The design and implementation of a new surveillance system for venous thromboembolism using combined active and passive methods
Wendelboe AM , Campbell J , McCumber M , Bratzler D , Ding K , Beckman M , Reyes N , Raskob G . Am Heart J 2015 170 (3) 447-54.e18 Estimates of venous thromboembolism (VTE) incidence in the United States are limited by lack of a national surveillance system. We implemented a population-based surveillance system in Oklahoma County, OK, for April 1, 2012 to March 31, 2014, to estimate the incidences of first-time and recurrent VTE events, VTE-related mortality, and the proportion of case patients with provoked versus unprovoked VTE. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. The surveillance system included active and passive methods. Active surveillance involved reviewing imaging studies (such as chest computed tomography and compression ultrasounds) from all inpatient and outpatient facilities. Interrater agreement between surveillance officers collecting data was assessed using κ. Passive surveillance used International Classification of Disease, Ninth Revision (ICD-9) codes from hospital discharge data to identify cases. The sensitivity and specificity of various ICD-9-based case definitions will be assessed by comparison with cases identified through active surveillance. As of February 1, 2015, we screened 54,451 (99.6%) of the imaging studies and identified 2,690 case patients, of which 91.5% were from inpatient facilities, and 8.5% were from outpatient facilities. Agreement between surveillance officers was high (κ ≥0.61 for 93.2% of variables). Agreement for the diagnosis of pulmonary embolism and diagnosis of deep vein thrombosis was κ = 0.92 (95% CI 0.74-1.00) and κ = 0.89 (95% CI 0.71-1.00), respectively. This surveillance system will provide data on the accuracy of ICD-9-based case definitions for surveillance of VTE events and help the Centers for Disease Control and Prevention develop a national VTE surveillance system. |
Epidemiology and molecular characteristics of norovirus GII.4 Sydney outbreaks in Taiwan, January 2012-December 2013.
Wu FT , Chen HC , Yen C , Wu CY , Katayama K , Park Y , Hall AJ , Vinje J , Huang JC , Wu HS . J Med Virol 2015 87 (9) 1462-70 In 2012, a new norovirus GII.4 variant (GII.4 Sydney) emerged and caused the majority of the acute gastroenteritis outbreaks in Australia, Asia, Europe, and North America. We examined the epidemiologic and molecular virologic characteristics of reported acute gastroenteritis outbreaks determined to be caused by norovirus in Taiwan from January 2012 to December 2013. A total of 253 (45.7%) of 552 reported acute gastroenteritis outbreaks tested positive for norovirus, of which 165 (65.5%) were typed as GII.4 Sydney. GII.4 Sydney outbreaks were reported from all geographic areas of Taiwan and occurred most frequently in schools (35.8%) and long-term care facilities (24.2%). Person-to-person transmission was identified in 116 (70.3%) of the outbreaks. Phylogenetic analyses of full-length ORF2 of eight specimens indicated that GII.4 Sydney strains detected in Taiwan were closely related to strains detected globally. Continued outbreak surveillance and strain typing are needed to provide information on epidemiologic and virologic trends of novel norovirus strains. |
Global circulation patterns of seasonal influenza viruses vary with antigenic drift.
Bedford T , Riley S , Barr IG , Broor S , Chadha M , Cox NJ , Daniels RS , Gunasekaran CP , Hurt AC , Kelso A , Klimov A , Lewis NS , Li X , McCauley JW , Odagiri T , Potdar V , Rambaut A , Shu Y , Skepner E , Smith DJ , Suchard MA , Tashiro M , Wang D , Xu X , Lemey P , Russell CA . Nature 2015 523 (7559) 217-20 Understanding the spatiotemporal patterns of emergence and circulation of new human seasonal influenza virus variants is a key scientific and public health challenge. The global circulation patterns of influenza A/H3N2 viruses are well characterized, but the patterns of A/H1N1 and B viruses have remained largely unexplored. Here we show that the global circulation patterns of A/H1N1 (up to 2009), B/Victoria, and B/Yamagata viruses differ substantially from those of A/H3N2 viruses, on the basis of analyses of 9,604 haemagglutinin sequences of human seasonal influenza viruses from 2000 to 2012. Whereas genetic variants of A/H3N2 viruses did not persist locally between epidemics and were reseeded from East and Southeast Asia, genetic variants of A/H1N1 and B viruses persisted across several seasons and exhibited complex global dynamics with East and Southeast Asia playing a limited role in disseminating new variants. The less frequent global movement of influenza A/H1N1 and B viruses coincided with slower rates of antigenic evolution, lower ages of infection, and smaller, less frequent epidemics compared to A/H3N2 viruses. Detailed epidemic models support differences in age of infection, combined with the less frequent travel of children, as probable drivers of the differences in the patterns of global circulation, suggesting a complex interaction between virus evolution, epidemiology, and human behaviour. |
Viral hepatitis surveillance - India, 2011-2013
Kumar T , Shrivastava A , Kumar A , Laserson KF , Narain JP , Venkatesh S , Chauhan LS , Averhoff F . MMWR Morb Mortal Wkly Rep 2015 64 (28) 758-62 The burden of viral hepatitis in India is not well characterized. In 2009, the national Integrated Disease Surveillance Programme (IDSP) began conducting surveillance across all Indian states for epidemic-prone diseases, including foodborne and waterborne forms of viral hepatitis (e.g., hepatitis A and E). Information on outbreaks of all forms of viral hepatitis, including A, B, C, and E, also is collected. This report summarizes viral hepatitis surveillance and outbreak data reported to IDSP during 2011-2013. During this period, 804,782 hepatitis cases and 291 outbreaks were reported; the virus type was unspecified in 92% of cases. Among 599,605 cases tested for hepatitis A, 44,663 (7.4%) were positive, and among 187,040 tested for hepatitis E, 19,508 (10.4%) were positive. At least one hepatitis outbreak report was received from 23 (66%) of 35 Indian states. Two-thirds of outbreaks were reported from rural areas. Among 163 (56%) outbreaks with known etiology, 78 (48%) were caused by hepatitis E, 54 (33%) by hepatitis A, 19 (12%) by both hepatitis A and E, and 12 (7%) by hepatitis B or hepatitis C. Contaminated drinking water was the source of most outbreaks. Improvements in water quality and sanitation as well as inclusion of hepatitis A vaccine in childhood immunization programs should be considered to reduce the public health burden of hepatitis in India. Efforts to decrease the proportion of cases for which the etiology is unspecified, including expanding the IDSP to support hepatitis B and C testing, might help further elucidate the epidemiology of these diseases. |
Launch of a nationwide hepatitis C elimination program - Georgia, April 2015
Mitruka K , Tsertsvadze T , Butsashvili M , Gamkrelidze A , Sabelashvili P , Adamia E , Chokheli M , Drobeniuc J , Hagan L , Harris AM , Jiqia T , Kasradze A , Ko S , Qerashvili V , Sharvadze L , Tskhomelidze I , Kvaratskhelia V , Morgan J , Ward JW , Averhoff F . MMWR Morb Mortal Wkly Rep 2015 64 (28) 753-7 Hepatitis C virus (HCV) infects an estimated 130-150 million persons globally and results in an estimated 700,000 deaths annually from hepatocellular carcinoma or cirrhosis. Georgia, a middle-income Eurasian country, has one of the highest estimated HCV prevalences in the world. In 2011, Georgia began offering treatment to a limited number of HCV-infected persons. Beginning in 2013, when new oral medications that can cure >90% of HCV infections were licensed, Georgia engaged partners to develop a comprehensive HCV prevention and control plan, during which the concept of elimination of HCV transmission and disease emerged. To prepare for the launch of an HCV elimination program, Georgia requested CDC's assistance to describe HCV epidemiology, evaluate laboratory and health care capacity, and conduct program monitoring and evaluation. This report describes the activities undertaken to prepare for the program, launched in April 2015, and early results of its initial phase, focused on improving access to affordable diagnostics and free curative treatment for HCV-infected persons with severe liver disease. A national population-based serosurvey began in May 2015, and four clinical sites and their laboratories were selected as initial pilot sites; since June, three additional sites have been added. Through July 3, 2015, a total of 6,491 persons sought treatment, and 6,177 (95.2%) initiated diagnostic work-up. Among these, 1,519 (24.6%) completed work-up, 1,474 (97.0%) of whom initiated treatment. Georgia is scaling up capacity to meet the demand for HCV treatment and is collaborating with CDC and other partners on development of a comprehensive HCV elimination plan that includes specific goals and activities needed to achieve them. |
The Link4Health study to evaluate the effectiveness of a combination intervention strategy for linkage to and retention in HIV care in Swaziland: protocol for a cluster randomized trial
McNairy ML , Gachuhi AB , Lamb MR , Nuwagaba-Biribonwoha H , Burke S , Ehrenkranz P , Mazibuko S , Sahabo R , Philip NM , Okello V , El-Sadr WM . Implement Sci 2015 10 (1) 101 BACKGROUND: Gaps in the HIV care continuum contribute to suboptimal individual health outcomes and increased risk of HIV transmission at the population level. Implementation science studies are needed to evaluate clinic-based interventions aimed at improving retention of patients across the continuum. METHODS/DESIGN: Link4Health uses an unblended cluster site-randomized design to evaluate the effectiveness of a combination intervention strategy (CIS) as compared to standard of care on linkage to and retention in care among HIV-diagnosed adults in Swaziland. The CIS intervention targets a multiplicity of structural, behavioral, and biomedical barriers through five interventions: (1) point-of-care CD4 testing at time of HIV testing, (2) accelerated antiretroviral therapy (ART) initiation for eligible patients, (3) mobile phone appointment reminders, (4) care and prevention packages, and (5) non-cash financial incentives for linkage and retention. The unit of randomization is a network of HIV clinics inclusive of a secondary facility coupled with an affiliated primary facility. Ten study units were randomized based on implementing partner, geographic location, and historic volume of HIV patients. Target enrollment was 2200 individuals, each to be followed for 12 months. Eligibility criteria includes HIV-positive test, age >18 years, willing to receive HIV care at a clinic in the study unit and consent to study procedures. Exclusion criteria included previous HIV care in the past 6 months, planning to leave the community, and current pregnancy. The primary study outcome is linkage within 1 month and retention at 12 months after testing HIV positive. Secondary outcomes include viral load suppression at 12 months, time to ART eligibility and initiation, participant acceptability, and cost-effectiveness. The trial status is that study enrollment is complete and follow-up procedures are ongoing. DISCUSSION: Link4Health evaluates a novel and pragmatic combination intervention strategy to improve linkage to and retention in care among adults with HIV in Swaziland. If the strategy is found to be effective, this study has the potential to inform HIV service delivery in resource-limited settings. TRIAL REGISTRATION: Clinicaltrials.gov NCT01904994. |
Nosocomial cholera outbreak in a mental hospital; challenges and lessons learnt from Butabika National Referral Mental Hospital, Uganda
Bwire G , Malimbo M , Kagirita A , Makumbi I , Mintz E , Mengel MA , Orach CG . Am J Trop Med Hyg 2015 93 (3) 534-8 During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered. |
Obesity not associated with severity among hospitalized adults with seasonal influenza virus infection
Braun ES , Crawford FW , Desai MM , Meek J , Kirley PD , Miller L , Anderson EJ , Oni O , Ryan P , Lynfield R , Bargsten M , Bennett NM , Lung KL , Thomas A , Mermel E , Lindegren ML , Schaffner W , Price A , Chaves SS . Infection 2015 43 (5) 569-75 We examined seasonal influenza severity [artificial ventilation, intensive care unit (ICU) admission, and radiographic-confirmed pneumonia] by weight category among adults hospitalized with laboratory-confirmed influenza. Using multivariate logistic regression models, we found no association between obesity or severe obesity and artificial ventilation or ICU admission; however, overweight and obese patients had decreased risk of pneumonia. Underweight was associated with pneumonia (adjusted odds ratio 1.31; 95 % confidence interval 1.04, 1.64). |
Examining fluoroquinolone claims among gonorrhea-associated prescription drug claims, 2000-2010
Owusu-Edusei K Jr , Carroll DS , Gift TL . Am J Prev Med 2015 49 (5) 761-764 INTRODUCTION: After the release of CDC's revised gonorrhea treatment guidelines in April 2007, a study reported the declining use of fluoroquinolones to treat gonorrhea among health departments participating in the Sexually Transmitted Disease Surveillance Network. In this study, we examine the proportion of fluoroquinolone claims among gonorrhea-associated prescription drug claims from a large insurance database from 2000 through 2010. METHODS: We extracted drug claims associated with gonorrhea diagnosis claims from the MarketScan database for 2000-2010 and calculated the proportion of the drug claims for fluoroquinolones on a monthly basis. We then used an interrupted time series analysis to investigate trend characteristics of fluoroquinolone claims before and after the gonorrhea treatment guidelines were revised in April 2007. RESULTS: Although there was a monthly decline in the proportion of fluoroquinolone claims before April 2007 (-0.11 percentage points, p<0.01), results indicate a sevenfold (-0.78 percentage points, p<0.01) increase in the rate of decline after the revised guidelines were released in April 2007. We did not find any sudden drop (immediate or delayed) in the proportion of fluoroquinolones after April 2007, implying a gradual permanent decline over the analytic period. CONCLUSIONS: Our results are consistent with the findings of the previous study and indicate a gradual and permanent decline (over the analytic period) in the proportion of fluoroquinolone claims among gonorrhea-associated prescription drug claims. However, because this is a convenience sample of claims data, these findings cannot be generalized to the entire privately insured population in the U.S. |
Factors associated with time since last HIV test among persons at high risk for HIV infection, National Survey of Family Growth, 2006-2010
