Laboratory Response to Anthrax Bioterrorism, New York City, 2001

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory’s (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and quality assurance and quality control are also described

The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.published_or_final_versio

New thermoresponsive polymer layers for skin cell culture and detachment

Covalent attachment of a thermoresponsive polymer to solid support leads to layers exhibiting temperature-dependent properties. Below the cloud point temperature (TCP) of the thermoresponsive polymer the layer is hydrophilic – it is hydrated and polymer chains adopt an expanded conformation. Above TCP, the polymer chains collapse due to dehydration and the surface becomes hydrophobic. This is a reversible process, lowering the temperature cause hydration and swelling of the layer. Such thermoresponsive layers can be obtained via reactions of entities present on the surface (e.g. functional groups, radicals etc.) with complementary functionalities in the polymer chains (grafting to) or with monomer subjected to polymerization (grafting from). Thermoresponsive layers may be used in many biomedical applications such as separation of molecules or cell sheet engineering. In this work, well-defined thermoresponsive (co)polymers of glycidol and ethyl glycidyl carbamate (mPGl), 2-ethyl and 2-nonyl-2-oxazoline (PENOx) as well as homopolymers of 2-isopropyl-2-oxazoline (PIPOx) were grafted to functionalized glass and silica substrates with the aim to obtain thermoresponsive layers for potential application in cell sheet engineering. Presence of polymers covalently bonded to substrates was confirmed by FT-IR and XPS studies. The polymer layers were 5-50 nm thick, depending on the molar mass and polymer concentration. Microscopic techniques indicated a smooth surface of mPGl layers, slightly rough texture of PENOx layers and fibrille-like fibers surface of PIPOx layers. Ellipsometry and contact angle studies revealed the response of layers to temperature changes. Biocompatibility of layers with dermal fibroblasts was confirmed by toxicity tests. Thermoresponsive surfaces were employed as substrates for skin cell culture and harvesting. Fibroblasts adhesion and proliferation on investigated surfaces was comparable with control sample. A confluent cell sheet was formed after 24 hours of culture. The influence of surface properties on cell adhesion and proliferation was examined. Detachment of cells from surfaces was controlled by variation of the temperature. An intact monolayer of cultured dermal fibroblasts was detached. No mechanical or enzymatic methods were required to harvest the cell sheets. Skin cell sheets, detached from thermoresponsive polymer layers may be applied in the cell sheet engineering that is highly desirable in tissue regeneration