Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 105 Records) |
Query Trace: Calvert G[original query] |
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Correction: Opioid prescriptions among the World Trade Center Health Program population
Liu R , Calvert GM , Anderson KR , Malcolm H , Cimineri L , Dupont H , Martinez M . BMC Health Serv Res 2024 24 (1) 551 |
Opioid prescriptions among the World Trade Center Health Program population
Liu R , Calvert GM , Anderson KR , Malcolm H , Cimineri L , Dupont H , Martinez M . BMC Health Serv Res 2023 23 (1) 1323 BACKGROUND: The World Trade Center Health Program (Program) provides limited health care to those directly affected by the 9/11 terrorist attacks. Because of physical/mental trauma arising from the 9/11 attacks, Program members might be at high risk of opioid use. To prevent prescription opioid overuse, in 2018 the Program implemented various measures to improve opioid prescribing and expand access to non-opioid pain management among Program members. However, the characteristics of opioid prescriptions dispensed among this population has never been described. METHODS: Administrative and claims data from 07/01/2011 to 09/30/2022 were used to describe opioid prescriptions dispensed during 2013-2021. RESULTS: From 2013-2021, 108,285 members were Program-enrolled for ≥ 10 months, 4,053 (3.7%) had 22,938 outpatient opioid prescriptions, of which, 62.1% were for cancer-related pain, 11.1% for hospice/end of life care, 4.8% for surgery pain, and 9.8% for acute/chronic pain. Among members with Program-paid diagnostic/treatment claims (n = 70,721), the proportion with opioid prescriptions for cancer/hospice/end of life care increased from 0.5% in 2013 to 1.6% in 2018 (p = 0.010), then decreased to 1.1% in 2021 (p = 0.070), and the proportion for non-cancer surgery/acute/chronic pain decreased from 0.6% in 2013 to 0.23% in 2021 (p = 0.0005). Among members prescribed opioids without cancer/hospice/sickle cell disease, the proportion who started with long-acting opioids or had opioid prescriptions from ≥ 4 prescribers were below 6.5% annually; the proportion receiving a high-dose (≥ 90 morphine milligram equivalents per day [MED]), or with concurrent opioids and benzodiazepines use, or who started opioids with MED ≥ 50 or with long duration (≥ 7 days' supply) were above 10% annually, but decreased since 2017. CONCLUSIONS: Prevalence of outpatient opioid prescriptions paid by the Program was very low and prescriptions were primarily dispensed for cancer/hospice/end of life care. Although Program efforts to improve opioid prescribing coincided with improvements in outcomes, ongoing surveillance is needed. |
Cache Valley virus: an emerging arbovirus of public and veterinary health importance
Hughes HR , Kenney JL , Calvert AE . J Med Entomol 2023 60 (6) 1230-1241 Cache Valley virus (CVV) is a mosquito-borne virus in the genus Orthobunyavirus (Bunyavirales: Peribunyaviridae) that has been identified as a teratogen in ruminants causing fetal death and severe malformations during epizootics in the U.S. CVV has recently emerged as a viral pathogen causing severe disease in humans. Despite its emergence as a public health and agricultural concern, CVV has yet to be significantly studied by the scientific community. Limited information exists on CVV's geographic distribution, ecological cycle, seroprevalence in humans and animals, and spectrum of disease, including its potential as a human teratogen. Here, we present what is known of CVV's virology, ecology, and clinical disease in ruminants and humans. We discuss the current diagnostic techniques available and highlight gaps in our current knowledge and considerations for future research. |
Characterization of a monoclonal antibody specific to California serogroup orthobunyaviruses and development as a chimeric immunoglobulin M-positive control in human diagnostics
Powers JA , Boroughs KL , Mikula S , Goodman CH , Davis EH , Thrasher EM , Hughes HR , Biggerstaff BJ , Calvert AE . Microbiol Spectr 2023 11 (5) e0196623 California serogroup viruses (CSGVs) of medical importance in the United States include La Crosse virus, Jamestown Canyon virus (JCV), California encephalitis virus, and snowshoe hare virus. Current diagnosis of CSGVs relies heavily on serologic techniques for detecting immunoglobulin M (IgM), an indication of a recent CSGV infection. However, human-positive control sera reactive to viruses in the serogroup are scarce because detection of recent infections is rare. Here, we describe the development of new murine monoclonal antibodies (MAbs) reactive to CSGVs and the engineering of a human-murine chimeric antibody by combining the variable regions of the broadly CSGV cross-reactive murine MAb, 3-3B6/2-3B2 and the constant region of the human IgM. MAb 3-3B6/2-3B2 recognizes a tertiary epitope on the Gn/Gc heterodimer, and epitopes important in JCV neutralization were mapped to the Gc glycoprotein. This engineered human IgM constitutively expressed in a HEK-293 stable cell line can replace human-positive control sera in diagnostic