Insecticide susceptibility in Coptotermes formosanus and Reticulitermes virginicus (Isoptera: Rhinotermitidae).

Lethal time to mortality responses were established for eight insecticides against workers and soldiers of the Formosan subterranean termite, Coptotermes formosanus Shiraki, and workers of Reticulitermes virginicus (Banks). There were significant differences in the tolerance ratios between workers of C. formosanus colonies to all toxicants tested except fipronil. One colony was 16 times more tolerant than another to deltamethin. C. formosanus soldiers had significant differences in tolerance ratios among colonies exposed to all toxicants except chlorpyrifos. Methoxychlor, permethrin, deltamethrin, and fipronil did not kill soldiers from two, one, one, and three colonies, respectively, within 8 h. Seventy-five percent of R. virginicus colonies were significantly less susceptible than the most susceptible colony to chlordane, methoxychlor, chlorpyrifos, cypermethrin, and fipronil, with 50% of the colonies less susceptible to permethrin and bendiocarb. In 50% of C. formosanus colonies the worker lethal time curves displayed substantial flattening in response to permethrin, and deltamethrin. Lethal time curses for C. formosanus soldiers exposed to chlordane, chlorpyrifos, permethrin, cypermethrin, deltamethrin, and bendiocarb showed substantial flattening. R. virginicus workers demonstrated substantial curve flattening when exposed to chlordane, methoxychlor, chlorpyrifos, deltamethrin, and fipronil. These findings indicate substantial intercolony and intra-colony differences in susceptibility to insecticides.

Stereotactic core-needle breast biopsy: a multi-institutional prospective trial.

PURPOSE: To assess the accuracy of stereotactic core-needle biopsy (CNB) of nonpalpable breast lesions within the context of clinically important parameters of anticipated tissue-sampling error and concordance with mammographic findings. MATERIALS AND METHODS: CNB was performed in 1,003 patients, with results validated at surgery or clinical and mammographic follow-up. Mammographic findings were scored according to the American College of Radiology Breast Imaging Reporting and Data System with a similar correlative scale for histopathologic samples obtained at either CNB or surgery. Agreement of CNB findings with surgical findings or evidence of no change during clinical and mammographic follow-up (median, 24 months) for benign lesions was used to determine results. Three forms of diagnostic discrimination measures (strict, working [strict conditioned by tissue sampling error], applied [working conditioned by concordance of imaging and CNB findings) were used to evaluate the correlation of CNB, surgical, and follow-up results. RESULTS: Strict, working, and applied sensitivities were 91% +/- 1.9; 92% +/- 1.8, and 98% +/- 0.9, respectively; strict, working, and applied specificities were 100%, 98% +/- 0.8, and 73% +/- 0.9; strict, working, and applied accuracies were 97%, 96%, and 79%. CONCLUSION: Percutaneous stereotactic CNB is an accurate method to establish a histopathologic diagnosis of nonpalpable breast lesions. Accuracy increases when additional surgery is performed for lesions with anticipated sampling error or when CNB findings are discordant with mammographic findings. An understanding of the interrelationship among these parameters is necessary to properly assess results.

Toxicity and in vitro metabolism of t-permethrin in eastern subterranean termite (Isoptera: Rhinotermitidae).

Toxicity and metabolism of t-permethrin were evaluated in two colonies (UF and ARS) of the eastern subterranean termite, Reticulitermes flavipes (Kollar), collected in Gainesville, FL. The UF colony (LC50 = 1.86 micrograms per vial) was approximately twofold more tolerant of t-permethrin than the ARS colony (LC50 = 0.89 microgram per vial) at the LC50. The synergists piperonyl butoxide and S,S,S-tributylphosphorotrithioate increased t-permethrin toxicity four- and threefold (at the LC50) in the UF and ARS colonies, respectively. Despite these differences in t-permethrin susceptibility, microsomal oxidase activities toward surrogate substrate (aldrin epoxidase, and methoxyresorufin O-demethylase), cytochrome P450 content, and microsomal esterase activity toward alpha-naphthyl acetate did not differ significantly between the colonies. Moreover, no significant differences in qualitative and quantitative metabolism of [14C]t-permethrin were observed between the UF and ARS colonies for three enzyme sources (microsomal oxidase, microsomal esterase, and cytosolic esterase). Based on in vitro metabolism assays, the major detoxification route of t-permethrin in the UF and ARS termite colonies appears to be hydrolysis catalyzed by microsomal esterases.

