BACKGROUND: The Centers for Disease Control and Prevention's Drug Overdose Surveillance and Epidemiology (DOSE) system captures non-fatal overdose data from health departments' emergency department (ED) and inpatient hospitalisation discharge data; however, these data have not been compared with other established state-level surveillance systems, which may lag by several years depending on the state. This analysis compared non-fatal overdose rates from DOSE discharge data with rates from the Healthcare Cost and Utilization Project (HCUP) in order to compare DOSE data against an established dataset. METHODS: DOSE discharge data case definitions (ie, International Classification of Diseases, 10th revision, Clinical Modification codes) for non-fatal unintentional/undetermined intent all drug, all opioid-involved, heroin-involved and stimulant-involved overdoses were applied to HCUP's 2018-2020 State Emergency Department Databases (SEDD) and State Inpatient Databases (SID). Quarterly crude rates (per 100 000 population) and rate differences of four overdose categories were calculated for ED and inpatient data sources across 18 states included in DOSE and HCUP datasets for at least 2 consecutive years. Joinpoint regression models examined trends from 2018 through 2020, estimating average quarterly percentage change (AQPC) and 95% CIs. RESULTS: Quarterly crude rate differences between DOSE ED and SEDD data (across 12 states) and DOSE inpatient and SID data (across 16 states) indicated that 82% and 93% of rates, respectively, were within ±0.5 non-fatal overdoses per 100 000 population of each other. AQPC across states and drug categories were similar between the two data sources for both ED and inpatient data. DISCUSSION: Non-fatal overdose surveillance through DOSE discharge data may be a valid and timely source for estimating non-fatal overdoses at the state level.

PURPOSE: In this manuscript, the abbreviation TG is defined as persons who identify as transgender, GNC is defined as persons who identify as gender nonconforming, and CG is defined as persons who identify as cisgender. TG and GNC (e.g., nonbinary), are those whose gender identity and sex assigned at birth do not align, as opposed to CG. This study describes drug poisonings among TG, GNC, and CG captured in the Toxicology Investigators Consortium (ToxIC) Core Registry during 2017-2021. METHODS: Authors conducted a secondary data analysis of medical toxicology physician consultations involving intentional exposures (i.e., use with the knowledge of the exposed person) within the ToxIC Core Registry from 2017 through 2021. Demographic characteristics, exposure intent, and reported drug classes are reported by gender identity and sex assigned at birth. FINDINGS: From a total of 15,800 medical toxicology consultations, 213 (1.3%) involved both TG (n = 187, 1.2%) and GNC (n = 26, 0.2%), and 15,587 (98.7%) involved CG. Among TG, 128 (68.8%) were transgender men, 58 (31.2%) transgender women. Sixty-two percent of TG/GNC (n = 132) and 34.8% of CG (n = 5,428) were aged ≤18 years. Reported intent for exposure (i.e., self-harm and misuse/harmful use) differed proportionally across both sexes assigned at birth and gender identity among transgender men and cisgender men. IMPLICATIONS: In the ToxIC Core Registry, the consultations varied proportionally by age group across TG/GNC and CG, with more than half of TG/GNC aged ≤18 years. The proportion of consultations also varied by intent across TG/GNC and CG. Further research to delineate differences between TG/GNC and CG could increase knowledge in prevention, assessment, and treatment of drug poisonings in this population.

BACKGROUND: Opioid-involved overdoses, especially those involving synthetic opioids like fentanyl, have driven increases in overdose morbidity and mortality. Emergency medical services (EMS) and emergency department (ED) data can each provide near real-time information on trends in nonfatal opioid-involved overdoses; however, minimal data exist on the comparability of trends in these two data sources. METHODS: EMS data from biospatial© and ED data from CDC's Drug Overdose Surveillance and Epidemiology system and National Syndromic Surveillance Program were queried for nine states. Counts of total encounters, opioid-involved overdose encounters, and rates of opioid-involved overdoses per 10,000 total encounters were calculated for each data source from 2020-2022. Trends in monthly counts and rates were assessed using Joinpoint regression. RESULTS: On average, EMS data captured 1.8 times more monthly opioid-involved overdose encounters than ED data. Trends in the counts of opioid-involved overdose encounters were similar in both data sources with increases and decreases occurring during roughly the same periods. Overall, trends in rates of opioid-involved overdose encounters were also comparable. CONCLUSIONS: EMS and ED data provide complementary information for understanding overdose trends. Study findings underscore the importance of implementing post-overdose response protocols by both EMS and ED providers to ensure patient receive services irrespective of care setting.