serological techniques such as IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA). Compared to the parent murine MAbs, the human-chimeric IgM antibody had identical serological activity to CSGVs in ELISA and demonstrated equivalent reactivity compared to human immune sera in the MAC-ELISA.IMPORTANCEOrthobunyaviruses in the California serogroup cause severe neurological disease in children and adults. While these viruses are known to circulate widely in North America, their occurrence is rare. Serological testing for CSGVs is hindered by the limited availability and volumes of human-positive specimens needed as controls in serologic assays. Here, we described the development of a murine monoclonal antibody cross-reactive to CSGVs engineered to contain the variable regions of the murine antibody on the backbone of human IgM. The chimeric IgM produced from the stably expressing HEK293 cell line was evaluated for use as a surrogate human-positive control in a serologic diagnostic test. |
The World Trade Center health program: Obstructive sleep apnea best practices
Udasin IG , Sunderram J , Calvert G . Arch Environ Occup Health 2023 78 (4) 1-3 The events of September 11, 2001 exposed nearly half a million community residents and workers engaged in rescue and recovery and clean-up to dust, debris and toxic chemicals, as well as psychologic and physical stressors. Early studies showed an excess of aerodigestive diseases including rhinosinusitis and gastroesophageal reflux. Several studies of World Trade Center (WTC) responders report an excess of obstructive sleep apnea among patients who developed new onset or worsening chronic rhinosinusitis. High quality clinical diagnostic and treatment guidelines are available from The American Academy of Sleep Medicine and the Department of Veterans Affairs/Department of Defense. For enrolled members, the WTC program covers diagnostic evaluation and treatment for sleep apnea in members diagnosed with WTC-related upper and lower respiratory disease and gastroesophageal reflux. |
The World Trade Center Health Program: Cancer screening and cancer care best practices
Calvert GM , Lilly G , Cochran J . Arch Environ Occup Health 2023 78 (4) 1-7 The events of September 11, 2001 (9/11) exposed nearly a half million persons to many carcinogenic chemicals and dusts, as well as psychological and physical stressors. Subsequent epidemiologic studies of 9/11-exposed persons have suggested elevated risks for some cancers, e.g., prostate cancer, thyroid cancer, and melanoma. To detect cancer at an early stage, the US Preventive Services Task Force recommends screening certain asymptomatic persons for lung, colorectal, cervical and breast cancer, but not for other cancers. High quality cancer diagnosis and treatment guidelines are available from the National Comprehensive Cancer Network and the National Cancer Institute. For enrolled members, the WTC Health Program provides coverage for cancer screening and diagnosis, and covers medically necessary treatment costs for all types of cancer, assuming 9/11-exposure and minimum latency requirements are met, and a Program-affiliated physician attests that 9/11 exposures were substantially likely to have been a significant factor in aggravating, contributing to, or causing the enrolled WTC member's cancer. |
The World Trade Center Health Program: Smoking cessation
Lilly G , Calvert GM . Arch Environ Occup Health 2023 78 (4) 1-4 Cigarette smoking can cause and/or worsen a variety of health conditions. The U.S. Preventive Services Task Force (USPSTF) recommends that smoking cessation services be offered to all adults who currently smoke, and governmental and non-governmental professional organizations support providing these interventions to patients who smoke. The World Trade Center (WTC) Health Program, a federal program that provides health monitoring and treatment to those directed exposed to the September 11, 2001 terrorist attacks, provides smoking cessation therapy for eligible members. This paper identifies treatment strategies for smoking cessation and references the treatment coverage policy in the WTC Health Program. In addition, this paper notes the higher smoking prevalence among those with mental health conditions such as posttraumatic stress disorder (PTSD), and the need for heightened cessation efforts given the lower quit success rates among such persons. |
Tracking diseases related to the terrorist attacks of September 11, 2001
Calvert GM . Arch Environ Occup Health 2023 78 (5) 1-7 Accurate, timely, and complete disease reporting is essential to understanding the extent and long-term consequences of diseases related to the terrorist attacks of September 11, 2001 (9/11). Although there are no public health disease reporting requirements that specifically mention 9/11, other mechanisms exist to track 9/11-related illnesses. These include the availability of 9/11-exposed cohorts, some open to new member recruitment and others closed. Record linkages of 9/11 cohorts to various data registries (eg statewide cancer registries and the National Death Index) are periodically performed. This paper describes these 9/11 cohorts and the efforts to track their health experience. |