Van Handel M , Lyons B , Oraka E , Nasrullah M , DiNenno E , Dietz P . AIDS Patient Care STDS 2015 29 (10) 533-40 The Centers for Disease Control and Prevention (CDC) recommends annual HIV screening for persons at high risk for HIV infection. We assessed the testing history and factors associated with recent testing (tested in the last 12 months) among persons at high risk for HIV infection. We analyzed 2006-2010 National Survey of Family Growth data and classified respondents aged 15-44 who reported a sexual or drug-use risk behavior in the past year as 'high-risk'. Logistic regression models estimated prevalence ratios assessing the association between demographic and health-related factors and having been recently tested for HIV compared with never been tested. Among high-risk men, 29.3% had recently tested for HIV, 30.7% tested more than 12 months ago, and 40.0% had never been tested. Among high-risk women, 38.0% had recently tested, 36.9% tested more than 12 months ago, and 26.1% had never been tested. Compared with men who were aged 15-19, white, heterosexual, and had not recently visited a doctor, men who were aged 40-44, black/African American, homosexual/gay or bisexual, and had visited a doctor in the past year were more likely to have recently tested. Compared with women who were white, had not recently visited a doctor, and had never been pregnant, women more likely to have recently tested were black/African American, had visited a doctor in the past year, and had been pregnant. Approximately two-thirds of high-risk men and women had not been recently tested for HIV. CDC recommendations for annual screening are not being implemented for the majority of persons at risk. |
Frequent nevirapine resistance in infants infected by HIV-1 via breastfeeding while on nevirapine prophylaxis: results of the Breastfeeding, Antiretrovirals and Nutrition study
Nelson JA , Fokar A , Hudgens MG , Compliment KJ , Hawkins JT , Tegha G , Kamwendo DD , Kayira D , Mofolo IA , Kourtis AP , Jamieson DJ , Van Der Horst CM , Fiscus SA . AIDS 2015 29 (16) 2131-8 OBJECTIVE: The objective of this study is to assess nevirapine (NVP) resistance in infants who became infected in the three arms of the Breastfeeding, Antiretrovirals and Nutrition (BAN) study: daily infant NVP prophylaxis, triple maternal antiretrovirals or no extra intervention for 28 weeks of breastfeeding. DESIGN: A prospective cohort study. METHODS: The latest available plasma or dried blood spot specimen was tested from infants who became HIV-positive between 3 and 48 weeks of age. Population sequencing was used to detect mutations associated with reverse transcriptase inhibitor resistance. Sequences were obtained from 22 out of 25 transmissions in the infant-NVP arm, 23 out of 30 transmissions in the maternal-antiretroviral arm and 33 out of 38 transmissions in the control arm. RESULTS: HIV-infected infants in the infant-NVP arm were significantly more likely to have NVP resistance than infected infants in the other two arms of the trial, especially during breastfeeding through 28 weeks of age (56% in infant-NVP arm vs. 6% in maternal-antiretroviral arm and 11% in control arm, P = 0.004). There was a nonsignificant trend, suggesting that infants with NVP resistance tended to be infected earlier and exposed to NVP while infected for a greater duration than infants without resistance. CONCLUSION: Infants on NVP prophylaxis during breastfeeding are at a reduced risk of acquiring HIV, but are at an increased risk of NVP resistance if they do become infected. These findings point to the need for frequent HIV testing of infants while on NVP prophylaxis, and for the availability of antiretroviral regimens excluding NVP for treating infants who become infected while on such a prophylactic regimen. |
The Global Trachoma Mapping Project: methodology of a 34-country population-based study
Solomon AW , Pavluck AL , Courtright P , Aboe A , Adamu L , Alemayehu W , Alemu M , Alexander ND , Kello AB , Bero B , Brooker SJ , Chu BK , Dejene M , Emerson PM , Flueckiger RM , Gadisa S , Gass K , Gebre T , Habtamu Z , Harvey E , Haslam D , King JD , Mesurier RL , Lewallen S , Lietman TM , MacArthur C , Mariotti SP , Massey A , Mathieu E , Mekasha A , Millar T , Mpyet C , Muñoz BE , Ngondi J , Ogden S , Pearce J , Sarah V , Sisay A , Smith JL , Taylor HR , Thomson J , West SK , Willis R , Bush S , Haddad D , Foster A . Ophthalmic Epidemiol 2015 22 (3) 214-25 PURPOSE: To complete the baseline trachoma map worldwide by conducting population-based surveys in an estimated 1238 suspected endemic districts of 34 countries. METHODS: A series of national and sub-national projects owned, managed and staffed by ministries of health, conduct house-to-house cluster random sample surveys in evaluation units, which generally correspond to "health district" size: populations of 100,000-250,000 people. In each evaluation unit, we invite all residents aged 1 year and older from h households in each of c clusters to be examined for clinical signs of trachoma, where h is the number of households that can be seen by 1 team in 1 day, and the product h x c is calculated to facilitate recruitment of 1019 children aged 1-9 years. In addition to individual-level demographic and clinical data, household-level water, sanitation and hygiene data are entered into the purpose-built LINKS application on Android smartphones, transmitted to the Cloud, and cleaned, analyzed and ministry-of-health-approved via a secure web-based portal. The main outcome measures are the evaluation unit-level prevalence of follicular trachoma in children aged 1-9 years, prevalence of trachomatous trichiasis in adults aged 15 + years, percentage of households using safe methods for disposal of human feces, and percentage of households with proximate access to water for personal hygiene purposes. RESULTS: In the first year of fieldwork, 347 field teams commenced work in 21 projects in 7 countries. CONCLUSION: With an approach that is innovative in design and scale, we aim to complete baseline mapping of trachoma throughout the world in 2015. |
HIV pre-exposure prophylaxis and health and community systems in the global south: Thailand case study
Colby D , Srithanaviboonchai K , Vanichseni S , Ongwandee S , Phanuphak N , Martin M , Choopanya K , Chariyalertsak S , van Griensven F . J Int AIDS Soc 2015 18 19953 INTRODUCTION: Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization as an effective method of HIV prevention for individuals at risk for infection. In this paper, we describe the unique role that Thailand has played in the global effort to combat the HIV epidemic, including its role in proving the efficacy of PrEP, and discuss the opportunities and challenges of implementing PrEP in a middle-income country. DISCUSSION: Thailand was one of the first countries in the world to successfully reverse a generalized HIV epidemic. Despite this early success, HIV prevalence has remained high among people who inject drugs and has surged among men who have sex with men (MSM) and transgender women (TGW). Two pivotal trials that showed that the use of oral antiretroviral medication as PrEP can reduce HIV transmission were conducted partially or entirely at Thai sites. Demonstration projects of PrEP, as well as clinical trials of alternative PrEP regimens, began or will begin in 2014-2015 in Thailand and will provide additional data and experience on how to best implement PrEP for high-risk individuals in the community. Financing of drug costs, the need for routine laboratory monitoring and lack of awareness about PrEP among at-risk groups all present challenges to the wider implementation of PrEP for HIV prevention in Thailand. CONCLUSIONS: Although significant challenges to wider use remain, PrEP holds promise as a safe and highly effective method to be used as part of a combined HIV prevention strategy for MSM and TGW in Thailand. |
Knowledge and attitudes regarding antibiotic use among adult consumers, adult Hispanic consumers, and health care providers - United States, 2012-2013
Francois Watkins LK , Sanchez GV , Albert AP , Roberts RM , Hicks LA . MMWR Morb Mortal Wkly Rep 2015 64 (28) 767-70 Appropriate antibiotic use, in particular avoidance of antibiotics for upper respiratory infections likely to be caused by viruses, is a key component of efforts to slow the increase in antibiotic-resistant infections. Studies suggest that Hispanic consumers might differ from non-Hispanic consumers in their knowledge and attitudes regarding antibiotic use. To better understand health care provider and consumer knowledge and attitudes that influence antibiotic use, CDC analyzed national internet survey data collected from participants living in the United States during 2012-2013. The participants represented three groups: 1) the total population of adult consumers (all ethnicities); 2) adult Hispanic consumers; and 3) health care providers. Hispanic consumers were more likely than all consumers to believe that if they have a cold, antibiotics would help them to get better more quickly (48% versus 25%), and more likely to obtain antibiotics not prescribed by a clinician, such as antibiotics left over from a previous illness (25% versus 9%), obtained from a neighborhood grocery store (23% versus 5%), or obtained from a friend or family member (17% versus 6%). Most providers surveyed (54%) reported that they believed their patients expect antibiotics during visits for a cough or cold, whereas 26% of all consumers reported this expectation. To maximize knowledge about appropriate antibiotic use among outpatients in the United States, public health initiatives should target Hispanic as well as general audiences. |
Association of HIV-1 envelope-specific breast milk IgA responses with reduced risk of postnatal mother-to-child transmission of HIV-1
Pollara J , McGuire E , Fouda GG , Rountree W , Eudailey J , Overman RG , Seaton KE , Deal A , Edwards RW , Tegha G , Kamwendo D , Kumwenda J , Nelson JA , Liao HX , Brinkley C , Denny TN , Ochsenbauer C , Ellington S , King CC , Jamieson DJ , van der Horst C , Kourtis AP , Tomaras GD , Ferrari G , Permar SR . J Virol 2015 89 (19) 9952-61 Infants born to HIV-1 infected mothers in resource-limited areas where replacement feeding is unsafe and impractical are repeatedly exposed to HIV-1 throughout breastfeeding. Despite this, the majority of infants do not contract HIV-1 postnatally, even in absence of maternal antiretroviral therapy. This suggests that immune factors in breast milk of HIV-1-infected mothers help to limit vertical transmission. We compared the HIV-1 envelope-specific breast milk and plasma antibody responses of clade C HIV-1-infected postnatally transmitting and nontransmitting mothers in the control arm of the Malawi-based Breastfeeding Antiretrovirals and Nutrition study using multivariable logistic regression modeling. We found no association between milk or plasma neutralization activity, antibody-dependent cell-mediated cytotoxicity, or HIV-1 envelope-specific IgG responses and postnatal transmission risk. While the envelope-specific breast milk and plasma IgA responses also did not reach significance in predicting postnatal transmission risk in the primary model after correction for multiple comparisons, subsequent exploratory analysis using two distinct assay methodologies demonstrated that the magnitudes of breast milk total and secretory IgA responses against a consensus HIV-1 envelope gp140 (B.con env03) were associated with reduced postnatal transmission risk. These results suggest a protective role for mucosal HIV-1 envelope-specific IgA responses in the context of postnatal virus transmission. This finding supports further investigations into the mechanisms by which mucosal IgA reduces risk of HIV-1 transmission via breast milk, and into immune interventions aimed at enhancing this response. IMPORTANCE: Infants born to HIV-1 infected mothers are repeatedly exposed to virus in breast milk. Remarkably, the transmission rate is low, suggesting that immune factors in breast milk of HIV-1-infected mothers help to limit transmission. We compared the antibody responses in plasma and breast milk of HIV-1 transmitting and nontransmitting mothers to identify responses that correlated with reduced risk of postnatal HIV-1 transmission. We found that neither plasma nor breast milk IgG antibody responses were associated with risk of HIV-1 transmission. In contrast, the magnitude of the breast milk IgA and secretory IgA response against HIV-1 envelope proteins was associated with reduced risk of postnatal HIV-1 transmission. The results of this study support further investigations of the mechanisms by which mucosal IgA may reduce the risk of HIV-1 transmission via breastfeeding, and development of strategies to enhance milk envelope-specific IgA responses to reduce mother-to-child HIV transmission and promote an HIV-free generation. |
Associations of hormonal contraceptive use with measures of HIV disease progression and antiretroviral therapy effectiveness
Whiteman MK , Jeng G , Samarina A , Akatova N , Martirosyan M , Kissin DM , Curtis KM , Marchbanks PA , Hillis SD , Mandel MG , Jamieson DJ . Contraception 2015 93 (1) 17-24 OBJECTIVE: To examine the associations between hormonal contraceptive use and measures of HIV disease progression and antiretroviral treatment (ART) effectiveness. STUDY DESIGN: A prospective cohort study of women with prevalent HIV infection in St Petersburg, Russia was conducted. After contraceptive counseling, participants chose to use combined oral contraceptives (COCs), depot-medroxyprogesterone acetate (DMPA), a copper intrauterine device (IUD), or male condoms for pregnancy prevention. Among participants not using ART at enrollment, we used multivariate Cox regression to assess the association between current (time-varying) contraceptive use and disease progression, measured by the primary composite outcome of CD4 decline to <350 cells/mm3, ART initiation, or death. Among participants using ART at enrollment, we used linear mixed models to estimate the predicted mean CD4 change at select time points by contraceptive method. RESULTS: During a total of 5,233 months follow-up among participants not using ART with enrollment CD4 ≥350 cells/mm3 (n=315), 97 experienced disease progression. Neither current use of COCs (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.56-1.48) nor DMPA (aHR 1.28, 95% CI 0.71-2.31) was associated with a statistically significant increased risk for disease progression compared with use of non-hormonal methods (IUD or condoms). Among participants using ART at enrollment (n=77), we found no statistically significant differences in the predicted mean changes in CD4 cell count comparing current use of COCs (P=0.1) or DMPA (P=0.3) with non-hormonal methods. CONCLUSION: Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection. IMPLICATIONS: Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection. |
Transgene expression in tick cells using Agrobacterium tumefaciens.
