Improving Public Health Readiness for Sea Level Rise: A New Initiative in Coastal Virginia

Sea level has been rising around the world, and in recent decades, the rate has been accelerating. Because rising seas have the potential to directly or indirectly affect the health of vast numbers of coastal communities and inhabitants, public health agencies and professionals—in conjunction with other fields—have a pivotal role to play in helping to protect populations, reduce and prevent health impacts, and foster resilience. This article discusses a novel effort that has been undertaken in Coastal Virginia to help prepare the next generation of public health professionals to grapple with sea level rise issues. The effort grew out of discussions of the importance of public health issues that took place through the Hampton Roads Sea Level Rise Preparedness and Resilience Intergovernmental Pilot Project. The new training effort focuses on public health graduate level training and incorporates both classroom and practice-based components. Though still in its early stages, the sea level rise and public health training effort has already achieved significant successes and continues to grow. The article begins by examining sea level rise as a public health issue. This is followed by a discussion of the new public health training initiative in Coastal Virginia. The article closes by exploring future directions

Development of Screening Tools for the Interpretation of Chemical Biomonitoring Data

Evaluation of a larger number of chemicals in commerce from the perspective of potential human health risk has become a focus of attention in North America and Europe. Screening-level chemical risk assessment evaluations consider both exposure and hazard. Exposures are increasingly being evaluated through biomonitoring studies in humans. Interpreting human biomonitoring results requires comparison to toxicity guidance values. However, conventional chemical-specific risk assessments result in identification of toxicity-based exposure guidance values such as tolerable daily intakes (TDIs) as applied doses that cannot directly be used to evaluate exposure information provided by biomonitoring data in a health risk context. This paper describes a variety of approaches for development of screening-level exposure guidance values with translation from an external dose to a biomarker concentration framework for interpreting biomonitoring data in a risk context. Applications of tools and concepts including biomonitoring equivalents (BEs), the threshold of toxicologic concern (TTC), and generic toxicokinetic and physiologically based toxicokinetic models are described. These approaches employ varying levels of existing chemical-specific data, chemical class-specific assessments, and generic modeling tools in response to varying levels of available data in order to allow assessment and prioritization of chemical exposures for refined assessment in a risk management context

Predictors and immunological correlates of sublethal mercury exposure in vampire bats

Mercury (Hg) is a pervasive heavy metal that often enters the environment from anthropogenic sources such as gold mining and agriculture. Chronic exposure to Hg can impair immune function, reducing the ability of animals to resist or recover from infections. How Hg influences immunity and susceptibility remains unknown for bats, which appear immunologically distinct from other mammals and are reservoir hosts of many pathogens of importance to human and animal health. We here quantify total Hg (THg) in hair collected from common vampire bats (Desmodus rotundus), which feed on blood and are the main reservoir hosts of rabies virus in Latin America. We examine how diet, sampling site and year, and bat demography influence THg and test the consequences of this variation for eight immune measures. In two populations from Belize, THg concentrations in bats were best explained by an interaction between long-term diet inferred from stable isotopes and year. Bats that foraged more consistently on domestic animals exhibited higher THg. However, relationships between diet and THg were evident only in 2015 but not in 2014, which could reflect recent environmental perturbations associated with agriculture. THg concentrations were low relative to values previously observed in other bat species but still correlated with bat immunity. Bats with higher THg had more neutrophils, weaker bacterial killing ability and impaired innate immunity. These patterns suggest that temporal variation in Hg exposure may impair bat innate immunity and increase susceptibility to pathogens such as bacteria. Unexpected associations between low-level Hg exposure and immune function underscore the need to better understand the environmental sources of Hg exposure in bats and the consequences for bat immunity and susceptibility

Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial.

<b>Objective</b>: It was hypothesized that the use of exercise limits prevents symptom increases and worsening of their health status following a walking exercise in people with Chronic Fatigue Syndrome (CFS). <b>Design</b>: An uncontrolled clinical trial (semi-experimental design). <b>Setting</b>: Outpatient clinic of a university department. <b>Subjects</b>: 24 patients with CFS. <b>Interventions</b>: Subjects undertook a walking test with the two concurrent exercise limits. Each subject walked at an <i>intensity</i> where the maximum heart rate was determined by heart rate corresponding to the respiratory exchange ratio =1.0 derived from a previous sub-maximal exercise test and for a duration calculated from how long each patient felt they were able to walk. <b>Main outcome measures</b>: The Short Form 36 Health Survey or SF-36, the CFS Symptom List, and the CFS-Activities and Participation Questionnaire were filled in prior to, immediately and 24 hours post-exercise. <b>Results</b>: The fatigue increase observed immediately post-exercise (p=0.006) returned to pre-exercise levels 24 hours post-exercise. The increase in pain observed immediately post-exercise was retained at 24 hours post-exercise (p=0.03). Fourteen of 24 subjects experienced a clinically meaningful change in bodily pain (change of SF-36 bodily pain score ³10). Six of 24 participants indicated that the exercise bout had slightly worsened their health status, and 2 of 24 had a clinically meaningful decrease in vitality (change of SF-36 vitality score ³20). There was no change in activity limitations/participation restrictions. <b>Conclusion</b>: It was shown that the use of exercise limits (limiting both the intensity and duration of exercise) prevents important health status changes following a walking exercise in people with CFS, but was unable to prevent short-term symptom increases

Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling

In light of the 2009 influenza pandemic and potential future pandemics, Maria Van Kerkhove and colleagues anticipate six public health challenges and the data needed to support sound public health decision making.The authors acknowledge support from the Bill & Melinda Gates Foundation (MDVK, CF, NMF); Royal Society (CF); Medical Research Council (MDVK, CF, PJW, NMF); EU FP7 programme (NMF); UK Health Protection Agency (PJW); US National Institutes of Health Models of Infectious Disease Agent Study program through cooperative agreement 1U54GM088588 (ML); NIH Director's Pioneer Award, DP1-OD000490-01 (DS); EU FP7 grant EMPERIE 223498 (DS); the Wellcome Trust (DS); 3R01TW008246-01S1 from Fogerty International Center and RAPIDD program from Fogerty International Center with the Science & Technology Directorate, Department of Homeland Security (SR); and the Institut de Veille Sanitaire Sanitaire funded by the French Ministry of Health (J-CD). The funders played no role in the decision to submit the article or in its preparation

Ca2+ and synaptotagmin VII–dependent delivery of lysosomal membrane to nascent phagosomes

Synaptotagmin (Syt) VII is a ubiquitously expressed member of the Syt family of Ca2+ sensors. It is present on lysosomes in several cell types, where it regulates Ca2+-dependent exocytosis. Because [Ca2+]i and exocytosis have been associated with phagocytosis, we investigated the phagocytic ability of macrophages from Syt VII−/− mice. Syt VII−/− macrophages phagocytose normally at low particle/cell ratios but show a progressive inhibition in particle uptake under high load conditions. Complementation with Syt VII rescues this phenotype, but only when functional Ca2+-binding sites are retained. Reinforcing a role for Syt VII in Ca2+-dependent phagocytosis, particle uptake in Syt VII−/− macrophages is significantly less dependent on [Ca2+]i. Syt VII is concentrated on peripheral domains of lysosomal compartments, from where it is recruited to nascent phagosomes. Syt VII recruitment is rapidly followed by the delivery of Lamp1 to phagosomes, a process that is inhibited in Syt VII−/− macrophages. Thus, Syt VII regulates the Ca2+-dependent mobilization of lysosomes as a supplemental source of membrane during phagocytosis

Spontaneous decompactification

Positive vacuum energy together with extra dimensions of space imply that our four-dimensional Universe is unstable, generically to decompactification of the extra dimensions. Either quantum tunneling or thermal fluctuations carry one past a barrier into the decompactifying regime. We give an overview of this process, and examine the subsequent expansion into the higher- dimensional geometry. This is governed by certain fixed-point solutions of the evolution equations, which are studied for both positive and negative spatial curvature. In the case where there is a higher-dimensional cosmological constant, we also outline a possible mechanism for compactification to a four-dimensional de Sitter cosmology.Comment: 27 pages, 5 figures, harvmac. v2: refs added, minor notation change

What the resonance peak cannot do

In certain cuprates, a spin 1 resonance mode is prominent in the magnetic structure measured by neutron scattering. It has been proposed that this mode is responsible for significant features seen in other spectroscopies, such as photoemission and optical absorption, which are sensitive to the charge dynamics, and even that this mode is the boson responsibile for ``mediating'' the superconducting pairing. We show that its small (measured) intensity and weak coupling to electron-hole pairs (as deduced from the measured lifetime) disqualifies the resonant mode from either proposed role.Comment: 4 pages, no figur

Effects of systematic asymmetric discounting on physician-patient interactions: a theoretical framework to explain poor compliance with lifestyle counseling

BACKGROUND: This study advances the use of a utility model to model physician-patient interactions from the perspectives of physicians and patients. PRESENTATION OF THE HYPOTHESIS: In cases involving acute care, patient counseling involves a relatively straightforward transfer of information from the physician to a patient. The patient has less information than the physician on the impact the condition and its treatment have on utility. In decisions involving lifestyle changes, the patient may have more information than the physician on his/her utility of consumption; moreover, differences in discounting future health may contribute significantly to differences between patients' preferences and physicians' recommendations. TESTING THE HYPOTHESIS: The expectation of differences in internal discount rate between patients and their physicians is discussed. IMPLICATIONS OF THE HYPOTHESIS: This utility model provides a conceptual basis for the finding that educational approaches alone may not effect changes in patient behavior and suggests other economic variables that could be targeted in the attempt to produce healthier behavior