World Trade Center Health Program best practices for the diagnosis and treatment of gastroesophageal reflux disease
Lin RA , Calvert GM , Udasin IG . Arch Environ Occup Health 2023 78 (4) 1-5 Gastroesophageal reflux disease (GERD) is one of the most common health conditions reported among persons exposed to the dust, debris and chemicals after the September 11, 2001 attacks in the United States. In the 9/11-exposed population, GERD is often found to be co-morbid with other conditions, such as asthma, post-traumatic stress disorder, and obesity. High-quality clinical practice guidelines for GERD are available from the American College of Gastroenterology. GERD diagnostic services and medically necessary treatment are covered by the WTC Health Program for persons who meet eligibility criteria. |
The World Trade Center Health Program: an introduction to best practices
Calvert GM , Anderson K , Cochran J , Cone JE , Harrison DJ , Haugen PT , Lilly G , Lowe SM , Luft BJ , Moline JM , Reibman J , Rosen R , Udasin IG , Werth AS . Arch Environ Occup Health 2022 78 (4) 1-7 More than 20 years have elapsed since the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC), Pentagon and at Shanksville, PA. Many persons continue to suffer a variety of physical and mental health conditions following their exposures to a mixture of incompletely characterized toxicants and psychological stressors at the terrorist attack sites. Primary care and specialized clinicians should ask patients who may have been present at any of the 9/11 sites about their 9/11 exposures, especially patients with cancer, respiratory symptoms, chronic rhinosinusitis, gastroesophageal reflux disease, psychiatric symptoms, and substance use disorders. Clinicians, especially those in the NY metropolitan area, should know how to evaluate, diagnose, and treat patients with conditions that could be associated with exposure to the 9/11 attacks and its aftermath. As such, this issue of Archives contains a series of updates to clinical best practices relevant to medical conditions whose treatment is covered by the WTC Health Program. This first paper in the 14-part series describes the purpose of this series, defines the WTC Health Program and its beneficiaries, and explains how relevant Clinical Practice Guidelines were identified. This paper also reminds readers that because physical and mental health conditions are often intertwined, a coordinated approach to care usually works best and referral to health centers affiliated with the WTC Health Program may be necessary, since all such Centers offer multidisciplinary care. |
Development of HEK-293 cell lines constitutively expressing flaviviral antigens for use in diagnostics
Powers JA , Skinner B , Davis BS , Biggerstaff BJ , Robb L , Gordon E , Calvert AE , Chang GJ . Microbiol Spectr 2022 10 (3) e0059222 Flaviviruses are important human pathogens worldwide. Diagnostic testing for these viruses is difficult because many of the pathogens require specialized biocontainment. To address this issue, we generated 39 virus-like particle (VLP)- and nonstructural protein 1 (NS1)-secreting stable cell lines in HEK-293 cells of 13 different flaviviruses, including dengue, yellow fever, Japanese encephalitis, West Nile, St. Louis encephalitis, Zika, Rocio, Ilheus, Usutu, and Powassan viruses. Antigen secretion was stable for at least 10 cell passages, as measured by enzyme-linked immunosorbent assays and immunofluorescence assays. Thirty-five cell lines (90%) had stable antigen expression over 10 passages, with three of these cell lines (7%) increasing in antigen expression and one cell line (3%) decreasing in antigen expression. Antigen secretion in the HEK-293 cell lines was higher than in previously developed COS-1 cell line counterparts. These antigens can replace current antigens derived from live or inactivated virus for safer use in diagnostic testing. IMPORTANCE Serological diagnostic testing for flaviviral infections is hindered by the need for specialized biocontainment for preparation of reagents and assay implementation. The use of previously developed COS-1 cell lines secreting noninfectious recombinant viral antigen is limited due to diminished antigen secretion over time. Here, we describe the generation of 39 flaviviral virus-like particle (VLP)- and nonstructural protein 1 (NS1)-secreting stable cell lines in HEK-293 cells representing 13 medically important flaviviruses. Antigen production was more stable and statistically higher in these newly developed cell lines than in their COS-1 cell line counterparts. The use of these cell lines for production of flaviviral antigens will expand serological diagnostic testing of flaviviruses worldwide. |
Monoclonal antibodies to Cache Valley virus for serological diagnosis.
