Metropolitan racial residential segregation and cardiovascular mortality: exploring pathways
Greer S , Kramer MR , Cook-Smith JN , Casper ML . J Urban Health 2013 91 (3) 499-509 Racial residential segregation has been associated with an increased risk for heart disease and stroke deaths. However, there has been little research into the role that candidate mediating pathways may play in the relationship between segregation and heart disease or stroke deaths. In this study, we examined the relationship between metropolitan statistical area (MSA)-level segregation and heart disease and stroke mortality rates, by age and race, and also estimated the effects of various educational, economic, social, and health-care indicators (which we refer to as pathways) on this relationship. We used Poisson mixed models to assess the relationship between the isolation index in 265 U.S. MSAs and county-level (heart disease, stroke) mortality rates. All models were stratified by race (non-Hispanic black, non-Hispanic white), age group (35-64 years, ≥65 years), and cause of death (heart disease, stroke). We included each potential pathway in the model separately to evaluate its effect on the segregation-mortality association. Among blacks, segregation was positively associated with heart disease mortality rates in both age groups but only with stroke mortality rates in the older age group. Among whites, segregation was marginally associated with heart disease mortality rates in the younger age group and was positively associated with heart disease mortality rates in the older age group. Three of the potential pathways we explored attenuated relationships between segregation and mortality rates among both blacks and whites: percentage of female-headed households, percentage of residents living in poverty, and median household income. Because the percentage of female-headed households can be seen as a proxy for the extent of social disorganization, our finding that it has the greatest attenuating effect on the relationship between racial segregation and heart disease and stroke mortality rates suggests that social disorganization may play a strong role in the elevated rates of heart disease and stroke found in racially segregated metropolitan areas. |
Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009)
Daniels RD , Kubale TL , Yiin JH , Dahm MM , Hales TR , Baris D , Zahm SH , Beaumont JJ , Waters KM , Pinkerton LE . Occup Environ Med 2013 71 (6) 388-97 OBJECTIVES: To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009. METHODS: Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias. RESULTS: Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR=0.99, 95% CI 0.97 to 1.01, n=12 028). There was excess cancer mortality (SMR=1.14, 95% CI 1.10 to 1.18, n=3285) and incidence (SIR=1.09, 95% CI 1.06 to 1.12, n=4461) comprised mainly of digestive (SMR=1.26, 95% CI 1.18 to 1.34, n=928; SIR=1.17, 95% CI 1.10 to 1.25, n=930) and respiratory (SMR=1.10, 95% CI 1.04 to 1.17, n=1096; SIR=1.16, 95% CI 1.08 to 1.24, n=813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR=2.00, 95% CI 1.03 to 3.49, n=12; SIR=2.29, 95% CI 1.60 to 3.19, n=35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques. CONCLUSIONS: Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting. |
Non-pneumococcal mitis-group streptococci confound detection of pneumococcal capsular serotype-specific loci in upper respiratory tract
Carvalho Mda G , Pimenta FC , Moura I , Roundtree A , Gertz RE Jr , Li Z , Jagero G , Bigogo G , Junghae M , Conklin L , Feikin DR , Breiman RF , Whitney CG , Beall BW . PeerJ 2013 1 e97 We performed culture-based and PCR-based tests for pneumococcal identification and serotyping from carriage specimens collected in rural and urban Kenya. Nasopharyngeal specimens from 237 healthy children <5 years old (C-NPs) and combined nasopharyngeal/oropharyngeal specimens from 158 adults (A-NP/OPs, 118 HIV-positive) were assessed using pneumococcal isolation (following broth culture enrichment) with Quellung-based serotyping, real-time lytA-PCR, and conventional multiplexed PCR-serotyping (cmPCR). Culture-based testing from C-NPs, HIV-positive A-NP/OPs, and HIV-negative A-NP/OPs revealed 85.2%, 40.7%, and 12.5% pneumococcal carriage, respectively. In contrast, cmPCR serotypes were found in 93.2%, 98.3%, and 95.0% of these sets, respectively. Two of 16 lytA-negative C-NPs and 26 of 28 lytA-negative A-NP/OPs were cmPCR-positive for 1-10 serotypes (sts) or serogroups (sgs). A-NP/OPs averaged 5.5 cmPCR serotypes/serogroups (5.2 in HIV-positive, 7.1 in HIV-negative) and C-NPs averaged 1.5 cmPCR serotypes/serogroups. cmPCR serotypes/serogroups from lytA-negative A-NP/OPs included st2, st4, sg7F/7A, sg9N/9L, st10A, sg10F/10C/33C, st13, st17F, sg18C/18A/18B/18F, sg22F/22A, and st39. Nine strains of three non-pneumococcal species (S. oralis, S. mitis, and S. parasanguinis) (7 from A-OP, 1 from both A-NP and A-OP, and 1 from C-NP) were each cmPCR-positive for one of 7 serotypes/serogroups (st5, st13, sg15A/15F, sg10F/10C/33C, sg33F/33A/37, sg18C/18A/18B/18F, sg12F/12A/12B/ 44/46) with amplicons revealing 83.6-99.7% sequence identity to pneumococcal references. In total, 150 cmPCR amplicons from carriage specimens were sequenced, including 25 from lytA-negative specimens. Amplicon sequences derived from specimens yielding a pneumococcal isolate with the corresponding serotype were identical or highly conserved (>98.7%) with the reference cmPCR amplicon for the st, while cmPCR amplicons from lytA-negative specimens were generally more divergent. Separate testing of 56 A-OPs and 56 A-NPs revealed that approximately 94% of the positive cmPCR results from A-NP/OPs were from OP microbiota. In contrast, A-NPs yielded >2-fold more pneumococcal isolates than A-OPs. Verified and suspected non-pneumococcal cmPCR serotypes/serogroups appeared to be relatively rare in C-NPs and A-NPs compared to A-OPs. Our findings indicate that non-pneumococcal species can confound serotype-specific PCR and other sequence-based assays due to evolutionarily conserved genes most likely involved in biosynthesis of surface polysaccharide structures. |
Investigation of the pulmonary bioactivity of double-walled carbon nanotubes
Sager TM , Wolfarth MW , Battelli LA , Leonard SS , Andrew M , Steinbach T , Endo M , Tsuruoka S , Porter DW , Castranova V . J Toxicol Environ Health A 2013 76 (15) 922-36 Double-walled carbon nanotubes (DWCNT) are a rather new and unexplored variety of carbon nanotubes. Previously conducted studies established that exposure to a variety of carbon nanotubes produced lung inflammation and fibrosis in mice after pharyngeal aspiration. However, the bioactivity of double-walled carbon nanotubes (DWCNT) has not been determined. In this study, the hypothesis that DWCNT would induce pulmonary toxicity was explored by analyzing the pulmonary bioactivity of DWCNT. To test this hypothesis, C57Bl/6 mice were exposed to DWCNT by pharyngeal aspiration. Mice underwent whole-lung lavage (WLL) to assess pulmonary inflammation and injury, and lung tissue was examined histologically for development of pulmonary disease as a function of dose and time. The results showed that DWCNT exposure produced a dose-dependent increase in WLL polymorphonuclear leukocytes (PMN), indicating that DWCNT exposure initiated pulmonary inflammation. DWCNT exposure also produced a dose-dependent rise in lactate dehydrogenase (LDH) activity, as well as albumin levels, in WLL fluid, indicating that DWCNT exposure promoted cytotoxicity as well as decreases in the integrity of the blood-gas barrier in the lung, respectively. In addition, at 7 and 56 d postexposure, the presence of significant alveolitis and fibrosis was noted in mice exposed to 40 mug/mouse DWCNT. In conclusion, this study provides insight into previously uninvestigated pulmonary bioactivity of DWCNT exposure. Data indicate that DWCNT exposure promotes inflammation, injury, and fibrosis in the lung. |
Age at asthma onset and subsequent asthma outcomes among adults with active asthma