We have conducted numerical simulations of dust dispersion within the NIOSH Rock Dust Dispersion Chamber. The apparatus consists of a low-speed background ventilation flow down a long box in which is placed a tray containing a rock dust powder. A nozzle upstream of the tray introduces a short pulse of a turbulent horizontal jet flow just above the powder surface. We have utilized an incompressible Reynolds-Averaged Navier-Stokes k-ω model for the turbulent flow; particles are incorporated within a one-way Euler-Lagrangian formalism. The Rock Dust Dispersion Chamber ventilation flow exhibits a recirculation zone just above the powder-containing tray. Aerosolization proceeds via the interplay of the jet pulse flow with the background recirculation flow. The air flow is not well-mixed. The aerosolized dust is convected as a concentration cloud downstream towards the detection zone. For larger particles, gravitational settling depletes the convected cloud, so the instrument behaves as a horizontal elutriator. The instrument is robust with respect to misalignment of the jet nozzle. However, reduced streamwise drift velocity allows mixing to disperse the optically detected dust cloud concentration pulse. Our large particle simulation results compare favorably with published experimental results for large, polydisperse calcium carbonate rock dust. © 2023

BACKGROUND: Nonfatal drug overdoses (NFODs) are often attributed to individual behaviors and risk factors; however, identifying community-level social determinants of health (SDOH) associated with increased NFOD rates may allow public health and clinical providers to develop more targeted interventions to address substance use and overdose health disparities. CDC's Social Vulnerability Index (SVI), which aggregates social vulnerability data from the American Community Survey to produce ranked county-level vulnerability scores, can help identify community factors associated with NFOD rates. This study aims to describe associations between county-level social vulnerability, urbanicity, and NFOD rates. METHODS: We analyzed county-level 2018-2020 emergency department (ED) and hospitalization discharge data submitted to CDC's Drug Overdose Surveillance and Epidemiology system. Counties were ranked in vulnerability quartiles based on SVI data. We used crude and adjusted negative binomial regression models, by drug category, to calculate rate ratios and 95% confidence intervals comparing NFOD rates by vulnerability. RESULTS: Generally, as social vulnerability scores increased, ED and hospitalization NFOD rates increased; however, the magnitude of the association varied across drugs, visit type, and urbanicity. SVI-related theme and individual variable analyses highlighted specific community characteristics associated with NFOD rates. CONCLUSIONS: The SVI can help identify associations between social vulnerabilities and NFOD rates. Development of an overdose-specific validated index could improve translation of findings to public health action. The development and implementation of overdose prevention strategies should consider a socioecological perspective and address health inequities and structural barriers associated with increased risk of NFODs at all levels of the social ecology.

Vibrio parahaemolyticus is the leading cause of seafood-related foodborne illness globally. In 2018, the U.S. federal, state, and local public health and regulatory partners investigated a multistate outbreak of V. parahaemolyticus infections linked to crabmeat that resulted in 26 ill people and nine hospitalizations. State and U.S. Food and Drug Administration (FDA) laboratories recovered V. parahaemolyticus, Salmonella spp., and Listeria monocytogenes isolates from crabmeat samples collected from various points of distribution and conducted phylogenetic analyses of whole-genome sequencing data. Federal, state, and local partners conducted traceback investigations to determine the source of crabmeat. Multiple Venezuelan processors that supplied various brands of crabmeat were identified, but a sole firm was not confirmed as the source of the outbreak. Travel restrictions between the United States and Venezuela prevented FDA officials from conducting on-site inspections of cooked crabmeat processors. Based on investigation findings, partners developed public communications advising consumers not to eat crabmeat imported from Venezuela and placed potentially implicated firms on import alerts. While some challenges limited the scope of the investigation, epidemiologic, traceback, and laboratory evidence identified the contaminated food and country of origin, and contributed to public health and regulatory actions, preventing additional illnesses. This multistate outbreak illustrates the importance of adhering to appropriate food safety practices and regulations for imported seafood.