Skinner B , Mikula S , Davis BS , Powers JA , Hughes HR , Calvert AE . PLoS Negl Trop Dis 2022 16 (1) e0010156 Cache Valley virus (CVV) is a mosquito-borne virus in the genus Orthobunyavirus, family Peribunyaviridae. It was first isolated from a Culiseta inorata mosquito in Cache Valley, Utah in 1956 and is known to circulate widely in the Americas. While only a handful of human cases have been reported since its discovery, it is the causative agent of fetal death and severe malformations in livestock. CVV has recently emerged as a potential viral pathogen causing severe disease in humans. Currently, the only serological assay available for diagnostic testing is plaque reduction neutralization test which takes several days to perform and requires biocontainment. To expand diagnostic capacity to detect CVV infections by immunoassays, 12 hybridoma clones secreting anti-CVV murine monoclonal antibodies (MAbs) were developed. All MAbs developed were found to be non-neutralizing and specific to the nucleoprotein of CVV. Cross-reactivity experiments with related orthobunyaviruses revealed several of the MAbs reacted with Tensaw, Fort Sherman, Tlacotalpan, Maguari, Playas, and Potosi viruses. Our data shows that MAbs CVV14, CVV15, CVV17, and CVV18 have high specific reactivity as a detector in an IgM antibody capture test with human sera. |
Exposing cryptic epitopes on the Venezuelan equine encephalitis virus E1 glycoprotein prior to treatment with alphavirus cross-reactive monoclonal antibody allows blockage of replication early in infection
Calvert AE , Bennett SL , Hunt AR , Fong RH , Doranz BJ , Roehrig JT , Blair CD . Virology 2021 565 13-21 Eastern equine encephalitis virus (EEEV), western equine encephalitis virus (WEEV) and Venezuelan equine encephalitis virus (VEEV) can cause fatal encephalitis in humans and equids. Some MAbs to the E1 glycoprotein are known to be cross-reactive, weakly neutralizing in vitro but can protect from disease in animal models. We investigated the mechanism of neutralization of VEEV infection by the broadly cross-reactive E1-specific MAb 1A4B-6. 1A4B-6 protected 3-week-old Swiss Webster mice prophylactically from lethal VEEV challenge. Likewise, 1A4B-6 inhibited virus growth in vitro at a pre-attachment step after virions were incubated at 37 °C and inhibited virus-mediated cell fusion. Amino acid residue N100 in the fusion loop of E1 protein was identified as critical for binding. The potential to elicit broadly cross-reactive MAbs with limited virus neutralizing activity in vitro but that can inhibit virus entry and protect animals from infection merits further exploration for vaccine and therapeutic developmental research. |
World Trade Center Health Program: 20 years after 9/11
Calvert GM , Reissman D , Howard J . Occup Environ Med 2021 78 (10) 697-698 The September 11, 2001 terrorist attacks in New York City, at the Pentagon in Arlington, Virginia, and at the crash site near Shanksville, Pennsylvania caused over 3000 deaths in the immediate aftermath, and adversely affected the health of hundreds of thousands of responders—those involved in the rescue, recovery and clean-up efforts following the 9/11 attacks—and survivors—building occupants, residents, workers and students attending schools in the New York City disaster area. The James Zadroga 9/11 Health and Compensation Act of 2010 enacted by Congress and signed into law by President Obama created the World Trade Center (WTC) Health Program to provide healthcare to responders and survivors affected by toxic agent exposures arising from the 9/11 terrorist attacks and their aftereffects. Originally authorised for only 5 years, the WTC Health Program was reauthorised by Congress in 2015 until the year 2090—thereby assuring a lifetime of care for those affected by 9/11 (42 US Code §§ 300 mm—300 mm-61). |
The Specificity of the Persistent IgM Neutralizing Antibody Response in Zika Viral Infections Among Individuals with Prior Dengue Virus Exposure
Calvert AE , Horiuchi K , Boroughs KL , Ong YT , Anderson KM , Biggerstaff BJ , Stone M , Simmons G , Busch MP , Huang CY . J Clin Microbiol 2021 59 (8) e0040021 Dengue viruses (DENV) and Zika virus (ZIKV) are related mosquito-borne flaviviruses with similar disease manifestations, vector ecology and geographic range. The ability to differentiate these viruses serologically is vital due to the teratogenic nature of ZIKV and the potential confounding of pre-existing cross-reactive anti-DENV antibodies. Here we illustrate the kinetics of the IgM neutralizing antibody (NAb) response using longitudinal samples ranging from acute ZIKV infection to late convalescence from individuals with evidence of prior DENV infection. By serially depleting antibody isotypes prior to neutralization assay, we determined that IgM contributes predominantly to ZIKV neutralization, and it is less cross-reactive than the IgG NAb. The IgM NAb peaked around 14 days (95% CI: 13-15) with a median duration of 257 days (95% CI: 133-427). These results demonstrate the persistence of IgM NAb after ZIKV infections and imply its potential role in diagnosis, vaccine evaluation, serosurveillance, and research of flaviviral-host interactions. |
First Month of COVID-19 Vaccine Safety Monitoring - United States, December 14, 2020-January 13, 2021.
