Assessing temporal and spatial variation in sensitivity of communities of periphyton sampled from agroecosystem to, and ability to recover from, atrazine exposure.

Lotic systems in agriculturally intensive watersheds can experience short-term pulsed exposures of pesticides as a result of runoff associated with rainfall events following field applications. Of special interest are herbicides that could potentially impair communities of primary producers, such as those associated with periphyton. Therefore, this study examined agroecosystem-derived lotic periphyton to assess (1) variation in community sensitivity to, and ability to recover from, acute (48h) exposure to the photosystem II (PSII)-inhibiting herbicide atrazine across sites and time, and (2) attempt to determine the variables (e.g., community structure, hydrology, water quality measures) that were predictive for observed differences in sensitivity and recovery. Periphyton were sampled from six streams in the Midwestern U.S. on four different dates in 2012 (April to August). Field-derived periphyton were exposed in the laboratory to concentrations of atrazine ranging from 10 to 320µg/L for 48h, followed by untreated media for evaluation of recovery for 48h. Effective quantum yield of PSII was measured after 24h and 48h exposure and 24h and 48h after replacement of media. Inhibition of PSII EC50 values ranged from 53 to >320µg/L. The majority of periphyton samples (16 out of 22) exposed to atrazine up to 320µg/L recovered completely by 48h after replacement of media. Percent inhibition of effective quantum yield of PSII in periphyton (6 of 22 samples) exposed to 320µg/L atrazine that were significantly lower than controls after 48h ranged from 2% to 24%. No distinct spatial or temporal trends in sensitivity and recovery potential were observed over the course of the study. Conditional inference forest analysis and variation partitioning were used to investigate potential associations between periphyton sensitivity to and ability to recover from exposure to atrazine. Although certain environmental variables (i.e., proximity of high flow/velocity events and dissolved solutes) were significantly associated with sensitivity to atrazine, recovery was not significantly associated with any variables, which is predicted by the rapid reversible binding at PSII. Consistent and rapid recovery of effective quantum yield of PSII across sites and sampling dates indicates that acute exposure to atrazine is unlikely to adversely affect function of these communities in their current state in intensive agroecosystems.

Seasonal Patterns in Microbial Community Composition in Denitrifying Bioreactors Treating Subsurface Agricultural Drainage.

Denitrifying bioreactors, consisting of water flow control structures and a woodchip-filled trench, are a promising approach for removing nitrate from agricultural subsurface or tile drainage systems. To better understand the seasonal dynamics and the ecological drivers of the microbial communities responsible for denitrification in these bioreactors, we employed microbial community "fingerprinting" techniques in a time-series examination of three denitrifying bioreactors over 2 years, looking at bacteria, fungi, and the denitrifier functional group responsible for the final step of complete denitrification. Our analysis revealed that microbial community composition responds to depth and seasonal variation in moisture content and inundation of the bioreactor media, as well as temperature. Using a geostatistical analysis approach, we observed recurring temporal patterns in bacterial and denitrifying bacterial community composition in these bioreactors, consistent with annual cycling. The fungal communities were more stable, having longer temporal autocorrelations, and did not show significant annual cycling. These results suggest a recurring seasonal cycle in the denitrifying bioreactor microbial community, likely due to seasonal variation in moisture content.

Spatial and temporal variation of algal assemblages in six Midwest agricultural streams having varying levels of atrazine and other physicochemical attributes.