Mirabelli MC , Beavers SF , Chatterjee AB , Moorman JE . Respir Med 2013 107 (12) 1829-36 INTRODUCTION: Little is known about the extent to which the age at which asthma first began influences respiratory health later in life. We conducted these analyses to examine the relationship between age at asthma onset and subsequent asthma-related outcomes. METHODS: We used data from 12,216 adults with asthma who participated in the 2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey to describe the distribution of age at asthma onset. Linear regression was used to estimate associations of age at asthma onset with asthma-related outcomes, including symptoms in the past 30 days and asthma-related emergency visits. RESULTS: Asthma onset before age 16 was reported by an estimated 42% of adults with active asthma, including 14% with onset at 5-9 years of age who reported experiencing any asthma symptoms on 21% of days in the past month. Compared to this group, the percentage of days in the past month with any asthma symptoms was 14.8% higher (95% confidence interval (CI): 5.4, 24.1) among those whose asthma onset occurred at <1 year. When age at onset occurred at 10 years or older there was little change in the prevalence of asthma-related emergency visits across age at onset categories. CONCLUSION: Age at asthma onset may affect subsequent asthma-related outcomes. |
A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children
Freedman DS , Horlick M , Berenson GS . Am J Clin Nutr 2013 98 (6) 1417-24 BACKGROUND: Although estimation of percentage body fat with the Slaughter skinfold-thickness equations (PBFSlaughter) is widely used, the accuracy of this method has not been well studied. OBJECTIVE: The objective was to determine the accuracy of the Slaughter skinfold-thickness equations. DESIGN: We compared agreement between PBFSlaughter and derived from dual-energy X-ray absorptiometry (PBFDXA) in 1169 children in the Pediatric Rosetta Body Composition Project and the relation to cardiovascular disease risk factors, as compared with body mass index (BMI), in 6725 children in the Bogalusa Heart Study. RESULTS: PBFSlaughter was highly correlated (r = 0.90) with PBFDXA, but it markedly overestimated levels of PBFDXA in children with large skinfold thicknesses. In the 65 boys with a sum of skinfold thicknesses (subscapular- plus triceps-skinfold thicknesses) ≥50 mm, PBFSlaughter overestimated PBFDXA by 12 percentage points. The comparable overestimation in girls with a high skinfold sum was 6 percentage points. We also found that, after adjustment for sex and age, BMI showed slightly stronger associations with lipid, lipoprotein, insulin, and blood pressure values than did PBFSlaughter. CONCLUSIONS: These results indicate that PBFSlaughter, which was developed among a group of much thinner children and adolescents, is fairly accurate among nonobese children, but markedly overestimate the body fatness of children who have thick skinfold thicknesses. Furthermore, PBFSlaughter has no advantage over sex- and age-adjusted BMIs at identifying children who are at increased risk of cardiovascular disease based on lipid, lipoprotein, insulin, and blood pressure values. |
Molecular characterization of ambiguous mutations in HIV-1 polymerase gene: implications for monitoring HIV infection status and drug resistance.
Zheng DP , Rodrigues M , Bile E , Nguyen DB , Diallo K , Devos JR , Nkengasong JN , Yang C . PLoS One 2013 8 (10) e77649 Detection of recent HIV infections is a prerequisite for reliable estimations of transmitted HIV drug resistance (t-HIVDR) and incidence. However, accurately identifying recent HIV infection is challenging due partially to the limitations of current serological tests. Ambiguous nucleotides are newly emerged mutations in quasispecies, and accumulate by time of viral infection. We utilized ambiguous mutations to establish a measurement for detecting recent HIV infection and monitoring early HIVDR development. Ambiguous nucleotides were extracted from HIV-1 pol-gene sequences in the datasets of recent (HIVDR threshold surveys [HIVDR-TS] in 7 countries; n=416) and established infections (1 HIVDR monitoring survey at baseline; n=271). An ambiguous mutation index of 2.04x10(-3) nts/site was detected in HIV-1 recent infections which is equivalent to the HIV-1 substitution rate (2x10(-3) nts/site/year) reported before. However, significantly higher index (14.41x10(-3) nts/site) was revealed with established infections. Using this substitution rate, 75.2% subjects in HIVDR-TS with the exception of the Vietnam dataset and 3.3% those in HIVDR-baseline were classified as recent infection within one year. We also calculated mutation scores at amino acid level at HIVDR sites based on ambiguous or fitted mutations. The overall mutation scores caused by ambiguous mutations increased (0.54x10(-2)3.48x10(-2)/DR-site) whereas those caused by fitted mutations remained stable (7.50-7.89x10(-2)/DR-site) in both recent and established infections, indicating that t-HIVDR exists in drug-naive populations regardless of infection status in which new HIVDR continues to emerge. Our findings suggest that characterization of ambiguous mutations in HIV may serve as an additional tool to differentiate recent from established infections and to monitor HIVDR emergence. |
Recent patterns in population-based HIV prevalence in Swaziland
Bicego GT , Nkambule R , Peterson I , Reed J , Donnell D , Ginindza H , Duong YT , Patel H , Bock N , Philip N , Mao C , Justman J . PLoS One 2013 8 (10) e77101 BACKGROUND: The 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) was conducted as part of a national study to evaluate the scale up of key HIV prevention programs. METHODS: From a randomly selected sample of all Swazi households, all women and men aged 18-49 were considered eligible, and all consenting adults were enrolled and received HIV testing and counseling. In this analysis, population-based measures of HIV prevalence were produced and compared against similarly measured HIV prevalence estimates from the 2006-7 Swaziland Demographic and Health. Also, measures of HIV service utilization in both HIV infected and uninfected populations were documented and discussed. RESULTS: HIV prevalence among adults aged 18-49 has remained unchanged between 2006-2011 at 31-32%, with substantial differences in current prevalence between women (39%) and men (24%). In both men and women, between since 2006-7 and 2011, prevalence has fallen in the young age groups and risen in the older age groups. Over a third (38%) of the HIV-infected population was unaware of their infection status, and this differed markedly between men (50%) and women (31%). Of those aware of their HIV-positive status, a higher percentage of men (63%) than women (49%) reported ART use. CONCLUSIONS: While overall HIV prevalence remains roughly constant, age-specific changes strongly suggest both improved survival of the HIV-infected and a reduction in new HIV infections. Awareness of HIV status and entry into ART services has improved in recent years but remains too low. This study identifies opportunities to improve both HIV preventive and care services in Swaziland. |
A systematic review and meta-analysis of the global seasonality of norovirus