Gee J , Marquez P , Su J , Calvert GM , Liu R , Myers T , Nair N , Martin S , Clark T , Markowitz L , Lindsey N , Zhang B , Licata C , Jazwa A , Sotir M , Shimabukuro T . MMWR Morb Mortal Wkly Rep 2021 70 (8) 283-288 Two coronavirus disease 2019 (COVID-19) vaccines are currently authorized for use in the United States. The Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine on December 11, 2020, and for the Moderna COVID-19 vaccine on December 18, 2020; each is administered as a 2-dose series. The Advisory Committee on Immunization Practices issued interim recommendations for Pfizer-BioNTech and Moderna COVID-19 vaccines on December 12, 2020 (1), and December 19, 2020 (2), respectively; initial doses were recommended for health care personnel and long-term care facility (LTCF) residents (3). Safety monitoring for these vaccines has been the most intense and comprehensive in U.S. history, using the Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting system, and v-safe,* an active surveillance system, during the initial implementation phases of the COVID-19 national vaccination program (4). CDC conducted descriptive analyses of safety data from the first month of vaccination (December 14, 2020-January 13, 2021). During this period, 13,794,904 vaccine doses were administered, and VAERS received and processed(†) 6,994 reports of adverse events after vaccination, including 6,354 (90.8%) that were classified as nonserious and 640 (9.2%) as serious.(§) The symptoms most frequently reported to VAERS were headache (22.4%), fatigue (16.5%), and dizziness (16.5%). A total of 113 deaths were reported to VAERS, including 78 (65%) among LTCF residents; available information from death certificates, autopsy reports, medical records, and clinical descriptions from VAERS reports and health care providers did not suggest any causal relationship between COVID-19 vaccination and death. Rare cases of anaphylaxis after receipt of both vaccines were reported (4.5 reported cases per million doses administered). Among persons who received Pfizer-BioNTech vaccine, reactions reported to the v-safe system were more frequent after receipt of the second dose than after the first. The initial postauthorization safety profiles of the two COVID-19 vaccines in current use did not indicate evidence of unexpected serious adverse events. These data provide reassurance and helpful information regarding what health care providers and vaccine recipients might expect after vaccination. |
A workshop on cognitive aging and impairment in the 9/11-exposed population
Daniels RD , Clouston SAP , Hall CB , Anderson KR , Bennett DA , Bromet EJ , Calvert GM , Carreón T , DeKosky ST , Diminich ED , Finch CE , Gandy S , Kreisl WC , Kritikos M , Kubale TL , Mielke MM , Peskind ER , Raskind MA , Richards M , Sano M , Santiago-Colón A , Sloan RP , Spiro A 3rd , Vasdev N , Luft BJ , Reissman DB . Int J Environ Res Public Health 2021 18 (2) The terrorist attacks on 11 September 2001 potentially exposed more than 400,000 responders, workers, and residents to psychological and physical stressors, and numerous hazardous pollutants. In 2011, the World Trade Center Health Program (WTCHP) was mandated to monitor and treat persons with 9/11-related adverse health conditions and conduct research on physical and mental health conditions related to the attacks. Emerging evidence suggests that persons exposed to 9/11 may be at increased risk of developing mild cognitive impairment. To investigate further, the WTCHP convened a scientific workshop that examined the natural history of cognitive aging and impairment, biomarkers in the pathway of neurodegenerative diseases, the neuropathological changes associated with hazardous exposures, and the evidence of cognitive decline and impairment in the 9/11-exposed population. Invited participants included scientists actively involved in health-effects research of 9/11-exposed persons and other at-risk populations. Attendees shared relevant research results from their respective programs and discussed several options for enhancements to research and surveillance activities, including the development of a multi-institutional collaborative research network. The goal of this report is to outline the meeting's agenda and provide an overview of the presentation materials and group discussion. |
Development of diagnostic microsphere-based immunoassays for Heartland virus
Basile AJ , Horiuchi K , Goodman CH , Kosoy O , Panella AJ , Velez JO , Pastula DM , Brault AC , Staples JE , Calvert AE . J Clin Virol 2020 134 104693 BACKGROUND: Heartland virus (HRTV), a recently reclassified member of the genus Bandavirus, family Phenuiviridae, was first isolated in 2009 from a Missouri farmer exhibiting leukopenia and thrombocytopenia with suspected ehrlichiosis. Since then, more HRTV cases have been diagnosed, and firstline laboratory diagnostic assays are needed to identify future infections Objectives. We sought to develop rapid and reliable IgM and IgG microsphere immunoassays (MIAs) to test sera of patients suspected of having HRTV infection, and to distinguish between recent and past infections. STUDY DESIGN: Heartland virus antigen was captured by an anti-HRTV monoclonal antibody covalently bound to microspheres. Antibodies in human sera from confirmed HRTV-positive and negative cases were reacted with the microsphere complexes and detected using a BioPlex® 200 instrument. Assay cutoffs were determined by receiver operator characteristic analysis of the normalized test output values, equivocal zones for each assay were defined, and sensitivities, specificities, accuracies, and imprecision values were calculated. RESULTS: Sensitivities, specificities and accuracies of the IgM and IgG MIAs were all >95 %. Both tests were precise within and between assay plates, and cross-reactivity with other arboviruses was not observed. CONCLUSIONS: HRTV IgM and IgG MIAs are accurate and rapid first-line methods to serologically identify recent and past HRTV infections. |
