TB risk by time since U.S. entry among non-U.S.-born residents of Washington State, USA.

BACKGROUND: Progress towards TB elimination in the United States will require improved detection and treatment of latent TB infection among non-U.S.-born residents who remain at disproportionate risk of TB disease. To inform targeted testing efforts, we evaluated risk of TB disease among non-U.S.-born residents of Washington State, USA, by region of origin and time from U.S. entry.METHODS: We conducted a retrospective cohort study among non-U.S.-born residents diagnosed with TB disease in Washington State from 2005 to 2014, for which country-specific population estimates were also available. The risk of TB disease among non-U.S.-born residents was estimated by time since U.S. entry, World Bank region of origin, and WHO TB incidence category.RESULTS: Risk of TB disease for non-U.S.-born residents was highest within the first year after U.S. entry. Among persons from countries with high TB incidence who had resided in the United States for more than 20 years, risk for TB remained elevated.CONCLUSION: Elevated risk of developing TB disease among individuals not born in the United States persisted long after U.S. entry, particularly among persons originating from certain regions and from high-burden countries. These findings contribute to evidence supporting a refinement of existing screening guidelines.

Multicenter study of QuantiFERON®-TB Gold Plus in patients with active tuberculosis.

SETTING: QuantiFERON®-TB Gold Plus (QFT-Plus), recently approved for use in the United States, is a new-generation QuantiFERON assay that differs from its predecessors in that it uses an additional antigen tube containing peptides to elicit both CD8+ and CD4+ T-lymphocyte responses. OBJECTIVE: To assess the sensitivity of QFT-Plus compared with QuantiFERON®-TB Gold In-Tube (QFT-GIT) in participants with active TB. DESIGN: Adult patients with active TB at three US and two Japanese sites were eligible for this study if they had culture-confirmed TB and were either untreated or had received 14 days of anti-tuberculosis treatment. RESULTS: We enrolled 164 participants, nine of whom had indeterminate results. Excluding indeterminate values, there were 150 QFT-GIT-positive results among 159 tests and 146 QFT-Plus-positive results among 157 tests, with sensitivities of respectively 94.3% (95%CI 89.5-97.4) and 93.02% (95%CI 87.8-96.5%). The estimated sensitivities for the two tests were not significantly different (P = 0.16). Overall test agreement was 98.7%, with a κ statistic of 0.89 (95%CI 0.75-1.00). CONCLUSION: In this multisite study, we found that QFT-Plus had similar sensitivity to QFT-GIT in adult patients with active TB.

TLR9 gene region polymorphisms and susceptibility to tuberculosis in Vietnam.

Humans exposed to Mycobacterium tuberculosis (Mtb) show variation in susceptibility to infection and differences in tuberculosis (TB) disease outcome. Toll-like receptor 9 (TLR9) is a pattern recognition receptor that mediates recognition of Mtb and modulates Mtb-specific T-cell responses. Using a case-population design, we evaluated whether single nucleotide polymorphisms (SNPs) in the TLR9 gene region are associated with susceptibility to pulmonary or meningeal TB as well as neurologic presentation and mortality in the meningeal TB group. In a discovery cohort (n = 352 cases, 382 controls), three SNPs were associated with TB (all forms, p < 0.05) while three additional SNPs neared significance (0.05 < p < 0.1). When these six SNPs were evaluated in a validation cohort (n = 339 cases, 367 controls), one was significant (rs352142) while another neared significance (rs352143). When the cohorts were combined, rs352142 was most strongly associated with meningeal tuberculosis (dominant model; p = 0.0002, OR 2.36, CI 1.43-3.87) while rs352143 was associated with pulmonary tuberculosis (recessive model; p = 0.006, OR 5.3, CI 1.26-31.13). None of the SNPs were associated with mortality. This is the first demonstration of an association between a TLR9 gene region SNP and tuberculous meningitis. In addition, this extends previous findings that support associations of TLR9 SNPs with pulmonary tuberculosis.