Reports of Salmonella enterica I serotype 4,[5],12:i:- infections resistant to ampicillin, streptomycin, sulphamethoxazole, and tetracycline (ASSuT) have been increasing. We analyzed data from 5 national surveillance systems to describe the epidemiology, resistance traits, and genetics of infections with this Salmonella strain in the United States. We found ASSuT-resistant Salmonella 4,[5],12:i:- increased from 1.1% of Salmonella infections during 2009-2013 to 2.6% during 2014-2018; the proportion of Salmonella 4,[5],12:i:- isolates without this resistance pattern declined from 3.1% to 2.4% during the same timeframe. Among isolates sequenced during 2015-2018, a total of 69% were in the same phylogenetic clade. Within that clade, 77% of isolates had genetic determinants of ASSuT resistance, and 16% had genetic determinants of decreased susceptibility to ciprofloxacin, ceftriaxone, or azithromycin. Among outbreaks related to the multidrug-resistant clade, 63% were associated with pork consumption or contact with swine. Preventing Salmonella 4,[5],12:i:- carriage in swine would likely avert human infections with this strain.

The guinea pig was the original animal model developed for investigating spotted fever rickettsiosis (SFR). This model system has persisted on account of the guinea pig's conduciveness to tick transmission of SFR agents and ability to recapitulate SFR in humans through clinical signs that include fever, unthriftiness, and in some cases the development of an eschar. The guinea pig is the smallest animal model for SFR that allows the collection of multiple blood and skin samples antemortem for longitudinal studies. This unit provides the basic protocols necessary to establish, maintain, and utilize a guinea pig-tick-Rickettsia model for monitoring the course of infection and immune response to an infection by spotted fever group Rickettsia (SFGR) that can be studied at biosafety level 2 (BSL-2) and arthropod containment level 2 (ACL-2); adaptations must be made for BSL-3 agents. The protocols cover methods for tick feeding and colony development, laboratory infection of ticks, tick transmission of Rickettsia to guinea pigs, and monitoring of the course of infection through clinical signs, rickettsial burden, and immune response. It should be feasible to adapt these methods to study other tick-borne pathogens. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Tick transmission of SFGR to guinea pigs Support Protocol 1: Laboratory infection of ticks by injection Alternate Protocol 1: Needle inoculation of SFGR to guinea pigs Basic Protocol 2: Monitoring the course of guinea pig rickettsial infection: clinical signs Basic Protocol 3: Monitoring the course of guinea pig rickettsial infection: collection of biological specimens Support Protocol 2: Guinea pig anesthesia Basic Protocol 4: Monitoring rickettsial burden in guinea pigs by multiplex qPCR Basic Protocol 5: Monitoring guinea pig immune response to infection: blood leukocytes by flow cytometry Basic Protocol 6: Monitoring immune response to guinea pig rickettsial infection: leukocyte infiltration of skin at the tick bite site by flow cytometry Basic Protocol 7: Monitoring the immune response to guinea pig rickettsial infection: antibody titer by ELISA Support Protocol 4: Coating ELISA Plates Alternate Protocol 2: Monitoring immune response to guinea pig rickettsial infection: antibody titer by immunofluorescence assay.

OBJECTIVES: To measure the impact of lost-time occupational injuries on all-cause mortality in Washington State and, using the same data elements and study design, to determine whether the estimated impact was similar to previous estimates for New Mexico. METHODS: We linked injuries in the Washington workers' compensation system with Social Security Administration data on earnings and mortality. We estimated Cox survival models of mortality for women and men with lost-time compared with medical-only injuries, adjusting for age, pre-injury earnings and industry. We used quantitative bias analysis to account for confounding by pre-injury smoking and obesity. RESULTS: The estimated mortality HR was 1.24 for women (95% CI 1.21 to 1.28) and 1.22 for men (95% CI 1.20 to 1.24). After adjusting for unmeasured pre-injury smoking and obesity, the estimated HR for women was 1.10, 95% simulation interval (SI) 1.00 to 1.21; for men, it was 1.15, 95% SI 1.04 to 1.27. CONCLUSIONS: All-cause mortality for Washington workers with lost-time injuries was higher than for those with medical-only injuries. Estimated HRs for Washington were consistent with those previously estimated for New Mexico, a less populous state with lower median wages and a different workers' compensation insurance mechanism. This suggests that the relationship between workplace injury and long-term mortality may be generalisable to other US states. These findings support greater efforts to enhance safety and to investigate factors that improve postinjury employment opportunities and long-term health. This association should be examined in additional locations, with different study conditions, or using additional data on pre-injury risk factors.