World Trade Center Health Program: First decade of research
Santiago-Colón A , Daniels R , Reissman D , Anderson K , Calvert G , Caplan A , Carreón T , Katruska A , Kubale T , Liu R , Nembhard R , Robison WA , Yiin J , Howard J . Int J Environ Res Public Health 2020 17 (19) The terrorist attacks on 11 September 2001 placed nearly a half million people at increased risk of adverse health. Health effects research began shortly after and continues today, now mostly as a coordinated effort under the federally mandated World Trade Center (WTC) Health Program (WTCHP). Established in 2011, the WTCHP provides medical monitoring and treatment of covered health conditions for responders and survivors and maintains a research program aimed to improve the care and well-being of the affected population. By 2020, funds in excess of USD 127 M had been awarded for health effects research. This review describes research findings and provides an overview of the WTCHP and its future directions. The literature was systematically searched for relevant articles published from 11 September 2001 through 30 June 2020. Synthesis was limited to broad categories of mental health, cancer, respiratory disease, vulnerable populations, and emerging conditions. In total, 944 WTC articles were published, including peer-reviewed articles funded by the WTCHP (n = 291) and other sources. Research has focused on characterizing the burden and etiology of WTC-related health conditions. As the program moves forward, translational research that directly enhances the care of individuals with chronic mental and physical health conditions is needed. |
Development of the Fitness Education Index: A scale of organizational level capacity
Chen YT , Barcelona JM , Cance JD , Calvert HG , Barnes SP , Wargo J , Castelli DM . Res Q Exerc Sport 2019 91 (1) 1-7 Purpose: Fitness education is essential for children's health, but determining the effectiveness of instruction related to health-related fitness is difficult. The present study developed and confirmed the validity of a 20-item scale, adapted from the School Health Index (Centers for Diseases Control and Prevention [CDC], 2014), to evaluate the success of fitness education portion of the Presidential Youth Fitness Program (PYFP) across a sample of 785 teachers. Method: The initial subset (n = 373) represented 353 schools and was used for conducting an exploratory factor analysis. The second subset (n = 412) representing 404 schools, was used to conduct the confirmatory factor analysis. Teachers self-assessed their perceived degree of implementation of fitness education (full, partial, under development, not in place) within their school (i.e., teachers helped students set fitness goals). Results: An initial exploratory factor analysis revealed that the Fitness Education Index questions clustered into six factors. A subsequent confirmatory factor analysis conducted using Mplus concluded the six-factor solution was a good fit (CFI = 0.90, TLI = 0.88, RMSEA = 0.08, SRMR = 0.06). Conclusion: This scale is a valid measure of a school's readiness to initiate and track progress toward the full implementation of fitness education. |
A monoclonal antibody specific for japanese encephalitis virus with high neutralizing capability for inclusion as a positive control in diagnostic neutralization tests
Calvert AE , Bennett SL , Dixon KL , Blair CD , Roehrig JT . Am J Trop Med Hyg 2019 101 (1) 233-236 Japanese encephalitis virus (JEV) is the most common cause of viral encephalitis in Asia, and it is increasingly a global public health concern because of its recent geographic expansion. Although commercial vaccines are available and used in some endemic countries, JEV continues to cause illness, with more than 60,000 cases reported annually. To develop a reproducible positive control antibody useable in diagnosis of JEV infections, murine hybridomas were developed from mice inoculated with a combination of IXIARO JEV vaccine and JEV domain III of the envelope protein (E-DIII). Monoclonal antibodies (MAbs) were characterized for their ability to neutralize virus in vitro. Monoclonal antibody 17BD3-2 was found to be JEV specific and highly neutralizing, with a plaque reduction neutralization test (PRNT)90 endpoint titer of 1.25 mug/mL. The functional epitopes were mapped using virus neutralization escape variants to amino acid residues S309, K312, and G333 in E-DIII. This MAb may be substituted for human immune sera used as a positive control in PRNT for distribution to public health laboratories worldwide in potential future outbreaks of JEV. |
Elevated blood lead levels in adults - Missouri, 2013
Victory KR , Braun CR , de Perio MA , Calvert GM , Alarcon W . Am J Ind Med 2019 62 (4) 347-351 BACKGROUND: Over 90% of adults with elevated blood lead levels (BLLs) in the United States are exposed occupationally. Missouri historically has been among the states with the highest prevalence rates of elevated BLLs. We characterized cases of elevated BLLs among Missouri adults to target preventive interventions. METHODS: We reviewed 2013 data on Missouri residents >/=16 years from the Missouri Adult Blood Lead Epidemiology and Surveillance system and analyzed characteristics of those with elevated BLLs. We used the contemporaneous CDC definition of elevated BLL as >/=10 mug/dL. RESULTS: Of the 15 123 residents with a BLL in 2013 (median: 1.5 mug/dL, range: 0-151 mug/dL), 3145 (21%) had BLLs >/=10 mug/dL. Occupational exposures accounted for the majority of residents (n = 3099, 98%) with elevated BLLs, mostly in battery manufacturing (n = 1373, 44%) and lead mining (n = 821, 26%) industries. CONCLUSIONS: Our findings highlight the need for focused interventions targeting battery manufacturing and lead mining, the high-risk industries, to further reduce overexposures to lead. |