Ahmed SM , Lopman BA , Levy K . PLoS One 2013 8 (10) e75922 BACKGROUND: Noroviruses are the most common cause of acute gastroenteritis across all ages worldwide. These pathogens are generally understood to exhibit a wintertime seasonality, though a systematic assessment of seasonal patterns has not been conducted in the era of modern diagnostics. METHODS: We conducted a systematic review of the Pubmed Medline database for articles published between 1997 and 2011 to identify and extract data from articles reporting on monthly counts of norovirus. We conducted a descriptive analysis to document seasonal patterns of norovirus disease, and we also constructed multivariate linear models to identify factors associated with the strength of norovirus seasonality. RESULTS: The searched identified 293 unique articles, yielding 38 case and 29 outbreak data series. Within these data series, 52.7% of cases and 41.2% of outbreaks occurred in winter months, and 78.9% of cases and 71.0% of outbreaks occurred in cool months. Both case and outbreak studies showed an earlier peak in season-year 2002-03, but not in season-year 2006-07, years when new genogroup II type 4 variants emerged. For outbreaks, norovirus season strength was positively associated with average rainfall in the wettest month, and inversely associated with crude birth rate in both bivariate and multivariate analyses. For cases, none of the covariates examined was associated with season strength. When case and outbreaks were combined, average rainfall in the wettest month was positively associated with season strength. CONCLUSIONS: Norovirus is a wintertime phenomenon, at least in the temperate northern hemisphere where most data are available. Our results point to possible associations of season strength with rain in the wettest month and crude birth rate. |
Understanding U.S. healthcare providers' practices and experiences with molluscum contagiosum
Hughes CM , Damon IK , Reynolds MG . PLoS One 2013 8 (10) e76948 INTRODUCTION: Molluscum contagiosum is a common superficial skin infection caused by the poxvirus, Molluscum Contagiosum virus. The study objective is to obtain a better understanding of physician practices and experiences with molluscum contagiosum in order to focus informational and guidance material. METHODS: A cross-sectional survey to assess medical practitioners' knowledge and practices with molluscum contagiosum was conducted using the 2009 DocStyles survey. Questions regarding category and number of molluscum contagiosum patients seen, treatments used and advice given to patients were included in the survey. RESULTS: Dermatologists saw the most cases, with the majority seeing 51-100 molluscum contagiosum cases/year. The most common cases seen were children with multiple lesions and adults with genital lesions. Respondents were most likely to recommend treatment to immunocompromised individuals, HIV patients, adults with genital lesions and children with multiple lesions. Cryotherapy was the top choice for all specialties with the exception of OB/GYNs, whose top choice was curettage. "Avoid intimate contact until lesions resolve", "Avoid touching lesions to reduce further spread", and "Don't be concerned, this will go away" were the top advice choices. DISCUSSION: Most survey respondents have dealt with molluscum contagiosum in their practice during the previous year. Overall, respondents picked appropriate choices for treatment and advice given; however some ineffective or unnecessary treatments were chosen and recommendations to prevent spread were chosen infrequently. Knowledge gaps for appropriate transmission precaution advice might cause unnecessary spread or autoinoculation. This survey has demonstrated that molluscum contagiosum is a common infection seen by many types of practitioners and therefore guidance on treatment considerations and infection control is valuable. |
Meeting the family planning needs of women living with HIV in US government global health programs
Johnston B , Ligiero D , Desilva S , Medley A , Nightingale V , Sripipatana T , Bachanas P , Abutu A , Brewinski-Isaacs M , Bathily F , Grillo M , Bertz L , Mani N . AIDS 2013 27 Suppl 1 S121-5 The integration of health programs, including HIV and voluntary family planning, is a priority for US government foreign assistance. One critical component of family planning and HIV integration that has significant positive health outcomes is ensuring that all women living with HIV have access to both a full range of contraceptives and safe pregnancy counseling. This article outlines the US government global health strategy to meet the family planning needs of women living with HIV based on three key principles: a focus on reproductive rights through voluntarism and informed choice, quality service provision through evidence-based programming, and development of partnerships. |
Parameters for sample size estimation from a group-randomized HIV prevention trial in HIV clinics in Sub-Saharan Africa
Zhang J , Pals SL , Medley A , Nichols C , Bachanas P , van Zyl D , Katuta F , Juma J . AIDS Behav 2013 18 (12) 2359-65 Sample size calculations for a group-randomized trial (GRT) require an estimate of the expected intraclass correlation coefficient (ICC). However, few ICC estimates from GRTs in HIV/AIDS research have been published, leaving investigators with little data on which to base expectations. We used data from a multi-country study to estimate ICCs for variables related to physical and mental health and HIV risk behaviors. ICCs for perceptions of physical and mental health tended to be higher than those for HIV risk behavior variables, which were higher than ICCs for CD4 count. Covariate adjustment for country and socio-demographic variables reduced most ICC estimates. For risk behavior variables, adjustment for country and socio-demographic variables reduced ICC estimates by as much as 84 %. Variability in ICC estimates has important implications for study design, as a larger ICC reduces power. ICC estimates presented in this analysis will allow more precise sample size estimates for future GRTs. |
The promise of worksite parent-based HIV prevention for youth
Dittus PJ . J Adolesc Health 2013 53 (5) 557-8 Although notable decreases have been observed in recent years, adolescents in the United States continue to engage in a range of risky sexual behaviors that contribute to unacceptably high rates of pregnancy, sexually transmitted infections, and human immunodeficiency virus (HIV) despite ongoing and longstanding educational and public health efforts to intervene [1]. Individual-level interventions have had success in reducing sexual risk behaviors and subsequent negative health outcomes among adolescents [2], although effects are modest and typically are not sustained for long periods of time [3]. | Because parents have such an important role in educating their children, targeting parents with intervention efforts has been shown to be an effective means of affecting a variety of adolescent risk behaviors and health outcomes, including sexual initiation, delinquent behavior, and alcohol, tobacco, and drug use [4]. Effective parenting interventions focused on adolescent sexual risk behavior are increasing in number and include Parents Matter! [5], Keepin’ It R.E.A.L. [6], and Families Talking Together [7,8], to name a few. These programs are delivered in a variety of settings including schools, clinics, and community-based organizations, and have been shown to lower intentions to have sex and delay initiation of sexual intercourse, and improve parent–adolescent communication about sex and parents’ comfort in discussing sex with their adolescents, as well as to have additional positive outcomes for both parents and adolescents. |
Effectiveness of inactivated influenza vaccines in preventing influenza-associated deaths and hospitalizations among Ontario residents Aged ≥65 years: estimates with generalized linear models accounting for healthy vaccinee effects