The number of nonfatal opioid-involved overdoses treated by health care providers has risen in the United States; the median number of emergency department (ED) visits for these overdoses was significantly higher during 2020 than during 2019 (1). ED visit data can underestimate nonfatal opioid-involved overdose incidence because, increasingly, persons experiencing a nonfatal opioid overdose are refusing transport to EDs by emergency medical services (EMS) (2). A study in Kentucky found that during a 6-month period, 19.8% of persons treated by EMS for an opioid overdose refused transport to an ED (2). Thus, EMS encounter data involving suspected nonfatal opioid-involved overdoses complement ED data and also allow for near real-time analysis (3). This report describes trends in rates of EMS encounters for nonfatal opioid-involved overdoses per 10,000 total EMS encounters (rates) by selected patient- and county-level characteristics during January 2018–March 2022 in 491 counties from 21 states using data from biospatial, Inc.* During this period, the nonfatal opioid-involved overdose rate increased, on average, 4.0% quarterly. Rates increased for both sexes and for most age groups. Rates were highest among non-Hispanic White (White) and non-Hispanic Native Hawaiian or other Pacific Islander (NH/OPI) persons, and increases were largest among non-Hispanic Black (Black), followed by Hispanic or Latino (Hispanic) persons. Rates increased in both urban and rural counties and for all quartiles of county-level characteristics (i.e., unemployment, education, and uninsured), except in counties with the lowest percentage of uninsured persons. Rates were highest and rate increases were largest in urban counties and counties with higher unemployment rates. This analysis of nonfatal opioid-involved overdose trends in EMS data highlights the utility of these data and the importance of addressing inequities that contribute to disproportionate overdose risk, such as through focused outreach to racial and ethnic minority groups, who disproportionately experience these inequities, and communities with higher levels of unemployment. EMS providers are in a unique position to engage in postoverdose response protocols and promote evidence-based overdose education and facilitate linkage to care and harm reduction services.†,§

Understanding particle detachment from surfaces is necessary to better characterize dust generation and entrainment. Previous work has studied the detachment of particles from flat surfaces. The present work generalizes this to investigate the aerodynamics of a particle attached to various locations on a model hill. The present work serves as a model for dust aerosolization in a tube, as powder is injected into the Venturi Dustiness Tester. The particle is represented as a sphere in a parallel plate channel, or, in two dimensions, as a cylinder oriented perpendicular to the flow. The substrate is modified to include a conical hill (3D) or wedge (2D), and the test particle is located at various positions on this hill. The governing incompressible Navier-Stokes equations are solved using the finite-volume FLUENT code. The coefficients of lift and drag are compared with the results on the flat substrate. Enhanced drag and significantly enhanced lift are observed as the test particle is situated near the summit of the hill.

PURPOSE: Recent studies have shown increased all-cause mortality among workers following disabling workplace injury. These studies did not account for 2 potentially important confounders, smoking and obesity. We estimated injury-related mortality accounting for these factors. METHODS: We followed workers receiving New Mexico workers' compensation benefits (1994-2000) through 2013. Using data from the Panel Study of Income Dynamics, we derived the joint distribution of smoking status and obesity for workers with and without lost-time injuries. We conducted a quantitative bias analysis (QBA) to determine the adjusted relationship of injury and mortality. RESULTS: We observed hazard ratios after adjusting for smoking and obesity of 1.13 for women (95% simulation interval (SI) 0.97 to 1.31) and 1.12 for men (95% SI 1.00 to 1.27). The estimated fully adjusted excess hazard was about half the estimates not adjusted for these factors. CONCLUSIONS: Using QBA to adjust for smoking and obesity reduced the estimated mortality hazard from lost-time injuries and widened the simulation interval. The adjusted estimate still showed more than a 10 percent increase for both women and men. The change in estimates reveals the importance of accounting for these confounders. Of course, the results depend on the methods and assumptions used.