Prevalence and types of school-based out-of-school time programs at elementary schools and implications for student nutrition and physical activity
Sliwa SA , Calvert HG , Williams HP , Turner L . J Sch Health 2019 89 (1) 48-58 BACKGROUND: Out-of-school time (OST) programs are an important setting for supporting student health and academic achievement. This study describes the prevalence and characteristics of school-based OST programs, which can inform efforts to promote healthy behaviors in this setting. METHODS: A nationally representative sample of public elementary schools (N = 640) completed surveys in 2013-2014. Administrators reported on OST programs and policies at their school. Multivariable logistic regression models estimated the prevalence of school-based OST programs, adjusting for school characteristics. Among schools with OST programs (N = 475), chi-square tests identified school characteristics associated with having an OST policy about physical activity or nutrition. RESULTS: Three fourths of elementary schools (75.6%) had a full- or partial-year school-based OST program, with 30.8% having both. Full- and partial-year programs were significantly less prevalent in rural and township areas versus urban settings. Only 27.5% of schools with OST programs reported having physical activity and/or nutrition policies. CONCLUSIONS: Most US elementary schools have an on-site OST program, but disparities in access exist, and most lack policies or awareness of existing policies regarding physical activity and nutrition. To maximize OST programs' potential benefits, strategies are needed to increase access to programs and physical activity and/or nutrition policy adoption. |
Incorporation of IgG depletion in a neutralization assay facilitates differential diagnosis of Zika and dengue in secondary flavivirus infection cases
Calvert AE , Boroughs KL , Laven J , Stovall JL , Luy BE , Kosoy OI , Huang CY . J Clin Microbiol 2018 56 (6) Zika virus (ZIKV) has emerged as a major global public health concern due to its link as a causative agent of human birth defects. Laboratory diagnosis of suspected ZIKV infections by serological testing of specimens collected a week or more after symptom onset primarily relies on detection of anti-ZIKV-specific IgM antibodies by enzyme-linked immunosorbent assay coupled with detection of ZIKV-specific neutralizing antibody by neutralization tests. A definitive diagnosis based on serological assays is possible during primary ZIKV infections; however, due to the cross-reactivity of antibodies elicited during flaviviral infections, a definitive diagnosis is not always possible, especially among individuals who have previously been exposed to closely related flaviviruses, such as dengue virus (DENV). Here, we investigated the neutralizing IgM antibody profiles of 33 diagnostic specimens collected from individuals with suspected primary and secondary flaviviral infections acquired when visiting areas experiencing active ZIKV transmission in 2015 and 2016. Specimens collected between 1 day and 3 months postexposure were tested for ZIKV and dengue virus type 1 (DENV1) and type 2 (DENV2) by the plaque reduction neutralization test (PRNT) before and after IgG depletion. We found that IgG depletion prior to neutralization testing had little effect in differentiating samples from individuals with secondary infections taken less than 3 weeks postexposure; however, IgG depletion significantly reduced the cross-reactive neutralizing antibody titers and increased the percentage of cases discernible by PRNT from 15.4% (95% confidence interval [CI], 4.3 to 42.2%) to 76.9% (95% CI, 49.7 to 91.8%) for samples collected between roughly 3 and 12 weeks postexposure. These results highlight the potential of IgG depletion to improve the specificity of PRNT for better confirmation and differential diagnosis of flavivirus infections. |
Phosphine exposure among emergency responders - Amarillo, Texas, January 2017
Hall EM , Patel K , Victory KR , Calvert GM , Nogueira LM , Bojes HK . MMWR Morb Mortal Wkly Rep 2018 67 (13) 387-389 Phosphine is a highly toxic gas that forms when aluminum phosphide, a restricted-use pesticide* typically used in agricultural settings, reacts with water. Acute exposure can lead to a wide range of respiratory, cardiovascular, and gastrointestinal symptoms, and can be fatal (1). On January 2, 2017, the Texas Department of State Health Services (DSHS) was notified by the Texas Panhandle Poison Center of an acute phosphine exposure incident in Amarillo, Texas. DSHS investigated potential occupational phosphine exposures among the 51 on-scene emergency responders; 40 (78.4%) did not use respiratory protection during response operations. Fifteen (37.5%) of these 40 responders received medical care for symptoms or as a precaution after the incident, and seven (17.5%) reported new or worsening symptoms consistent with phosphine exposure within 24 hours of the incident. Emergency response organizations should ensure that appropriate personal protective equipment (PPE) is used during all incidents when an unknown hazardous substance is suspected. Additional evaluation is needed to identify targeted interventions that increase emergency responder PPE use during this type of incident. |
Codability of industry and occupation information from cancer registry records: Differences by patient demographics, casefinding source, payor, and cancer type