Potential effects of pesticides on stream algae occur alongside complex environmental influences; in situ studies examining these effects together are few, and have not typically controlled for collinearity of variables. We monitored the dynamics of periphyton, phytoplankton, and environmental factors including atrazine, and other water chemistry variables at 6 agricultural streams in the Midwest US from spring to summer of 2011 and 2012, and used variation partitioning of community models to determine the community inertia that is explained uniquely and/or jointly by atrazine and other environmental factors or groups of factors. Periphyton and phytoplankton assemblages were significantly structured by year, day of year, and site, and exhibited dynamic synchrony both between site-years and between periphyton and phytoplankton in the same site-year. The majority of inertia in the models (55.4% for periphyton, 68.4% for phytoplankton) was unexplained. The explained inertia in the models was predominantly shared (confounded) between variables and variable groups (13.3, 30.9%); the magnitude of inertia that was explained uniquely by variable groups (15.1, 18.3%) was of the order hydroclimate>chemistry>geography>atrazine for periphyton, and chemistry>hydroclimate>geography>atrazine for phytoplankton. The variables most influential to the assemblage structure included flow and velocity variables, and time since pulses above certain thresholds of nitrate+nitrite, total phosphorus, total suspended solids, and atrazine. Time since a ≥30 µg/L atrazine pulse uniquely explained more inertia than time since pulses ≥ 10 µg/L or daily or historic atrazine concentrations; this result is consistent with studies concluding that the effects of atrazine on algae typically only occur at ≥30 µg/L and are recovered from.

Spatial variation in the bacterial and denitrifying bacterial community in a biofilter treating subsurface agricultural drainage.

Denitrifying biofilters can remove agricultural nitrates from subsurface drainage, reducing nitrate pollution that contributes to coastal hypoxic zones. The performance and reliability of natural and engineered systems dependent upon microbially mediated processes, such as the denitrifying biofilters, can be affected by the spatial structure of their microbial communities. Furthermore, our understanding of the relationship between microbial community composition and function is influenced by the spatial distribution of samples.In this study we characterized the spatial structure of bacterial communities in a denitrifying biofilter in central Illinois. Bacterial communities were assessed using automated ribosomal intergenic spacer analysis for bacteria and terminal restriction fragment length polymorphism of nosZ for denitrifying bacteria.Non-metric multidimensional scaling and analysis of similarity (ANOSIM) analyses indicated that bacteria showed statistically significant spatial structure by depth and transect,while denitrifying bacteria did not exhibit significant spatial structure. For determination of spatial patterns, we developed a package of automated functions for the R statistical environment that allows directional analysis of microbial community composition data using either ANOSIM or Mantel statistics.Applying this package to the biofilter data, the flow path correlation range for the bacterial community was 6.4 m at the shallower, periodically in undated depth and 10.7 m at the deeper, continually submerged depth. These spatial structures suggest a strong influence of hydrology on the microbial community composition in these denitrifying biofilters. Understanding such spatial structure can also guide optimal sample collection strategies for microbial community analyses.

Identification of serologic markers for school-aged children with congenital rubella syndrone

BACKGROUND: Congenital rubella syndrome (CRS) case identification is challenging in older children since laboratory markers of congenital rubella virus (RUBV) infection do not persist beyond age 12 months. METHODS: We enrolled children with CRS born between 1998 and 2003 and compared their immune responses to RUBV with those of their mothers and a group of similarly aged children without CRS. Demographic data and sera were collected. Sera were tested for anti-RUBV immunoglobulin G (IgG), IgG avidity, and IgG response to the 3 viral structural proteins (E1, E2, and C), reflected by immunoblot fluorescent signals. RESULTS: We enrolled 32 children with CRS, 31 mothers, and 62 children without CRS. The immunoblot signal strength to C and the ratio of the C signal to the RUBV-specific IgG concentration were higher (P < .029 for both) and the ratio of the E1 signal to the RUBV-specific IgG concentration lower (P = .001) in children with CRS, compared with their mothers. Compared with children without CRS, children with CRS had more RUBV-specific IgG (P < .001), a stronger C signal (P < .001), and a stronger E2 signal (P ≤ .001). Two classification rules for children with versus children without CRS gave 100% specificity with >65% sensitivity. CONCLUSIONS: This study was the first to establish classification rules for identifying CRS in school-aged children, using laboratory biomarkers. These biomarkers should allow improved burden of disease estimates and monitoring of CRS control programs. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Establishing a regional network of academic centers to support decision making for new vaccine introduction in Latin America and the Caribbean: the ProVac experience.