OBJECTIVES: The Abbot ID NOW COVID-19 assay and Quidel Sofia 2 SARS Antigen FIA are point-of-care assays that offer rapid testing for severe acute respiratory syndrome coronavirus 2 viral RNA and nucleocapsid protein, respectively. Given the utility of these devices in the field, we investigated the feasibility and safety of using the ID NOW and Sofia assays in the public health response to the coronavirus disease 2019 pandemic and in future public health emergencies. METHODS: A combination of utilization and contamination testing in addition to a review of instrument workflows was conducted. RESULTS: Utilization testing demonstrated that both tests are intuitive, associated with high user test success (85%) in our study, and could be implemented by staff after minimal training. Contamination tests revealed potential biosafety concerns due to the open design of the ID NOW instrument and the transfer mechanisms with the Sofia. When comparing the workflow of the ID NOW and the Sofia, we found that the ID NOW was more user-friendly and that the transfer technology reduces the chance of contamination. CONCLUSIONS: The ID NOW, Sofia, and other emerging point-of-care tests should be used only after careful consideration of testing workflow, biosafety risk mitigations, and appropriate staff training.

Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million-12.0 million), results in 601,000 ED visits (95% CrI 364,000-866,000), 118,000 hospitalizations (95% CrI 86,800-150,000), and 6,630 deaths (95% CrI 4,520-8,870) and incurring US $3.33 billion (95% CrI 1.37 billion-8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.

This study identified a genotype of RSV associated with increased acute respiratory disease severity in a cohort of term, previously healthy infants. The genotype (2stop+A4G) consists of two components. The A4G component is a prevalent point mutation in the 4(th) position of the gene end transcription termination signal of the G gene of currently circulating RSV strains. The 2stop component is two tandem stop codons at the G gene terminus, preceding the gene end transcription termination signal. To investigate the biological role of these RSV G gene mutations, recombinant RSV strains harboring either a wild type A2 strain G gene (one stop codon preceding a wild type gene end signal), an A4G gene end signal preceded by one stop codon, or the 2stop+A4G virulence-associated combination were generated and characterized. Infection with the rA4G RSV mutant resulted in transcriptional read-through and lower G and fusion (F) protein levels relative to wild type. Addition of a second stop codon preceding the A4G point mutation (2stop+A4G) restored G protein expression but retained lower F protein levels. These data suggest that RSV G and F glycoprotein expression is regulated by transcriptional and translational read-through. Notably, while rA4G and r2stop+A4G RSV were attenuated in cells and in naïve BALB/c mice compared to wild type RSV, the r2stop+A4G RSV was better able to infect BALB/c mice in the presence of pre-existing immunity in comparison to rA4G RSV. Together these factors may contribute to the maintenance and virulence of the 2stop+A4G genotype in currently circulating RSV-A strains.IMPORTANCE Strain-specific differences in respiratory syncytial virus (RSV) isolates are associated with differential pathogenesis in mice. However, the role of RSV genotypes in human infection is incompletely understood. This work demonstrates that one such genotype, 2stop+A4G, present in the RSV attachment (G) gene terminus is associated with greater infant disease severity. The genotype consists of two tandem stop codons preceding an A-to-G point mutation in the 4(th) position of the G gene end transcription termination signal. Virologically, the 2stop+A4G RSV genotype results in reduced levels of the RSV fusion (F) glycoprotein. A recombinant 2stop+A4G RSV was better able to establish infection in the presence of existing RSV immunity compared to a virus harboring the common A4G mutation. These data suggest that regulation of G and F expression has implications for virulence and potentially immune evasion.

