Spatial clustering of non-transported cardiac decedents: the results of a point pattern analysis and an inquiry into social environmental correlates

<p>Abstract</p> <p>Background</p> <p>People who die from heart disease at home before any attempt at transport has been made may represent missed opportunities for life-saving medical intervention. In this study, we undertook a point-pattern spatial analysis of heart disease deaths occurring before transport in a large metropolitan area to determine whether there was spatial clustering of non-transported decedents and whether there were significant differences between the clusters of non-transported cardiac decedents and the clusters of transported cardiac decedents in terms of average travel distances to nearest hospital and area socioeconomic characteristics. These analyses were adjusted for individual predictors of transport status.</p> <p>Methods</p> <p>We obtained transport status from the <it>place of death </it>variable on the death certificate. We geocoded heart disease decedents to residential street addresses using a rigorous, multistep process with 97% success. Our final study population consisted of 11,485 adults aged 25-74 years who resided in a large metropolitan area in west-central Florida and died from heart disease during 1998-2002. We conducted a kernel density analysis to identify clusters of the residential locations of cardiac decedents where there was a statistically significant excess probability of being either transported or not transported prior to death; we controlled for individual-level covariates using logistic regression-derived probability estimates.</p> <p>Results</p> <p>The majority of heart disease decedents were married (53.4%), male (66.4%), white (85.6%), and aged 65-74 years at the time of death (54.7%), and a slight majority were transported prior to death (57.7%). After adjustment for individual predictors, 21 geographic clusters of non-transported heart disease decedents were observed. Contrary to our hypothesis, clusters of non-transported decedents were slightly closer to hospitals than clusters of transported decedents. The social environmental characteristics of clusters varied in the expected direction, with lower socioeconomic and household resources in the clusters of non-transported heart disease deaths.</p> <p>Conclusions</p> <p>These results suggest that in this large metropolitan area unfavorable household and neighborhood resources played a larger role than distance to hospital with regard to transport status of cardiac patients; more research is needed in different geographic areas of the United States and in other industrialized nations.</p

Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear in Total Hip Arthroplasty.

Background: Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner. Methods: A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors for accelerated polyethylene wear were additionally investigated. Results: The mean age at the time of surgery was 65.8 years and the mean follow-up was 5.5 years. The mean linear wear rate was 0.003 mm/year and the mean volumetric wear rate was 0.42 mm Conclusion: Wear rates for this third-generation XLPE liner were low at mid-term follow-up, and no adverse sequelae of oxidation or deleterious mechanical properties were observed. This remained true regardless of femoral head size and material or patient age and body mass index. Further analysis will be necessary to ensure continued wear resistance, oxidative stability, and mechanical strength at long-term follow-up

Development of Dietary-Based Toxicity Reference Values to Assess the Risk of Chlorophacinone to Non-Target Raptorial Birds

Regulatory changes in the use of some second-generation anticoagulant rodenticides in parts of North America may result in expanded use of first-generation anticoagulant rodenticides (FGARs). Recent toxicological studies with captive raptors have demonstrated that these species are considerably more sensitive to the FGAR diphacinone than traditional avian wildlife test species (mallard, bobwhite). We have now examined the toxicity of the FGAR chlorophacinone (CPN) to American kestrels fed rat tissue mechanically amended with CPN, or rat tissue containing biologically-incorporated CPN, for 7 days. Nominal CPN concentrations in these diets were 0.15, 0.75, and 1.5 μg/g food wet weight, and actual CPN concentration in diets were analytically verified as being close to target values. Food intake was consistent among groups, body weight fluctuated by less than 6%, exposure and adverse effects were generally dose-dependent, and there were no dramatic differences in toxicity between mechanically-amended and biologically-incorporated CPN diets. Using benchmark dose statistical methods, toxicity reference values at which clotting times were prolonged in 50% of the kestrels was estimated to be about 80 μg CPN consumed/kg body weight-day for prothrombin time and 40 μg CPN/kg body weight-day for Russell’s viper venom time. Based upon carcass CPN residues reported in rodents from field baiting studies, empirical measures of food consumption in kestrels, and dietary-based toxicity reference values derived from the 7-day exposure scenario, some free-ranging raptors consuming CPN-exposed prey might exhibit coagulopathy and hemorrhage. These sublethal responses associated with exposure to environmentally realistic concentrations of CPN could compromise survival of exposed birds

