Roles of Vegetable Surface Properties and Sanitizer Type on Annual Disease Burden of Rotavirus Illness by Consumption of Rotavirus-Contaminated Fresh Vegetables: A Quantitative Microbial Risk Assessment

Enteric viruses are often detected in water used for crop irrigation. One concern is foodborne viral disease via the consumption of fresh produce irrigated with virus-contaminated water. Although the food industry routinely uses chemical sanitizers to disinfect post-harvest fresh produce, it remains unknown how sanitizer and fresh produce properties affect the risk of viral illness through fresh produce consumption. A quantitative microbial risk assessment model was conducted to estimate (i) the health risks associated with consumption of rotavirus (RV)-contaminated fresh produce with different surface properties (endive and kale) and (ii) how risks changed when using peracetic acid (PAA) or a surfactant-based sanitizer. The modeling results showed that the annual disease burden depended on the combination of sanitizer and vegetable type when vegetables were irrigated with RV-contaminated water. Global sensitivity analyses revealed that the most influential factors in the disease burden were RV concentration in irrigation water and postharvest disinfection efficacy. A postharvest disinfection efficacy of higher than 99% (2-log₁₀) was needed to decrease the disease burden below the World Health Organization (WHO) threshold, even in scenarios with low RV concentrations in irrigation water (i.e., river water). All scenarios tested here with at least 99.9% (3-log₁₀) disinfection efficacy had a disease burden lower than the WHO threshold, except for the endive treated with PAA. The disinfection efficacy for the endive treated with PAA was only about 80%, leading to a disease burden 100 times higher than the WHO threshold. These findings should be considered and incorporated into future models for estimating foodborne viral illness risks.     

Bayesian Hierarchical Structure for Quantifying Population Variability to Inform Probabilistic Health Risk Assessments

Human variability is a very important factor considered in human health risk assessment for protecting sensitive populations from chemical exposure. Traditionally, to account for this variability, an interhuman uncertainty factor is applied to lower the exposure limit. However, using a fixed uncertainty factor rather than probabilistically accounting for human variability can hardly support probabilistic risk assessment advocated by a number of researchers; new methods are needed to probabilistically quantify human population variability. We propose a Bayesian hierarchical model to quantify variability among different populations. This approach jointly characterizes the distribution of risk at background exposure and the sensitivity of response to exposure, which are commonly represented by model parameters. We demonstrate, through both an application to real data and a simulation study, that using the proposed hierarchical structure adequately characterizes variability across different populations.     

Exploring differences in crisis literacy and efficacy on behavioral responses during infectious disease outbreaks

This study examined the effects of literacy and efficacy on individuals’ protective action taking and information seeking during the early phase of infectious disease outbreaks through a nationally representative survey of 1164 U.S. adults. New measures of disaster literacy and crisis efficacy were tested. Overall, results revealed that crisis efficacy and organizational efficacy drove protective action taking and information seeking intentions, while health literacy did not. Disaster literacy negatively predicted both protective action advice seeking and information seeking. The findings highlight the importance of strengthening public efficacy and improving relationships between health authorities and the public, which is greatly influenced by the public’s confidence in the health authority’s management of the crisis.     

An unconditional space–time scan statistic for ZIP‐distributed data

A scan statistic is proposed for the prospective monitoring of spatiotemporal count data with an excess of zeros. The method that is based on an outbreak model for the zero‐inflated Poisson distribution is shown to be superior to traditional scan statistics based on the Poisson distribution in the presence of structural zeros. The spatial accuracy and the detection timeliness of the proposed scan statistic are investigated by means of simulation, and an application on the weekly cases of Campylobacteriosis in Germany illustrates how the scan statistic could be used to detect emerging disease outbreaks. An implementation of the method is provided in the open‐source R package scanstatistics available on the Comprehensive R Archive Network.     

Analysis of cardiovascular risk factors associated with serum testosterone levels according to the US 2011–2012 National Health and Nutrition Examination Survey

Objective: To investigate associations between cardiovascular disease risk factors, including fasting glucose, cholesterol, high density lipoprotein cholesterol (HDL-c), LDL-c, blood pressure, body mass index (BMI), C-peptide, creatinine kinase, smoking, alcohol use, physical activity, C-reactive protein as well as homocysteine levels and cardiovascular events.

Methods: Data from 1545 men aged ≥40?years, with testosterone deficiency (TD) (<300?ng/dL) and non-TD (≥300?ng/dL) which were extracted from the National Health and Nutrition Examination Survey database 2011–2012 and analyzed.

Results: Multivariate logistic regression analysis showed positive associations between TD and BMI (≥35 vs.?p?=?.016), HDL-c (<0.91 vs. ≥0.91: OR?=?1.60, 95% CI: 1.14–2.24, p?=?.006) and diabetes (diabetes vs. non-diabetes: OR?=?1.48, 95% CI: 1.14–1.92, p?=?.004) as well as negative associations between TD and metabolic equivalent scores (≥12 vs. <12: OR?=?0.69, 95% CI: 0.52–0.91, p?=?.009) and smoking (Ever vs. never: OR?=?0.69, 95% CI: 0.51–0.94, p?=?.018). Furthermore, total serum testosterone levels were lower in patients with heart failure (p?=?.04) and angina/angina pectoris (p?=?.001) compared with subjects without these cardiac problems.

Conclusion: Low serum testosterone was associated with multiple risk factors for CHD.     