The coronavirus disease 2019 (COVID-19) pandemic resulted in 5,817,385 reported cases and 362,705 deaths worldwide through May, 30, 2020,(dagger) including 1,761,503 aggregated reported cases and 103,700 deaths in the United States.( section sign) Previous analyses during February-early April 2020 indicated that age >/=65 years and underlying health conditions were associated with a higher risk for severe outcomes, which were less common among children aged <18 years (1-3). This report describes demographic characteristics, underlying health conditions, symptoms, and outcomes among 1,320,488 laboratory-confirmed COVID-19 cases individually reported to CDC during January 22-May 30, 2020. Cumulative incidence, 403.6 cases per 100,000 persons,( paragraph sign) was similar among males (401.1) and females (406.0) and highest among persons aged >/=80 years (902.0). Among 599,636 (45%) cases with known information, 33% of persons were Hispanic or Latino of any race (Hispanic), 22% were non-Hispanic black (black), and 1.3% were non-Hispanic American Indian or Alaska Native (AI/AN). Among 287,320 (22%) cases with sufficient data on underlying health conditions, the most common were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Overall, 184,673 (14%) patients were hospitalized, 29,837 (2%) were admitted to an intensive care unit (ICU), and 71,116 (5%) died. Hospitalizations were six times higher among patients with a reported underlying condition (45.4%) than those without reported underlying conditions (7.6%). Deaths were 12 times higher among patients with reported underlying conditions (19.5%) compared with those without reported underlying conditions (1.6%). The COVID-19 pandemic continues to be severe, particularly in certain population groups. These preliminary findings underscore the need to build on current efforts to collect and analyze case data, especially among those with underlying health conditions. These data are used to monitor trends in COVID-19 illness, identify and respond to localized incidence increase, and inform policies and practices designed to reduce transmission in the United States.

Dermacentor variabilis, a common human-biting tick found throughout the eastern half and along the west coast of the United States, is a vector of multiple bacterial pathogens. Historically, D. variabilis has been considered a primary vector of Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever. A total of 883 adult D. variabilis, collected between 2012 and 2017 from various locations in 12 states across the United States, were screened for rickettsial DNA. Tick extracts were evaluated using three real-time PCR assays; an R. rickettsii-specific assay, a Rickettsia bellii-specific assay, and a Rickettsia genus-specific assay. Sequencing of ompA gene amplicons generated using a seminested PCR assay was used to determine the rickettsial species present in positive samples not already identified by species-specific real-time assays. A total of 87 (9.9%) tick extracts contained R. bellii DNA and 203 (23%) contained DNA of other rickettsial species, including 47 (5.3%) with Rickettsia montanensis, 11 (1.2%) with Rickettsia amblyommatis, 2 (0.2%) with Rickettsia rhipicephali, and 3 (0.3%) with Rickettsia parkeri. Only 1 (0.1%) tick extract contained DNA of R. rickettsii. These data support multiple other contemporary studies that indicate infrequent detection of R. rickettsii in D. variabilis in North America.

Dustiness quantifies the propensity of a finely divided solid to be aerosolized by a prescribed mechanical stimulus. Dustiness is relevant wherever powders are mixed, transferred or handled, and is important in the control of hazardous exposures and the prevention of dust explosions and product loss. Limited quantities of active pharmaceutical powders available for testing led to the development (at University of North Carolina) of a Venturi-driven dustiness tester. The powder is turbulently injected at high speed (Re ~ 2 × 104) into a glass chamber; the aerosol is then gently sampled (Re ~ 2 × 103) through two filters located at the top of the chamber; the dustiness index is the ratio of sampled to injected mass of powder. Injection is activated by suction at an Extraction Port at the top of the chamber; loss of powder during injection compromises the sampled dustiness. The present work analyzes the flow inside the Venturi Dustiness Tester, using an Unsteady Reynolds-Averaged Navier-Stokes formulation with the k-ω Shear Stress Transport turbulence model. The simulation considers single-phase flow, valid for small particles (Stokes number Stk &lt; 1). Results show that ~ 24% of fluid-tracers escape the tester before the Sampling Phase begins. Dispersion of the powder during the Injection Phase results in a uniform aerosol inside the tester, even for inhomogeneous injections, satisfying a necessary condition for the accurate evaluation of dustiness. Simulations are also performed under the conditions of reduced Extraction-Port flow; results confirm the importance of high Extraction-Port flow rate (standard operation) for uniform distribution of fluid tracers. Simulations are also performed under the conditions of delayed powder injection; results show that a uniform aerosol is still achieved provided 0.5 s elapses between powder injection and sampling.

Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions.

The Companion Animal Parasite Council hosted a meeting to identify quantifiable factors that can influence the prevalence of tick-borne disease agents among dogs in North America. This report summarizes the approach used and the factors identified for further analysis with mathematical models of canine exposure to tick-borne pathogens.