Origin of metallic particles resembling microcalcifications on mammograms after use of abrasive cautery-tip cleaning pads during breast surgery: experimental demonstration.

PURPOSE: To determine if the act of cleaning a cautery tip with an abrasive pad dislodges radiopaque particles that can be transferred to breast tissue during surgery, thereby mimicking microcalcifications at mammography. MATERIALS AND METHODS: Mock breast surgery was performed by cauterizing bovine liver or fresh, normal, human breast tissue. The cautery tip was rubbed against a cleaning pad five to 20 times in the manner used intraoperatively and was touched on separate breast tissue specimens two to six times. Specimen radiography was then performed. Thirty-six breast specimens were used in three experiments, including 28 used for the experimental conditions and eight control specimens. RESULTS: Particles collected from the cleaning pads resembled microcalcifications. After cauterization of liver, breast tissue, or both, in series, particles transferred from the cautery tip to breast tissue specimens could be identified on specimen radiographs. Transfer of particles after cautery of breast tissue occurred with increased numbers of rubs and specimen contacts. CONCLUSION: Radiopaque aluminum oxide particles from abrasive cautery-tip cleaning pads can be dislodged and transferred to breast tissue during surgery. Scrutiny of high-detail, spot-compression, magnification mammograms will help identify these particles. Simple measures to mitigate particle transfer during breast surgery can prevent this problem and obviate a potential second procedure to remove particles mistaken for microcalcifications.

False-negative mammograms. Medical, legal, and risk management implications.

From a strictly biologic perspective, delay in diagnosis of breast cancer is axiomatic. The number of cell divisions that must occur before detection is possible by either clinical or mammographic methods means that a finite time has occurred in which the outcome for any given case may have already been determined. That early detection and diagnosis of breast cancer lead to improved survival may be intuitive, but clinical trials have been necessary to validate the concept. Delay in diagnosis is unavoidable but the period of delay may be lessened in many cases, prompting earlier intervention and impacting outcomes. Mammography is an important vehicle for such earlier intervention and the issue of the false-negative mammogram is of concern to the radiology community, the lay community, and the courts. Mammographic interpretation has not yet approached a sufficiently standardized benchmark. Detection and diagnosis are dependent on a series of factors that need to be integrated to achieve the dual goals of timely intervention for bonafide purposes and reduction of unnecessary procedures and interventions. Some of the reasons for delay in diagnosis are unavoidable, beginning with the absence of clinical or imaging features of malignancy and extending to limitations of sufficiently specific features to prompt intervention. On the other hand, other reasons are avoidable and attention to many of these causes should lessen the incidence of such delay. Regardless of the reason, those women who feel that their breast cancer should have been diagnosed at an earlier time may consider subjecting their mammographic studies to independent reviews. At such a point, the precise reasons for delay may be better analyzed, all in an attempt to provide an adequate reconciliation of what has come to be known as the false-negative mammogram.

Accuracy of screening mammography using single versus independent double interpretation.