Silver SR , Tsai RJ , Morris CR , Boiano JM , Ju J , Scocozza MS , Calvert GM . Am J Ind Med 2018 61 (6) 524-532 INTRODUCTION: Industry and occupation (I&O) information collected by cancer registries is useful for assessing associations among jobs and malignancies. However, systematic differences in I&O availability can bias findings. METHODS: Codability by patient demographics, payor, identifying (casefinding) source, and cancer site was assessed using I&O text from first primaries diagnosed 2011-2012 and reported to California Cancer Registry. I&O were coded to a U.S. Census code or classified as blank/inadequate/unknown, retired, or not working for pay. RESULTS: Industry was codable for 37% of cases; 50% had "unknown" and 9% "retired" instead of usual industry. Cases initially reported by hospitals, covered by preferred providers, or with known occupational etiology had highest codable industry; cases from private pathology laboratories, with Medicaid, or diagnosed in outpatient settings had least. Occupation results were similar. CONCLUSIONS: Recording usual I&O for retirees and improving linkages for reporting entities without patient access would improve I&O codability and research validity. |
Cardiovascular conditions, hearing difficulty, and occupational noise exposure within US industries and occupations
Kerns E , Masterson EA , Themann CL , Calvert GM . Am J Ind Med 2018 61 (6) 477-491 BACKGROUND: The purpose of this study was to estimate the prevalence of occupational noise exposure, hearing difficulty and cardiovascular conditions within US industries and occupations, and to examine any associations of these outcomes with occupational noise exposure. METHODS: National Health Interview Survey data from 2014 were examined. Weighted prevalence and adjusted prevalence ratios of self-reported hearing difficulty, hypertension, elevated cholesterol, and coronary heart disease or stroke were estimated by level of occupational noise exposure, industry, and occupation. RESULTS: Twenty-five percent of current workers had a history of occupational noise exposure (14% exposed in the last year), 12% had hearing difficulty, 24% had hypertension, 28% had elevated cholesterol; 58%, 14%, and 9% of these cases can be attributed to occupational noise exposure, respectively. CONCLUSIONS: Hypertension, elevated cholesterol, and hearing difficulty are more prevalent among noise-exposed workers. Reducing workplace noise levels is critical. Workplace-based health and wellness programs should also be considered. |
Acute illnesses and injuries related to total release foggers - 10 States, 2007-2015
Liu R , Alarcon WA , Calvert GM , Aubin KG , Beckman J , Cummings KR , Graham LS , Higgins SA , Mulay P , Patel K , Prado JB , Schwartz A , Stover D , Waltz J . MMWR Morb Mortal Wkly Rep 2018 67 (4) 125-130 Total release foggers (TRFs) (also known as "bug bombs") are pesticide products often used indoors to kill insects. After an earlier report found that TRFs pose a risk for acute illness (1), the Environmental Protection Agency required improved labels on TRFs manufactured after September 2012 (2). To examine the early impact of relabeling, the magnitude and characteristics of acute TRF-related illness were evaluated for the period 2007-2015. A total of 3,222 TRF-related illnesses were identified in 10 participating states, based on three data sources: Sentinel Event Notification System for Occupational Risk-Pesticides (SENSOR) programs, the California Department of Pesticide Regulation (CDPR) program, and poison control centers (PCCs) in Florida, Texas, and Washington. No statistically significant decline in the overall TRF-illness incidence rate was found. Failure to vacate treated premises during application was the most commonly reported cause of exposure. To reduce TRF-related illness, integrated pest management strategies (3) need to be adopted, as well as better communication about the hazards and proper uses of TRFs. Redesigning TRFs to prevent sudden, unexpected activation might also be useful. |
Prevalence of hearing loss among noise-exposed workers within the agriculture, forestry, fishing, and hunting sector, 2003-2012
Masterson EA , Themann CL , Calvert GM . Am J Ind Med 2017 61 (1) 42-50 BACKGROUND: The purpose of this study was to estimate the prevalence of hearing loss among noise-exposed US workers within the Agriculture, Forestry, Fishing, and Hunting (AFFH) sector. METHODS: Audiograms for 1.4 million workers (17 299 within AFFH) from 2003 to 2012 were examined. Prevalence, and the adjusted risk for hearing loss as compared with the reference industry (Couriers and Messengers), were estimated. RESULTS: The overall AFFH sector prevalence was 15% compared to 19% for all industries combined, but many of the AFFH sub-sectors exceeded the overall prevalence. Forestry sub-sector prevalences were highest with Forest Nurseries and Gathering of Forest Products at 36% and Timber Tract Operations at 22%. The Aquaculture sub-sector had the highest adjusted risk of all AFFH sub-sectors (PR = 1.70; CI = 1.42-2.04). CONCLUSIONS: High risk industries within the AFFH sector need continued hearing conservation efforts. Barriers to hearing loss prevention and early detection of hearing loss need to be recognized and addressed. |
Prevalence of hearing loss among noise-exposed workers within the healthcare and social assistance sector, 2003-2012
Masterson EA , Themann CL , Calvert GM . J Occup Environ Med 2017 60 (4) 350-356 OBJECTIVE: The purpose was to estimate the prevalence of hearing loss for noise-exposed U.S. workers within the Healthcare and Social Assistance (HSA) sector. METHODS: Audiograms for 1.4 million workers (8,702 within HSA) from 2003-2012 were examined. Prevalences and adjusted risks for hearing loss as compared with a reference industry were estimated for the HSA sector and all industries combined. RESULTS: While the overall HSA sector prevalence for hearing loss was 19%, the prevalences in the Medical Laboratories sub-sector and the Offices of All Other Miscellaneous Health Practitioners sub-sector were 31% and 24%, respectively. The Child Day Care Services sub-sector had a 52% higher risk than the reference industry. CONCLUSIONS: High risk industries for hearing loss exist within the HSA sector. Further work is needed to identify the sources of noise exposure and protect worker hearing. |
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