Ranking the Risks: The 10 Pathogen-Food Combinations With the Greatest Burden on Public Health

Examines food-borne pathogens with the highest disease burdens and the top ten foods most commonly contaminated by them, such as salmonella in poultry, toxoplasma in pork, and listeria in deli meats. Makes policy recommendations for improving prevention

Harnessing Knowledge to Ensure Food Safety: Opportunities to Improve the Nation\u27s Food Safety Information Infrastructure

Those working in the food industry face an abundance of information generated by diverse institutions and individuals. Ensuring the safety of food is critically important to the public\u27s health and a challenge for policy-makers seeking to enhance the government\u27s role in this arena. Although the food industry has an inherent duty to make food safe, the effectiveness of what they do is highly dependent on the quality of the information they receive on potential hazards and good practices. In this context, the Robert Wood Johnson Foundation funded a project under the auspices of the Food Safety Research Consortium to examine and make recommendations for improving the food safety information infrastructure (FSII). Through this initiative, a collection of food safety experts met for a series of workshops to discuss information needs around food safety. Key Findings: Establish a national FSII policy and program. Build a database for tracking research and data collection. Provide broader public access to journal articles and to complete data from research projects. Create a networking Web site. In this report, whose recommendations are based on those workshop discussions, the authors explore the constraints facing today\u27s FSII. These include the diversity of the information currently available, the plethora of information sources, and the numerous agencies and actors involved in generating data

Attributing Illness to Food

Identification and prioritization of effective food safety interventions require an understanding of the relationship between food and pathogen from farm to consumption. Critical to this cause is food attribution, the capacity to attribute cases of foodborne disease to the food vehicle or other source responsible for illness. A wide variety of food attribution approaches and data are used around the world, including the analysis of outbreak data, case-control studies, microbial subtyping and source tracking methods, and expert judgment, among others. The Food Safety Research Consortium sponsored the Food Attribution Data Workshop in October 2003 to discuss the virtues and limitations of these approaches and to identify future options for collecting food attribution data in the United States. We summarize workshop discussions and identify challenges that affect progress in this critical component of a risk-based approach to improving food safety

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Maquiladoras, Air Pollution, and Human Health in Ciudad Juarez and El Paso

Ciudad Juarez, Chihuahua, is home to the U.S.-Mexico border's largest maquiladora labor force, and also its worst air pollution. We marshal two types of evidence to examine the link between maquiladoras and air pollution in Ciudad Juarez, and in its sister city, El Paso, Texas. First, we use a publicly available sector-level emissions inventory for Ciudad Juarez to determine the importance of all industrial facilities (including maquiladoras) as a source of air pollution. Second, we use original plant-level data from two sample maquiladoras to better understand the impacts of maquiladora air pollution on human health. We use a series of computational models to estimate health damages attributable to air pollution from these plants, we compare these damages to estimates of damages from non-maquiladora industrial polluters, and we use regression analysis to determine whether the poor suffer disproportionately from maquiladora air pollution. We find that air pollution from maquiladoras has serious consequences for human health, including respiratory disease and premature mortality. However, maquiladoras are clearly not the leading cause of air pollution in Ciudad Juarez and El Paso. Moreover, most maquiladoras are probably less important sources of dangerous air pollution than at least one notoriously polluting Mexican-owned industry. Finally, we find no evidence to suggest that maquiladora air pollution affects the poor disproportionately

Shade-Grown Coffee: Simulation and Policy Analysis for Coastal Oaxaca, Mexico

Shade-grown coffee provides a livelihood to many farmers, protects biodiversity, and creates environmental services. Many shade-coffee farmers have abandoned production in recent years, however, in response to declines in international coffee prices. This paper builds a farmer decision model under price uncertainty and uses simulation analysis of that model to examine the likely impact of various policies on abandonment of shade-coffee plantations. Using information from coastal Oaxaca, Mexico, this paper examines the role of various constraints in abandonment decisions, reveals the importance of the timing of policies, and characterizes the current situation in the study region

IDENTIFYING THE MOST SIGNIFICANT MICROBIOLOGICAL FOODBORNE RISKS TO PUBLIC HEALTH: A NEW RISK-RANKING MODEL

This paper presents a decision-analytic model for ranking the social burden of foodborne illness. The availability a consistent, transparent model allowing use of alternative ranking criteria and data assumptions will facilitate discussions between agencies committed to different criteria. By use of multiple criteria, the model highlights overlooked food safety problems

Cost-Effective NOx Control in the Eastern United States

Reducing nitrogen oxide (NOx) emissions in the eastern United States has become the focus of efforts to meet ozone air quality goals and will be useful for reducing particulate matter (PM) concentrations in the future. This paper addresses many aspects of the debate over the appropriate approach for obtaining reductions in NOx emissions from point sources beyond those called for in the Clean Air Act Amendments of 1990. Data on NOx control technologies and their associated costs, spatial models linking NOx emissions and air quality, and benefit estimates of the health effects of changes in ozone and PM concentrations are combined to allow an analysis of alternative policies in thirteen states in the eastern United States. The first part of the study examines the cost and other consequences of a command-and-control approach embodied in the Environmental Protection Agency's (EPA) NOx SIP call, which envisions large reductions in NOx from electric utilities and other point sources. These results are compared to the alternative policy of ton-for-ton NOx emissions trading, similar to that proposed by the EPA for utilities. We find that emission reduction targets can be met at roughly 50% cost savings under a trading program when there are no transaction costs. The paper examines a number of alternative economic incentive policies that have the potential to improve upon the utility NOx trading plan proposed by EPA, including incorporation of other point sources in the trading program, incorporation of ancillary PM benefits to ozone reductions in the trading program, and trading on the basis of ozone exposures that incorporates the spatial impact of emissions on ozone levels. For the latter analysis, we examine spatially differentiated permit systems for reducing ozone exposures under different and uncertain meteorological conditions, including an empirical analysis of the trade-off between the reliability (or degree of certainty) of meeting ozone exposure reduction targets and the cost of NOx control. Finally, several policies that combine costs and health benefits from both ozone and PM reductions are compared to command-and-control and single-pollutant trading policies. The first of these is a full multipollutant trading system that achieves a health benefit goal, with the interpollutant trading ratios governed by the ratio of unit health benefits of ozone and PM. Then, a model that maximizes aggregate benefits from both ozone and PM exposure reductions net of the costs of NOx controls is estimated. EPA's program appears to be reasonably cost-effective compared to all of the other more complex trading programs we examined. It may even be considered an optimal policy that maximizes net aggregate benefits if the high estimate of benefits is used in which mortality risk is linked to ozone exposure. Without this controversial assumption, however, we find that EPA's NOx reduction target is far too large