Ridenhour BJ , Campitelli MA , Kwong JC , Rosella LC , Armstrong BG , Mangtani P , Calzavara AJ , Shay DK . PLoS One 2013 8 (10) e76318 BACKGROUND: Estimates of the effectiveness of influenza vaccines in older adults may be biased because of difficulties identifying and adjusting for confounders of the vaccine-outcome association. We estimated vaccine effectiveness for prevention of serious influenza complications among older persons by using methods to account for underlying differences in risk for these complications. METHODS: We conducted a retrospective cohort study among Ontario residents aged ≥65 years from September 1993 through September 2008. We linked weekly vaccination, hospitalization, and death records for 1.4 million community-dwelling persons aged ≥65 years. Vaccine effectiveness was estimated by comparing ratios of outcome rates during weeks of high versus low influenza activity (defined by viral surveillance data) among vaccinated and unvaccinated subjects by using log-linear regression models that accounted for temperature and time trends with natural spline functions. Effectiveness was estimated for three influenza-associated outcomes: all-cause deaths, deaths occurring within 30 days of pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations. RESULTS: During weeks when 5% of respiratory specimens tested positive for influenza A, vaccine effectiveness among persons aged ≥65 years was 22% (95% confidence interval [CI], -6%-42%) for all influenza-associated deaths, 25% (95% CI, 13%-37%) for deaths occurring within 30 days after an influenza-associated pneumonia/influenza hospitalization, and 19% (95% CI, 4%-31%) for influenza-associated pneumonia/influenza hospitalizations. Because small proportions of deaths, deaths after pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations were associated with influenza virus circulation, we estimated that vaccination prevented 1.6%, 4.8%, and 4.1% of these outcomes, respectively. CONCLUSIONS: By using confounding-reducing techniques with 15 years of provincial-level data including vaccination and health outcomes, we estimated that influenza vaccination prevented approximately 4% of influenza-associated hospitalizations and deaths occurring after hospitalizations among older adults in Ontario. |
HIV infection and testing among Latino men who have sex with men in the United States: The role of location of birth and other social determinants
Oster AM , Russell K , Wiegand RE , Valverde E , Forrest DW , Cribbin M , Le BC , Paz-Bailey G . PLoS One 2013 8 (9) e73779 BACKGROUND: In the United States, Latino men who have sex with men (MSM) are disproportionately affected by HIV. Latino MSM are a diverse group who differ culturally based on their countries or regions of birth and their time in the United States. We assessed differences in HIV prevalence and testing among Latino MSM by location of birth, time since arrival, and other social determinants of health. METHODS: For the 2008 National HIV Behavioral Surveillance System, a cross-sectional survey conducted in large US cities, MSM were interviewed and tested for HIV infection. We used generalized estimating equations to test associations between various factors and 1) prevalent HIV infection and 2) being tested for HIV infection in the past 12 months. RESULTS: Among 1734 Latino MSM, HIV prevalence was 19%. In multivariable analysis, increasing age, low income, and gay identity were associated with HIV infection. Moreover, men who were U.S.-born or who arrived ≥5 years ago had significantly higher HIV prevalence than recent immigrants. Among men not reporting a previous positive HIV test, 63% had been tested for HIV infection in the past 12 months; recent testing was most strongly associated with having seen a health care provider and disclosing male-male attraction/sexual behavior to a health care provider. CONCLUSIONS: We identified several social determinants of health associated with HIV infection and testing among Latino MSM. Lower HIV prevalence among recent immigrants contrasts with higher prevalence among established immigrants and suggests a critical window of opportunity for HIV prevention, which should prioritize those with low income, who are at particular risk for HIV infection. Expanding health care utilization and encouraging communication with health care providers about sexual orientation may increase testing. |
Immunological assessment of influenza vaccines and immune correlates of protection
Reber A , Katz J . Expert Rev Vaccines 2013 12 (5) 519-36 Influenza vaccines remain the primary public health tool in reducing the ever-present burden of influenza and its complications. In seeking more immunogenic, more effective and more broadly cross-protective influenza vaccines, the landscape of influenza vaccines is rapidly expanding, both in near-term advances and next-generation vaccine design. Although the first influenza vaccines were licensed over 60 years ago, the hemagglutination-inhibition antibody titer is currently the only universally accepted immune correlate of protection against influenza. However, hemagglutination-inhibition titers appear to be less effective at predicting protection in populations at high risk for severe influenza disease; older adults, young children and those with certain medical conditions. The lack of knowledge and validated methods to measure alternate immune markers of protection against influenza remain a substantial barrier to the development of more immunogenic, broadly cross-reactive and effective influenza vaccines. Here, the authors review the knowledge of immune effectors of protection against influenza and discuss assessment methods for a broader range of immunological parameters that could be considered in the evaluation of traditional or new-generation influenza vaccines. |
Influenza infection control practices in labor and delivery units during the 2009 H1N1 influenza pandemic
Williams JL , Mersereau PW , Ruch-Ross H , Zapata LB , Ruhl C . J Obstet Gynecol Neonatal Nurs 2013 42 (5) 527-40 OBJECTIVE: To assess the presence and usefulness of written policies and practices on infection control consistent with the Center for Disease Control and Prevention's (CDC) guidance in hospital labor and delivery (L&D) units during the 2009 H1N1 influenza pandemic. SETTING: Online survey. PARTICIPANTS: Of 11,845 eligible nurses, 2,641 (22%) participated. This analysis includes a subset of 1,866 nurses who worked exclusively in L&D units. METHODS: A cross-sectional descriptive evaluation was sent to 12,612 members from the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) who reported working in labor, delivery, postpartum, or newborn care settings during the 2009 H1N1 influenza pandemic. RESULTS: Respondents (73.8%) reported that CDC guidance was very useful for infection control in L&D settings during the pandemic. We assessed the presence of the following infection control written policies, consistent with CDC's guidance in hospital L&D units, during the 2009 H1N1 influenza pandemic and their rate of implementation most of the time: questioning women upon arrival about recent flu-like symptoms (89.4%, 89.9%), immediate initiation of antiviral medicines if flu suspected or confirmed (65.2%, 49%), isolating ill women from healthy women immediately (90.7%, 84.7%), ask ill women to wear masks during L&D (67%, 57.7%), immediately separating healthy newborns from ill mothers (50.9%, 42.4%), and bathing healthy infants when stable (58.4%, 56.9%). Reported written policies for five of the six practices increased during the pandemic. Five of six written policies remained above baseline after the pandemic. CONCLUSIONS: Respondents considered CDC guidance very useful. The presence of written policies is important for the implementation of infection control practices by L&D nurses. |
Inter-laboratory assessment of a prototype multiplex kit for determination of recent HIV-1 infection