In 1990, Congress passed the Breast and Cervical Cancer Mortality Prevention Act because of increases in the number of low-income and uninsured women being diagnosed with breast cancer. This act authorized the Centers for Disease Control and Prevention (CDC) to establish the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide high-quality and timely breast and cervical cancer screening and diagnostic services to low-income, uninsured women. The program started in 1991, and, in 1993, Congress amended the act to allow the CDC to fund American Indian and Alaska Native tribes and tribal organizations. By 1996, the program was providing cancer screening across the United States. To ensure appropriate delivery and monitoring of services, the program adopted detailed policies on program management, evidence-based guidelines for clinical services, a systematized clinical data system to track service quality, and key partnerships that expand the program's reach. The NBCCEDP currently funds 67 programs, including all 50 states, the District of Columbia, 5 US territories, and 11 tribes or tribal organizations.

The Baron fiber classifier is an instrument used to separate fibers by length. The flow combination section (FCS) of this instrument is an upstream annular region, where an aerosol of uncharged fibers is introduced along with two sheath flows; length separation occurs by dielectrophoresis downstream in the flow classification section. In its current implementation at NIOSH, the instrument is capable of processing only very small quantities of fibers. In order to prepare large quantities of length-separated fibers for toxicological studies, the throughput of the instrument needs to be increased, and hence, higher aerosol flow rates need to be considered. However, higher aerosol flow rates may give rise to flow separation or vortex formation in the FCS, arising from the sudden expansion of the aerosol at the inlet nozzle. The goal of the present investigation is to understand the interaction of the sheath and aerosol flows inside the FCS, using computational fluid dynamics (CFD), and to identify possible limits to increasing aerosol flow rates. Numerical solutions are obtained using an axisymmetric model of the FCS, and solving the Navier-Stokes equations governing these flows; in this study, the aerosol flow is treated purely aerodynamically. Results of computations are presented for four different flow rates. The geometry of the converging outer cylinder, along with the two sheath flows, is effective in preventing vortex formation in the FCS for aerosol-to-sheath flow inlet velocity ratios below ~50. For higher aerosol flow rates, recirculation is observed in both inner and outer sheaths. Results for velocity, streamlines, and shear stress are presented.

BACKGROUND: Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives. OBJECTIVES: (1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs' decision to implement QI initiatives. METHODS: In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs' QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration's Area Resource Files and the Association of State and Territorial Health Officials' 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design. RESULTS: The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives. CONCLUSION: According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed.

Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach.

BACKGROUND: Amblyomma maculatum is the primary vector for Rickettsia parkeri, a spotted fever group rickettsia (SFGR) and human pathogen. Cotton rats and quail are known hosts for larval and nymphal A. maculatum; however, the role of these hosts in the ecology of R. parkeri is unknown. METHODS: Cotton rats and quail were inoculated with low or high doses of R. parkeri (strain Portsmouth) grown in Vero cells to evaluate infection by R. parkeri in these two hosts species. Animals were euthanized 2, 4, 7, 10, and 14 days post-injection (dpi) and blood, skin, and spleen samples were collected to analyze by Vero cell culture and polymerase chain reaction (PCR). In a second trial, cotton rats and quail were inoculated with R. parkeri and nymphal A. maculatum ticks were allowed to feed on animals. Animals were euthanized on 14, 20, 28, 31, and 38 dpi and blood and tissues were collected for serology and PCR assays. Fed ticks were tested for R. parkeri by PCR and Vero cell culture. RESULTS: Rickettsia parkeri was isolated in cell culture and detected by PCR in skin, blood, and spleen tissues of cotton rats in the initial trial 2, 4, and 7 dpi, but not in quail tissues. In the second trial, no ticks tested positive for R. parkeri by PCR or cell culture. CONCLUSIONS: These studies demonstrate that viable R. parkeri rickettsiae can persist in the tissues of cotton rats for at least 7 days following subcutaneous inoculation of these bacteria; however, quail are apparently resistant to infection. Rickettsia parkeri was not detected in nymphal ticks that fed on R. parkeri-inoculated cotton rats or quail, suggesting an alternate route of transmission to naive ticks.

TO THE EDITOR: Rickettsia parkeri, a spotted fever group Rickettsia (SFGR) bacterium, is transmitted by Amblyomma maculatum, the Gulf Coast tick (1). The prevalence of R. parkeri in Gulf Coast ticks has been reported as <42% in the United States, which is higher than reported rates of R. rickettsii (the cause of Rocky Mountain spotted fever) in Dermacentor species ticks. Misdiagnosis among SFGR infections is not uncommon, and R. parkeri rickettsiosis can cause symptoms similar to those for mild Rocky Mountain spotted fever (1). We evaluated infection rates of R. parkeri and Candidatus Rickettsia andeanae, a recently identified but incompletely characterized SFGR, in Gulf Coast ticks in Mississippi, USA.

On behalf of the CDC Foundation, it is my pleasure to congratulate the staff of CDC's National Center for Injury Prevention and Control on 20 years of life-saving injury prevention work! We appreciate the opportunity to collaborate with CDC on addressing one of the leading causes of death and disability in this country. | The CDC Foundation is proud to build partnerships that support CDC's injury prevention activities. Since 2004, the CDC Foundation has raised more than $15 million to help CDC reduce injuries and violence through prevention. These partnerships have helped CDC protect Americans from motor-vehicle injuries and death, sports-related injuries, and intimate partner violence. Recently, private-sector partners have signed-on to support CDC's injury prevention work globally - supporting a fleet safety program in India and an initiative to evaluate the impact of sexual violence against girls and young women in countries around the world. | A few of these programs are highlighted below. Each program has expanded CDC's capacity to work with local, state, national, and international partners to save lives. Over the next 20 years, as CDC continues to build our knowledge and understanding of what works to prevent injuries and violence, the CDC Foundation looks forward to new opportunities to advance CDC's work to protect our families, our communities, and our workforce, and to share the science of what works with partners around the world.

Potency testing of most human and veterinary rabies vaccines requires vaccination of mice followed by a challenge test using an intracerebral injection of live rabies virus. NICEATM, ICCVAM, and their international partners organized a workshop to review the availability and validation status of alternative methods that might reduce, refine, or replace the use of animals for rabies vaccine potency testing, and to identify research and development efforts to further advance alternative methods. Workshop participants agreed that general anesthesia should be used for intracerebral virus injections and that humane endpoints should be used routinely as the basis for euthanizing animals when conducting the mouse rabies challenge test. Workshop participants recommended as a near-term priority replacement of the mouse challenge with a test validated to ensure potency, such as the mouse antibody serum neutralization test for adjuvanted veterinary rabies vaccines for which an international collaborative study was recently completed. The workshop recommended that an in vitro antigen quantification test should be a high priority for product-specific validation of human and non-adjuvanted veterinary rabies vaccines. Finally, workshop participants recommended greater international cooperation to expedite development, validation, regulatory acceptance, and implementation of alternative test methods for rabies vaccine potency testing.

We detected Rickettsia parkeri in 20%-33% of Amblyomma maculatum ticks sampled in North Carolina. Results highlight the high frequencies of R. parkeri-infected ticks in the state with the highest annual incidence of Rocky Mountain spotted fever. Epidemiologic studies are needed to definitively link R. parkeri to cases of spotted fever rickettsiosis.

A 1-year-old castrated male Saanen goat was observed to have drooping and edema of the left ear consistent with published accounts of gotch ear in cattle associated with a tick bite. The goat's left ear was edematous from the tip of the pinna to the base of the ear. No signs of trauma or infectious processes were observed. Three engorged Gulf Coast ticks (Amblyomma maculatum) were observed attached inside the ear. Ticks were removed and the ear biopsied at tick attachment sites. The affected ear was treated topically with betadine after removal of the ticks. No other treatment was administered. The goat remained free of clinical signs and the edema of the ear resolved within 3 days after tick removal. No clinical adverse effects of the condition were evident. All three ticks were positive for spotted fever group rickettsia by polymerase chain reaction analysis and showed 100% similarity with the homologous sequence of Rickettsia parkeri. There was no immunohistochemical evidence of spotted fever group rickettsia in the ear samples, supporting the hypothesis that gotch ear is not due to rickettsial infection. This report represents the first apparent case of gotch ear in a goat.