, 95% CI 1.30-1.74) and of Hispanic ethnicity (IRR 1.70, 95% CI 1.34-2.17). These differences disappeared after excluding pregnant women. Overall, 26% of 1083 hospitalized females aged 18-49 were pregnant. Pregnant adult females were more likely to have influenza-associated hospitalizations than their non-pregnant counterparts (relative risk [RR] 5.86, 95% CI 5.12-6.71), but vaccination levels were similar (25.5% vs 27.8%). CONCLUSIONS: Overall rates of influenza-associated hospitalization were not significantly different for men and women after excluding pregnant women. Among women aged 18-49, pregnancy increased the risk of influenza-associated hospitalization sixfold but did not increase the likelihood of vaccination. Improving vaccination rates in pregnant women should be an influenza vaccination priority. |
Risky trade: Individual and neighborhood-level socio-demographics associated with transactional sex among urban African American MSM
Stevens R , Icard L , Jemmott JB , O'Leary A , Rutledge S , Hsu J , Stephens-Shields A . J Urban Health 2017 94 (5) 676-682 There is a clear, persistent association between poverty and HIV risk and HIV infection. Low educational attainment, neighborhood disadvantage, and residential instability are ways in which poverty is instrumentally experienced in urban America. We investigated the role of lived poverty at both the individual and neighborhood levels in transactional sex behavior among African American men who have sex with men (MSM) residing in urban neighborhoods. Using population-averaged models estimated by generalized estimating equation (GEE) models, we identified individual-level and neighborhood-level factors that are associated with exchanging sex for drugs and/or money. We tested the association between neighborhood and individual-level socioeconomic status and HIV risk behavior by combining area-based measures of neighborhood quality from the US Census with individual survey data from 542 low-income African American MSM. The primary outcome measure was self-reported transactional sex defined as exchanging sex for drugs or money. Individual-level covariates included high school non-completion, income, and problem drug use. Neighborhood-level covariates were high school non-completion and poverty rates. The findings suggested that educational attainment is associated with both the individual level and neighborhood level. Participants were more likely to engage in transactional sex if they did not complete high school (OR = 1.78), and similarly if their neighbors did not complete high school (OR = 7.70). These findings suggest potential leverage points for both community-level interventions and advocacy for this population, particularly related to transactional sex and education, and will aid HIV prevention efforts that seek to address the contextual constraints on individual risk behavior. |
Early impact of rotavirus vaccine in under 5year old children hospitalized due to diarrhea, Swaziland
Maphalala G , Phungwayo N , Masona G , Lukhele N , Tsegaye G , Dube N , Sindisiwe D , Khumalo L , Daniel F , Katsande R , Tate JE , Mwenda JM , Weldegebriel G . Vaccine 2017 36 (47) 7210-7214 BACKGROUND: Swaziland introduced rotavirus vaccine in the National Immunization Program, in May 2015, with the objective of reducing the burden of rotavirus diarrheal disease. We monitored the early impact of the vaccine in reducing rotavirus diarrhea. METHODS: We conducted sentinel rotavirus surveillance from January 2013 to December 2016 in children under five years of age admitted due to diarrhea attending Mbabane Government Referral Hospital in the Hhohho Region and Raleigh Fitkin Memorial Hospital in the Manzini Region. All cases had stool samples collected and tested for rotavirus antigen by enzyme immunoassay. RESULTS: Between 2013 and 2016, 596 samples were collected and tested. Rotavirus positivity reduced from average of 50.8% (172/338) (in 2013-2014 (pre vaccine period)) to 29% (24/82) in 2016, post-vaccine introduction. The median age of children with rotavirus infection increased from average of 10months in 2013-2014 to 13.7months in 2016. The peak season for all-cause diarrhea and rotavirus-specific hospitalizations among children under five years of age was June-August in all years with a blunting of the peak season in 2016. Rotavirus positivity among children 0-11months reduced from an average of 49% in 2013-2014 (116/236) to 33% (15/45) in 2016, a 33% reduction following rotavirus vaccine introduction. CONCLUSION: There has been a rapid reduction of all-cause diarrhea and rotavirus hospitalizations in Swaziland, particularly in young children and during the rotavirus season, after the introduction rotavirus vaccine. Continued surveillance is needed to monitor the long-term impact of rotavirus vaccine introduction. |
Evolution and current understanding of physicochemical characterization of particulate matter from reactivity controlled compression ignition combustion on a multicylinder light-duty engine
Storey JME , Curran SJ , Lewis SA , Barone TL , Dempsey AB , Moses-Debusk M , Hanson RM , Prikhodko VY , Northrop WF . Int J Engine Res 2017 18 505-519 Low-temperature compression ignition combustion can result in nearly smokeless combustion, as indicated by a smoke meter or other forms of soot measurement that rely on absorbance due to elemental carbon content. Highly premixed low-temperature combustion modes do not form particulate matter in the traditional pathways seen with conventional diesel combustion. Previous research into reactivity controlled compression ignition particulate matter has shown, despite a near zero smoke number, significant mass can be collected on filter media used for particulate matter certification measurement. In addition, particulate matter size distributions reveal that a fraction of the particles survive heated double-dilution conditions. This study summarizes research completed at Oak Ridge National Laboratory to date on characterizing the nature, chemistry and aftertreatment considerations of reactivity controlled compression ignition particulate matter and presents new research highlighting the importance of injection strategy and fuel composition on reactivity controlled compression ignition particulate matter formation. Particle size measurements and the transmission electron microscopy results do show the presence of soot particles; however, the elemental carbon fraction was, in many cases, within the uncertainty of the thermal-optical measurement. Particulate matter emitted during reactivity controlled compression ignition operation was also collected with a novel sampling technique and analyzed by thermal desorption or pyrolysis gas chromatography mass spectroscopy. Particulate matter speciation results indicated that the high boiling range of diesel hydrocarbons was likely responsible for the particulate matter mass captured on the filter media. To investigate potential fuel chemistry effects, either ethanol or biodiesel were incorporated to assess whether oxygenated fuels may enhance particle emission reduction. © 2016 IMechE. |