BACKGROUND: The Pan American Health Organization's ProVac Initiative, designed to strengthen national decision making regarding the introduction of new vaccines, was initiated in 2004. Central to realizing ProVac's vision of regional capacity building, the ProVac Network of Centers of Excellence (CoEs) was established in 2010 to provide research support to the ProVac Initiative, leveraging existing capacity at Latin American and Caribbean (LAC) universities. We describe the process of establishing the ProVac Network of CoEs and its initial outcomes and challenges. METHODS: A survey was sent to academic, not-for-profit institutions in LAC that had recently published work in the areas of clinical decision sciences and health economic analysis. Centers invited to join the Network were selected by an international committee on the basis of the survey results. Selection criteria included academic productivity in immunization-related work, team size and expertise, successful collaboration with governmental agencies and international organizations, and experience in training and education. The Network currently includes five academic institutions across LAC. RESULTS: Through open dialog and negotiation, specific projects were assigned to centers according to their areas of expertise. Collaboration among centers was highly encouraged. Faculty from ProVac's technical partners were assigned as focal points for each project. The resulting work led to the development and piloting of tools, methodological guides, and training materials that support countries in assessing existing evidence and generating new evidence on vaccine introduction. The evidence generated is shared with country-level decision makers and the scientific community. CONCLUSIONS: As the ProVac Initiative expands to other regions of the world with support from immunization and public health partners, the establishment of other regional and global networks of CoEs will be critical. The experience of LAC in creating the current network could benefit the formation of similar structures that support evidence-based decisions regarding new public health interventions.

Seasonal synchronicity of algal assemblages in three Midwestern agricultural streams having varying concentrations of atrazine, nutrients, and sediment.

Numerous studies characterizing the potential effects of atrazine on algal assemblages have been conducted using micro- or mesocosms; however, few evaluations focused on in situ lotic algal communities, potentially confounding risk assessment conclusions. This exploratory study, conducted at several sites in the midwestern United States where atrazine is commonly used, presents in situ observations of native algal communities relative to atrazine exposure and other parameters. Planktonic and periphytic algae from three streams in three Midwestern states, having historically differing atrazine levels, were sampled over a 16-week period in 2011 encompassing atrazine applications and the summer algal growth period at each site. Changes in abundance, diversity, and composition of algal communities were placed in the context of hydrological, climatic, and water quality parameters (including components sometimes present in agricultural runoff) also collected during the study. Diatoms dominated communities at each of the three sites and periphyton was much more abundant than phytoplankton. As expected, significant variations in algal community and environmental parameters were observed between sites. However, correspondence analysis plots revealed that patterns of temporal variation in algal communities at each site and in periphyton or phytoplankton were dominated by seasonal environmental gradients. Significant concordance in these seasonal patterns was detected among sites and between phytoplankton and periphyton communities (via procrustes Protest analysis), suggesting synchronicity of algal communities across a regional scale. While atrazine concentrations generally exhibited seasonal trends at the study watersheds; no effects on algal abundance, diversity or assemblage structure were observed as a result of atrazine pulses. This lack of response may be due to exposure events of insufficient concentration or duration (consistent with previously reported results) or the composition of the algal assemblages present. This was in contrast to the effects of elevated flow events, which were associated with significant changes in periphyton abundance, diversity and assemblage.

Has the time come to control hepatitis A globally? Matching prevention to the changing epidemiology.

For the first time a global meeting on hepatitis A virus (HAV) infection as vaccine preventable disease was organized at the end of 2007. More than 200 experts from 46 countries gathered to investigate the changing global HAV epidemiology reflecting the increasing numbers of persons at risk for severe clinical disease and mortality from HAV infection. The benefits of childhood and adult hepatitis A (HepA) vaccination strategies and the data needed by individual countries and international health organizations to assess current HepA prevention strategies were discussed. New approaches in preventing HAV infection including universal HepA vaccination were considered. This introductory paper summarizes the major findings of the meeting and describes the changing epidemiology of HAV infections and the impact of HepA vaccination strategies in various countries. Implementation of HepA vaccination strategies should take into account the level of endemicity, the level of the socio-economic development and sanitation, and the risk of outbreaks. A stepwise strategy for introduction of HepA universal immunisation of children was recommended. This strategy should be based on accurate surveillance of cases and qualitative documentation of outbreaks and their control, secure political support on the basis of high-quality results, and comprehensive cost-effectiveness studies. The recognition of the need for increased global attention towards HepA prevention is an important outcome of this meeting.