Modeling the Airborne Infection Risk of Tuberculosis for a Research Facility in eMalahleni,South Africa

A detailed mathematical modeling framework for the risk of airborne infectious disease transmission in indoor spaces was developed to enable mathematical analysis of experiments conducted at the Airborne Infections Research (AIR) facility, eMalahleni, South Africa. A model was built using this framework to explore possible causes of why an experiment at the AIR facility did not produce expected results. The experiment was conducted at the AIR facility from August 31, 2015 to December 4, 2015, in which the efficacy of upper room germicidal ultraviolet (GUV) irradiation as an environmental control was tested. However, the experiment did not produce the expected outcome of having fewer infections in the test animal room than the control room. The simulation results indicate that dynamic effects, caused by switching the GUV lights, power outages, or introduction of new patients, did not result in the unexpected outcomes. However, a sensitivity analysis highlights that significant uncertainty exists with risk of transmission predictions based on current measurement practices, due to the reliance on large viable literature ranges for parameters.     

A nationwide cohort study of the role of CHADS2 score in predicting lower extremity amputation and death among patients with peripheral arterial occlusive disease

Objectives: The current study aimed to explore whether the CHADS₂ score was predictive of lower extremity amputation (LEA) and death in people with peripheral arterial occlusive disease (PAOD).

Methods: This nationwide cohort came from Taiwan, with 16,888 PAOD patients, from 2000 through 2011, extracted from the Longitudinal Health Insurance Database 2000. Cox proportional hazard regression models were employed to identify the LEA and mortality risk according to CHADS₂ score. The discriminatory properties of the score in predicting the outcomes were quantified by the area under the receiver operating characteristic curve (AUROC) and the Cox C-index.

Results: The AUROC of the CHADS₂ score in predicting LEA and death were 0.75 (95% CI?=?0.73–0.77) and 0.70 (95% CI?=?0.69–0.71), respectively. The CHADS₂ score had an acceptable stratification capacity for LEA (C-index?=?0.79) and death (C-index?=?0.76) based on Cox-regression analysis.

Conclusions: This study correlates the CHADS₂ score with risk of developing LEA and death in patients with PAOD. The acceptable discriminative power of the score diversifies its predictive role in this population.     

Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Pakistan and Afghanistan

Since most poliovirus infections occur with no paralytic symptoms, the possibility of silent circulation complicates the confirmation of the end of poliovirus transmission. Based on empirical field experience and theoretical modeling results, the Global Polio Eradication Initiative identified three years without observing paralytic cases from wild polioviruses with good acute flaccid paralysis surveillance as an indication of sufficient confidence that poliovirus circulation stopped. The complexities of real populations and the imperfect nature of real surveillance systems subsequently demonstrated the importance of specific modeling for areas at high risk of undetected circulation, resulting in varying periods of time required to obtain the same level of confidence about no undetected circulation. Using a poliovirus transmission model that accounts for variability in transmissibility and neurovirulence for different poliovirus serotypes and characterizes country‐specific factors (e.g., vaccination and surveillance activities, demographics) related to wild and vaccine‐derived poliovirus transmission in Pakistan and Afghanistan, we consider the probability of undetected poliovirus circulation for those countries once apparent die‐out occurs (i.e., in the absence of any epidemiological signals). We find that gaps in poliovirus surveillance or reaching elimination with borderline sufficient population immunity could significantly increase the time to reach high confidence about interruption of live poliovirus transmission, such that the path taken to achieve and maintain poliovirus elimination matters. Pakistan and Afghanistan will need to sustain high‐quality surveillance for polioviruses after apparent interruption of transmission and recognize that as efforts to identify cases or circulating live polioviruses decrease, the risks of undetected circulation increase and significantly delay the global polio endgame.     

小儿股骨头缺血性坏死的X线平片与CT对照研究

目的：探讨ＣＴ 在小儿股骨头缺血性坏死（ＬＰＤ） 诊断中的作用和价值－ 材料和方法：回顾性分析５０ 例５８ 髋小儿股骨头缺血性坏死的Ｘ 线平片与ＣＴ 表现,按Ｃａｔｔｅｒａｌｌ 分期标准比较各自的征象－ 结果：ＣＴ在早期病变中可发现较多的征象,包括骺骨化中心微小密度改变、骺软骨的改变和少量关节积液等,对病变的定位和定量更清楚,分期更准确;Ｘ 线平片完全可满足中后期病变诊断和分期要求－ 结论：Ｘ 线平片是ＬＰＤ的首选影像检查方法,ＣＴ在ＬＰＤ 的早期诊断中有帮助,中晚期病变无需ＣＴ扫描     

Major Depressive Disorder and Cardiovascular Disease in African-American Women

Major depression is a risk factor for cardiovascular disease (CVD). This study used the National Survey of American Life (NSAL) to examine the co-occurrence of major depressive disorder (MDD) and CVD in a nationally representative sample of African American women (n = 2,216). Results from a series of logistic regression models indicated high rates of MDD and CVD in the sample, and the African American women with MDD were 1.59 times more likely to have CVD compared to those without MDD. High rates of MDD/CVD co-morbidity appeared across those living in and not living in poverty. These individuals demonstrated greater functional impairment and were high users of mental health services. Our findings validate that MDD and CVD co-occur and the need for more holistic interventions are warranted. The interface of co-morbid health conditions is critical to developing integrated models of care. Integrated health care systems are central for improving physical and mental health outcomes. These findings facilitate developing targeted assessment procedures and culturally appropriate treatment interventions. Increased knowledge regarding the role of gender, chronic health conditions, and the burden of mental illness in African American Women provides the opportunity to examine other chronic health conditions co-occurring with MDD.