Curtis KA , Longosz AF , Kennedy MS , Keating S , Heitman J , Laeyendecker O , Owen SM . PLoS One 2013 8 (10) e77765 BACKGROUND: Accurate and reliable laboratory-based assays are needed for estimating HIV-1 incidence from cross-sectional samples. We recently described the development of a customized, HIV-1-specific Bio-Plex assay that allows for the measurement of HIV-specific antibody levels and avidity to multiple analytes for improved HIV-1 incidence estimates. METHODS: To assess intra- and inter-laboratory assay performance, prototype multiplex kits were developed and evaluated by three distinct laboratories. Longitudinal seroconversion specimens were tested in parallel by each laboratory and kit performance was compared to that of an in-house assay. Additionally, the ability of the kit to distinguish recent from long-term HIV-1 infection, as compared to the in-house assay, was determined by comparing the reactivity of known recent (infected <6 months) and long-term (infected >12 months) drug naive specimens. RESULTS: Although the range of reactivity for each analyte varied between the prototype kit and in-house assay, a measurable distinction in reactivity between recent and long-term specimens was observed with both assays in all three laboratories. Additionally, kit performance was consistent between all three laboratories. The intra-assay coefficient of variation (CV), between sample replicates for all laboratories, ranged from 0.5% to 6.1%. The inter-laboratory CVs ranged from 8.5% to 21.3% for gp160-avidity index (a) and gp120-normalized mean fluorescent intensity (MFI) value (n), respectively. CONCLUSION: We demonstrate the feasibility of producing a multiplex kit for measuring HIV antibody levels and avidity, with the potential for improved incidence estimates based on multi-analyte algorithms. The availability of a commercial kit will facilitate the transfer of technology among diverse laboratories for widespread assay use. |
Cholera in Africa: a closer look and a time for action
Mintz ED , Tauxe RV . J Infect Dis 2013 208 Suppl 1 S4-7 Timely, accurate, and representative data on disease occurrence are the foundation for effective, targeted prevention and control. In recent years, the achievements of disease-specific programs in Africa, including the President's Emergency Plan for AIDS Relief, the President's Malaria Initiative, and campaigns to eradicate Guinea worm and polio, have demonstrated the power of enhanced surveillance closely coupled with prevention and control measures. Broadly-based programs for strengthening public health capacity, such as the Integrated Diseases Surveillance and Response program [1], the Field Epidemiology and Laboratory Training Program [2], the African Field Epidemiology Network [3], and the EPIVAC Field Vaccinology Training Program [4], combined with new international health regulations adopted in 2005 and fully implemented in 2012 [5], have provided new resources and lent new impetus to improved surveillance, investigation, and reporting for many diseases, including cholera. |
A comparison of the analytical level of agreement of nine treponemal assays for syphilis and possible implications for screening algorithms
Castro A , Jost H , Cox D , Fakile Y , Kikkert S , Tun Y , Zaidi A , Park M . BMJ Open 2013 3 (9) e003347 OBJECTIVE: The serological diagnosis of syphilis requires the detection of two distinct antibodies, the non-treponemal and trepomenal. Center for Disease Control and Prevention (CDC) recommends screening first with a non-treponemal test such as (Rapid Plasma Reagin/Venereal Disease Research Laboratory), and then confirming those results with one of the several treponemal tests (Fluorescent Treponemal Antibody-Absorption (FTA-ABS), Enzyme Immunoassay, chemiluminescence, treponema pallidum particle agglutination (TP-PA) or Point of Care). Owing to the high volume of samples processed by some laboratories using automated systems, the screening with treponemal assays and confirming with non-treponemal tests is becoming the established norm. The purpose of this study was to evaluate eight treponemal assays using TP-PA as the predicate assay. METHODS: 290 stored serum samples were tested qualitatively according to the manufacturer's directions. RESULTS: Concordance with specimens tested as reactive or non-reactive using TP-PA was: FTA-ABS 94.5-100%, Trep-Sure 100-98.9%, BioELISA 100-98.9%, INNO-LIA 99.1-99.4%, BIOLINE 100-98.9%, CAPTIA IgG 100-97.2%, Trep-ID 100-100% and LIAISON 100-99.4%. In order to properly evaluate the performance of these assays, the analytical sensitivity was determined by endpoint titration of serial dilutions of the reactive serum samples in normal sera. The median endpoint titre varied from 1:4 for FTA-ABS to 1:512 for Trep-Sure. CONCLUSIONS: The performance of the treponemal serological assays was comparable while using medium and high-titre sera. However, the varying performance on specimen dilutions suggests that there may be differences in sensitivity with low-titre sera that are more prevalent in primary and late syphilis cases. |
Development and initial testing of messages to encourage tuberculosis testing and treatment among bacille calmette-guerin (BCG) vaccinated persons
Mangan JM , Galindo-Gonzalez S , Irani TA . J Immigr Minor Health 2013 17 (1) 79-88 Misperceptions surrounding the Bacille Calmette-Guerin (BCG) vaccine can lead some vaccinated individuals to resist being tested and treated for tuberculosis (TB). Educational messages to best explain the risk of TB to BCG-vaccinated, Hispanic persons were systematically developed and tested. First, TB program staff provided messages they considered effective. These were analyzed and validated by TB experts, and then presented in group interviews initially to foreign-born Hispanic persons with a TB diagnosis, and then persons without a prior TB diagnosis. Based on interviewees' feedback, preferred statements were used to develop one long and three short comprehensive messages. One-on-one interviews were conducted with Hispanic persons to assess the saliency of the comprehensive educational messages. Participants preferred messages that were gain or positively-framed and explained that BCG does not confer lifelong protection against TB. Participants confirmed the messages would likely have a positive impact on patient decisions to undergo TB testing and treatment. |
Inappropriate testing for urinary tract infection in hospitalized patients: an opportunity for improvement
Hartley S , Valley S , Kuhn L , Washer LL , Gandhi T , Meddings J , Chenoweth C , Malani AN , Saint S , Srinivasan A , Flanders SA . Infect Control Hosp Epidemiol 2013 34 (11) 1204-7 Urine cultures are frequently obtained for hospitalized patients. We reviewed documented indications for culture and compared these with professional society guidelines. Lack of documentation and important clinical scenarios (before orthopedic procedures and when the patient has altered mental status without a urinary catheter) are highlighted as areas of use outside of current guidelines. |
Stability of ricinine, abrine, and alpha-amanitin in finished tap water
Knaack Jennifer S , Pittman Christopher T , Wooten Joe V , Jacob Justin T , Magnuson Matthew , Silvestri Erin , Johnson Rudolph C . Anal Methods 2013 5 (20) 5804-5811 Ricinine and abrine are potential indicators of drinking water contamination by ricin and abrin, respectively. Simultaneous detection of ricinine and abrine, along with -amanitin, another potential biotoxin water contaminant, is reportable through the use of automated sample preparation via solid phase extraction and detection using liquid chromatography/tandem- mass spectrometry. Performance of the method was characterized over eight analytical batches with quality control samples analyzed over 10 days. For solutions of analytes prepared with appropriate preservatives, the minimum reporting level (MRL) was 0.50 g L-1 for ricinine and abrine and 2.0 g L-1 for -amanitin. Among the analytes, the accuracy of the analysis ranged between 93 and 100% at concentrations of 1-2.5x the MRL, with analytical precision ranging from 4 to 8%. Five drinking waters representing a range of water quality parameters and disinfection practices were fortified with the analytes and analyzed over a 28 day period to determine their storage stability in these waters. The analytical signal from ricinine was observed to be stable for 28 days after being spiked into all tap waters investigated. The analytical signal for abrine and -amanitin decreased within 5 h after these analytes were spiked into some drinking waters, but afterwards, remained stable for 28 days. The magnitude of the decrease correlated with common water quality parameters potentially related to sorption of contaminants onto dissolved and colloidal components within the particular water. Even with the decrease, the detectability offered by the method may be 100-1000 times greater than potential toxicological benchmarks, suggesting the utility of the method for all three analytes, with additional quality control precautions for abrine and -amanitin. 2013 The Royal Society of Chemistry. |