OBJECTIVE: We conducted an analysis among 31 community radiologists to identify the average change in screening mammography interpretive accuracy afforded by independent double interpretation. MATERIALS AND METHODS: We assessed interpretive accuracy using a stratified random sample of test mammograms that included 30 women with cancer and 83 without. Radiologists were unaware of clinical information and of each other's assessments. We describe accuracy for individual radiologists and for double interpretation, including average sensitivity, specificity, diagnostic likelihood ratios positive and negative, and area under the receiver operating characteristic (ROC) curve. We also assessed weighted and nonweighted kappa statistics among all 465 pairs of radiologists and 31,465 pairs of unique pairs. The assessment for double interpretations used the "highest" (i.e., most abnormal) assessment of the two radiologists. We calculated the difference between each radiologist's individual accuracy and the average accuracy across that radiologist's 30 double interpretations. RESULTS: We found the following average accuracy statistics for individual radiologists: sensitivity, 79%; specificity, 81%; diagnostic likelihood ratio positive, 5.53; diagnostic likelihood ratio negative, 0.26; and area under the ROC curve, 0.85. The mean kappa statistic among radiologists for cancer cases increased with double interpretation from 0.59 to 0.70, and for noncancer cases from 0.30 to 0.34. Double interpretation resulted in an average increase in sensitivity of 7%, an average decrease in specificity of 11%, a decrease in diagnostic likelihood ratio positive of 2.35, a decrease in diagnostic likelihood ratio negative of 0.06, and an increase in area under the ROC curve of 0.02. CONCLUSION: Independent double interpretation does not increase accuracy as measured by the area under the ROC curve.

Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts.

The expense and ineffectiveness of drift-based insecticide aerosols to control dengue epidemics has led to suppression strategies based on eliminating larval breeding sites. With the notable but short-lived exceptions of Cuba and Singapore, these source reduction efforts have met with little documented success; failure has chiefly been attributed to inadequate participation of the communities involved. The present work attempts to estimate transmission thresholds for dengue based on an easily-derived statistic, the standing crop of Aedes aegypti pupae per person in the environment. We have developed these thresholds for use in the assessment of risk of transmission and to provide targets for the actual degree of suppression required to prevent or eliminate transmission in source reduction programs. The notion of thresholds is based on 2 concepts: the mass action principal-the course of an epidemic is dependent on the rate of contact between susceptible hosts and infectious vectors, and threshold theory-the introduction of a few infectious individuals into a community of susceptible individuals will not give rise to an outbreak unless the density of vectors exceeds a certain critical level. We use validated transmission models to estimate thresholds as a function of levels of pre-existing antibody levels in human populations, ambient air temperatures, and size and frequency of viral introduction. Threshold levels were estimated to range between about 0.5 and 1.5 Ae. aegypti pupae per person for ambient air temperatures of 28 degrees C and initial seroprevalences ranging between 0% to 67%. Surprisingly, the size of the viral introduction used in these studies, ranging between 1 and 12 infectious individuals per year, was not seen to significantly influence the magnitude of the threshold. From a control perspective, these results are not particularly encouraging. The ratio of Ae. aegypti pupae to human density has been observed in limited field studies to range between 0.3 and >60 in 25 sites in dengue-endemic or dengue-susceptible areas in the Caribbean, Central America, and Southeast Asia. If, for purposes of illustration, we assume an initial seroprevalence of 33%, the degree of suppression required to essentially eliminate the possibility of summertime transmission in Puerto Rico, Honduras, and Bangkok, Thailand was estimated to range between 10% and 83%; however in Mexico and Trinidad, reductions of >90% would be required. A clearer picture of the actual magnitude of the reductions required to eliminate the threat of transmission is provided by the ratio of the observed standing crop of Ae. aegypti pupae per person and the threshold. For example, in a site in Mayaguez, Puerto Rico, the ratio of observed and threshold was 1.7, meaning roughly that about 7 of every 17 breeding containers would have to be eliminated. For Reynosa, Mexico, with a ratio of approximately 10, 9 of every 10 containers would have to be eliminated. For sites in Trinidad with ratios averaging approximately 25, the elimination of 24 of every 25 would be required. With the exceptions of Cuba and Singapore, no published reports of sustained source reduction efforts have achieved anything near these levels of reductions in breeding containers. Practical advice on the use of thresholds is provided for operational control projects.

Lesions entirely removed during stereotactic biopsy: preoperative localization on the basis of mammographic landmarks and feasibility of freehand technique--initial experience.

Seven patients with mammographic lesions entirely removed at percutaneous core needle biopsy that required wider excision underwent freehand localization of the site of the prior lesion with orthogonal and reproducible mammographic landmarks to guide needle placement. Successful excision was accomplished in all cases, as evidenced by similar histopathologic findings, fibrin bands or collagen, and core needle biopsy tract at microscopy.

Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts

The expense and ineffectiveness of drift-based insecticide aerosols to control dengue epidemics has led to suppression strategies based on eliminating larval breeding sites. With the notable but short-lived exceptions of Cuba and Singapore, these source reduction efforts have met with little documented success; failure has chiefly been attributed to inadequate participation of the communities involved. The present work attempts to estimate transmission thresholds for dengue based on an easily-derived statistic, the standing crop of Aedes aegypti pupae per person in the environment. We have developed these thresholds for use in the assessment of risk of transmission and to provide targets for the actual degree of suppression required to prevent or eliminate transmission in source reduction programs. The notion of thresholds is based on 2 concepts: the mass action principal-the course of an epidemic is dependent on the rate of contact between susceptible hosts and infectious vectors, and threshold theory-the introduction of a few infectious individuals into a community of susceptible individuals will not give rise to an outbreak unless the density of vectors exceeds a certain critical level. We use validated transmission models to estimate thresholds as a function of levels of pre-existing antibody levels in human populations, ambient air temperatures, and size and frequency of viral introduction. Threshold levels were estimated to range between about 0.5 and 1.5 Ae. aegypti pupae per person for ambient air temperatures of 28 degrees C and initial seroprevalences ranging between 0% to 67%. Surprisingly, the size of the viral introduction used in these studies, ranging between 1 and 12 infectious individuals per year, was not seen to significantly influence the magnitude of the threshold. From a control perspective, these results are not particularly encouraging. The ratio of Ae. aegypti pupae to human density has been observed in limited field studies to range between 0.3 and >60 in 25 sites in dengue-endemic or dengue-susceptible areas in the Caribbean, Central America, and Southeast Asia. If, for purposes of illustration, we assume an initial seroprevalence of 33%, the degree of suppression required to essentially eliminate the possibility of summertime transmission in Puerto Rico, Honduras, and Bangkok, Thailand was estimated to range between 10% and 83%; however in Mexico and Trinidad, reductions of >90% would be required. A clearer picture of the actual magnitude of the reductions required to eliminate the threat of transmission is provided by the ratio of the observed standing crop of Ae. aegypti pupae per person and the threshold. For example, in a site in Mayaguez, Puerto Rico, the ratio of observed and threshold was 1.7, meaning roughly that about 7 of every 17 breeding containers would have to be eliminated. For Reynosa, Mexico, with a ratio of approximately 10, 9 of every 10 containers would have to be eliminated. For sites in Trinidad with ratios averaging approximately 25, the elimination of 24 of every 25 would be required. With the exceptions of Cuba and Singapore, no published reports of sustained source reduction efforts have achieved anything near these levels of reductions in breeding containers. Practical advice on the use of thresholds is provided for operational control projects.

Effect of temperature and the synergist piperonyl butoxide on imidacloprid toxicity to the cat flea (Siphonaptera: Pulicidae).

The toxicity of imidacloprid to cat fleas on glass was investigated at 20, 26, 30, and 35 degrees C. Imidacloprid was most toxic to adult cat fleas at 35 degrees C and to larvae at 20 degrees C. Piperonyl butoxide (PBO), a synergist, increased the relative potency of imidacloprid (1:5 imidacloprid:PBO) 16-fold at 26 degrees C against adults, but had no effect at 35 degrees C. No synergism occurred in larvae at 20 degrees C, but addition of PBO (1:5 imidacloprid:PBO) doubled toxicity at 26 degrees C. PBO (1:5 imidacloprid:PBO) could possibly be used to synergize imidacloprid premise treatments (20-30 degrees C), but it is not likely to be effective in pet treatments because no synergism occurred in adult fleas at 35 degrees C (average fur temperature of tested cats and dogs).

Spray-dried bovine blood: an effective laboratory diet for Ctenocephalides felis felis (Siphonaptera: Pulicidae).

Commercially available spray-dried protein sources were evaluated as replacement laboratory cat flea, Ctenocephalides felis felis (Bouché), larval diets for slaughterhouse-collected heat-dried blood. Percentage of adult emergence of fleas reared on adult flea feces (87.7%) and spray-dried bovine blood (79%) did not significantly differ, and yeast supplementation did not significantly increase adult emergence for spray-dried diets. However, yeast supplementation of heat-dried blood increased percentage adult emergence from 0 to 41.7%. Spray-dried bovine blood was found to be a satisfactory laboratory diet for cat flea larvae.