Machado-Ferreira E , Balsemao-Pires E , Dietrich G , Hojgaard A , Vizzoni VF , Scoles G , Bell-Sakyi L , Piesman J , Zeidner NS , Soares CA . Exp Appl Acarol 2015 67 (2) 269-87 Ticks transmit infectious agents to humans and other animals. Genetic manipulation of vectors like ticks could enhance the development of alternative disease control strategies. Transgene expression using the phytopathogen Agrobacterium tumefaciens has been shown to promote the genetic modification of non-plant cells. In the present work we developed T-DNA constructs for A. tumefaciens to mediate transgene expression in HeLa cells as well as Rhipicephalus microplus tick cells. Translational fusions eGfp:eGfp or Salp15:eGfp, including the enhanced-green fluorescent protein and the Ixodes scapularis salivary factor SALP15 genes, were constructed using the CaMV 35S (cauliflower mosaic virus) promoter, "PBm" tick promoter (R. microplus pyrethroid metabolizing esterase gene) or the Simian Virus SV40 promoter. Confocal microscopy, RT-PCR and Western-blot assays demonstrated transgene(s) expression in both cell lines. Transgene expression was also achieved in vivo, in both R. microplus and I. scapularis larvae utilizing a soaking method including the A. tumefaciens donor cells and confirmed by nested-RT-PCR showing eGfp or Salp15 poly-A-mRNA(s). This strategy opens up a new avenue to express exogenous genes in ticks and represents a potential breakthrough for the study of tick-host pathophysiology. |
Transmission of H7N9 influenza viruses with polymorphism at PB2 residue 627 in chickens and ferrets.
Luk GS , Leung CY , Sia SF , Choy KT , Zhou J , Ho CC , Cheung PP , Lee EF , Wai CK , Li PC , Ip SM , Poon LL , Lindsley WG , Peiris M , Yen HL . J Virol 2015 Poultry exposure is a major risk factor for human H7N9 zoonotic infections of which the mode of transmission remains unclear. We studied the transmission of genetically related poultry and human H7N9 influenza viruses differed by four amino acids including the host determinant PB2 residue 627. A/Silkie Chicken/HK/1772/2014 (SCk1772) and A/HK/3263/14 (HK3263) replicated to comparable titers in chickens with superior oropharyngeal over cloacal shedding; both viruses transmitted efficiently among chickens via direct contact but inefficiently via airborne route. Interspecies transmission via the airborne route was observed for ferrets exposed to the SCk1772 or HK3263 infected chickens while low numbers of copies of influenza viral genome were detected in the air, predominantly at particle sizes larger than 4mum. In ferrets, the human isolate HK3263 replicated to higher titers and transmitted more efficiently via direct contact than SCk1772. We monitored "intra-host" and "inter-host" adaptive changes at PB2 residue 627 during infection and transmission of the SCK1772 that carried E627 and HK3263 that carried V/K/E polymorphism at 60%, 20%, and 20%, respectively. For SCk1772, positive selection for K627 over E627 was observed in ferrets during the chicken-to-ferret or ferret-to-ferret transmission. For HK3263 that contained V/K/E polymorphism, mixed V627 and E627 genotypes were transmitted among chickens while either V627 or K627 was transmitted from chicken-to-ferret or ferret-to-ferret with a narrow transmission bottleneck. Overall, our results suggest direct contact as the main mode for H7N9 transmission and identify the PB2-V627 genotype with uncompromised fitness and transmissibility in both avian and mammalian species. IMPORTANCE: We studied the modes of H7N9 transmission, as this information is crucial for developing effective control measures for prevention. Using chicken (SCk1772) and human (HK3263) H7N9 isolates that differed by four amino acids, including the host determinant PB2 residue 627, we observed both viruses transmitted efficiently among chickens via direct contact but inefficiently via airborne route. Chicken-to-ferret transmission via airborne route was observed along with the detection of viral genome in the air at low copies. In ferrets, HK3263 transmitted more efficiently than SCk1772 via direct contact. During the transmission of SCk1772 that contained E and HK3263 that contained V/K/E polymorphism at PB2 residue 627, positive selections of E627 and K627 were observed in chickens and ferrets, respectively. In addition, PB2-V627 was transmitted and stably maintained in both avian and mammalian species. Our results support applying intervention strategies that minimize direct and indirect contact at the poultry markets during epidemics. |
Toward a mechanistic understanding of environmentally forced zoonotic disease emergence: Sin Nombre hantavirus
Carver S , Mills JN , Parmenter CA , Parmenter RR , Richardson KS , Harris RL , Douglass RJ , Kuenzi AJ , Luis AD . BioScience 2015 65 (7) 651-666 Understanding the environmental drivers of zoonotic reservoir and human interactions is crucial to understanding disease risk, but these drivers are poorly predicted. We propose a mechanistic understanding of human-reservoir interactions, using hantavirus pulmonary syndrome as a case study. Crucial processes underpinning the disease's incidence remain poorly studied, including the connectivity among natural and peridomestic deer mouse host activity, virus transmission, and human exposure. We found that disease cases were greatest in arid states and declined exponentially with increasing precipitation. Within arid environments, relatively rare climatic conditions (e.g., El Niño) are associated with increased rainfall and reservoir abundance, producing more frequent virus transmission and host dispersal. We suggest that deer mice increase their occupancy of peridomestic structures during spring-summer, amplifying intraspecific transmission and human infection risk. Disease incidence in arid states may increase with predicted climatic changes. Mechanistic approaches incorporating reservoir behavior, reservoir-human interactions, and pathogen spillover could enhance our understanding of global hantavirus ecology, with applications to other directly transmitted zoonoses. |
On palms, bugs, and Chagas disease in the Americas
Abad-Franch F , Lima MM , Sarquis O , Gurgel-Goncalves R , Sanchez-Martin M , Calzada J , Saldana A , Monteiro FA , Palomeque FS , Santos WS , Angulo VM , Esteban L , Dias FB , Diotaiuti L , Bar ME , Gottdenker NL . Acta Trop 2015 151 126-41 Palms are ubiquitous across Neotropical landscapes, from pristine forests or savannahs to large cities. Although palms provide useful ecosystem services, they also offer suitable habitat for triatomines and for Trypanosoma cruzi mammalian hosts. Wild triatomines often invade houses by flying from nearby palms, potentially leading to new cases of human Chagas disease. Understanding and predicting triatomine-palm associations and palm infestation probabilities is important for enhancing Chagas disease prevention in areas where palm-associated vectors transmit T. cruzi. We present a comprehensive overview of palm infestation by triatomines in the Americas, combining a thorough reanalysis of our published and unpublished records with an in-depth review of the literature. We use site-occupancy modeling (SOM) to examine infestation in 3590 palms sampled with non-destructive methods, and standard statistics to describe and compare infestation in 2940 palms sampled by felling-and-dissection. Thirty-eight palm species (18 genera) have been reported to be infested by approximately 39 triatomine species (10 genera) from the USA to Argentina. Overall infestation varied from 49.1-55.3% (SOM) to 62.6-66.1% (dissection), with important heterogeneities among sub-regions and particularly among palm species. Large palms with complex crowns (e.g., Attalea butyracea, Acrocomia aculeata) and some medium-crowned palms (e.g., Copernicia, Butia) are often infested; in slender, small-crowned palms (e.g., Euterpe) triatomines associate with vertebrate nests. Palm infestation tends to be higher in rural settings, but urban palms can also be infested. Most Rhodnius species are probably true palm specialists, whereas Psammolestes, Eratyrus, Cavernicola, Panstrongylus, Triatoma, Alberprosenia, and some Bolboderini seem to use palms opportunistically. Palms provide extensive habitat for enzootic T. cruzi cycles and a critical link between wild cycles and transmission to humans. Unless effective means to reduce contact between people and palm-living triatomines are devised, palms will contribute to maintaining long-term and widespread, albeit possibly low-intensity, transmission of human Chagas disease. Graphical Abstract summary Palms are widely distributed throughout the Americas, as this 1853 map by Alfred Russel Wallace shows. This distribution almost perfectly matches the distribution of endemic human Chagas disease. Palm-living triatomine bugs make up the bridge between palms and disease. The bugs share palm crown habitats with Trypanosoma cruzi hosts. Flying from palms, infected vectors invade houses and can transmit the parasite to humans. Understanding the ecological links between palms and the parasite's vectors and hosts will be crucial for the long-term prevention of human Chagas disease. |
Severe illness from methyl bromide exposure at a condominium resort - U.S. Virgin Islands, March 2015
Kulkarni PA , Duncan MA , Watters MT , Graziano LT , Vaouli E , Cseh LF , Risher JF , Orr MF , Hunte-Ceasar TC , Ellis EM . MMWR Morb Mortal Wkly Rep 2015 64 (28) 763-6 On March 22, 2015, the Agency for Toxic Substances and Disease Registry (ATSDR) was notified by the U.S. Environmental Protection Agency (EPA) of four cases of suspected acute methyl bromide toxicity among family members vacationing at a condominium resort in the U.S. Virgin Islands. Methyl bromide is a pesticide that has been banned in the United States for use in homes and other residential settings. An investigation conducted by the U.S. Virgin Islands Department of Health (VIDOH), the U.S. Virgin Islands Department of Planning and Natural Resources (DPNR), and EPA confirmed that methyl bromide had been used as a fumigant on March 18 in the building where the family had been residing, 2 days before they were transported to the hospital; three family members had life-threatening illness. On March 25, 2015, a stop-use order for methyl bromide was issued by DPNR to the pest control company that had performed the fumigation. Subsequent investigation revealed that previous fumigation with methyl bromide had occurred on October 20, 2014, at the same condominium resort. In addition to the four ill family members, 37 persons who might have been exposed to methyl bromide as a result of the October 2014 or March 2015 fumigations were identified by VIDOH and ATSDR. Standardized health questionnaires were administered to 16 of the 20 persons for whom contact information was available; six of 16 had symptoms consistent with methyl bromide exposure, including headache and fatigue. Pest control companies should be aware that use of methyl bromide is banned in homes and other residential settings, and clinicians should be aware of the toxicologic syndrome that exposure to methyl bromide can cause. |
"Improved" but not necessarily safe: an assessment of fecal contamination of household drinking water in rural Peru
Heitzinger K , Rocha CA , Quick RE , Montano SM , Tilley DH Jr , Mock CN , Carrasco AJ , Cabrera RM , Hawes SE . Am J Trop Med Hyg 2015 93 (3) 501-8 The indicator used to measure progress toward the Millennium Development Goal (MDG) for water is access to an improved water supply. However, improved supplies are frequently fecally contaminated in developing countries. We examined factors associated with Escherichia coli contamination of improved water supplies in rural Pisco province, Peru. A random sample of 207 households with at least one child less than 5 years old was surveyed, and water samples from the source and storage container were tested for E. coli contamination. Although over 90% of households used an improved water source, 47% of source and 43% of stored water samples were contaminated with E. coli. Pouring or using a spigot to obtain water from the storage container instead of dipping a hand or object was associated with decreased risk of contamination of stored water (adjusted prevalence ratio [aPR] = 0.58, 95% confidence interval [CI] = 0.42, 0.80). Container cleanliness (aPR = 0.67, 95% CI = 0.45, 1.00) and correct handwashing technique (aPR = 0.62, 95% CI = 0.42, 0.90) were also associated with decreased contamination risk. These findings highlighted the limitations of improved water supplies as an indicator of safe water access. To ensure water safety in the home, household water treatment and improved hygiene, water handling, and storage practices should be promoted. |
Muscular Grip Strength Estimates of the U.S. Population from the National Health and Nutrition Examination Survey 2011-2012
Perna FM , Coa K , Troiano RP , Lawman HG , Wang CY , Li Y , Moser RP , Ciccolo JT , Comstock BA , Kraemer WJ . J Strength Cond Res 2015 The purposes of this study were to use the National Health and Nutrition Examination Study (NHANES 2011-12) data to determine nationally representative combined-hand grip strength ranges and percentile information by sex and age group, examine trends in strength across age by sex, and to determine the relative proportion of children and adults falling into established Health Benefit Zones (HBZ). Results indicate that mean strength was greater among males than females, increased linearly for children and in a quadratic fashion among adults for both sexes. Grip strength peaked in the 30 -39 year age group for both men (216.4lbs) and women (136.5lbs) with subsequent age groups showing gradual decline, ps < .0001. Relative and absolute increase in grip strength was greater for males than for females, but relative decrease from peak strength was less among women than men. Although absolute strength was greater among men than women, HBZ data indicated that a higher percentage of males than females overall and at each age group fell into the Needs Improvement zone, with differences particularly pronounced during adolescence and older adulthood. These data provide the first nationally representative population estimates of combined-hand grip strength and percentile information from childhood through senescence, and suggest consideration of HBZ information in conjunction with grip strength to improve surveillance data interpretation and intervention planning. |
Escherichia coli O157:H7 outbreak associated with restaurant beef grinding
Torso LM , Voorhees RE , Forest SA , Gordon AZ , Silvestri SA , Kissler B , Schlackman J , Sandt CH , Toma P , Bachert J , Mertz KJ , Harrison LH . J Food Prot 2015 78 (7) 1272-9 Escherichia coli O157:H7 is a common cause of foodborne illness in the United States. Beef ground at establishments regulated by the U.S. Department of Agriculture, Food Safety and Inspection Service is routinely tested for E. coli O157:H7. Prior to December 2013, boxed beef product (wholesale cuts of beef, such as beef loin, packaged into bags and boxed for shipping) was not always tested for this pathogen. Downstream processors or retailers may grind the product; and, if the ground beef is not cooked to the recommended temperature, pathogens on the exterior of the beef introduced to the interior through grinding may survive. On 18 October 2013, the Allegheny County Health Department identified two E. coli O157:H7 cases, both of whom were food handlers at restaurant A, a restaurant that ground locally produced boxed beef for hamburgers on site. Case finding was conducted through public messaging, employee surveys, and disease surveillance. All potential cases were interviewed using a standard questionnaire. A confirmed case was defined as laboratory-confirmed E. coli O157:H7 with exposure to restaurant A. A probable case was defined as a patient with compatible symptoms and exposure to restaurant A but without laboratory confirmation. All human and food isolates were characterized by pulsed-field gel electrophoresis and multilocus variable-number tandem repeat analysis. The analysis identified 14 confirmed and 10 probable cases of E. coli; 18 nonintact ground beef samples tested positive for E. coli O157:H7. Nine confirmed cases were restaurant A employees. All confirmed cases recalled eating a restaurant A hamburger in the 10 days before illness onset; most cases reported consuming medium to rare hamburgers. Multiple pulsed-field gel electrophoresis and multilocus variable-number tandem repeat analysis patterns were identified among both the human and ground beef isolates, and the patient isolates matched those found in ground beef samples. Restaurant A voluntarily closed for 1.5 days, changed beef suppliers, ceased grinding beef in-house, and has had no new cases since reopening. |
Complete Genome Sequence of Chikungunya Virus Isolated from an Aedes aegypti Mosquito during an Outbreak in Yemen, 2011.