Toxicity reference values for chlorophacinone and their application for assessing anticoagulant rodenticide risk to raptors

Despite widespread use and benefit, there are growing concerns regarding hazards of second-generation anticoagulant rodenticides to non-target wildlife which may result in expanded use of first-generation compounds, including chlorophacinone (CPN). The toxicity of CPN over a 7-day exposure period was investigated in American kestrels (Falco sparverius) fed either rat tissue mechanically- amended with CPN, tissue from rats fed Rozol bait (biologically-incorporated CPN), or control diets (tissue from untreated rats or commercial bird of prey diet) ad libitum. Nominal CPN concentrations in the formulated diets were 0.15, 0.75 and 1.5 µg/g food wet weight, and measured concentrations averaged 94 % of target values. Kestrel food consumption was similar among groups and body weight varied by less than 6 %. Overt signs of intoxication, liver CPN residues, and changes in prothrombin time (PT), Russell’s viper venom time (RVVT) and hematocrit, were generally dose-dependent. Histological evidence of hemorrhage was present at all CPN dose levels, and most frequently observed in pectoral muscle and heart. There were no apparent differences in toxicity between mechanically-amended and biologically-incorporated CPN diet formulations. Dietary-based toxicity reference values at which clotting times were prolonged in 50 % of the kestrels were 79.2 µg CPN consumed/kg body weight-day for PT and 39.1 µg/kg body weight-day for RVVT. Based upon daily food consumption of kestrels and previously reported CPN concentrations found in small mammals following field baiting trials, these toxicity reference values might be exceeded by free-ranging raptors consuming such exposed prey. Tissue-based toxicity reference values for coagulopathy in 50 % of exposed birds were 0.107 µg CPN/g liver wet weight for PT and 0.076 µg/g liver for RVVT, and are below the range of residue levels reported in raptor mortality incidents attributed to CPN exposure. Sublethal responses associated with exposure to environmentally realistic concentrations of CPN could compromise survival of free-ranging raptors, and should be considered in weighing the costs and benefits of anticoagulant rodenticide use in pest control and eradication programs

Children’s physical activity levels in a sports-oriented summer day camp

Physical activity engagement during childhood helps create lifelong patterns of health and fitness. Summer camps are an important domain of influence for health promotion, with over 14 million American children attending annually. No known studies have evaluated the impact of sports-focused camps on activity levels. We test the hypothesis that children attending a sports camp (STEC) spend more time in moderate-to-vigorous physical activity (MVPA) compared to children attending general day camps. A repeated measures design used waist-worn accelerometers to measure MVPA and vigorous physical activity (VPA) among children at a sports camp in Dorchester, Massachusetts (n = 40). We compared these data with data from a similar study at five Boston-area non-sports-focused summer day camps (BSC) (n = 142), resulting in 764 total person-days analyzed. Multivariable linear regression models estimated differences in percent of accelerometer-monitored time spent in physical activity, adjusting for potential confounders and clustering of observations. STEC children spent a higher percentage of time in MVPA and VPA compared to BSC children (MVPA: 11.4%, p = .005; VPA: 2.4%, p = .023). These findings support the hypothesis that sports-focused camps can provide children with significantly more activity than general day camps. STEC children also spend a higher percent of time in MVPA than do children in a school-day national sample (NHANES). This is the first study to document that a sports-oriented camp generates more physical activity compared to a general summer camp. Our findings are relevant for public health efforts to promote physical activity and prevent chronic disease