Psychiatric illness delays diagnosis of esophageal cancer.

Evidence suggests that patients with psychiatric illnesses may be more likely to experience a delay in diagnosis of coexisting cancer. The association between psychiatric illness and timely diagnosis and survival in patients with esophageal cancer has not been studied. The specific aim of this retrospective cohort study was to determine the impact of coexisting psychiatric illness on time to diagnosis, disease stage and survival in patients with esophageal cancer. All patients with a diagnosis of esophageal cancer between 1989 and 2003 at the Portland Veteran's Administration hospital were identified by ICD-9 code. One hundred and sixty patients were identified: 52 patients had one or more DSM-IV diagnoses, and 108 patients had no DSM-IV diagnosis. Electronic charts were reviewed beginning from the first recorded encounter for all patients and clinical and demographic data were collected. The association between psychiatric illness and time to diagnosis of esophageal cancer and survival was studied using Cox proportional hazard models. Groups were similar in age, ethnicity, body mass index, and history of tobacco and alcohol use. Psychiatric illness was associated with delayed diagnosis (median time from alarm symptoms to diagnosis 90 days vs. 35 days in patients with and without psychiatric illness, respectively, P < 0.001) and the presence of advanced disease at the time of diagnosis (37% vs. 18% of patients with and without psychiatric illness, respectively, P= 0.009). In multivariate analysis, psychiatric illness and depression were independent predictors for delayed diagnosis (hazard ratios 0.605 and 0.622, respectively, hazard ratio < 1 indicating longer time to diagnosis). Dementia was an independent risk factor for worse survival (hazard ratio 2.984). Finally, psychiatric illness was associated with a decreased likelihood of receiving surgical therapy. Psychiatric illness is a risk factor for delayed diagnosis, a diagnosis of advanced cancer, and a lower likelihood of receiving surgical therapy in patients with esophageal cancer. Dementia is associated with worse survival in these patients. These findings emphasize the importance of prompt evaluation of foregut symptoms in patients with psychiatric illness.

A new paradigm for international disease control: lessons learned from polio eradication in Southeast Asia.

OBJECTIVES: This study evaluated the impact of international coordination on polio eradication in Southeast Asia. METHODS: Active surveillance systems for acute flaccid paralysis were assessed. Analyses focused on surveillance proficiency and polio incidence. RESULTS: Ten countries coordinated activities. Importations occurred and were rapidly contained in China and Myanmar. Countries that have been free of indigenous polio transmission for at least 3 years include Sri Lanka, Indonesia, Myanmar, and Thailand. In the remaining endemic countries--India, Nepal, and Bangladesh--poliovirus transmission has been substantially reduced; however, these countries still harbor the world's largest polio reservoir. CONCLUSIONS: Unprecedented international coordination in Southeast Asia resulted in dramatic progress in polio eradication and serves as a paradigm for control of other infectious diseases such as malaria and tuberculosis.

Surveillance for polio eradication: current status and lessons learnt--India, 1999.

With the launch of the Universal Immunisation Programme in India in 1985, childhood immunisation was provided to children in all districts of the country in a phased manner by 1990. Surveillance for vaccine preventable diseases (VPD) including polio was started at the same time with monthly reporting from the districts to the Ministry of Health and Family Welfare (MOHFW), Government of India (GOI). In 1995, the Pulse Polio Immunisation (PPI) campaign was launched with the objective of polio eradication. Prior to 1997, surveillance for polio was directed at finding clinical polio cases by passive reporting from health facilities. There was no active surveillance for all cases of acute flaccid paralysis (AFP). In 1996, a scheme for the surveillance of AFP was drawn up. With the support of the Danish and US governments and Rotary International, 59 surveillance medical officers (SMOs) were hired, trained, and posted throughout the country in October 1997 to establish active surveillance of AFP. The number of SMOs was increased to 108 in August 1999. The SMOs along with their government counterparts established 10,069 reporting units nationwide by the end of November 1999 reporting weekly the occurrence of AFP cases to the district, state, and national levels; timely case investigation and collection of stool specimens from AFP cases; linkages to support the polio laboratory network; and extensive training of government counterparts. Data reported to the national level is analysed and put on an internet website which is updated every two weeks. Annualised rates of reported non-polio AFP have increased from 0.22 per 100,000 children aged < 15 years in 1997 to 1.57 in 1999. The number of polio cases associated with isolation of wild poliovirus decreased from 1404 in the third trimester of 1998 to 664 in the third trimester of 1999, yet widespread transmission of wild polioviruses persists throughout the country.

