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1.
Zoonoses Public Health ; 62(3): 222-7, 2015 May.
Article in English | MEDLINE | ID: mdl-24995792

ABSTRACT

Adverse events can occur after rabies post-exposure prophylaxis (PEP), and linkage to causality is often difficult to determine. We report a case of recurrent temporary paralysis that began immediately after the initiation of rabies PEP in a man exposed to a bat. The recurrent temporary paralysis first occurred in the patient after his initial dose and then again after day 3 of his rabies PEP. The PEP was terminated prior to a serologic response. The patient continued to experience numerous discrete episodes of temporary paralysis for over two years.


Subject(s)
Paralysis/chemically induced , Rabies Vaccines/adverse effects , Rabies virus/immunology , Rabies/prevention & control , Animals , Humans , Male , Middle Aged , Post-Exposure Prophylaxis , Rabies/immunology
2.
Zoonoses Public Health ; 61(5): 346-55, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24134434

ABSTRACT

Rabid free-ranging cats have been a public health concern in Pennsylvania since raccoon variant rabies first was recognized in the state in the early 1980s. Over the last decade, between 1.5 and 2.5% of cats submitted to Pennsylvania's state laboratories for rabies testing have been positive. In this report, we describe the extent of rabies in free-ranging cats in Pennsylvania. We also present two examples of human exposure to rabid free-ranging cats that occurred in Pennsylvania during 2010-2011 and the public health actions taken to address rabies exposure in the humans and animals. We then describe the concerns surrounding the unvaccinated and free-ranging cat population in Pennsylvania and possible options in managing this public and animal health problem.


Subject(s)
Cat Diseases/virology , Rabies/veterinary , Animals , Cat Diseases/epidemiology , Cats , Female , Humans , Livestock , Middle Aged , Pennsylvania/epidemiology , Public Health , Rabies/epidemiology , Raccoons , Risk Factors , Time Factors
3.
Mol Endocrinol ; 18(11): 2817-29, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15319451

ABSTRACT

We previously demonstrated that transcription of the rat sodium/iodide symporter (NIS) gene is regulated by NUE, an upstream enhancer located between nucleotides -2264 and -2495 of the 5'-flanking region. To elucidate the mechanism of TSH/cAMP-mediated regulation of NIS gene expression, we have characterized the putative cAMP response element (CRE)/activator protein (AP)-1 site (termed NUC) that is closely located between the two Pax-8 (paired box domain transcription factor-8) binding sites within NUE. In two different approaches using either gel supershift analyses or dominant-negative inhibitors of b-Zip molecules, we have shown that NUC can be recognized by several members of the AP-1 and CREB family transcription factors that modulate the transcriptional activity of NUE. Using tethered dimers of b-Zip molecules, we have also demonstrated that specific homo- or heterodimers of AP-1 can synergistically stimulate NUE activity in concert with Pax-8. To demonstrate further that NUC is a bona fide CRE, we made an artificial promoter with the five-time tandem repeat of this sequence (5xNUC). In comparison to the canonical CRE (5xCRE), 5xNUC manifested greater transcriptional activity and broader response to cAMP signaling. Hence, we postulate that the significance of this evolutionally conserved CRE-like site may lie in its broader cell type specificity.


Subject(s)
Cyclic AMP Response Element-Binding Protein/metabolism , DNA-Binding Proteins/metabolism , Gene Expression Regulation , Nuclear Proteins/metabolism , Response Elements/genetics , Symporters/genetics , Trans-Activators/metabolism , Transcription Factors/metabolism , 5' Flanking Region/genetics , Animals , Binding Sites/genetics , Cell Line , Conserved Sequence , Cyclic AMP/metabolism , Cyclic AMP/pharmacology , Dimerization , Electrophoretic Mobility Shift Assay , Mutation/genetics , PAX8 Transcription Factor , Paired Box Transcription Factors , Promoter Regions, Genetic/genetics , Rats , Transcription Factor AP-1/metabolism
4.
J Public Health Manag Pract ; 7(6): 51-9, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11710168

ABSTRACT

A surge of development of new public health surveillance systems designed to provide more timely detection of outbreaks suggests that public health has a new requirement: extreme timeliness of detection. The authors review previous work relevant to measuring timeliness and to defining timeliness requirements. Using signal detection theory and decision theory, the authors identify strategies to improve timeliness of detection and position ongoing system development within that framework.


Subject(s)
Communicable Diseases/diagnosis , Disease Outbreaks , Sentinel Surveillance , Bioterrorism , Decision Theory , Humans , Information Systems , Public Health Administration , Sensitivity and Specificity , United States
5.
J Public Health Manag Pract ; 7(4): 91-5, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11434047

ABSTRACT

The Healthy People 2010 Objectives and the Taskforce on Public Health Workforce Development both have recognized the important roles of state and local agencies in the education and training of their employees. This article describes an initial step in the development of a tool to assess agencies' training readiness using five factors derived from learning organization theory. These factors (resources, policies, learning culture, programs, and leadership) offer a useful framework for further development of a tool to assess training program readiness.


Subject(s)
Public Health Administration/standards , Public Health/education , Staff Development/standards , Education, Continuing , Humans , Organizational Innovation , Public Health Practice/standards , Public Policy , United States , Workforce
6.
Proc AMIA Symp ; : 711-5, 2001.
Article in English | MEDLINE | ID: mdl-11825278

ABSTRACT

To assess the value of ICD-9 coded chief complaints for early detection of epidemics, we measured sensitivity, positive predictive value, and timeliness of Influenza detection using a respiratory set (RS) of ICD-9 codes and an Influenza set (IS). We also measured inherent timeliness of these data using the cross-correlation function. We found that, for a one-year period, the detectors had sensitivity of 100% (1/1 epidemic) and positive predictive values of 50% (1/2) for RS and 25% (1/4) for IS. The timeliness of detection using ICD-9 coded chief complaints was one week earlier than the detection using Pneumonia and Influenza deaths (the gold standard). The inherent timeliness of ICD-9 data measured by the cross-correlation function was two weeks earlier than the gold standard.


Subject(s)
Disease Outbreaks , Disease/classification , Population Surveillance/methods , Humans , Predictive Value of Tests , Sensitivity and Specificity
7.
Am J Public Health ; 90(8): 1294-6, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10937012

ABSTRACT

OBJECTIVES: A training needs assessment project tested the use of "universal" competencies for establishing a model training agenda for the public health workforce. METHODS: Agency supervisors selected competencies for training priorities. Regional and national public health leaders used these selections to design the model training agenda. RESULTS: The competencies given high priority by supervisors varied among state and local agencies and included some not within the universal set. The model training agenda reflected supervisors' priorities as well as leaders' perspectives. CONCLUSIONS: The universal competencies provide a useful starting point, but not necessarily an exclusive framework, for assessing and meeting the training needs of the public health workforce.


Subject(s)
Models, Educational , Needs Assessment , Professional Competence , Public Health/education , Curriculum , Humans , United States
8.
Matern Child Health J ; 4(4): 223-31, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11272342

ABSTRACT

OBJECTIVE: To assess length of stay, home visits, and mothers' feelings after full implementation of a law requiring a 48-hour minimum stay for women with normal vaginal deliveries. METHODS: The New Jersey Electronic Birth Certificate System (EBC) was used to capture demographic characteristics, and length of stay (LOS), and to select a sample of women with low risk uncomplicated vaginal deliveries. A follow-up mail survey (with a nonresponder phone component) enhanced the information available on the EBC. RESULTS: The response rate for women included in the sample was 82.1% (1276/1555). The mean length of stay was 1.9 days. Sixty-two percent (787) of women thought their LOS after delivery was just right. Women who thought their stays were too short tended to be older, married, working outside the home, or have an LOS of less than 48 hours. The most common reasons for thinking the LOS was too short was a need for rest and concern about the baby. DISCUSSION: The combination of an augmented electronic birth certificate system and a follow-up survey proved to be a rapid, reliable, and inexpensive method of assessment. The mothers' desires for rest, education on the care of her newborn, and reassurance that any medical complications could be handled, are paramount concerns that need to be taken into account by payers and practitioners wanting to decrease LOS.


Subject(s)
Hospital-Patient Relations , Length of Stay/statistics & numerical data , Mothers/psychology , Patient Satisfaction/statistics & numerical data , Postnatal Care/standards , Adolescent , Adult , Birth Certificates , Electronic Data Processing , Female , Follow-Up Studies , Health Care Surveys , Humans , Infant, Newborn , Length of Stay/legislation & jurisprudence , Middle Aged , Mothers/statistics & numerical data , New Jersey , Research Design
10.
N J Med ; 90(10): 751-4, 1993 Oct.
Article in English | MEDLINE | ID: mdl-8233105

ABSTRACT

Physicians are required by law to report all animal bites and human rabies postexposure treatments to a local health department. This information is extremely important to physicians and to New Jersey residents. The authors present recommendations for rabies pre- and postexposure treatment.


Subject(s)
Rabies Vaccines/administration & dosage , Rabies/prevention & control , Animals , Humans , New Jersey
11.
J Am Vet Med Assoc ; 201(12): 1873-82, 1992 Dec 15.
Article in English | MEDLINE | ID: mdl-1483905

ABSTRACT

In November 1989, the epizootic of rabies affecting raccoons in the mid-Atlantic states reached New Jersey. An economic evaluation was conducted in 2 counties first affected by the epizootic to estimate the costs of the epizootic and to assess the costs and benefits of orally administering a newly developed recombinant rabies vaccine to prevent further spread of the disease. Data on expenditures associated with prevention of rabies in human beings and domestic animals and laboratory testing of suspect animals were collected and analyzed for 1988 (before the epizootic) and 1990 (first full year of the epizootic). Benefit-cost ratios were calculated and used to evaluate the economic advisability of the vaccine at various vaccination program alternatives. Two indices of capital investment analysis, payback period and net present value, were used to evaluate the economic benefits of the rabies vaccine. Expenditures were estimated to be $1,952,014 in 1990 (primarily for pet animal vaccinations), compared with $768,488 in 1988. Benefit-cost ratios ranged from 2.21 for the most expensive vaccination program alternative to 6.80 for the least expensive alternative. The payback period varied from 0.69 to 2.11 years, and the net present value ranged from $2,105,453 to $4,877,452. The high costs of this epizootic necessitated the reallocation of scarce public health resources to various rabies prevention activities, particularly the vaccination of dogs. This study also demonstrated the usefulness of benefit-cost analysis in developing public health strategies. Although the mass application of this recombinant vaccine was found to be economically beneficial, other qualitative considerations must be used to supplement these findings.


Subject(s)
Disease Outbreaks/veterinary , Rabies Vaccines/economics , Rabies/veterinary , Raccoons , Vaccination/veterinary , Administration, Oral , Animals , Animals, Domestic , Cost-Benefit Analysis , Disease Outbreaks/economics , Disease Outbreaks/prevention & control , Disease Reservoirs , Humans , New Jersey/epidemiology , Rabies/economics , Rabies/epidemiology , Rabies/prevention & control , Rabies Vaccines/administration & dosage , Vaccination/economics
12.
JAMA ; 267(10): 1349-53, 1992 Mar 11.
Article in English | MEDLINE | ID: mdl-1740856

ABSTRACT

OBJECTIVE: After an employee at a cancer research institute was diagnosed with lymphocytic choriomeningitis, an investigation was performed to determine the extent of lymphocytic choriomeningitis virus (LCMV) infections among the institute's employees and to identify risk factors for infection. DESIGN: Retrospective cohort study. SETTING: A US cancer research institute. PARTICIPANTS: Eighty-two of 90 institute employees. MAIN OUTCOME MEASURES: Serum LCMV antibodies. RESULTS: Seven workers (9%) with definite LCMV infection (LCMV IgG antibody titer greater than or equal to 16) and one worker (1%) with probable infection (IgG titer = 8) were identified (10% overall seroprevalence). All infected employees handled animals or animal tissues and were more likely than other animal handlers to have worked with nude mice (Mus musculus) (P less than .02). Among the 31 employees who worked with nude mice at the institute, infected workers were more likely to clean the cages of nude mice (P much less than .001), change their bedding (P less than .01), and change their water (P less than .001). The institute had been injecting nude mice with LCMV-infected tumor cell lines and had recently increased the nude mouse population and the duration of experiments. These changes would have increased the LCMV burden at the facility and were temporally associated with the cluster of LCMV infections in employees. CONCLUSIONS: This LCMV outbreak, the first reported since 1974, is the first associated with nude mice. It illustrates the ongoing hazard LCMV poses in research laboratories. Since the symptoms of LCMV infection can be nonspecific, clinicians should consider this diagnosis in ill patients who report laboratory rodent exposure.


Subject(s)
Disease Outbreaks , Laboratory Infection/epidemiology , Lymphocytic Choriomeningitis/epidemiology , Mice, Nude/microbiology , Adult , Animals , Antibodies, Viral/analysis , Female , Humans , Laboratory Infection/immunology , Laboratory Infection/microbiology , Lymphocytic Choriomeningitis/microbiology , Lymphocytic choriomeningitis virus/immunology , Male , Mice , Mice, Nude/immunology , Rodent Diseases/immunology , Rodent Diseases/microbiology , Rodent Diseases/transmission
13.
J Urol ; 143(6): 1223-4, 1990 Jun.
Article in English | MEDLINE | ID: mdl-2342186

ABSTRACT

We report a case of Lyme disease that presented with urinary retention. The individual then experienced lower extremity paralysis. Paralysis and urinary retention resolved with intravenous ceftriaxone antibiotic. To our knowledge this is the first report of a urological manifestation as the initial clinical presentation of Lyme disease. Recognition of clinical symptoms and urological complications of Lyme disease also are discussed.


Subject(s)
Lyme Disease/complications , Urination Disorders/etiology , Adult , Ceftriaxone/therapeutic use , Encephalomyelitis/etiology , Female , Humans , Lyme Disease/drug therapy , Meningoencephalitis/etiology , Paraplegia/etiology
14.
Pediatr Infect Dis J ; 9(5): 309-14, 1990 May.
Article in English | MEDLINE | ID: mdl-2352815

ABSTRACT

We reviewed retrospectively 31 cases of candidemia in children with central venous catheters. Infection rate was significantly higher in 1- to 4-year-old children with central venous catheters. Infection rate was significantly higher in 1- to 4-year-old children than in other age groups (8.4% vs. 2.2%; P less than 0.05). Serious sequelae occurred in 11 (35%) cases and included fatal outcome (5 instances), Candida endocarditis (2), renal abscesses, meningitis, arthritis and osteomyelitis (1 each). Complications were significantly more common in infants than in older children (P less than 0.05) and appeared 3 to 52 days after the first positive blood culture (mean, 16 days). In fatal cases catheters were left in place a significantly greater number of days than in nonfatal cases (P less than 0.05). A literature review identified 43 additional cases of catheter-related candidemia described in 11 series. The rate of Candida infection in the group as a whole was 2.7%. Patients treated with catheter removal plus amphotericin B had a significantly higher cure rate then patients treated with catheter retention plus amphotericin B (P = 0.009). Prompt catheter removal remains crucial in the treatment of catheter-related candidemia.


Subject(s)
Amphotericin B/therapeutic use , Candidiasis/therapy , Catheterization, Central Venous , Adolescent , Age Factors , Candidiasis/blood , Candidiasis/complications , Catheters, Indwelling , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Retrospective Studies
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