Prevalence and risk factors associated with lymphatic filariasis in American Samoa after mass drug administration
Coutts SP , King JD , Pa'au M , Fuimaono S , Roth J , King MR , Lammie PJ , Lau CL , Graves PM . Trop Med Health 2017 45 22 BACKGROUND: In 2000, American Samoa had 16.5% prevalence of lymphatic filariasis (LF) antigenemia. Annual mass drug administration (MDA) was conducted using single-dose albendazole plus diethylcarbamazine from 2000 to 2006. This study presents the results of a 2007 population-based PacELF C-survey in all ages and compares the adult filarial antigenemia results of this survey to those of a subsequent 2010 survey in adults with the aim of improving understanding of LF transmission after MDA. RESULTS: The 2007 C-survey used simple random sampling of households from a geolocated list. In 2007, the overall LF antigen prevalence by immunochromatographic card test (ICT) for all ages was 2.29% (95% CI 1.66-3.07). Microfilaremia prevalence was 0.27% (95% CI 0.09-0.62). Increasing age (OR 1.04 per year, 95% CI 1.02-1.05) was significantly associated with ICT positivity on multivariate analysis, while having ever taking MDA was protective (OR 0.39, 95% CI 0.16-0.96). The 2010 survey used a similar spatial sampling design. The overall adult filarial antigenemia prevalence remained relatively stable between the surveys at 3.32% (95% CI 2.44-4.51) by ICT in 2007 and 3.23 (95% CI 2.21-4.69) by Og4C3 antigen in 2010. However, there were changes in village-level prevalence. Eight village/village groupings had antigen-positive individuals identified in 2007 but not in 2010, while three villages/village groupings that had no antigen-positive individuals identified in 2007 had positive individuals identified in 2010. CONCLUSIONS: After 7 years of MDA, with four rounds achieving effective coverage, a representative household survey in 2007 showed a decline in prevalence from 16.5 to 2.3% in all ages. However, lack of further decline in adult prevalence by 2010 and fluctuation at the village level showed that overall antigenemia prevalence at a broader scale may not provide an accurate reflection of ongoing transmission at the village level. |
Bias correction in estimating proportions by pooled testing
Hepworth G , Biggerstaff BJ . J Agric Biol Environ Stat 2017 22 (4) 602-614 In the estimation of proportions by pooled testing, the MLE is biased, and several methods of correcting the bias have been presented in previous studies. We propose a new estimator based on the bias correction method introduced by Firth (Biometrika 80:27–38, 1993), which uses a modification of the score function, and we provide an easily computable, Newton–Raphson iterative formula for its computation. Our proposed estimator is almost unbiased across a range of problems, and superior to existing methods. We show that for equal pool sizes the new estimator is equivalent to the estimator proposed by Burrows (Phytopathology 77:363–365, 1987). The performance of our estimator is examined using pooled testing problems encountered in plant disease assessment and prevalence estimation of mosquito-borne viruses. Supplementary materials accompanying this paper appear online. |
Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease - Margibi County, Liberia: February-March 2015
Wilken JA , Pordell P , Goode B , Jarteh R , Miller Z , Saygar BG , Maximore L , Borbor WM , Carmue M , Walker GW , Yeiah A . Prehosp Disaster Med 2017 32 (6) 1-6 BACKGROUND: In early 2015, a patient from a cluster of cases of Ebola Virus Disease (EVD) in Monrovia, Liberia traveled to a rural village in Margibi County, potentially exposing numerous persons. The patient died in the village and post-mortem testing confirmed Ebola Virus infection. Problem The Margibi County Health Team (CHT; Kakata, Margibi, Liberia) needed to prevent further transmission of EVD within and outside of the affected villages, and they needed to better understand the factors that support or impede compliance with measures to stop the spread of EVD. METHODS: In February-March 2015, the Margibi CHT instituted a 21-day quarantine and active monitoring for two villages where the patient had contact with numerous residents, and a 21-day active monitoring for five other villages where the patient had possible contact with an unknown number of persons. One contact developed EVD and quarantine was extended an additional 12 days in one village. In April 2015, the Margibi CHT conducted a household-based EVD knowledge, attitudes, and practices (KAP) survey of the seven villages. From April 24-29, 2015, interview teams approached every household in the seven villages and collected information on demographics, knowledge of EVD, attitudes about quarantine to prevent the spread of EVD, and their quarantine experiences and practices. Descriptive statistics were calculated. RESULTS: One hundred fifteen interviews were conducted, representing the majority of the households in the seven villages. Most (99%) correctly identified touching an infected person's body fluids and contact with the body of someone who has died from EVD as transmission routes. However, interviewees sometimes incorrectly identified mosquito bites (58%) and airborne spread (32%) as routes of EVD transmission, and 72% incorrectly identified the longest EVD incubation period as ≤seven days. Eight of 16 households in the two quarantined villages (50%) reported times when there was not enough water or food during quarantine. Nine of 16 (56%) reported that a household member had illnesses or injuries during quarantine; of these, all (100%) obtained care from a clinic, hospital, or Ebola treatment unit (ETU). CONCLUSION: Residents' knowledge of EVD transmission routes and incubation period were suboptimal. Public health authorities should consider assessing residents' understanding of Ebola transmission routes and effectively educate them to ensure correct understanding. Quarantined residents should be provided with sufficient food, water, and access to medical care. |
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