Fahmy NT , Klena JD , Mohamed AS , Zayed A , Villinski JT . Genome Announc 2015 3 (4) Chikungunya virus is recognized as a serious public health problem. The complete genome was sequenced for a chikungunya virus isolated from the mosquito Aedes aegypti during a 2011 outbreak in Al Hodayda, Yemen, which resulted in significant human fatalities. Phylogenetic analysis demonstrated that this Yemeni isolate is most closely related to Indian Ocean strains of the east/central/south African genotype. |
Genomic Analysis of the Emergence and Rapid Global Dissemination of the Clonal Group 258 Klebsiella pneumoniae Pandemic.
Bowers JR , Kitchel B , Driebe EM , MacCannell DR , Roe C , Lemmer D , de Man T , Rasheed JK , Engelthaler DM , Keim P , Limbago BM . PLoS One 2015 10 (7) e0133727 Multidrug-resistant Klebsiella pneumoniae producing the KPC carbapenemase have rapidly spread throughout the world, causing severe healthcare-associated infections with limited antimicrobial treatment options. Dissemination of KPC-producing K. pneumoniae is largely attributed to expansion of a single dominant strain, ST258. In this study, we explore phylogenetic relationships and evolution within ST258 and its clonal group, CG258, using whole genome sequence analysis of 167 isolates from 20 countries collected over 17 years. Our results show a common ST258 ancestor emerged from its diverse parental clonal group around 1995 and likely acquired blaKPC prior to dissemination. Over the past two decades, ST258 has remained highly clonal despite diversity in accessory elements and divergence in the capsule polysaccharide synthesis locus. Apart from the large recombination event that gave rise to ST258, few mutations set it apart from its clonal group. However, one mutation occurs in a global transcription regulator. Characterization of outer membrane protein sequences revealed a profile in ST258 that includes a truncated OmpK35 and modified OmpK37. Our work illuminates potential genomic contributors to the pathogenic success of ST258, helps us better understand the global dissemination of this strain, and identifies genetic markers unique to ST258. |
Development of a Multi-Locus Sequence Typing System for Medically Relevant Bipolaris Species.
Pham CD , Purfield AE , Fader R , Pascoe N , Lockhart SR . J Clin Microbiol 2015 53 (10) 3239-46 Multi-locus sequence typing (MLST) is the 'gold standard' genotyping technique for many microorganisms. This classification approach satisfies the requirements for a high-resolution, standardized, and archivable taxonomic system. Here, we describe the development of a novel MLST system to assist with the investigation of an unusual cluster of surgical site infections caused by Bipolaris spp. in post-operative cardiothoracic surgery (POCS) patients during January, 2008-December, 2013 in the southeastern US. We also used the same MLST system to perform retrospective analysis on isolates from a 2012 Bipolaris endophthalmitis outbreak caused by a contaminated product. This MLST system showed high intraspecies discriminatory power for B. spicifera, B. hawaiiensis, and B. australiensis. Based on relatedness of the isolates, the MLST data supported the hypothesis that infections in the POCS cluster were from different environmental sources while confirming the endophthalmitis outbreak resulted from a point-source, which was a contaminated medication. |
The mitochondrial genome of the lone star tick (Amblyomma americanum).
Williams-Newkirk AJ , Burroughs M , Changayil SS , Dasch GA . Ticks Tick Borne Dis 2015 6 (6) 793-801 Amblyomma americanum is an abundant tick in the southeastern, midwestern, and northeastern United States. It is a vector of multiple diseases, but limited genomic resources are available for it. We sequenced the complete mitochondrial genome of a single female A. americanum collected in Georgia using the Illumina platform. The consensus sequence was 14,709bp long, and the mean coverage across the assembly was >12,000x. All expected tick genomic features were present, including two "Tick-Box" motifs, and in the expected order for the Metastriata. Heteroplasmy rates were low compared to the most closely related tick for which data are available, Amblyomma cajennense. The phylogeny derived from the concatenated protein coding and rRNA genes from the 33 available tick mitochondrial genomes was consistent with those previously proposed for the Acari. This is the first complete mitochondrial sequence for A. americanum, which provides a useful reference for future studies of A. americanum population genetics and tick phylogeny. |
A Large-Scale Community-Based Outbreak of Paratyphoid Fever Caused by Hospital-Derived Transmission in Southern China.
Yan M , Yang B , Wang Z , Wang S , Zhang X , Zhou Y , Pang B , Diao B , Yang R , Wu S , Klena JD , Kan B . PLoS Negl Trop Dis 2015 9 (7) e0003859 BACKGROUND: Since the 1990s, paratyphoid fever caused by Salmonella Paratyphi A has emerged in Southeast Asia and China. In 2010, a large-scale outbreak involving 601 cases of paratyphoid fever occurred in the whole of Yuanjiang county in China. Epidemiological and laboratory investigations were conducted to determine the etiology, source and transmission factors of the outbreak. METHODOLOGY/PRINCIPAL FINDINGS: A case-control study was performed to identify the risk factors for this paratyphoid outbreak. Cases were identified as patients with blood culture-confirmed S. Paratyphi A infection. Controls were healthy persons without fever within the past month and matched to cases by age, gender and geography. Pulsed-field gel electrophoresis and whole-genome sequencing of the S. Paratyphi A strains isolated from patients and environmental sources were performed to facilitate transmission analysis and source tracking. We found that farmers and young adults were the populations mainly affected in this outbreak, and the consumption of raw vegetables was the main risk factor associated with paratyphoid fever. Molecular subtyping and genome sequencing of S. Paratyphi A isolates recovered from improperly disinfected hospital wastewater showed indistinguishable patterns matching most of the isolates from the cases. An investigation showed that hospital wastewater mixed with surface water was used for crop irrigation, promoting a cycle of contamination. After prohibition of the planting of vegetables in contaminated fields and the thorough disinfection of hospital wastewater, the outbreak subsided. Further analysis of the isolates indicated that the origin of the outbreak was most likely from patients outside Yuanjiang county. CONCLUSIONS: This outbreak is an example of the combined effect of social behaviors, prevailing ecological conditions and improper disinfection of hospital wastewater on facilitating a sustained epidemic of paratyphoid fever. This study underscores the critical need for strict treatment measures of hospital wastewater and the maintenance of independent agricultural irrigation systems in rural areas. |
Laboratory replication of filtration procedures associated with Serratia marcescens bloodstream infections in patients receiving compounded amino acid solutions
Moulton-Meissner H , Noble-Wang J , Gupta N , Hocevar S , Kallen A , Arduino M . Am J Health Syst Pharm 2015 72 (15) 1285-91 PURPOSE: Specific deviations from United States Pharmacopeia standards were analyzed to investigate the factors allowing an outbreak of Serratia marcescens bloodstream infections in patients receiving compounded amino acid solutions. METHODS: Filter challenge experiments using the outbreak strain of S. marcescens were compared with those that used the filter challenge organism recommended by ASTM International (Brevundimonas diminuta ATCC 19162) to determine the frequency and degree of organism breakthrough. Disk and capsule filters (0.22- and 0.2-mum nominal pore size, respectively) were challenged with either the outbreak strain of S. marcescens or B. diminuta ATCC 19162. The following variables were compared: culture conditions in which organisms were grown overnight or cultured in sterile water (starved), solution type (15% amino acid solution or sterile water), and filtration with or without a 0.5-mum prefilter. RESULTS: Small-scale, syringe-driven, disk-filtration experiments of starved bacterial cultures indicated that approximately 1 in every 1,000 starved S. marcescens cells (0.12%) was able to pass through a 0.22-mum nominal pore-size filter, and about 1 in every 1,000,000 cells was able to pass through a 0.1-mum nominal pore-size filter. No passage of the B. diminuta ATCC 19162 cells was observed with either filter. In full-scale experiments, breakthrough was observed only when 0.2-mum capsule filters were challenged with starved S. marcescens in 15% amino acid solution without a 0.5-mum prefiltration step. CONCLUSION: Laboratory simulation testing revealed that under certain conditions, bacteria can pass through 0.22- and 0.2-mum filters intended for sterilization of an amino acid solution. Bacteria did not pass through 0.2-mum filters when a 0.5-mum prefilter was used. |
Promoting prevention through meaningful measures: improving the Centers for Disease Control and Prevention's National Healthcare Safety Network urinary tract infection surveillance definitions
Allen-Bridson K , Pollock D , Gould CV . Am J Infect Control 2015 43 (10) 1096-8 The new year of 2015 brought with it the release of the update to the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN) urinary tract infection (UTI) definitions. Although the NHSN UTI definitions were last updated in 2009, the inclusion of catheter-associated UTIs (CAUTIs) in the Centers for Medicare & Medicaid Services' Inpatient Quality Reporting Program in 2012 heightened the challenges to the definitions by many professionals involved in infection prevention. Feedback to CDC beginning in 2012 highlighted the gap between clinical and surveillance determinations of CAUTI1, raised questions about the clinical relevance of some CAUTIs reported to NHSN and drew attention to variability in the application of, and adherence to, the UTI surveillance criteria and differences in clinical laboratory practices relevant to the criteria. Many commenters questioned the validity and fairness of using CAUTI data for public reporting and payment purposes and called for definitions which would more accurately measure the success of CAUTI prevention activities. | For these reasons, in early 2013, CDC began a systematic process of reviewing the NHSN UTI definitions. The main objectives of this work were to: 1) improve the objectivity, credibility, and reliability of the UTI definitions, 2) promote best practices for patient safety with a metric that is reflective of the success or failure of quality improvement and prevention activities, 3) develop a metric that is amenable to full electronic capture to allow for increased objectivity and reduced burden of data collection, and 4) help target CAUTI prevention. |
Pilot to evaluate the feasibility of measuring seasonal influenza vaccine effectiveness using surveillance platforms in Central-America, 2012
El Omeiri N , Azziz-Baumgartner E , Clara W , Guzman-Saborio G , Elas M , Mejia H , Molina IB , De Molto Y , Mirza S , Widdowson MA , Ropero-Alvarez AM . BMC Public Health 2015 15 (1) 673 BACKGROUND: Since 2004, the uptake of seasonal influenza vaccines in Latin America and the Caribbean has markedly increased. However, vaccine effectiveness (VE) is not routinely measured in the region. We assessed the feasibility of using routine surveillance data collected by sentinel hospitals to estimate influenza VE during 2012 against laboratory-confirmed influenza hospitalizations in Costa-Rica, El Salvador, Honduras and Panama. We explored the completeness of variables needed for VE estimation. METHODS: We conducted the pilot case-control study at 23 severe acute respiratory infections (SARI) surveillance hospitals. Participant inclusion criteria included children 6 months-11 years and adults ≥60 years targeted for vaccination and hospitalized for SARI during January-December 2012. We abstracted information needed to estimate target group specific VE (i.e., date of illness onset and specimen collection, preexisting medical conditions, 2012 and 2011 vaccination status and date, and pneumococcal vaccination status for children and adults) from SARI case-reports and for children ≤9 years, inquired about the number of annual vaccine doses given. A case was defined as an influenza virus positive by RT-PCR in a person with SARI, while controls were RT-PCR negative. We recruited 3 controls per case from the same age group and month of onset of symptoms. RESULTS: We identified 1,186 SARI case-patients (342 influenza cases; 849 influenza-negative controls), of which 994 (84 %) had all the information on key variables sought. In 893 (75 %) SARI case-patients, the vaccination status field was missing in the SARI case-report forms and had to be completed using national vaccination registers (36 %), vaccination cards (30 %), or other sources (34 %). After applying exclusion criteria for VE analyses, 541 (46 %) SARI case-patients with variables necessary for the group-specific VE analyses were selected (87 cases, 236 controls among children; 64 cases, 154 controls among older adults) and were insufficient to provide precise regional estimates (39 % for children and 25 % for adults of minimum sample size needed). CONCLUSIONS: Sentinel surveillance networks in middle income countries, such as some Latin American and Caribbean countries, could provide a simple and timely platform to estimate regional influenza VE annually provided SARI forms collect all necessary information. |