Outdoor survival and development of immature cat fleas (Siphonaptera: Pulicidae) in Florida.

In north-central Florida, cat flea, Ctenocephalides felis felis Bouché, larvae survived outdoors year round. Their survival was greatest (up to 84.6%) outdoors in the fall, from September to November, when both temperatures and relative humidities were moderate. Female cat fleas developed faster than males. Development times for flea larvae were shortest (20-24 d) in June and July. From January to March, flea larval mortality was highest (91.7-100%) and development times the longest (36-50 d) outdoors. This was the result of low temperatures and low relative humidities associated with the passage of cold fronts during this time of year. Flea larvae survived light frosts in protected microhabitats such as inside a doghouse and under a mobile home.

Methods of compliance with Mammography Quality Standards Act regulations for tracking positive mammograms: survey results.

OBJECTIVE: We sent a questionnaire to fellows of the Society of Breast Imaging to determine how breast imaging facilities comply with regulations mandated by the Mammography Quality Standards Act for tracking patients whose mammograms show positive findings. SUBJECTS AND METHODS: We surveyed the Society of Breast Imaging fellows to determine practice types, follow-up methodology, additional time and personnel required, and end points of radiologists' responsibility for follow-up of mammograms with positive findings. RESULTS: Forty-six (68%) of 68 surveyed practices responded, including 21 academic, 16 private, and nine mixed practices that averaged 15,761 mammograms a year (range, 300-50,000). The 46 practices used computers (n = 30) or handwritten paper (n = 16) audits. Radiologists (n = 8), technologists (n = 6), other personnel (n = 10), or a combination (n = 22) tracked procedures and patients with abnormal mammographic results. Average time spent tracking was given as a few hours a week (n = 28), 2-4 hr a day (n = 11), and 40 hr a week (n = 5). The remaining two practices indicated that less than 1 hr per month was required (n = 1) or that they used two full-time data managers (n = 1). Accepted tracking end points included surgical biopsy (n = 30), referring physician recommended other management (n = 16), patient refused recommendation (n = 27), medical care transfer (n = 27), patient moved (n = 22), or patient lost to referring physician follow-up (n = 16). CONCLUSION: Among dedicated mammographers, the methodology in the task of tracking patients with positive findings on mammography varies. All methodologies described in responses to our survey involved considerable time and effort.

Comparative insecticide susceptibility and detoxification enzyme activities among pestiferous blattodea.

Topical bioassays using propoxur, chlorpyrifos, and lambda-cyhalothrin were conducted on eight cockroach species. Based on lethal dose values, the relative toxicities of the insecticide classes were generally pyrethroid > carbamate > organophosphorous. Lambda-Cyhalothrin and propoxur were more toxic toward the Blattidae as compared with the Blattellidae. The order of lambda-cyhalothrin toxicity was Periplaneta americana > Periplaneta brunnea = Periplaneta australasiae = Periplaneta fuliginosa = Blatta orientalis > Blattella asahinai = Blattella germanica > Blattella vaga. The order of propoxur toxicity was B. orientalis > P. americana > P. brunnea = P. australasiae > B. asahinai > P. fuliginosa = B. germanica > B. vaga. The order of chlorpyrifos toxicity was P. americana > B. asahinai = B. vaga > B. orientalis = P. australasiae = P. brunnea > B. germanica = P. fuliginosa. Detoxification enzyme activities for each species also were measured and compared with insecticide toxicity. Propoxur LD50 was significantly (P = 0.01; r = 0.81) correlated with glutathione S-transferase activity. Lambda-Cyhalothrin LD50 correlated with methoxyresorufin O-demethylase activity (P = 0.01; r = 0.81), carboxylesterase activity (P = 0.03; r = - 0.75), general esterase activity (P = 0.02; r = - 0.79), and cockroach weight (P = 0.01; r = -0.95).