First record of preserved soft parts in a Palaeozoic podocopid (Metacopina) ostracod, Cytherellina submagna: phylogenetic implications.

The metacopines represent one of the oldest and most important extinct groups of ostracods, with a fossil record from the Mid-Ordovician to the Early Jurassic. Herein, we report the discovery of a representative of the group with three-dimensionally preserved soft parts. The specimen--a male of Cytherellina submagna--was found in the Early Devonian (416 Ma) of Podolia, Ukraine. A branchial plate (Bp) of the cephalic maxillula (Mx), a pair of thoracic appendages (walking legs), a presumed furca (Fu) and a copulatory organ are preserved. The material also includes phosphatized steinkerns with exceptionally preserved marginal pore canals and muscle scars. The morphology of the preserved limbs and valves of C. submagna suggests its relationship with extant Podocopida, particularly with the superfamilies Darwinuloidea and Sigillioidea, which have many similar characteristic features, including a large Bp on the Mx, the morphology of walking legs, Fu with two terminal claws, internal stop-teeth in the left valve, adductor muscle scar pattern, and a very narrow fused zone along the anterior and posterior margins. More precise determination of affinities will depend on the soft-part morphology of the cephalic segment, which has not been revealed in the present material.

Experience with rifabutin replacing rifampin in the treatment of tuberculosis.

SETTING: The use of a rifamycin in anti-tuberculosis treatment regimens is crucial for shortening treatment and achieving favorable outcomes. Rifampin (RMP) is the recommended rifamycin, although adverse effects (AEs) may require its discontinuation. The use of rifabutin (RFB), a rifamycin with activity against Mycobacterium tuberculosis, in patients with an RMP-related AE has not been well studied. OBJECTIVE: To review our experience with RFB in tuberculosis (TB) treatment. METHODS: We included TB patients who received RFB in their treatment regimens from 2003 to 2009. We evaluated the indications for RFB and, if applicable, the likelihood that RMP caused an AE. We identified RMPrelated AEs associated with RFB intolerance. RESULTS: One hundred subjects were included. The indications for RFB use were RMP-related AE (57%), con- current antiretroviral therapy (21%), potential/actual interaction with other medications (14%), and as part of an alternative regimen in liver disease (8%). Nineteen patients experienced an AE while taking RFB. Among patients with a prior RMP-related AE, 80% of whom were successfully treated with RFB, only a dermatologic AE was associated with subsequent RFB intolerance. CONCLUSIONS: Our study suggests that RFB is well tolerated by patients who develop RMP-related AEs. There may be an increased risk for RFB-related AE in patients who experienced RMP-related dermatologic events.

Synthetic- and bio-polymer use for runoff water quality management in irrigated agriculture.

Low concentrations of synthetic- or bio-polymers in irrigation water can nearly eliminate sediment, N, ortho- and total-P, DOM, pesticides, micro-organisms, and weed seed from runoff. These environmentally safe polymers are employed in various sensitive uses including food processing, animal feeds, and potable water purification. The most common synthetic polymer is anionic, high purity polyacrylamide (PAM), which typically provides 70-90% contaminant elimination. Excellent results are achieved adding only 10 ppm PAM to irrigation water, applying 1-2 kg ha(-1) per irrigation, costing 4 dollars - 12 dollars kg(-1). Biopolymers are less effective. Using twice or higher concentrations, existing biopolymers are approximately 60% effective as PAM, at 2-3 times the cost. A half million ha of US irrigated land use PAM for erosion control and runoff protection. The practice is spreading rapidly in the US and worldwide. Interest in development of biopolymer surrogates for PAM is high. If the supply of cheap natural gas (raw material for PAM synthesis) diminishes, industries may seek alternative polymers. Also "green" perceptions and preferences favor biopolymers for certain applications.

Biomass production and nutrient cycling in Eucalyptus short rotation energy forests in New Zealand. I: Biomass and nutrient accumulation.