A potent broad-spectrum protective human monoclonal antibody crosslinking two haemagglutinin monomers of influenza A virus
Wu Y , Cho M , Shore D , Song M , Choi J , Jiang T , Deng YQ , Bourgeois M , Almli L , Yang H , Chen LM , Shi Y , Qi J , Li A , Yi KS , Chang M , Bae JS , Lee H , Shin J , Stevens J , Hong S , Qin CF , Gao GF , Chang SJ , Donis RO . Nat Commun 2015 6 7708 Effective annual influenza vaccination requires frequent changes in vaccine composition due to both antigenic shift for different subtype hemagglutinins (HAs) and antigenic drift in a particular HA. Here we present a broadly neutralizing human monoclonal antibody with an unusual binding modality. The antibody, designated CT149, was isolated from convalescent patients infected with pandemic H1N1 in 2009. CT149 is found to neutralize all tested group 2 and some group 1 influenza A viruses by inhibiting low pH-induced, HA-mediated membrane fusion. It promotes killing of infected cells by Fc-mediated antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. X-ray crystallographic data reveal that CT149 binds primarily to the fusion domain in HA2, and the light chain is also largely involved in binding. The epitope recognized by this antibody comprises amino-acid residues from two adjacent protomers of HA. This binding characteristic of CT149 will provide more information to support the design of more potent influenza vaccines. |
Impact of the US Two-dose Varicella Vaccination Program on the Epidemiology of Varicella Outbreaks: Data from Nine States, 2005-2012
Leung J , Lopez AS , Blostein J , Thayer N , Zipprich J , Clayton A , Buttery V , Andersen J , Thomas CA , Del Rosario M , Seetoo K , Woodall T , Wiseman R , Bialek SR . Pediatr Infect Dis J 2015 34 (10) 1105-9 BACKGROUND: A routine 2-dose varicella vaccination program was adopted in 2007 in the United States to help further decrease varicella disease and prevent varicella outbreaks. We describe trends and characteristics of varicella outbreaks reported to CDC during 2005-2012 from 9 states. METHODS: Data on varicella outbreaks collected by 9 state health departments were submitted to CDC using the CDC outbreak reporting worksheet. Information was collected on dates of the outbreak, outbreak setting, and number of cases by outbreak; aggregate data was provided on the numbers of outbreak-related cases by age group, vaccination status, and laboratory confirmation. RESULTS: Nine hundred and twenty-nine outbreaks were reported from the 6 states which provided data for each year during 2005-2012. Based on data from these 6 states, the number of outbreaks declined by 78%, decreasing from 147 in 2005 to 33 outbreaks in 2012 (p=0.0001). There were a total of 1,015 varicella outbreaks involving 13,595 cases reported by the 9 states from 2005-2012. The size and duration of outbreaks declined significantly over time (p<0.001). The median size of outbreaks was 12, 9, and 7 cases and median duration of outbreaks was 38, 35, and 26 days during 2005-2006, 2007-2009, and 2010-2012 respectively. Majority of outbreaks (95%) were reported from schools, declining from 97% in 2005-2006 to 89% in 2010-2012. Sixty-fivepercent of outbreak-related casesoccurred among 5-9 year olds, with the proportion declining from 76% in 2005-2006 to 45% during 2010-2012. CONCLUSIONS: The routine 2-dose varicella vaccination program appears to have significantly reduced the number, size, and duration of varicella outbreaks in the U.S. |
Changes in J-SOAP-II and SAVRY scores over the course of residential, cognitive-behavioral treatment for adolescent sexual offending
Viljoen JL , Gray AL , Shaffer C , Latzman NE , Scalora MJ , Ullman D . Sex Abuse 2015 29 (4) 342-374 Although the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) and the Structured Assessment of Violence Risk in Youth (SAVRY) include an emphasis on dynamic, or modifiable factors, there has been little research on dynamic changes on these tools. To help address this gap, we compared admission and discharge scores of 163 adolescents who attended a residential, cognitive-behavioral treatment program for sexual offending. Based on reliable change indices, one half of youth showed a reliable decrease on the J-SOAP-II Dynamic Risk Total Score and one third of youth showed a reliable decrease on the SAVRY Dynamic Risk Total Score. Contrary to expectations, decreases in risk factors and increases in protective factors did not predict reduced sexual, violent nonsexual, or any reoffending. In addition, no associations were found between scores on the Psychopathy Checklist:Youth Version and levels of change. Overall, the J-SOAP-II and the SAVRY hold promise in measuring change, but further research is needed. |
Re-evaluation of an Acanthamoeba Molecular Diagnostic Algorithm following an Atypical Case of Amoebic Keratitis.
Lau R , Cunanan M , Jackson J , Ali IK , Chong-Kit A , Gasgas J , Tian J , Ralevski F , Boggild AK . J Clin Microbiol 2015 BACKGROUND: Amoebic keratitis (AK) is a potentially blinding infection, the prompt diagnosis of which is essential to limiting ocular morbidity. We undertook a quality improvement initiative around the molecular detection of Acanthamoebae in our laboratory due to an unusual case of discordance. METHODS: Nine ATCC strains of Acanthamoeba and 40 delinked, biobanked surplus corneal scrapings were retrieved and analyzed for the presence of Acanthamoebae by 4 separate real time PCR assays. The assay used by the Free Living and Intestinal Amebas laboratory of the CDC was considered the reference standard, and performance characteristics of each individual assay, and pairs of assays were calculated. Outcome measures were sensitivity, specificity, and positive predictive value (PPV) and negative (NPV) predictive value. RESULTS: Of 49 included specimens, 14 (28.6%) were positive by the gold standard assay, and 35 (71.4%) were negative. Sensitivity of the individual test assays ranged from 64.3% to 92.9% compared to the gold standard, while specificity ranged from 88.6% to 91.4%. PPV and NPV ranged from 69.2% to 78.6%, and 86.1% to 96.9%, respectively. Combinations of assay pairs led to improved performance with sensitivities ranging from 92.9% to 100%, and specificity from 97.1% to 100%. ATCC and clinical strains of Acanthamoeba that failed detection by certain individual assays included A. castellani, A. culbertsoni, and A. lenticulata. In 3 clinical specimens, false negativity of the gold standard assay could not be excluded. CONCLUSIONS: Molecular diagnostic approaches, especially combinations of both highly sensitive and specific assays, offer a reasonably performing, operator independent, and rapid strategy for the detection of Acanthamoebae from clinical specimens, and are likely more practical than either culture or direct microscopic detection. |
Simultaneous identification and susceptibility determination to multiple antibiotics of Staphylococcus aureus by bacteriophage amplification detection combined with mass spectrometry
Rees JC , Pierce CL , Schieltz DM , Barr JR . Anal Chem 2015 87 (13) 6769-77 The continued advance of antibiotic resistance in clinically relevant bacterial strains necessitates the development and refinement of assays that can rapidly and cost-effectively identify bacteria and determine their susceptibility to a panel of antibiotics. A methodology is described herein that exploits the specificity and physiology of the Staphylococci bacteriophage K to identify Staphylococcus aureus (S. aureus) and determine its susceptibility to clindamycin and cefoxitin. The method uses liquid chromatography-mass spectrometry to monitor the replication of bacteriophage after it is used to infect samples thought to contain S. aureus. Amplification of bacteriophage K indicates the sample contains S. aureus, for it is only in the presence of a suitable host that bacteriophage K can amplify. If bacteriophage amplification is detected in samples containing the antibiotics clindamycin or cefoxitin, the sample is deemed to be resistant to these antibiotics, respectively, for bacteriophage can only amplify in a viable host. Thus, with a single work flow, S. aureus can be detected in an unknown sample and susceptibility to clindamycin and cefoxitin can be ascertained. This Article discusses implications for the use of bacteriophage amplification in the clinical laboratory. |
Effect of jet injection on infectivity of measles, mumps, and rubella vaccine in a bench model
Coughlin MM , Collins M , Saxon G , Jarrahian C , Zehrung D , Cappello C , Dhere R , Royals M , Papania M , Rota PA . Vaccine 2015 33 (36) 4540-7 Disposable-syringe jet injectors (DSJIs) with single-use, auto disable, needle-free syringes offer the opportunity to avoid hazards associated with injection using a needle and syringe. Clinical studies have evaluated DSJIs for vaccine delivery, but most studies have focused on inactivated, subunit, or DNA vaccines. Questions have been raised about possible damage to live attenuated viral vaccines by forces generated during the jet injection process. This study examines the effect of jet injection on the integrity of measles, mumps, and rubella vaccine (MMR), measured by viral RNA content and infectivity. Three models of DSJIs were evaluated, each generating a different ejection force. Following jet injection, the RNA content for each of the vaccine components was measured using RT-qPCR immediately after injection and following passage in Vero cells. Jet injection was performed with and without pig skin as a simulation of human skin. There was little to no reduction of RNA content immediately following jet injection with any of the three DSJIs. Samples passaged in Vero cells showed no loss in infectivity of the measles vaccine following jet injection. Mumps vaccine consistently showed increased replication following jet injection. Rubella vaccine showed no loss after jet injection alone but some infectivity loss following injection through pig skin with two of the devices. Overall, these data demonstrated that forces exerted on a live attenuated MMR vaccine did not compromise vaccine infectivity. The bench model and protocol used in this study can be applied to evaluate the impact of jet injection on other live virus vaccines. |
Ethanol attenuates histiotrophic nutrition pathways and alters the intracellular redox environment and thiol proteome during rat organogenesis
Jilek JL , Sant KE , Cho KH , Reed MS , Pohl J , Hansen JM , Harris C . Toxicol Sci 2015 147 (2) 475-89 Ethanol (EtOH) is a reactive oxygen-generating teratogen involved in the etiology of structural and functional developmental defects. Embryonic nutrition, redox environment, and changes in the thiol proteome following EtOH exposures (1.5-6.0 mg/ml) were studied in rat whole embryo culture (rWEC). Glutathione (GSH) and cysteine (Cys) concentrations with their respective intracellular redox potentials (Eh) were determined using HPLC. Ethanol reduced GSH and Cys concentrations in embryo (EMB) and visceral yolk sac (VYS) tissues, and also in yolk sac (YSF) and amniotic (AF) fluids. These changes produced greater oxidation as indicated by increasingly positive Eh values. Ethanol reduced histiotrophic nutrition pathway (HNP) activities as measured by the clearance of FITC-albumin from culture media. A significant decrease in total FITC clearance was observed at all concentrations, reaching ~50% at the highest dose. Ethanol-induced changes to the thiol proteome were measured in EMBs and VYSs using isotope-coded affinity tags (ICAT). Decreased concentrations for specific proteins from cytoskeletal dynamics and endocytosis pathways (alpha-actinin, alpha-tubulin, cubilin, and actin-related protein 2); nuclear translocation (Ran and RanBP1); and maintenance of receptor mediated endocytosis (cubilin) were observed. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis also identified a decrease in ribosomal proteins in both EMB and VYS. Results show that EtOH interferes with nutrient uptake to reduce availability of amino acids and micronutrients required by the conceptus. Intracellular antioxidants such as GSH and Cys are depleted following EtOH and Eh values increase. Thiol proteome analysis in the EMB and VYS show selectively altered actin/cytoskeleton, endocytosis, ribosome biogenesis and function, nuclear transport, and stress-related responses. |
