Patients' request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak

BACKGROUND: Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. METHODS: We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. RESULTS: Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. CONCLUSION: During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events

Interrater reliability of surveillance for ventilator-associated events and pneumonia

OBJECTIVETo compare interrater reliabilities for ventilator-associated event (VAE) surveillance, traditional ventilator-associated pneumonia (VAP) surveillance, and clinical diagnosis of VAP by intensivists.DESIGNA retrospective study nested within a prospective multicenter quality improvement study.SETTINGIntensive care units (ICUs) within 5 hospitals of the Centers for Disease Control and Prevention Epicenters.PATIENTSPatients who underwent mechanical ventilation.METHODSWe selected 150 charts for review, including all VAEs and traditionally defined VAPs identified during the primary study and randomly selected charts of patients without VAEs or VAPs. Each chart was independently reviewed by 2 research assistants (RAs) for VAEs, 2 hospital infection preventionists (IPs) for traditionally defined VAP, and 2 intensivists for any episodes of pulmonary deterioration. We calculated interrater agreement using κ estimates.RESULTSThe 150 selected episodes spanned 2,500 ventilator days. In total, 93–96 VAEs were identified by RAs; 31–49 VAPs were identified by IPs, and 29–35 VAPs were diagnosed by intensivists. Interrater reliability between RAs for VAEs was high (κ, 0.71; 95% CI, 0.59–0.81). Agreement between IPs using traditional VAP criteria was slight (κ, 0.12; 95% CI, −0.05–0.29). Agreement between intensivists was slight regarding episodes of pulmonary deterioration (κ 0.22; 95% CI, 0.05–0.39) and was fair regarding whether episodes of deterioration were attributable to clinically defined VAP (κ, 0.34; 95% CI, 0.17–0.51). The clinical correlation between VAE surveillance and intensivists’ clinical assessments was poor.CONCLUSIONSProspective surveillance using VAE criteria is more reliable than traditional VAP surveillance and clinical VAP diagnosis; the correlation between VAEs and clinically recognized pulmonary deterioration is poor.Infect Control Hosp Epidemiol 2017;38:172–178</jats:sec

The thermal structure at the topside and above of polar mesosphere summer echoes over Spitsbergen 78&deg; N

Simultaneous measurements of temperature and polar mesosphere summer echoes (PMSE) were performed at the polar cap (78&deg; N) during summer 2001 and 2003. In summer time the mesopause region is characterized by extremely low temperatures around 120 K. It is remarkable that PMSE are practically never observed above 92 km although temperatures are low enough to allow the existence of ice particles. In this case study we compare the PMSE topside with temperatures measured by the potassium lidar and with frost point temperatures using water-vapor mixing ratios from models. We find striking discrepancies with our current understanding of ice particles and temperature in this region. In this case study we find that the temperature can be more than 20 K lower than the frost point temperature but no PMSE is observed above 92 km altitude. We show that the lack of PMSE does not necessarily imply that the temperature is too high

Ten-year climatology of potassium number density at 54° N, 12° E

In the years from 2002 to 2012 potassium densities observations were performed in the mesopause region at Kühlungsborn using a potassium Doppler lidar. The 10-year diurnal data set comprises 5090 h of potassium number densities at 741 days with 25.2% under full daylight conditions. Potassium number densities show a clear semi-annual variation with two broad maxima reoccurring every year. The first maximum occurs in summer and lasts for about 4 months (May–August) with number densities up to 60 atoms/cc. The second maximum is observed from early December to late February with densities up to 30 atoms/cc. Both the peak density and the column density are higher at solstices than at equinoxes. The large data set shows little variation of the mean layer over the 10 years

Seasonal variation of nocturnal temperatures between 1 and 105 km altitude at 54&deg; N observed by lidar

Temperature soundings are performed by lidar at the mid-latitude station of Kühlungsborn (Germany, 54&deg; N, 12&deg; E). The profiles cover the complete range from the lower troposphere (~1 km) to the lower thermosphere (~105 km) by simultaneous and co-located operation of a Rayleigh-Mie-Raman lidar and a potassium resonance lidar. Observations have been done during 266 nights between June 2002 and July 2007, each of 3–15 h length. This large and unique data set provides comprehensive information on the altitudinal and seasonal variation of temperatures from the troposphere to the lower thermosphere. The remaining day-to-day-variability is strongly reduced by harmonic fits at constant altitude levels and a representative data set is achieved. This data set reveals a two-level mesopause structure with an altitude of about 86–87 km (~144 K) in summer and ~102 km (~170 K) during the rest of the year. The average stratopause altitude is ~48 km throughout the whole year, with temperatures varying between 258 and 276 K. From the fit parameters amplitudes and phases of annual, semi-annual, and quarter-annual variations are derived. The amplitude of the annual component is largest with amplitudes of up to 30 K in 85 km, while the quarter-annual variation is smallest and less than 3 K at all altitudes. The lidar data set is compared with ECMWF temperatures below about 70 km altitude and reference data from the NRLMSISE-00 model above. Apart from the temperature soundings the aerosol backscatter ratio is measured between 20 and 35 km. The seasonal variation of these values is presented here for the first time

Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009

Background Substantial progress has been made in reducing childhood mortality worldwide from 1990–2015 (Millennium Development Goal, target 4). Achieving target goals on this however remains a challenge in Sub-Saharan Africa. Kenya’s infant mortality rates are higher than the global average and are more pronounced in urban areas as compared to rural areas. Only limited knowledge exists about the differences in individual level risk factors for infant death among rural, non-slum urban, and slum areas in Kenya. Therefore, this paper aims at 1) assess individual and socio-ecological risk factors for infant death in Kenya, and at 2) identify whether living in rural, non-slum urban, or slum areas moderated individual or socio-ecological risk factors for infant death in Kenya. Methodology We used a cross-sectional study design based on the most recent Kenya Population and Housing Census of 2009 and extracted the records of all females who had their last child born in 12 months preceding the survey (N = 1,120,960). Multivariable regression analyses were used to identify risk factors that accounted for the risk of dying before the age of one at the individual level in Kenya. Place of residence (rural, non-slum urban, slum) was used as an interaction term to account for moderating effects in individual and socio-ecological risk factors. Results Individual characteristics of mothers and children (older age, less previously born children that died, better education, girl infants) and household contexts (better structural quality of housing, improved water and sanitation, married household head) were associated with lower risk for infant death in Kenya. Living in non-slum urban areas was associated with significantly lower infant death as compared to living in rural or slum areas, when all predictors were held at their reference levels. Moreover, place of residence was significantly moderating individual level predictors: As compared to rural areas, living in urban areas was a protective factor for mothers who had previous born children who died, and who were better educated. However, living in urban areas also reduced the health promoting effects of better structural quality of housing (i.e. poor or good versus non-durable). Furthermore, durable housing quality in urban areas turned out to be a risk factor for infant death as compared to rural areas. Living in slum areas was also a protective factor for mothers with previous child death, however it also reduced the promoting effects of older ages in mothers. Conclusions While urbanization and slum development continues in Kenya, public health interventions should invest in healthy environments that ideally would include improvements to access to safe water and sanitation, better structural quality of housing, and to access to education, health care, and family planning services, especially in urban slums and rural areas. In non-slum urban areas however, health education programs that target healthy diets and promote physical exercise may be an important adjunct to these structural interventions

Seasonal variation of nocturnal temperatures between 1 and 105 km altitude at 54° N observed by lidar

Temperature soundings are performed by lidar at the mid-latitude station of K¨uhlungsborn (Germany, 54° N, 12° E). The profiles cover the complete range from the lower troposphere (~1 km) to the lower thermosphere (~105 km) by simultaneous and co-located operation of a Rayleigh-Mie- Raman lidar and a potassium resonance lidar. Observations have been done during 266 nights between June 2002 and July 2007, each of 3–15 h length. This large and unique data set provides comprehensive information on the altitudinal and seasonal variation of temperatures from the troposphere to the lower thermosphere. The remaining day-today- variability is strongly reduced by harmonic fits at constant altitude levels and a representative data set is achieved. This data set reveals a two-level mesopause structure with an altitude of about 86–87 km (~144 K) in summer and ~102 km (~170 K) during the rest of the year. The average stratopause altitude is ~48 km throughout the whole year, with temperatures varying between 258 and 276 K. From the fit parameters amplitudes and phases of annual, semi-annual, and quarter-annual variations are derived. The amplitude of the annual component is largest with amplitudes of up to 30K in 85 km, while the quarter-annual variation is smallest and less than 3K at all altitudes. The lidar data set is compared with ECMWF temperatures below about 70 km altitude and reference data from the NRLMSISE-00 model above. Apart from the temperature soundings the aerosol backscatter ratio is measured between 20 and 35 km. The seasonal variation of these values is presented here for the first time

Mechanical Harvesting Effectively Controls Young Typha spp. Invasion and Unmanned Aerial Vehicle Data Enhances Post-treatment Monitoring

The ecological impacts of invasive plants increase dramatically with time since invasion. Targeting young populations for treatment is therefore an economically and ecologically effective management approach, especially when linked to post-treatment monitoring to evaluate the efficacy of management. However, collecting detailed field-based post-treatment data is prohibitively expensive, typically resulting in inadequate documentation of the ecological effects of invasive plant management. Alternative approaches, such as remote detection with unmanned aerial vehicles (UAV), provide an opportunity to advance the science and practice of restoration ecology. In this study, we sought to determine the plant community response to different mechanical removal treatments to a dominant invasive wetland macrophyte (Typha spp.) along an age-gradient within a Great Lakes coastal wetland. We assessed the post-treatment responses with both intensive field vegetation and UAV data. Prior to treatment, the oldest Typha stands had the lowest plant diversity, lowest native sedge (Carex spp.) cover, and the greatest Typha cover. Following treatment, plots that were mechanically harvested below the surface of the water differed from unharvested control and above-water harvested plots for several plant community measures, including lower Typha dominance, lower native plant cover, and greater floating and submerged aquatic species cover. Repeated-measures analysis revealed that above-water cutting increased plant diversity and aquatic species cover across all ages, and maintained native Carex spp. cover in the youngest portions of Typha stands. UAV data revealed significant post-treatment differences in normalized difference vegetation index (NDVI) scores, blue band reflectance, and vegetation height, and these remotely collected measures corresponded to field observations. Our findings suggest that both mechanically harvesting the above-water biomass of young Typha stands and harvesting older stands below-water will promote overall native community resilience, and increase the abundance of the floating and submerged aquatic plant guilds , which are the most vulnerable to invasions by large macrophytes. UAV’s provided fast and spatially expansive data compared to field monitoring, and effectively measured plant community structural responses to different treatments. Study results suggest pairing UAV flights with targeted field data collection to maximize the quality of post-restoration vegetation monitoring