Accumulation of biomass and nutrients (N, P, K, Ca, Mg and Mn) was measured during the first 3-year rotation of three Eucalyptus short rotation forest species (E. botryoides, E. globulus and E. ovata) irrigated with meatworks effluent compared with no irrigation. E. globulus had the highest biomass and nutrient accumulation either irrigated with effluent or without irrigation. After 3-year growth, E. globulus stands irrigated with effluent accumulated 72 oven dry t/ha of above-ground total biomass with a total of 651 kg N, 55 kg P, 393 kg K, 251 kg Ca, 35 kg Mg and 67 kg Mn. Effluent irrigation increased the accumulation of biomass, N, P, K and Mn, but tended to reduce the leaf area index and leaf biomass, and decreased the accumulation of Ca and Mg.

Pain language of bone marrow transplantation patients.

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.

Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences.

This study aimed to develop a pain attitudes questionnaire (PAQ) and examine its reliability and validity for use in assessing the constructs of stoicism and cautiousness relevant to pain perception. The questionnaire was administered to 373 healthy community-dwelling individuals who were subsequently divided into four age groups to test for differences in stoicism and cautiousness, two attitudes that have previously been claimed to influence pain perception and report among older adults. Factor analysis revealed that two dimensions of stoicism and two dimensions of cautiousness are measured by the scale, with reticence and superiority characterizing the first construct and self-doubt and reluctance characterizing the second. There was support for the scale's reliability and validity. Age-related increase in degree of reticence to pain, self-doubt, and reluctance to label a sensation as painful was found, emphasizing the need for careful consideration of pain attitudes in older patients who may underreport their pain symptoms.

Neuropsychologic testing within 18 hours after cardiac surgery.

OBJECTIVE: To undertake neuropsychologic testing within 18 hours of cardiac surgery after fast-track anesthesia. DESIGN: Prospective study. SETTING: University hospital, single center. PARTICIPANTS: Fifty patients undergoing first-time elective coronary artery surgery. INTERVENTIONS: A neuropsychologic test battery was administered preoperatively and 18 hours and 5 days after surgery. MAIN RESULTS: Seven patients were withdrawn, and 9 patients did not attempt the postoperative tests (on both occasions) because of medical complications. Thirty patients completed > or =4 tests at both postoperative occasions. Of these, 9 patients (30%) showed a deficit in > or =2 tests at 18 hours postoperatively, and 3 (10%) showed a deficit at 5 days postoperatively. CONCLUSION: In the absence of medical complications and despite the difficulties, early postoperative neuropsychologic testing is possible after fast-track anesthesia. Such testing has the potential to more clearly define the course of cognitive decline after cardiac surgery.

Accident cognitions and subsequent psychological trauma.

This study used a sample of 72 consecutive attendees to hospital following motor vehicle accidents. It aimed to assess the relationship between demographic variables, details of the accident and cognitions about the accident recorded soon afterward, and degree of psychological trauma 3 and 6 months later. Psychological trauma was assessed using the General Health Questionnaire, Impact of Event Scale, and Posttraumatic Stress Disorder Interview. A structured interview was used to gain information about demographic, accident, and accident cognition variables. Results showed that initial cognitions such as perceived threat to life, rather than demographic or accident variables, had the strongest relationships to subsequent trauma.

Coping style and psychological trauma after road accidents.

This prospective study aimed to follow a cohort of road accident victims for 6 months and to examine changes in psychological trauma and coping styles over this time. It also aimed to examine the relationship between initial coping style and subsequent psychological trauma. Seventy-two consecutive hospital attendees were assessed using the General Health Questionnaire, Impact of Event Scale, Posttraumatic Stress Disorder Interview and the Coping Inventory for Stressful Situations. Results showed that there was little change in reported coping style over the 6 months but there was a significant decrease in scores on trauma symptom measures. Initial emotion-focussed coping style and to a lesser extent avoidance had strong positive relationships with later trauma scores.

The development of a practical and reliable assessment measure for atopic dermatitis (ADAM).