Evaluation of the biotyper MALDI-TOF MS system for identification of Staphylococcus species
Zhu W , Sieradzki K , Albrecht V , McAllister S , Lin W , Stuchlik O , Limbago B , Pohl J , Kamile Rasheed J . J Microbiol Methods 2015 117 14-17 The Bruker Biotyper MALDI-TOF MS (Biotyper) system, with a modified 30minute formic acid extraction method, was evaluated by its ability to identify 216 clinical Staphylococcus isolates from the CDC reference collection comprising 23 species previously identified by conventional biochemical tests. 16S rDNA sequence analysis was used to resolve discrepancies. Of these, 209 (96.8%) isolates were correctly identified: 177 (84.7%) isolates had scores ≥2.0, while 32 (15.3%) had scores between 1.70 and 1.99. The Biotyper identification was inconsistent with the biochemical identification for seven (3.2%) isolates, but the Biotyper identifications were confirmed by 16S rDNA analysis. The distribution of low scores was strongly species-dependent, e.g. only 5% of Staphylococcus epidermidis and 4.8% of Staphylococcus aureus isolates scored below 2.0, while 100% of Staphylococcus cohnii, 75% of Staphylococcus sciuri, and 60% of Staphylococcus caprae produced low but accurate Biotyper scores. Our results demonstrate that the Biotyper can reliably identify Staphylococcus species with greater accuracy than conventional biochemicals. Broadening of the reference database by inclusion of additional examples of under-represented species could further optimize Biotyper results. |
Development of a cobinamide-based end-of-service-life indicator for detection of hydrogen cyanide gas
Greenawald LA , Snyder JL , Fry NL , Sailor MJ , Boss GR , Finklea HO , Bell S . Sens Actuators B Chem 2015 221 379-385 We describe an inexpensive paper-based sensor for rapid detection of low concentrations (ppm) of hydrogen cyanide gas. A piece of filter paper pre-spotted with a dilute monocyanocobinamide [CN(H2O)Cbi] solution was placed on the end of a bifurcated optical fiber and the reflectance spectrum of the CN(H2O)Cbi was monitored during exposure to 1.0-10.0 ppm hydrogen cyanide gas. Formation of dicyanocobinamide yielded a peak at 583 nm with a simultaneous decrease in reflectance from 450-500 nm. Spectral changes were monitored as a function of time at several relative humidity values: 25, 50, and 85% relative humidity. With either cellulose or glass fiber papers, spectral changes occurred within 10 s of exposure to 5.0 ppm hydrogen cyanide gas (NIOSH recommended short-term exposure limit). We conclude that this sensor could provide a real-time end-of-service-life alert to a respirator user. |
Predictors of health worker performance after Integrated Management of Childhood Illness training in Benin: a cohort study
Steinhardt LC , Onikpo F , Kouame J , Piercefield E , Lama M , Deming MS , Rowe AK . BMC Health Serv Res 2015 15 276 BACKGROUND: Correct treatment of potentially life-threatening illnesses (PLTIs) in children under 5 years, such as malaria, pneumonia, and diarrhea, can substantially reduce mortality. The Integrated Management of Childhood Illness (IMCI) strategy has been shown to improve treatment of child illnesses, but multiple studies have shown that gaps in health worker performance remain after training. To better understand factors related to health worker performance, we analyzed 9,330 patient consultations in Benin from 2001-2002, after training one of the first cohorts of 32 health workers in IMCI. METHODS: With data abstracted from patient registers specially designed for IMCI-trained health workers, we examined associations between health facility-, health worker-, and patient-level factors and 10 case-management outcomes for PLTIs. RESULTS: Altogether, 63.6 % of children received treatment for all their PLTIs in accordance with IMCI guidelines, and 77.8 % received life-saving treatment (i.e., clinically effective treatment, even if not exactly in accordance with IMCI guidelines). Performance of individual health workers varied greatly, from 15-88 % of patients treated correctly, on average. Multivariate regression analyses identified several factors that might have influenced case-management quality, many outside a manager's direct control. Younger health workers significantly outperformed older ones, and infants received better care than older children. Children with danger signs, those with more complex illnesses, and those with anemia received worse care. Health worker supervision was associated with improved performance for some outcomes. CONCLUSIONS: A variety of factors, some outside the direct control of program managers, can influence health worker practices. An understanding of these influences can help inform the development of strategies to improve performance. |
In the smallest patients, hearing loss screening takes big strides
Williams T . Hear J 2015 68 (7) 6 More infants were screened for hearing loss and received recommended follow-up services in 2012 compared with 2006, researchers from the Centers for Disease Control and Prevention (CDC) found. This information is important for the public health administrators and staff members who manage infant hearing programs and the healthcare providers who see these young patients and report results. | The number of infants known to be diagnosed with permanent hearing loss also increased, the researchers reported. Among newborns who did not pass the hearing screening test, more were identified early with permanent hearing loss in 2012 compared with 2006 (10.3% vs. 4.8%, respectively). | In addition, a higher percentage of infants diagnosed with permanent hearing loss were confirmed to be receiving early intervention services in 2012 than in 2006 (61.7% vs. 55.4%, respectively). These improvements are the result of continuing efforts and collaboration by federal and state public health/hearing programs, service organizations, healthcare professionals, involved parents, and other advocates. |
Medium frequency propagation characteristics of different transmission lines in an underground coal mine
Li J , Waynert JA , Whisner BG . Int J Commun Antenna Propag 2015 5 (1) 7-15 A medium frequency (MF) communication system operating in an underground coal mine couples its signals to a long conductor, which acts as an MF transmission line (TL) in a tunnel to permit communications among transceivers along the line. The TL is generally the longest signal path for the system, and its propagation characteristics will have a major impact on the performance of the MF communication system. In this study, the propagation characteristics of three types of MF TLs in two layouts-on the roof and on the floor of a coal mine tunnel-were obtained in an effort to understand the propagation characteristics of different TLs in different locations. The study confirmed a low MF signal loss on all of these TLs. The study also found that the TLs in different layouts had substantially different propagation characteristics. The propagation characteristics of these different TLs in different layouts are presented in the paper. |
Law enforcement officers’ risk perceptions toward on-duty motor-vehicle events
Tiesman HM , Heick RJ , Konda S , Hendricks S . Policing 2015 38 (3) 563-577 PURPOSE: Motor-vehicle related events (MVEs) are the leading cause of on-duty death for law enforcement officers, yet little is known about how officers view this significant job hazard. This paper explores officers’ motor-vehicle risk perception and examines how prior on-duty MVEs and the death or injury of a fellow officer influences this perception. DESIGN/METHODOLOGY/APPROACH: A state-wide random sample of 136 law enforcement agencies was drawn using publically accessible databases, stratified on type and size of agency. Sixty agencies agreed to participate and a cross-sectional questionnaire was distributed to 1,466 officers. Using 6-point Likert scales, composite scores for motor-vehicle and intentional violence risk perception were derived. A linear regression multivariable model was used to examine factors affecting motor-vehicle risk perception. FINDINGS: Motor-vehicle risk perception scores were significantly higher than intentional violence scores. A prior on-duty motor-vehicle crash, prior roadside incident, or knowledge of fellow officer’s injury or death from a MVE significantly increased motor-vehicle risk perception scores. After controlling for potential confounders though, only prior on-duty crashes and roadside incidents impacted motor-vehicle risk perception. RESEARCH LIMITATIONS/IMPLICATIONS: The study comprised primarily small, rural agencies and generalizability may be limited. Also, although the data were collected anonymously, reporting and response biases may affect these findings. ORIGINALITY/VALUE: This study involved a large and diverse cohort of officers and explored motor-vehicle risk perception. A better understanding of officers’ risk perceptions will assist in the development and implementation of occupational injury prevention programs, training, and policy. |
Characteristics of officer-involved vehicle collisions in California
Wolfe S , Rojek jJ , Alpert GP , Tiesman HM , James S . Policing 2015 38 (3) 458-477 PURPOSE: The purpose of this paper is to examine the situational and individual officer characteristics of officer-involved vehicle collisions that result in fatality, injury, and non-injury outcomes. DESIGN/METHODOLOGY/APPROACH: Data on 35,840 vehicle collisions involving law enforcement officers in California occurring between January 2000 and December 2009 are examined. A descriptive analysis of collision characteristics is presented. FINDINGS: There were 39 officers killed by collisions over this study period and 7,684 officers who received some type injury. Incidents involving officers on motorcycles represented 39% of officer fatalities and 39% of severe injuries. In the case of fatalities, 33% of officers were reported as wearing seatbelts, 38% were not wearing a seatbelt, and seatbelt use was not stated in 29% of car fatalities. RESEARCH LIMITATIONS/IMPLICATIONS: The findings only represent one state and the analysis is based on an estimated 86% of collisions that occurred during the study period due to missing data. Nonetheless, the results are based on a robust sample and address key limitations in the existing literature. PRACTICAL IMPLICATIONS: During the study period in California the estimated financial impact of collisions reached into the hundreds of millions of dollars when considering related fatality, injury, and vehicle damage costs combined. These impacts highlight the need for the law enforcement community to give greater attention to this issue. ORIGINALITY/VALUE: At the time of this writing there was no published independent research that compares the situational and officer characteristics across fatality, injury, and non-injury outcomes in these events. The findings reported here will help inform emerging interest in this issue within the law enforcement, academic, and policy-making communities. |
Particle size and surface area effects on explosibility using a 20-L chamber
Harris ML , Sapko MJ , Zlochower IA , Perera IE , Weiss ES . J Loss Prev Process Ind 2015 37 33-38 The Mine Safety and Health Administration (MSHA) specification for rock dust used in underground coal mines, as defined by 30 CFR 75.2, requires 70% of the material to pass through a 200 mesh sieve (<75 μm). However, in a collection of rock dusts, 47% were found to not meet the criteria. Upon further investigation, it was determined that some of the samples did meet the specification, but were inadequate to render pulverized Pittsburgh coal inert in the National Institute for Occupational Safety and Health (NIOSH) Office of Mine Safety and Health Research (OMSHR) 20-L chamber. This paper will examine the particle size distributions, specific surface areas (SSA), and the explosion suppression effectiveness of these rock dusts. It will also discuss related findings from other studies, including full-scale results from work performed at the Lake Lynn Experimental Mine. Further, a minimum SSA for effective rock dust will be suggested. |
Robust Algorithm for Systematic Classification of Malaria Late Treatment Failures as Recrudescence or Reinfection using Microsatellite Genotyping.