Survey of culture, golden gate assay, universal biosensor assay, and 16S rRNA gene sequencing as alternative methods of bacterial pathogen detection
Lindsay B , Pop M , Antonio M , Walker AW , Mai V , Ahmed D , Oundo J , Tamboura B , Panchalingam S , Levine MM , Kotloff K , Li S , Magder LS , Paulson JN , Liu B , Ikumapayi U , Ebruke C , Dione M , Adeyemi M , Rance R , Stares MD , Ukhanova M , Barnes B , Lewis I , Ahmed F , Alam MT , Amin R , Siddiqui S , Ochieng JB , Ouma E , Juma J , Mailu E , Omore R , O'Reilly CE , Hannis J , Manalili S , Deleon J , Yasuda I , Blyn L , Ranken R , Li F , Housley R , Ecker DJ , Hossain MA , Breiman RF , Morris JG , McDaniel TK , Parkhill J , Saha D , Sampath R , Stine OC , Nataro JP . J Clin Microbiol 2013 51 (10) 3263-9 Cultivation-based assays combined with PCR or enzyme-linked immunosorbent assay (ELISA)-based methods for finding virulence factors are standard methods for detecting bacterial pathogens in stools; however, with emerging molecular technologies, new methods have become available. The aim of this study was to compare four distinct detection technologies for the identification of pathogens in stools from children under 5 years of age in The Gambia, Mali, Kenya, and Bangladesh. The children were identified, using currently accepted clinical protocols, as either controls or cases with moderate to severe diarrhea. A total of 3,610 stool samples were tested by established clinical culture techniques: 3,179 DNA samples by the Universal Biosensor assay (Ibis Biosciences, Inc.), 1,466 DNA samples by the GoldenGate assay (Illumina), and 1,006 DNA samples by sequencing of 16S rRNA genes. Each method detected different proportions of samples testing positive for each of seven enteric pathogens, enteroaggregative Escherichia coli (EAEC), enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), Shigella spp., Campylobacter jejuni, Salmonella enterica, and Aeromonas spp. The comparisons among detection methods included the frequency of positive stool samples and kappa values for making pairwise comparisons. Overall, the standard culture methods detected Shigella spp., EPEC, ETEC, and EAEC in smaller proportions of the samples than either of the methods based on detection of the virulence genes from DNA in whole stools. The GoldenGate method revealed the greatest agreement with the other methods. The agreement among methods was higher in cases than in controls. The new molecular technologies have a high potential for highly sensitive identification of bacterial diarrheal pathogens. |
Toxicity of lunar dust assessed in inhalation-exposed rats
Lam CW , Scully RR , Zhang Y , Renne RA , Hunter RL , McCluskey RA , Chen BT , Castranova V , Driscoll KE , Gardner DE , McClellan RO , Cooper BL , McKay DS , Marshall L , James JT . Inhal Toxicol 2013 25 (12) 661-78 Humans will again set foot on the moon. The moon is covered by a layer of fine dust, which can pose a respiratory hazard. We investigated the pulmonary toxicity of lunar dust in rats exposed to 0, 2.1, 6.8, 20.8 and 60.6 mg/m(3) of respirable-size lunar dust for 4 weeks (6 h/day, 5 days/week); the aerosols in the nose-only exposure chambers were generated from a jet-mill ground preparation of a lunar soil collected during the Apollo 14 mission. After 4 weeks of exposure to air or lunar dust, groups of five rats were euthanized 1 day, 1 week, 4 weeks or 13 weeks after the last exposure for assessment of pulmonary toxicity. Biomarkers of toxicity assessed in bronchoalveolar fluids showed concentration-dependent changes; biomarkers that showed treatment effects were total cell and neutrophil counts, total protein concentrations and cellular enzymes (lactate dehydrogenase, glutamyl transferase and aspartate transaminase). No statistically significant differences in these biomarkers were detected between rats exposed to air and those exposed to the two low concentrations of lunar dust. Dose-dependent histopathology, including inflammation, septal thickening, fibrosis and granulomas, in the lung was observed at the two higher exposure concentrations. No lesions were detected in rats exposed to ≤6.8 mg/m(3). This 4-week exposure study in rats showed that 6.8 mg/m(3) was the highest no-observable-adverse-effect level (NOAEL). These results will be useful for assessing the health risk to humans of exposure to lunar dust, establishing human exposure limits and guiding the design of dust mitigation systems in lunar landers or habitats. |
"They say" the next big pandemic is near: are we prepared?
Ratzan SC . J Health Commun 2013 18 (7) 757-9 Most of us have heard or read about the next epidemic ready to happen—authorities give them code names such as H7N9 or novel coronaviruses. A new acronym, MERS (Middle East Respiratory Syndrome), is being whispered. | World Health Organization Secretary General Margaret Chan warned the world in her annual World Health Assembly speech (May 19, 2013), “These two new diseases remind us that the threat from emerging and epidemic-prone diseases is ever-present.” She reminded, “We must maintain a high level of vigilance … [as] the current situation demands collaboration and cooperation from the entire world.” | Yet, we have other recent threats from the Centers for Disease Control and Prevention about the “nightmare” bacteria (Carbapenem-Resistant Enterobacteriaceae, or CRE), a superbug in hospitals. | We are getting used to these apocalyptic warnings. They are discussed on radio, TV, and through the internet and via new technologies. They continue in conversations in which we communicate that “they say” this new disease could be the next big one—epidemic, pandemic, or just deadly everywhere. Many of these reports reference the doomsday scenario of the 1918 influenza epidemic when 50 million people around the world—mostly young and otherwise healthy—died. |
Evaluating the safety of influenza vaccine using a claims-based health system
McCarthy NL , Gee J , Lin ND , Thyagarajan V , Pan Y , Su S , Turnbull B , Chan KA , Weintraub E . Vaccine 2013 31 (50) 5975-82 INTRODUCTION: As part of the Centers for Disease Control and Prevention's monitoring and evaluation activities for influenza vaccines, we examined relationships between influenza vaccination and selected outcomes in the 2009-2010 and 2010-2011 influenza seasons in a claims-based data environment. METHODS: We included patients with claims for trivalent influenza vaccine (TIV) and/or 2009 pandemic influenza A H1N1 vaccine (H1N1) during the 2009-2010 and 2010-2011 influenza seasons. Patients were followed for several pre-specified outcomes identified in claims. Seizures and Guillain-Barre Syndrome were selected a priori for medical record confirmation. We estimated incidence rate ratios (IRR) using a self-controlled risk interval (SCRI) or a historical comparison design. Outcomes with elevated IRRs, not selected a priori for medical record review, were further investigated with review of claims histories surrounding the outcome date to determine whether the potential event could be ruled-out or attributed to other causes based on the pattern of medical care. RESULTS: In the 2009-2010 season, no significant increased risks for outcomes following H1N1 vaccination were observed. Following TIV administration, the IRR for peripheral nervous system disorders and neuropathy was slightly elevated (1.07, 95% CI: 1.01-1.13). The IRR for anaphylaxis following TIV was 28.55 (95% CI: 3.57-228.44). After further investigation of claims histories, the majority of potential anaphylaxis cases had additional claims around the time of the event indicating alternate explanatory factors or diagnoses. In the 2010-2011 season following TIV administration, a non-significant elevated IRR for anaphylaxis was observed with no other significant outcome findings. CONCLUSION: After claims history review, we ultimately found no increased outcome risk following administration of 998,881 TIV and 538,257 H1N1 vaccine doses in the 2009-2010 season, and 1,158,932 TIV doses in the 2010-2011 season. |
Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions
Cho BH , Stoecker C , Link-Gelles R , Moore MR . Vaccine 2013 31 (50) 6011-21 BACKGROUND: In June, 2012 a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) was added to the recommendation for immunocompromised adults who were previously recommended to receive only 23-valent pneumococcal polysaccharide vaccine (PPSV23). PCV13 may be more effective, though it covers fewer disease-causing strains. OBJECTIVE: We examined the incremental cost-effectiveness of adding one dose of PCV13 to the pre-2012 recommendation of PPSV23 for adults with 4 immunocompromising conditions who are at increased risk of pneumococcal disease: HIV/AIDS, hematologic cancer, solid organ transplants, and end stage renal disease. METHODS: We used a probabilistic model following a single cohort of 302,397 immunocompromised adults. We used vaccination coverage and disease incidence data specific to each immunocompromising condition. Assumptions about PPSV23 and PCV13 vaccine effectiveness were based on two randomized controlled trials and several observational studies conducted among HIV-infected adults. Because no such studies have been conducted among other immunocompromised populations, we made further assumptions about the relative vaccine effectiveness in those groups. Cost-effectiveness ratios were determined for each condition and for all 4 groups in total. RESULTS: Our model indicated that adding one dose of PCV13 to adults in the United States with 4 immunocompromising conditions would cost $16 million (in 2009$) but provide off-setting savings of $21 million per cohort from the societal perspective. These savings come largely from decreased medical costs among adults with end stage renal disease. This dose of PCV13 would prevent 57 cases of invasive pneumococcal disease, 619 cases of hospitalized all-cause pneumonia, avert 93 deaths, and save 1360 quality adjusted life years per cohort. CONCLUSION: The addition of one dose of PCV13 to the previously recommended PPSV23 doses for adults with selected immunocompromised conditions potentially reduces both disease and costs. |
CLIA requirements for proficiency testing: the basics for laboratory professionals
Astles JR , Stang H , Alspach T , Mitchell G , Gagnon M , Bosse D . MLO Med Lab Obs 2013 45 (9) 8-10, 12, 14-5; quiz 16 Along with requirements for personnel qualifications and quality control testing, proficiency testing (PT) is one of the central safeguards of laboratory quality under the Clinical Laboratory Improvement Amendments of 1988 (CLIA)1 and its regulations.2 The CLIA regulations have often been compared to a three-legged stool, resting on requirements for personnel qualifications and two performance indicators: quality control testing and proficiency testing. Proficiency testing is the only external performance indicator required by CLIA. |
Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects.
Tinker SC , Devine O , Mai C , Hamner HC , Reefhuis J , Gilboa SM , Dowling NF , Honein MA . Birth Defects Res A Clin Mol Teratol 2013 97 (10) 649-57 BACKGROUND: Hispanics in the US have a higher prevalence of neural tube defect (NTD) -affected pregnancies than non-Hispanic whites, and lower median total folic acid (FA) intake. FA fortification of corn masa flour (CMF) is a policy-level intervention for NTD prevention; however, the impact on NTD prevalence has not been estimated. METHODS: We developed a model to estimate the percentage reduction in prevalence of spina bifida and anencephaly (NTDs) that could occur with FA fortification of CMF. Model inputs included estimates of the percentage reduction in United States NTD prevalence attributed to FA fortification of enriched cereal grain products (1995-1996 vs. 1998-2002), the increase in median FA intake after enriched cereal grain product fortification, and the estimated increase in median FA intake that could occur with CMF fortification at the same level as enriched cereal grain products (140 mug/100 g). We used Monte Carlo simulation to quantify uncertainty. We stratified analyses by racial/ethnic group and rounded results to the nearest 10. RESULTS: We estimated CMF fortification could prevent 30 Hispanic infants from having spina bifida (95% uncertainty interval: 0, 80) and 10 infants from having anencephaly (95% uncertainty interval: 0, 40) annually. The estimated impact among non-Hispanic whites and blacks was smaller. CONCLUSION: CMF fortification with FA could prevent from 0 to 120 infants, with the most likely value of approximately 40, from having spina bifida or anencephaly among Hispanics, the population most likely to benefit from the proposed intervention. While this estimated reduction is unlikely to be discernible using current birth defect surveillance methods, it still suggests an important benefit to the target population. Birth Defects Research (Part A) 97:649-657, 2013. (c) 2013 Wiley Periodicals, Inc. |
An in vivo and in vitro toxicological characterisation of realistic nanoscale CeO2 inhalation exposures
Demokritou P , Gass S , Pyrgiotakis G , Cohen JM , Goldsmith W , McKinney W , Frazer D , Ma J , Schwegler-Berry D , Brain J , Castranova V . Nanotoxicology 2013 7 (8) 1338-50 Nanoscale CeO2 is increasingly used for industrial and commercial applications, including catalysis, UV-shielding and as an additive in various nanocomposites. Because of its increasing potential for consumer and occupational exposures, a comprehensive toxicological characterisation of this nanomaterial is needed. Preliminary results from intratracheal instillation studies in rats point to cytotoxicity and inflammation, though these studies may not accurately use realistic nanoscale exposure profiles. By contrast, published in vitro cellular studies have reported limited toxicological outcomes for the case of nano-ceria. Here, the authors present an integrative study evaluating the toxicity of nanoscale CeO2 both in vitro, using the A549 lung epithelial cell line, and in vivo using an intact rat model. Realistic nano-ceria exposure atmospheres were generated using the Harvard Versatile Engineered Nanomaterial Generation System (VENGES), and rats were exposed via inhalation. Finally, the use of a nanothin amorphous SiO2 encapsulation coating as a means of mitigating CeO2 toxicity was assessed. Results from the inhalation experiments show lung injury and inflammation with increased PMN and LDH levels in the bronchoalveolar lavage fluid of the CeO2-exposed rats. Moreover, exposure to SiO2-coated CeO2 did not induce any pulmonary toxicity to the animals, representing clear evidence for the safe by design SiO2-encapsualtion concept. |
Borrelia burgdorferi BbHtrA degrades host ECM proteins and stimulates release of inflammatory cytokines in vitro
Russell TM , Delorey MJ , Johnson BJ . Mol Microbiol 2013 90 (2) 241-51 The Lyme disease spirochaete, Borrelia burgdorferi, causes damage to diverse host tissues and induces inflammation but the mechanisms of injury are poorly understood. We recently reported that a surface-exposed B. burgdorferi protease, which is expressed during human disease and is conserved within the major Lyme disease spirochaete species, degrades the extracellular matrix proteoglycan, aggrecan. Here we demonstrate that BbHtrA also degrades fibronectin and numerous proteoglycans found in skin, joints and neural tissues. BbHtrA degradation of fibronectin released known pro-inflammatory fibronectin fragments FnIII13-14 and Fnf-29, which may amplify the inflammatory processes triggered by the presence of the bacteria. When this hypothesis was tested directly by exposing chondrocytes to BbHtrA in vitro, inflammatory cytokines (sICAM-1 and IL-6) and chemokines (CXCL1, CCL1, CCL2 and CCL5) that are hallmarks of Lyme disease were induced. These results provide the first evidence that, by utilizing BbHtrA, B. burgdorferi may actively participate in its dissemination and in the tissue damage and inflammation observed in Lyme disease. |