Previous measures of Atopic Dermatitis (AD) have not been adequate for research purposes. This paper describes a study conducted in dermatology clinics of the Royal Children's Hospital, Melbourne, Australia, to develop a reliable, valid and practical measure. A pool of items to describe both site and morphology of AD was generated from a literature survey and expert opinion. Selected items were incorporated into a measure with each item rated on a four point scale. The measure was piloted and revised to a simpler format and called the Atopic Dermatitis Assessment Measure (ADAM). Unidimensionality was established. Reliability was determined by comparing two doctors blind ratings on 51 patients (mean age = 70 months). Agreement varied depending upon site and morphology with more agreement on "mild" AD than on "severe" AD. These results imply that operational definitions of the scales need to be defined more clearly. The measure satisfies the assumptions for a partial credit analysis.

Psychological symptoms in rural road trauma victims.

There is limited research into the psychological aftermath for people who have experienced road accidents, especially outside major cities. This study by postal survey used the General Health Questionnaire-28, the Impact of Events Scale, the Post-Traumatic Stress Disorder Interview, and the Late Effects of Accidental Injury Questionnaire to assess the psychological effects on a sample of 80 people who had attended a hospital in a regional Australian centre following road accidents. Results showed that there were marked effects on many people and that these had not always been diagnosed or treated.

Sociotropy, autonomy, and dysphoric emotional responses to specific classes of stress: a psychophysiological evaluation.

The aim of this study was to assess the ability of trait measures of sociotropy and autonomy to predict immediate emotional responses to imagery conditions depicting social rejection and achievement failure. Emotional responses were assessed by self-report techniques and by 2 putative psychophysiological measures of dysphoric mood: heart rate and facial muscle activity. Undergraduate volunteers (N = 100) were assessed for sociotropic and autonomous traits, general levels of depression, and sensory imagery ability, before performing a series of imagery trials depicting neutral and stressful (social rejection and achievement failure) scenes. Results provided support for the role of sociotropy as a vulnerability factor to dysphoric response to social rejection and to a lesser degree for achievement failure, but there was no support for autonomy as a vulnerability factor for either type of stressful script.

Childhood depression, stressors and parental depression.

The relationship between depression and stressors and the relationship between depression in children and depression in their parents were investigated. Depressed children aged 7-11 years (n = 20) were compared with clinical non-depressed children (n = 88) and normal children (n = 55). Children, mothers and fathers in the three groups were tested. Measures included the Children's Depression Inventory, Recent Life Events Scale, Stressor Scale and Beck Depression Inventory. The findings showed that children and mothers in the depressed group reported more stressors than other children and other mothers while fathers of children in the depressed group did not report more stressors. The findings also showed that mothers of depressed children were more depressed than mothers of normal children while there were no differences between the scores of fathers in the three groups.

Preparing patients for invasive medical and surgical procedures. 1: Adding behavioral and cognitive interventions.

The authors of three related articles look at various aspects of preparing adult and child patients psychologically for invasive surgical procedures. The first article is a review of the literature in the field, primarily from the last 30 years. Researchers have examined anxiety and coping mechanisms, patient-practitioner relationships, medical phobias, and the effectiveness of different types of psychological intervention. In the second article, the authors offer practical suggestions for implementing preparatory psychological interventions, describing effective communication techniques such as active listening, role plays, imaging, modeling, and progressive relaxation. In the final article in the series, the author considers policy, practice, and educational implications of the use of behavioral and cognitive interventions for patients, medical practitioners, and healthcare planners.

Reactions of first-year medical students to their initial encounter with a cadaver in the dissecting room.

This study reports the results of a 1986 questionnaire survey of 100 first-year medical students regarding their preparation for and reactions to their first encounter with a human cadaver in the dissecting room. The students were aware of psychological and physical reactions to this experience, and although they felt adequately prepared prior to the class, expressed a desire for greater preparation afterwards, particularly through more discussion of the experience with the anatomy staff. A surprising number of the students (62) had had prior exposure to a dead human body, which was a significant influence upon their reactions. The results of this study suggest a need for improving both the preparation for coping with dissection and the follow-up opportunities for dealing with professional and emotional issues raised during human dissection.