Plucinski MM , Morton L , Bushman M , Dimbu PR , Udhayakumar V . Antimicrob Agents Chemother 2015 59 (10) 6096-100 Routine therapeutic efficacy monitoring to measure the response to antimalarial treatment is a cornerstone of malaria control. To correctly measure drug efficacy, therapeutic efficacy studies require genotyping parasites from late treatment failures to differentiate between recrudescent infections and reinfections. However, there is a lack of statistical methods to systematically classify late treatment failures from genotyping data. A Bayesian algorithm was developed to estimate the posterior probability of a late treatment failure being the result of a recrudescent infection from microsatellite genotyping data. The algorithm was implemented using a Monte Carlo Markov Chain approach and was used to classify late treatment failures using published microsatellite data from therapeutic efficacy studies in Ethiopia and Angola.The algorithm classified 81% of the Ethiopian and 95% of the Angolan late treatment failures as either likely reinfection or likely recrudescence, defined as a posterior probability of recrudescence of <0.1 or >0.9, respectively. The adjusted efficacies calculated using the new algorithm differed from efficacies estimated using commonly-used methods for differentiating recrudescence from reinfection. In a high-transmission setting such as Angola, as few as fifteen samples needed to be genotyped in order to have enough power to correctly classify treatment failures. Analysis of microsatellite genotyping data for differentiating between recrudescence and reinfection benefits from an approach that both systematically classifies late treatment failures and estimates the uncertainty of these classifications. Researchers analyzing genotyping data from antimalarial therapeutic efficacy monitoring are urged to publish their raw genetic data and to estimate the uncertainty around their classification. |
Design of a study to determine the impact of insecticide resistance on malaria vector control: a multi-country investigation
Kleinschmidt I , Mnzava AP , Kafy HT , Mbogo C , Bashir AI , Bigoga J , Adechoubou A , Raghavendra K , Knox TB , Malik EM , Nkuni ZJ , Bayoh N , Ochomo E , Fondjo E , Kouambeng C , Awono-Ambene HP , Etang J , Akogbeto M , Bhatt R , Swain DK , Kinyari T , Njagi K , Muthami L , Subramaniam K , Bradley J , West P , Massougbodji A , Okê-Sopoh M , Hounto A , Elmardi K , Valecha N , Kamau L , Mathenge E , Donnelly MJ . Malar J 2015 14 282 BACKGROUND: Progress in reducing the malaria disease burden through the substantial scale up of insecticide-based vector control in recent years could be reversed by the widespread emergence of insecticide resistance. The impact of insecticide resistance on the protective effectiveness of insecticide-treated nets (ITN) and indoor residual spraying (IRS) is not known. A multi-country study was undertaken in Sudan, Kenya, India, Cameroon and Benin to quantify the potential loss of epidemiological effectiveness of ITNs and IRS due to decreased susceptibility of malaria vectors to insecticides. The design of the study is described in this paper. METHODS: Malaria disease incidence rates by active case detection in cohorts of children, and indicators of insecticide resistance in local vectors were monitored in each of approximately 300 separate locations (clusters) with high coverage of malaria vector control over multiple malaria seasons. Phenotypic and genotypic resistance was assessed annually. In two countries, Sudan and India, clusters were randomly assigned to receive universal coverage of ITNs only, or universal coverage of ITNs combined with high coverage of IRS. Association between malaria incidence and insecticide resistance, and protective effectiveness of vector control methods and insecticide resistance were estimated, respectively. RESULTS: Cohorts have been set up in all five countries, and phenotypic resistance data have been collected in all clusters. In Sudan, Kenya, Cameroon and Benin data collection is due to be completed in 2015. In India data collection will be completed in 2016. DISCUSSION: The paper discusses challenges faced in the design and execution of the study, the analysis plan, the strengths and weaknesses, and the possible alternatives to the chosen study design. |
Youth-friendly family planning services for young people: a systematic review
Brittain AW , Williams JR , Zapata LB , Pazol K , Romero LM , Weik TS . Am J Prev Med 2015 49 S73-84 CONTEXT: "Youth-friendly" family planning services, services tailored to meet the particular sexual and reproductive health needs of young people (aged 10-24 years), may improve reproductive health outcomes, including reduction of unintended pregnancy. The objectives of this systematic review were to summarize the evidence of the effect of youth-friendly family planning services on reproductive health outcomes and to describe key characteristics of youth-friendly family planning interventions. The review, conducted in 2011, was used to inform national recommendations on quality family planning services. EVIDENCE ACQUISITION: Several electronic bibliographic databases, including PubMed, PsycINFO, and Popline, were used to identify relevant articles published from January 1985 through February 2011. EVIDENCE SYNTHESIS: Nineteen articles met the inclusion criteria. Of these, six evaluated outcomes relevant to unintended pregnancy, contraceptive use, and knowledge or patient satisfaction. The 13 remaining studies identified perspectives on youth-friendly characteristics. Of the studies examining outcomes, most had a positive effect (two of three for unintended pregnancy, three of three for contraceptive use, and three of three for knowledge and/or patient satisfaction). Remaining studies described nine key characteristics of youth-friendly family planning services. CONCLUSIONS: This review demonstrates that there is limited evidence that youth-friendly services may improve reproductive health outcomes for young people and identifies service characteristics that might increase their receptivity to using these services. Although more rigorous studies are needed, the interventions and characteristics identified in this review should be considered in the development and evaluation of youth-friendly family planning interventions in clinical settings. |
Programs to strengthen parent-adolescent communication about reproductive health: a systematic review
Gavin LE , Williams JR , Rivera MI , Lachance CR . Am J Prev Med 2015 49 S65-72 CONTEXT: When caring for an adolescent client, providers of contraceptive services must consider whether and how to encourage parent/guardian-child communication about the adolescent's reproductive health. The objective of this systematic review was to summarize the evidence on the effectiveness of programs designed to increase parent-child communication about reproductive health. The review was used to inform national recommendations on quality family planning services. Data analysis occurred from mid-2011 through 2012. EVIDENCE ACQUISITION: Several electronic bibliographic databases were used to identify relevant articles, including PubMed, CINAHL, PsycINFO, and Popline, published from January 1985 through February 2011. EVIDENCE SYNTHESIS: Sixteen articles met the inclusion criteria: all studies examined the impact on at least one medium- or short-term outcome, and two studies assessed the impact on teen pregnancy. One study examined the impact of a program conducted in a clinic setting; the remainder examined the impact of programs in community settings. All studies showed a positive impact on at least one short-term outcome, and 12 of 16 studies showed an increase in parent-child communication about reproductive health. Four of seven studies found an impact on sexual risk behavior. CONCLUSIONS: Most programs increased parent-child communication, and several resulted in reduced sexual risk behavior of adolescents. This suggests that delivering a clinic-based program that effectively helps parents/guardians talk to their adolescent child(ren) about reproductive health, or referring parents/guardians to an evidence-based program in the community, may be beneficial. However, further rigorous research on delivery of these programs in clinical settings is needed. |
Impact of contraceptive counseling in clinical settings: a systematic review
Zapata LB , Tregear SJ , Curtis KM , Tiller M , Pazol K , Mautone-Smith N , Gavin LE . Am J Prev Med 2015 49 S31-45 CONTEXT: This systematic review evaluated the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes to provide information to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION: Multiple databases were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies that evaluated contraceptive counseling interventions in clinical settings. Studies were excluded if they focused primarily on prevention of HIV or sexually transmitted infections, focused solely on men, or were conducted outside the U.S., Canada, Europe, Australia, or New Zealand. EVIDENCE SYNTHESIS: The initial search identified 12,327 articles, of which 22 studies (from 23 articles) met the inclusion criteria. Six studies examined the impact of contraceptive counseling among adolescents, with four finding a significant positive impact on at least one outcome of interest. Sixteen studies examined the impact of counseling among adults or mixed populations (adults and adolescents), with 11 finding a significant positive impact on at least one outcome of interest. CONCLUSIONS: Promising components of contraceptive counseling were identified despite the diversity of interventions and inability to compare the relative effectiveness of one approach versus another. The evidence base would be strengthened by improved documentation of counseling procedures; assessment of intervention implementation and fidelity to put study findings into context; and development and inclusion of more RCTs, studies conducted among general samples of women, and studies with sample sizes sufficient to detect important behavioral outcomes at least 12 months post-intervention. |
Impact of contraceptive education on contraceptive knowledge and decision making: a systematic review
Pazol K , Zapata LB , Tregear SJ , Mautone-Smith N , Gavin LE . Am J Prev Med 2015 49 S46-56 CONTEXT: Educational interventions can help increase knowledge of available contraceptive methods, enabling individuals to make informed decisions and use contraception more effectively. This systematic review evaluated contraceptive education interventions to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION: Three databases (CINAHL, PubMed, and PsycINFO) were searched from 1985 through 2012 for peer-reviewed articles on educational interventions, with supplemental searches conducted through 2015. Primary outcomes were knowledge, participation in and comfort with decision making, and attitudes toward contraception. Secondary outcomes included contraceptive use behaviors and unintended pregnancy. EVIDENCE SYNTHESIS: Database searches in 2011 identified 5,830 articles; 17 met inclusion criteria and were abstracted into evidence tables. Searches in 2012 and 2015 identified four additional studies. Studies used a wide range of tools (decision aids, written materials, audio/videotapes, and interactive games), with and without input from a healthcare provider or educator. Of 15 studies that examined the impact of educational interventions on knowledge, 14 found significant improvement using a range of tools, with and without input from a healthcare provider or educator. Fewer studies evaluated outcomes related to decision making, attitudes toward contraception, contraceptive use behaviors, or unintended pregnancy. CONCLUSIONS: Results from this systematic review are consistent with evidence from the broader healthcare field suggesting that a range of educational interventions can increase knowledge. Future studies should assess what aspects of educational interventions are most effective, the extent to which it is necessary to include a healthcare provider or educator, and the extent to which educational interventions can impact behaviors. |
Impact of reminder systems in clinical settings to improve family planning outcomes: a systematic review
Zapata LB , Tregear SJ , Tiller M , Pazol K , Mautone-Smith N , Gavin LE . Am J Prev Med 2015 49 S57-64 CONTEXT: This systematic review evaluated the evidence on the impact of family planning reminder systems-interventions intended to remind patients of behaviors to achieve reproductive health goals (e.g., daily text messages reminding oral contraceptive [OC] users to take a pill)-to provide information to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION: Multiple databases including PubMed were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies evaluating reminder systems to improve family planning outcomes. Studies were excluded if they focused primarily on HIV or sexually transmitted infection prevention, focused solely on men, or were conducted outside the U.S., Europe, Australia, or New Zealand. EVIDENCE SYNTHESIS: The initial search identified 16,129 articles, five of which met the inclusion criteria. Three studies examined the impact of OC reminder systems; two found a statistically significant positive impact on correct use. Two studies examined the impact of reminder systems among depot medroxyprogesterone acetate (DMPA) users; one found a statistically significant positive impact on correct use. CONCLUSIONS: Although mixed support was found for the effectiveness of reminder system interventions on correct use of OCs and DMPA, the highest-quality evidence yielded null findings. The evidence base would be strengthened by the development of additional studies, especially RCTs, which objectively measure outcomes, examine additional contraceptive methods, and have sufficient sample sizes to detect behavioral outcomes at least 12 months post-intervention. |
Introduction to the supplement: development of federal recommendations for family planning services
Gavin LE , Moskosky SB , Barfield WD . Am J Prev Med 2015 49 S1-5 In 2014, the U.S. CDC and the Office of Population Affairs (OPA) released clinical recommendations for providing family planning services, entitled “Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs.”1 Family planning services help women and their male partners achieve the number and spacing of children they desire, and increase the likelihood that those children are born healthy. As such, family planning includes contraceptive services to prevent pregnancy, services to help clients achieve pregnancy, and preconception services to improve the health of infants and their parents. | The purpose of this journal supplement is to describe the process by which the CDC–OPA recommendations were developed. This effort is consistent with recent calls for more rigorous processes for guideline development and more thorough and transparent articulation of that process. For example, WHO has defined a rigorous process for developing clinical guidelines,2,3 and IOM recently published standards for how to develop “trust-worthy” clinical practice guidelines.4 Yet, many guidelines are still developed without following the WHO and IOM procedures and—perhaps even more important—without clearly articulating the process by which they were developed.5 |
Client and provider perspectives on quality of care: a systematic review
Williams JR , Gavin LE , Carter MW , Glass E . Am J Prev Med 2015 49 S93-S106 CONTEXT: A central premise of the literature on healthcare quality is that improving the quality of care will lead to improvements in health outcomes. A systematic review was conducted to better inform quality improvement efforts in the area of family planning. The objective of this systematic review is to update a previous review focused on the quality of family planning services, namely, the impact of quality improvement efforts and client perspectives about what constitutes quality family planning services. In addition, this review includes new literature examining provider perspectives. EVIDENCE ACQUISITION: Multiple databases from January 1985 through January 2015 were searched within the peer-reviewed literature that described the quality of family planning services. The retrieval and inclusion criteria included full-length articles published in English, which described studies occurring in a clinic-based setting to include family planning services. EVIDENCE SYNTHESIS: Search strategies identified 16,145 articles, 16 of which met the inclusion criteria. No new intervention studies addressing the impact of quality improvement efforts on family planning outcomes were identified. Sixteen articles provided information relevant to client or provider perspectives about what constitutes quality family planning services. Clients and providers mostly identified the need for services that were accessible, client-centered, and equitable. Themes related to effectiveness, efficiency, and safety were mentioned less frequently. CONCLUSIONS: Family planning services that account for both patient and provider perspectives may be more effective. Further research is needed to examine the impact of improved quality on provider practices, client behavior, and health outcomes. |
Community education for family planning in the U.S.: a systematic review
Carter MW , Tregear ML , Moskosky SB . Am J Prev Med 2015 49 S107-15 CONTEXT: Community education may involve activities that seek to raise awareness and promote behavior change, using mass media, social media, and other media or interpersonal methods in community settings. This systematic review evaluated the evidence of the effects of community education on select short- and medium-term family planning outcomes. EVIDENCE ACQUISITION: Using an analytic approach drawn from the U.S. Preventive Services Task Force, multiple databases were searched for articles published from January 1985 through February 2011 describing studies of community education related to family planning in the U.S. Included articles were reviewed and assessed for potential bias using a standardized process in 2011. An updated, targeted review for the 2011-2014 period was conducted in early 2015. EVIDENCE SYNTHESIS: Seventeen papers were identified. Most (nine) related to mass media interventions; three involved targeted print media, two involved text messaging or e-mail, two described outcome workers conducting community education, and one involved community theater. Study designs, strength of evidence, and levels of possible bias varied widely. Twelve of 15 studies that addressed outcomes such as increased awareness found positive associations with those outcomes, with six also reporting null findings. Seven of eight studies that addressed use of services reported positive associations, with two also reporting null findings. The targeted, additional review identified two other studies. CONCLUSIONS: Evidence related to community education for family planning purposes is limited and highly variable. As goals of community education are usually limited to shorter-term outcomes, the evidence suggests that a range of approaches may be effective. |