Poliomyelitis surveillance: the model used in India for polio eradication.

Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases. The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP). In October 1997, 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11,533 units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted. Data reported at the national level are analysed and distributed weekly. Annualized rates of non-polio AFP increased from 0.22 per 100,000 children aged under 15 years in 1997 to 1.39 per 100,000 in 1999. The proportion of cases with two adequate stools collected within two weeks of the onset of paralysis increased from 34% in 1997 to 68% in 1999. The number of polio cases associated with the isolation of wild poliovirus decreased from 211 in the first quarter of 1998 to 77 in the first quarter of 1999. Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh. In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized.

Growth of preterm infants with cystic periventricular leukomalacia.

Etiology of the high rates of growth failure in children with cerebral palsy (CP) remains unclear. The purpose of this study was to evaluate the relation between growth failure in preterm infants with cystic periventricular leukomalacia (CPVL) and neonatal health complications. The population consisted of all preterm infants (51) with a gestational age of <33 weeks who were admitted to the Children's Hospital of Buffalo from 1988 to 1993 and who had CPVL. Out of the 41 survivors with CPVL who were followed, 39 developed CP and 18 developed growth failure during infancy. At the time of greatest growth failure, the majority (72%) of infants had signs of undernutrition as defined by the Waterlow (1972) classification. Oral feeding impairment was the sole risk factor for the occurrence of growth failure. Undernutrition appears to be important in the occurrence of growth failure in preterm infants with CPVL and CP.

Economic outcomes associated with the use of risperidone in a naturalistic group practice setting.

The purpose of this cohort pilot study was to compare the resource utilization and economic outcomes associated with the use of risperidone versus haloperidol in a naturalistic setting. Patient charts from a large psychiatric group practice were reviewed, and hospital billing data were obtained. Patients meeting the inclusion criteria were placed into one of two cohorts depending on their medication history. Thirty patients treated with risperidone met the selection criteria, and a random quota sampling technique was used to allow for a matched control cohort of 30 patients treated with haloperidol. In the haloperidol and risperidone cohorts, 24 and 28 patients, respectively, were evaluated statistically. Mean utilization rates and costs per patient per month for each service were estimated by using regression analysis. Patients in the risperidone cohort had significantly fewer hospitalizations than did those in the haloperidol cohort (P = 0.004). Likewise, risperidone patients had significantly lower hospitalization costs than haloperidol patients (P = 0.005). Conversely, patients treated with risperidone visited the physician more frequently than did those treated with haloperidol (P = 0.0005). Estimated mean total monthly costs were $123.34 lower (95% confidence interval = $464, $217) per patient in the risperidone cohort than in the haloperidol cohort ($1,636.11 vs $1759.45; P = 0.4693). Significant reductions in hospital costs in the risperidone cohort offset higher medication and physician costs. Overall, total monthly costs were similar for the two cohorts.

Perspectives from the global poliomyelitis eradication initiative.

Ten years after the year 2000 target was set by the World Health Assembly, the global poliomyelitis eradication effort has made significant progress towards that goal. The success of the initiative is built on political commitment within the endemic countries. A partnership of international organizations and donor countries works to support the work of the countries. Interagency coordinating committees are used to ensure that all country needs are met and to avoid duplication of donor effort. Private sector support has greatly expanded the resources available at both the national and international level. At the programmatic level, rapid implementation of surveillance is the key to success, but the difficulty of building effective surveillance programmes is often underestimated. Mass immunization campaigns must be carefully planned with resources mobilized well in advance. Programme strategies should be simple, clear and concise. While improvements in strategy and technology should be continuously sought, changes should be introduced only after careful consideration. Careful consideration should be given in the planning phases of a disease control initiative on how the initiative can be used to support other health initiatives.