Anticancer Properties of a Novel Class of Tetrafluorinated Thalidomide Analogues

The authors thank Scott McMenemy for carrying out preliminary, early studies looking at effects of Gu compounds upon chicken embryology, as well as Charles D. Crowe, Jeffrey E. Roth, and Adam C. Rolt for critical comments on the article. fli1:EGFP zebrafish were obtained from the Zebrafish International Research Center (27). mpo:GFP zebrafish [also termed Tg(MPO:GFP)114] zebrafish were obtained from Dr. Stephen Renshaw, University of Sheffield (Sheffield, South Yorkshire, UK; ref. 29).Peer reviewedPostprin

Collaboration With Deaf Communities to Conduct Accessible Health Surveillance

Introduction Populations of deaf sign language users experience health disparities unmeasured by current public health surveillance. Population-specific health data are necessary to collaboratively identify health priorities and evaluate interventions. Standardized, reproducible, and language-concordant data collection in sign language is impossible via written or telephone surveys. Methods Deaf and hearing researchers, community members, and other stakeholders developed a broad computer-based health survey based on the telephone-administered Behavioral Risk Factor Surveillance System. They translated survey items from English to sign language, evaluated the translations, and filmed the survey items for inclusion in their custom software. They initiated the second Rochester Deaf Health Survey in 2013 (n=211). Analyses (conducted in 2015) compared Rochester Deaf Health Survey 2013 findings with those of the Behavioral Risk Factor Surveillance System with the general adult population in the same community (2012, n=1,816). Results The Rochester Deaf Health Survey 2013 participants’ mean age was 44.7 (range, 18—87) years. Most were deaf since birth or early childhood (87.1%) and highly educated (53.6% with ≥4 years of college). The median household income was \u3c $35,000. The prevalence of current smokers was low (8.1%). Nearly all (93.8%) reported having health insurance, yet barriers to appropriate health care were evident, with high emergency department use (16.2% with two or more past-year visits) and 22.7% forgoing needed health care in the past year because of cost. Conclusions Community-engaged research with deaf populations identifies strengths and priorities, providing essential information otherwise missing from existing public health surveillance, and forming a foundation for collaborative dissemination to facilitate broader inclusion of deaf communities

Interpatient heterogeneity in expression of CYP3A4 and CYP3A5 in small bowel: Lack of prediction by the erythromycin breath test

The CYP3A subfamily of cytochromes P450 metabolize many medications and environmental contaminants. CYP3A4 and, in 25% of patients, CYP3A5 seem to be the major CYP3A genes expressed in adult liver. Hepatic levels of CYP3A4 can be estimated by the erythromycin breath test and vary at least 10-fold among patients. CYP3A4 has also been shown to be present in small bowel where it is responsible for significant "first-pass" metabolism of orally administered substrates. However, it is not known whether there is significant interindividual variability in the intestinal expression of CYP3A4, or whether the liver and intestinal catalytic activities of CYP3A4 correlate within an individual. It is also not known whether CYP3A5 is expressed in the small intestine. To address these questions, we administered the erythromycin breath test to 20 patients and obtained biopsies from their small bowel. There was a 6-fold variation in CYP3A catalytic activity (midazolam hydroxylation), an 11-fold variation in CYP3A4 protein content, and an 8-fold variation in CYP3A4 mRNA content in intestinal biopsies. There was an excellent correlation between intestinal CYP3A4 protein level and catalytic activity (r = 0.86; p = 0.0001); however, neither parameter significantly correlated with hepatic CYP3A4 activity as measured by the erythromycin breath test result (r = 0.27; p = 0.24 and r = 0.33; p = 0.15, respectively). We also found that CYP3A5 protein was readily detectable in biopsies from 14 (70%) of the patients, indicating that CYP3A5 is commonly expressed in human small intestine