Community engagement in family planning in the U.S.: a systematic review
Carter MW , Tregear ML , Lachance CR . Am J Prev Med 2015 49 S116-23 CONTEXT: Community engagement may include activities that involve community members in the design, implementation, and evaluation of services. The objective of this systematic review was to evaluate the evidence on this kind of community engagement in U.S. family planning programs, including its effects on various health outcomes, its perceived value, and the barriers and facilitators to implementation. EVIDENCE ACQUISITION: Using an analytic approach drawn from U.S. Preventive Services Task Force, multiple databases were searched for articles published from 1985 through February 2011 that described studies about community engagement related to family planning. In 2011, relevant articles were reviewed, summarized, and assessed for potential bias using a standardized abstraction process. An updated, targeted review for the 2011-2014 period was conducted in early 2015. EVIDENCE SYNTHESIS: Eleven papers related to family planning were included. All were qualitative, descriptive, and at high risk for bias. Engagement strategies involved various methods for developing educational materials, program development, or program evaluation. All studies reported benefits to community engagement, such as more-appropriate educational materials or more community support for programs. Barriers to engagement included the substantial time and resources required. Four more articles were identified in the targeted, additional search. CONCLUSIONS: Community engagement is described as beneficial across the included studies, but the body of evidence for community engagement in family planning is relatively small. Given the high value ascribed to community engagement, more research and documentation of the various approaches taken and their relative strengths and weaknesses are needed. |
Confidentiality in family planning services for young people: a systematic review
Brittain AW , Williams JR , Zapata LB , Moskosky SB , Weik TS . Am J Prev Med 2015 49 S85-92 CONTEXT: Family planning services are essential for reducing high rates of unintended pregnancies among young people, yet a perception that providers will not preserve confidentiality may deter youth from accessing these services. This systematic review, conducted in 2011, summarizes the evidence on the effect of assuring confidentiality in family planning services to young people on reproductive health outcomes. The review was used to inform national recommendations on providing quality family planning services. EVIDENCE ACQUISITION: Multiple databases were searched to identify articles addressing confidentiality in family planning services to youth aged 10-24 years. Included studies were published from January 1985 through February 2011. Studies conducted outside the U.S., Canada, Europe, Australia, or New Zealand, and those that focused exclusively on HIV or sexually transmitted diseases, were excluded. EVIDENCE SYNTHESIS: The search strategy identified 19,332 articles, nine of which met the inclusion criteria. Four studies examined outcomes. Examined outcomes included use of clinical services and intention to use services. Of the four outcome studies, three found a positive association between assurance of confidentiality and at least one outcome of interest. Five studies provided information on youth perspectives and underscored the idea that young people greatly value confidentiality when receiving family planning services. CONCLUSIONS: This review demonstrates that there is limited research examining whether confidentiality in family planning services to young people affects reproductive health outcomes. A robust research agenda is needed, given the importance young people place on confidentiality. |
Developing federal clinical care rRecommendations for women
Godfrey EM , Tepper NK , Curtis KM , Moskosky SB , Gavin LE . Am J Prev Med 2015 49 S6-S13 The provision of family planning services has important health benefits for the U.S. POPULATION: Approximately 25 million women in the U.S. receive contraceptive services annually and 44 million make at least one family planning-related clinical visit each year. These services are provided by private clinicians, as well as publicly funded clinics, including specialty family planning clinics, health departments, Planned Parenthoods, community health centers, and primary care clinics. Recommendations for providing quality family planning services have been published by CDC and the Office of Population Affairs of the DHHS. This paper describes the process used to develop the women's clinical services portion of the new recommendations and the rationale underpinning them. The recommendations define family planning services as contraceptive care, pregnancy testing and counseling, achieving pregnancy, basic infertility care, sexually transmitted disease services, and preconception health. Because many women who seek family planning services have no other source of care, the recommendations also include additional screening services related to women's health, such as cervical cancer screening. These clinical guidelines are aimed at providing the highest-quality care and are designed to establish a national standard for family planning in the U.S. |
Estimating the prevalence of any impairing childhood mental disorder in the National Health Interview Survey
Ringeisen H , Aldworth J , Colpe LJ , Pringle B , Simile C . Int J Methods Psychiatr Res 2015 24 (4) 266-74 This study investigates whether the six-item Strengths and Difficulties Questionnaire SDQ (five symptoms and one impact item) included in the National Health Interview Survey (NHIS) can be used to construct models that accurately estimate the prevalence of any impairing mental disorder among children 4-17 years old as measured by a shortened Child/Adolescent or Preschool Age Psychiatric Assessment (CAPA or PAPA). A subsample of 217 NHIS respondents completed a follow-up CAPA or PAPA interview. Logistic regression models were developed to model presence of any child mental disorder with impairment (MDI) or with severe impairment (MDSI). Models containing only the SDQ impact item exhibited highly biased prevalence estimates. The best-performing model included information from both the five symptom SDQ items and the impact item, where absolute bias was reduced and sensitivity and concordance were increased. This study illustrates the importance of using all available information from the six-item SDQ to accurately estimate the prevalence of any impairing childhood mental disorder from the NHIS. |
Validation of multilevel regression and poststratification methodology for small area estimation of health indicators from the Behavioral Risk Factor Surveillance System
Zhang X , Holt JB , Yun S , Lu H , Greenlund KJ , Croft JB . Am J Epidemiol 2015 182 (2) 127-37 Small area estimation is a statistical technique used to produce reliable estimates for smaller geographic areas than those for which the original surveys were designed. Such small area estimates (SAEs) often lack rigorous external validation. In this study, we validated our multilevel regression and poststratification SAEs from 2011 Behavioral Risk Factor Surveillance System data using direct estimates from 2011 Missouri County-Level Study and American Community Survey data at both the state and county levels. Coefficients for correlation between model-based SAEs and Missouri County-Level Study direct estimates for 115 counties in Missouri were all significantly positive (0.28 for obesity and no health-care coverage, 0.40 for current smoking, 0.51 for diabetes, and 0.69 for chronic obstructive pulmonary disease). Coefficients for correlation between model-based SAEs and American Community Survey direct estimates of no health-care coverage were 0.85 at the county level (811 counties) and 0.95 at the state level. Unweighted and weighted model-based SAEs were compared with direct estimates; unweighted models performed better. External validation results suggest that multilevel regression and poststratification model-based SAEs using single-year Behavioral Risk Factor Surveillance System data are valid and could be used to characterize geographic variations in health indicators at local levels (such as counties) when high-quality local survey data are not available. |
Approximation of the ruin probability using the scaled Laplace transform inversion
Mnatsakanov RM , Sarkisian K , Hakobyan A . Appl Math Comput 2015 268 717-727 The problem of recovering the ruin probability in the classical risk model based on the scaled Laplace transform inversion is studied. It is shown how to overcome the problem of evaluating the ruin probability at large values of an initial surplus process. Comparisons of proposed approximations with the ones based on the Laplace transform inversions using a fixed Talbot algorithm as well as on the ones using the Trefethen–Weideman–Schmelzer and maximum entropy methods are presented via a simulation study. |
Best (but oft-forgotten) practices: checking assumptions concerning regression residuals
Barker LE , Shaw KM . Am J Clin Nutr 2015 102 (3) 533-9 The residuals of a least squares regression model are defined as the observations minus the modeled values. For least squares regression to produce valid CIs and P values, the residuals must be independent, be normally distributed, and have a constant variance. If these assumptions are not satisfied, estimates can be biased and power can be reduced. However, there are ways to assess these assumptions and steps one can take if the assumptions are violated. Here, we discuss both assessment and appropriate responses to violation of assumptions. |
Nicotine replacement therapy and other interventions for pregnant smokers: Pregnancy Risk Assessment Monitoring System, 2009-2010
Kapaya M , Tong V , Ding H . Prev Med 2015 78 92-100 BACKGROUND: Current U.S. guidelines recommend consideration of nicotine replacement therapy (NRT) for pregnant smokers if behavioral therapies fail, only under close supervision of a provider, and after discussion of known risks of continued smoking and possible risks of NRT. The percentage of pregnant smokers offered NRT by their prenatal care providers is unknown. PURPOSE: The study aims to calculate the percentage of pregnant smokers offered cessation intervention and NRT and assess independent associations between selected maternal characteristics and being offered NRT. METHODS: Data were analyzed from the 2009-2010 Pregnancy Risk Assessment Monitoring System from four states that asked about provider practices for prenatal smoking cessation. Adjusted prevalence ratios were calculated to examine associations between being offered NRT, selected maternal characteristics, and smoking level. Variables used in adjusted models were based on factors associated with smoking cessation during pregnancy from prior literature and included race, age, education, insurance type, and stress. RESULTS: Of 3559 women who smoked 3 months before pregnancy, 77.4% (95% CI: 74.2, 80.3) of 3rd trimester smokers and 42% (95% CI: 38.5, 46.4) of women who quit smoking during pregnancy were offered at least one cessation method. Among smokers, 19.1% (95% CI: 16.5, 22.1) were offered NRT and of these, almost all (94%) were offered another cessation method. CONCLUSIONS: One in five pregnant smokers was offered NRT. About a quarter of pregnant smokers did not receive any interventions to stop smoking. There may still be reluctance to provide NRT to pregnant women, despite known harms of continued smoking during pregnancy. |
Notes from the field: death following ingestion of an edible marijuana product - Colorado, March 2014
Hancock-Allen JB , Barker L , VanDyke M , Holmes DB . MMWR Morb Mortal Wkly Rep 2015 64 (28) 771-2 In March 2014, the Colorado Department of Public Health and Environment (CDPHE) learned of the death of a man aged 19 years after consuming an edible marijuana product. CDPHE reviewed autopsy and police reports to assess factors associated with his death and to guide prevention efforts. The decedent's friend, aged 23 years, had purchased marijuana cookies and provided one to the decedent. A police report indicated that initially the decedent ate only a single piece of his cookie, as directed by the sales clerk. Approximately 30-60 minutes later, not feeling any effects, he consumed the remainder of the cookie. During the next 2 hours, he reportedly exhibited erratic speech and hostile behaviors. Approximately 3.5 hours after initial ingestion, and 2.5 hours after consuming the remainder of the cookie, he jumped off a fourth floor balcony and died from trauma. The autopsy, performed 29 hours after time of death, found marijuana intoxication as a chief contributing factor. Quantitative toxicologic analyses for drugs of abuse, synthetic cannabinoid, and cathinones ("bath salts") were performed on chest cavity blood by gas chromatography and mass spectrometry. The only confirmed findings were cannabinoids (7.2 ng/mL delta-9 tetrahydrocannabinol [THC] and 49 ng/mL delta-9 carboxy-THC, an inactive marijuana metabolite). The legal whole blood limit of delta-9 THC for driving a vehicle in Colorado is 5.0 ng/mL. This was the first reported death in Colorado linked to marijuana consumption without evidence of polysubstance use since the state approved recreational use of marijuana in 2012. |
Qualitatively assessing the experiences of college students completing AlcoholEdu: do participants report altering behavior after intervention?
Barry AE , Hobbs LA , Haas EJ , Gibson G . J Health Commun 2015 21 (3) 1-9 To reduce college student drinking and associated alcohol-related consequences, many universities are turning to e-interventions, such as AlcoholEdu. To date, however, results of evaluations examining the impact of AlcoholEdu are mixed. Among these evaluations, few qualitative assessments have examined the experiences and perceptions of students who complete AlcoholEdu. This investigation aimed to assess whether students (a) find the program educational and engaging, (b) implemented specific strategies learned from participation, and (c) self-report altering their behavior as a result of participation. Even though respondents universally reported an increase in alcohol-related knowledge, there was an evident disconnect between this knowledge and their actual behavior. In other words, respondents reported that they did not implement what was taught in AlcoholEdu. Moreover, students highlighted several limitations associated with the program that would have influenced its overall impact, such as ignoring video segments of the program and clicking through assessments simply to complete the task. If used, college administrators and health professionals should implement e-interventions such as AlcoholEdu as one component of a multifaceted approach rather than a panacea for the current high-risk drinking practices of college students. |
Effect of the inoculation site of bovine purified protein derivative (PPD) on the skin fold thickness increase in cattle from officially tuberculosis free and tuberculosis-infected herds
Casal C , Alvarez J , Bezos J , Quick H , Diez-Guerrier A , Romero B , Saez JL , Liandris E , Navarro A , Perez A , Dominguez L , Juan L . Prev Vet Med 2015 121 86-92 The official technique for diagnosis of bovine tuberculosis (bTB) worldwide is the tuberculin skin test, based on the evaluation of the skin thickness increase after the intradermal inoculation of a purified protein derivative (PPD) in cattle. A number of studies performed on experimentally infected or sensitized cattle have suggested that the relative sensitivity of the cervical test (performed in the neck) may vary depending on the exact location in which the PPD is injected. However, quantitative evidence on the variation of the test accuracy associated to changes in the site of inoculation in naturally infected animals (the population in which performance of the test is most critical for disease eradication) is lacking. Here, the probability of obtaining a positive reaction (>2 or 4 millimeters and/or presence of local clinical signs) after multiple inoculations of bovine PPD in different cervical and scapular locations was assessed in animals from five bTB-infected herds (818 cattle receiving eight inoculations) using a hierarchical Bayesian logistic regression model and adjusting for the potential effect of age and sex. The effect of the inoculation site was also assessed qualitatively in animals from four officially tuberculosis free (OTF) herds (two inoculations in 210 animals and eight inoculations in 38 cattle). Although no differences in the qualitative outcome of the test were observed in cattle from OTF herds, a statistically important association between the test outcome and the inoculation site in animals from infected herds was observed, with higher probabilities of positive results when the test was performed in the neck anterior area. Our results suggest that test sensitivity may be maximized by considering the area of the neck in which the test is applied, although lack of effect of the inoculation site in the specificity of the test should be confirmed in a larger sample. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Mining
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Reproductive Health
- Social and Behavioral Sciences
- Statistics as Topic
- Substance Use and Abuse
- Veterinary Medicine
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure