Spotted Fever Group Rickettsioses (SFGR): weather and incidence in Illinois.

The purpose of this study was to identify predictors of increasing incidence of Spotted Fever Group rickettsioses (SFGR) in Illinois, with a specific focus on weather variables. We analysed cases of SFGR reported to the Illinois Department of Public Health from 2004 to 2013. Surveillance definitions changed in 2008 and 2010, but those changes alone did not account for observed spikes in incidence in 2008, 2012 and 2013. A total of 590 cases of SFGR occurred, with the majority in the southernmost portion of the state. Only 3·4% of the reported cases were considered confirmed under the case definition. Increased mean winter temperature (IRR 1·32, CI 1·25-1·40) and increased precipitation (IRR 1·08, CI 1·04-1·11) were each associated with increased incidence of SFGR. Our findings show that weather appears to play a significant role in explaining the increasing annual incidence of SFGR in Illinois.

Effectiveness of qPCR permutations, internal controls and dilution as means for minimizing the impact of inhibition while measuring Enterococcus in environmental waters.

AIMS: Draft criteria for the optional use of qPCR for recreational water quality monitoring have been published in the United States. One concern is that inhibition of the qPCR assay can lead to false-negative results and potentially inadequate public health protection. We evaluate the effectiveness of strategies for minimizing the impact of inhibition. METHODS AND RESULTS: Five qPCR method permutations for measuring Enterococcus were challenged with 133 potentially inhibitory fresh and marine water samples. Serial dilutions were conducted to assess Enterococcus target assay inhibition, to which inhibition identified using four internal controls (IC) was compared. The frequency and magnitude of inhibition varied considerably among qPCR methods, with the permutation using an environmental master mix performing substantially better. Fivefold dilution was also effective at reducing inhibition in most samples (>78%). ICs were variable and somewhat ineffective, with 54-85% agreement between ICs and serial dilution. CONCLUSIONS: The current IC methods appear to not accurately predict Enterococcus inhibition and should be used with caution; fivefold dilution and the use of reagents designed for environmental sample analysis (i.e. more robust qPCR chemistry) may be preferable. SIGNIFICANCE AND IMPACT OF THE STUDY: Suitable approaches for defining, detecting and reducing inhibition will improve implementation of qPCR for water monitoring.

Occurrence of adenovirus and other enteric viruses in limited-contact freshwater recreational areas and bathing waters.

AIMS: The goal of this study was to characterize enteric virus concentrations and their infectivity in a variety of limited-contact recreation and bathing waters, including Great Lakes beaches, inland lakes, rivers, and an effluent-dominated urban waterway. Additionally, we evaluated associations between point sources of human faecal pollution and enterovirus and adenovirus presence and concentrations. METHODS AND RESULTS: Quantitative polymerase chain reaction (qPCR) and two cell culture lines were used to identify and quantify viruses in water samples. The presence of human adenoviruses F was strongly associated with effluent-dominated waters (odds ratio 6·1, confidence interval 2·3, 15·7), as was adenovirus concentration; though, neither enterovirus presence nor concentration was associated with an effluent source. Samples with high concentrations of qPCR targets all tested positive by cell culture on both cell lines, although qPCR target concentrations were not correlated with culture values. CONCLUSIONS: Adenovirus was strongly associated with point sources of human faecal pollution while enterovirus was not, indicating that adenovirus measured by qPCR is a better target than enterovirus for identifying wastewater discharges in recreational freshwaters. SIGNIFICANCE AND IMPACT OF THE STUDY: The development of monitoring for enteric human viral pathogens at recreational waters should include adenovirus testing. Further research is needed to interpret the results of qPCR testing in relationship to the presence of infectious viruses using cell culture.

Health hazards of ceramic artists.

Ceramic artists can be exposed to many hazards including metals (such as lead), fibrogenic dusts (such as silica), heat, repetitive motion, radiation, and toxic emissions from kilns. The health risks of these exposures have not been well characterized among artists, although limited information is available from commercial potteries. Adverse health effects may be prevented by using less hazardous materials (such as lead-free glazes), improved ventilation, and proper work practices. Special precautions must be in place if children have access to the ceramics studio. The use of glazed ceramic dishes can be a risk for lead toxicity. Food should not be stored in glazed ceramics, and pregnant women should avoid daily use of ceramic mugs for drinking hot beverages.

Occupational hazards of municipal solid waste workers.

The removal of municipal solid waste is a job associated with a variety of physical, chemical, and biological hazards. Municipal solid waste workers (MSWWs) have a risk of fatal occupational injuries that is much higher than for the general workforce. Among this group of workers, non-fatal injuries are mainly musculoskeletal. Other common injuries are fractures, ocular trauma, and bites, and diseases include skin and gastrointestinal disorders. Workers at municipal solid waste incinerators are exposed to a variety of concerning substances, such as heavy metals, respirable quartz dust, dioxins, furans, and mutagens. Workers can be protected by using safety procedures on and around garbage trucks and with personal protective equipment. The burden of morbidity due to occupational exposure to bioaerosols and carcinogens among MSWWs is unknown.

The occupational hazards of emergency physicians.

Emergency physicians are exposed to a variety of occupational hazards. Among these are infectious diseases, such the human immunodeficiency virus, hepatitis B and C viruses, and tuberculosis. Hepatitis G virus is transmissible but may not be a cause of illness. The likelihood of being exposed to these agents appears to be higher in the ED than other medical settings but estimates of the prevalence of these diseases in the ED vary, depending on the patient population served. Estimates of risk for contracting these infections are reviewed. Measures to prevent these exposures can reduce risk, but compliance is low, particularly for those involving changes in the behavior of emergency physicians (such as not recapping needles). Latex allergy is a hazard of health care workers. Its prevalence is reported to be quite high, but these findings are difficult to interpret in the absence of a universally accepted definition of the condition. Its prevalence in emergency physicians is not known. Other noninfectious hazards include workplace violence and exposure to nitrous oxide. The health effects of rotating shift work may put emergency physicians at increased risk of coronary artery disease and impaired reproductive health. Emotional stress is another hazard of emergency physicians, and may lead to burnout.

Intravenous access in the critically ill trauma patient: a multicentered, prospective, randomized trial of saphenous cutdown and percutaneous femoral access.

STUDY OBJECTIVE: To compare the speed of IV access and the rate of infusion for saphenous venous cutdown and percutaneous femoral catheterization. DESIGN: Prospective, randomized, multicentered trial. Patient enrollment occurred from September 1990 through September 1991. SETTING: Patients were enrolled at three urban Level I trauma centers. TYPE OF PARTICIPANTS: Seventy-eight critically ill trauma patients. INTERVENTIONS: Participants were randomized to one of two groups: saphenous cutdown or percutaneous femoral line. After successful cannulation of the vein, 1 L of crystalloid was infused by gravity. RESULTS: The mean procedure time for the cutdown group was 5.63 +/- 2.58 minutes compared with 3.18 +/- 1.19 minutes for the femoral line group (P < .0001). The mean infusion time for the cutdown group was 6.65 +/- 4.29 minutes compared with 4.56 +/- 2.47 minutes for the femoral line group (P < .03). The mean overall time for the cutdown group was 11.76 +/- 4.81 minutes compared with 7.67 +/- 2.78 minutes for the femoral line group (P < .0002). CONCLUSION: Percutaneous femoral catheterization can be performed more rapidly than saphenous cutdown in the critically ill trauma patient with a palpable femoral pulse and allows for more rapid fluid administration. We support the use of a percutaneous femoral line as an acceptable alternative to saphenous venous cutdown in the initial resuscitation of trauma patients.