Non-high-density lipoprotein cholesterol: distribution and prevalence of high serum levels in children and adolescents: United States National Health and Nutrition Examination Surveys, 2005-2010
Dai S , Yang Q , Yuan K , Loustalot F , Fang J , Daniels SR , Hong Y . J Pediatr 2013 164 (2) 247-53 OBJECTIVES: To estimate age-related changes for serum concentration of non-high-density lipoprotein cholesterol (HDL-C), describe non-HDL-C distribution, and examine the prevalence of high non-HDL-C levels in children and adolescents by demographic characteristics and weight status. STUDY DESIGN: Data from 7058 participants ages 6-19 years in the 2005-2010 National Health and Nutrition Examination Surveys were analyzed. A high level of non-HDL-C was defined as a non-HDL-C value ≥145mg/dL. RESULTS: Locally weighted scatterplot smoothing-smoothed curves showed that non-HDL-C levels increased from 101 mg/dL at age 6 to 111 mg/dL at age 10, decreased to 101 mg/dL at age 14, and then increased to 122 mg/dL at age 19 in non-Hispanic white males. Non-HDL-C levels generally were greater in female than male subjects, lower in non-Hispanic black subjects, and similar in male and slightly lower in female Mexican American subjects, compared with non-Hispanic white subjects. The overall mean was 108 (SE 0.5), and the percentiles were 67 (5th), 74 (10th), 87 (25th), 104 (50th), 123 (75th), 145 (90th), and 158 (95th) mg/dL. Mean and percentiles were greater among age groups 9-11 and 17-19 years than others and greater among non-Hispanic white than non-Hispanic black subjects. The prevalence of high non-HDL-C was 11.8% (95% CI 9.9%-14.0%) and 15.0% (95% CI 12.9%-17.3%) for the age groups 9-11 and 17-19, respectively. It varied significantly by race/ethnicity and overweight/obesity status. CONCLUSION: Non-HDL-C levels vary by age, sex, race/ethnicity, and weight classification status. Evaluation of non-HDL-C in youth should account for its normal physiologic patterns and variations in demographic characteristics and weight classification. |
Theoretical relationship between vibration transmissibility and driving-point response functions of the human body
Dong RG , Welcome DE , McDowell TW , Wu JZ . J Sound Vib 2013 332 (24) 6193-6202 The relationship between the vibration transmissibility and driving-point response functions (DPRFs) of the human body is important for understanding vibration exposures of the system and for developing valid models. This study identified their theoretical relationship and demonstrated that the sum of the DPRFs can be expressed as a linear combination of the transmissibility functions of the individual mass elements distributed throughout the system. The relationship is verified using several human vibration models. This study also clarified the requirements for reliably quantifying transmissibility values used as references for calibrating the system models. As an example application, this study used the developed theory to perform a preliminary analysis of the method for calibrating models using both vibration transmissibility and DPRFs. The results of the analysis show that the combined method can theoretically result in a unique and valid solution of the model parameters, at least for linear systems. However, the validation of the method itself does not guarantee the validation of the calibrated model, because the validation of the calibration also depends on the model structure and the reliability and appropriate representation of the reference functions. The basic theory developed in this study is also applicable to the vibration analyses of other structures. Published by Elsevier Ltd. |
Parametrial anisakidosis
Ramanan P , Blumberg AK , Mathison B , Pritt BS . J Clin Microbiol 2013 51 (10) 3430-4 Anisakidosis is a parasitic infection caused by anisakid nematodes in the genera Anisakis and Pseudoterranova. Infection is not uncommon in the United States due to increased raw seafood consumption. We report the first known case of parametrial anisakidosis in a 42-year-old woman and review existing literature. |
Public health grand rounds at the Centers for Disease Control and Prevention: evaluation feedback from a broad community of learners
Iskander J , Ari M , Chen B , Hall S , Ghiya N , Popovic T . J Public Health Manag Pract 2013 20 (5) 542-50 OBJECTIVE: To evaluate the relevance and educational benefit of monthly Public Health Grand Rounds (GR), an hour-long interactive lecture series featuring 1 current, relevant public health topic. DESIGN:: Quantitative and qualitative analysis of data evaluating GR format and content submitted by 2063 continuing education (CE) participants. SETTING: Survey data submitted electronically to the Centers for Disease Control and Prevention online CE system from January 2010 through December 2011. PARTICIPANTS: Physicians, nurses, pharmacists, health education specialists, and other health care professionals seeking CE credits for Public Health GR. MAIN OUTCOME MEASURES: Proportion of respondents agreeing or strongly agreeing that GR is using educational strategies that enhance user learning and is meeting preidentified learning objectives. RESULTS: On questions involving instructional strategies and delivery methods, 95.0% and 95.6% of respondents, respectively, agreed or strongly agreed that the GR was conducive to learning. More than 90% of respondents agreed or strongly agreed that they could describe the burden of the disease/condition in question and identify key preventive interventions, knowledge gaps, and measures of public health progress. CONCLUSIONS: These evaluation results indicate that the GR is meeting content-specific and educational needs of diverse health care professionals. The GR models organized scientific discussions on evidence and translation into real-world impacts of decreased morbidity, mortality, and health care costs, and links public health to clinical practice. This promotes a greater understanding of the interplay of different health fields and may lead to greater and cross-disciplinary collaborations. |
Etymologia: shewanella haliotis
Henry R . Emerg Infect Dis 2013 19 (6) 988 From the Greek halios (marine) and ōtos (ear), abalones, genus Haliotis, were first mentioned ≈2,500 years ago by Aristotle, who wrote of “the wild limpet (called by some the ‘sea ear’).” In D’Arcy Thompson’s translation of Aristotle, he notes that “wild limpet” is “commonly attributed to Fissurella graecea ... and conceals a forgotten name for Haliotis.” The “sea ear” was familiar to the Greeks and was named otia (little ear) by Pliny. | Shewanella haliotis, a species of rod-shaped, gram-negative, facultatively anaerobic bacteria, was first isolated from the gut microflora of abalones collected from the ocean near Yeosu, South Korea, by Kim et al. in 2007. The genus Shewanella had been previously named in 1985 by MacDonell and Colwell in honor of Scottish microbiologist James M. Shewan, for his work in fisheries microbiology. |
Novel poxvirus in big brown bats, northwestern United States
Emerson GL , Nordhausen R , Garner MM , Huckabee JR , Johnson S , Wohrle RD , Davidson WB , Wilkins K , Li Y , Doty JB , Gallardo-Romero NF , Metcalfe MG , Karem KL , Damon IK , Carroll DS . Emerg Infect Dis 2013 19 (6) 1002-4 A wildlife hospital and rehabilitation center in northwestern United States received several big brown bats with necrosuppurative osteomyelitis in multiple joints. Wing and joint tissues were positive by PCR for poxvirus. Thin-section electron microscopy showed poxvirus particles within A-type inclusions. Phylogenetic comparison supports establishment of a new genus of Poxviridae. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Environmental Health
- Epidemiology and Surveillance
- Immunity and Immunization
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Public Health Leadership and Management
- Sciences, General
- 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:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure