For those who wait.... Care of the status 1 patient awaiting cardiac transplantation.

In conclusion, successfully bridging a Status 1 patient to the time of heart transplant requires a variety of skills. Vigilance is key in averting potential complications and addressing patient issues. Also, health care professionals will be called on to use their knowledge and expertise to deal with psychosocial and medical matters. When skillfully executed, the result of a successful transplant is an improved quality of life and a longer life. A successful transplant reflects a job well done by the professionals and is the ultimate goals for all of those who care for those who wait.

Role of peridomestic birds in the transmission of St. Louis encephalitis virus in southern California.

In response to the 1984 St. Louis encephalitis (SLE) epidemic in the Los Angeles Basin of southern California (USA), an investigative program was initiated to evaluate the interactive components of the SLE virus transmission cycle. From 1987 through 1996 (10 yr), 52,589 birds were bled and their sera tested for SLE and western equine encephalomyelitis (WEE) virus antibodies by the hemagglutination inhibition (HAI) test. Eighty-three percent of the birds tested were house finches (Carpodacus mexicanus) (48.7%) and house sparrows (Passer domesticus) (34.6%); 1.1% of these birds were positive for SLE antibodies. Prevalence of WEE antibodies was negligible. The analysis of 5,481 sera from rock doves (Columbia livia) yielded 3.6% SLE positives and 0.4% WEE positives. Collection sites were maintained as study sites when identified as positive bird, mosquito, and SLE virus activity localities; others were abandoned. Serial serum samples from 7,749 banded house sparrows and 9,428 banded house finches from these selected sites demonstrated year-round SLE virus transmission. One location exhibited significant numbers of house finches undergoing annual SLE seroconversion and a number of seroconversion-reversion-reconversion sequences suggesting either viral reinfection from mosquitoes or recrudescence by latent virus. A proportion of both bird species also lived for longer than 1 yr, thus, increasing the possibility of virus carry-over from autumn to spring. Assessment of concurrently collected mosquitoes indicated no correlative association between mosquito populations and SLE seroconversion and reconversion. European house sparrows introduced in the 1800's may have provided a supplemental link to the existing SLE virus enzootic cycle involving endemic house finches. Meteorological factors are reviewed as possible important correlates of SLE epidemics. The house finch/house sparrow serosurveillance system is also evaluated for use as an "Early Warning" indicator of SLE virus activity.

Arenavirus antibody in rodents indigenous to coastal southern California.

The purpose of this study was to extend our knowledge on the geographic and natural rodent host ranges of New World arenaviruses in California. Sera from 1,094 sigmodontine and 112 murine rodents were tested for antibody against Whitewater Arroyo and Amapari viruses. Antibody was found in 55 (4.6%) of the 1,206 rodents: 4 from northwestern San Diego County, 3 from Los Angeles County, and 48 from Orange County. The antibody-positive rodents included 8 (7.8%) of 103 Neotoma fuscipes, 1 (0.6%) of 180 Neotoma lepida, 1 (3.1%) of 32 Peromyscus boylii, 8 (11.0%) of 73 Peromyscus californicus, 1 (1.2%) of 85 Peromyscus eremicus, 30 (8.5%) of 353 Peromyscus maniculatus, and 6 (2.2%) of 268 Reithrodontomys megalotis. This study provides the first evidence that New World arenaviruses occur in Los Angeles and Orange counties and northwestern San Diego County, and the first evidence that Peromyscus and Reithrodontomys species are naturally infected with New World arenaviruses.

Abrocomaphthirus hoplai, a new genus and species of sucking louse from Chile and its relevance to zoogeography.

Both sexes of Abrocomaphthirus hoplai, new genus and new species (Anoplura: Polyplacidae), are described and illustrated. The endemic Chilean chinchilla rat Abrocoma bennetti Waterhouse (Rodentia: Abrocomidae) is the type host. The definition of the family Polyplacidae is amended to accommodate the new genus. Polyplax longa (Werneck), also referred to in the literature as Neohaematopinus longus Werneck, is reassigned to Abrocomaphthirus. The host of A. longus comb.n., is Abrocoma cinerea Thomas, another chinchilla rat, which inhabits parts of Argentina, Bolivia, Chile and Peru. The erection of Abrocomaphthirus as a distinct genus has important zoogeographical and evolutionary implications. The tenuous anomaly of P. longa being the sole native representative of the genus Polyplax in South America, possibly with African affinities, is now refuted. Instead, partial colonization of the neotropics by native species of both Polyplax and Neohaematopinus appears to have been relatively recent and from North America. The phylogenetic affinities of Abrocomaphthirus are unknown, but it appears to be closely related to other, more ancient, native South American polyplacid louse genera, such as Cuyana, Eulinognathus, Galeophthirus, and Lagidiophthirus. Arguments are presented in support of an ancestral zoogeographical link to Africa for these louse genera.

Hantavirus (Bunyaviridae) infections in rodents from Orange and San Diego counties, California.

During a screening program to determine the extent of hantavirus activity in Orange and San Diego Counties, California, serum samples from 2,365 rodents representing nine genera and 15 species were tested for hantavirus antibodies. A reverse transcription-polymerase chain reaction on selected seropositive rodents was used to identify the specific hantavirus. Rodents positive for Sin Nombre virus (SNV) antibodies by Western blot included 86 (9.1%) of 948 deer mice (Peromyscus maniculatus), four (1.5%) of 275 California mice (Peromyscus californicus), one (0.5%) of 196 cactus mice (Peromyscus eremicus), 51 (12.2%) of 417 harvest mice (Reithrodontomys megalotis), and five (12.5%) of 40 California voles (Microtus californicus). All other specimens tested were negative for hantavirus antibodies. There was a correlation between age and sex of the reservoir host and prevalence of SNV antibody, especially among male deer mice and harvest mice. Few seasonal trends in antibody prevalence were observed and continued maintenance of SNV and El Moro Canyon virus was found at several foci over a 4-5-year period. Isla Vista virus was also found in voles and represents the first recorded in Orange County. Microhabitat selection on the part of these rodents based on plant density, plant height, and availability of food plants may explain, to some extent, all of the hantavirus-positive foci throughout the study area over a broad geographic range and the lack of antibody-positive rodents in dense chaparral, woodland, and riparian areas. The majority of rodents positive for SNV was identified from localities along coastal bluffs and the foothills of the Santa Ana Mountains, where trap success was high and P. maniculatus represented 43% of all rodents collected. Several residential, commercial, and industrial sites exist in these areas and the potential health risk should not be overlooked. This study represents an in-depth analysis of the prevalence, host distribution, and characteristics of rodent populations infected by three hantaviruses within a small, well-defined, geographic area.

Smoking initiation in youth: the roles of gender, race, socioeconomics, and developmental status.

PURPOSE: To describe smoking initiation, and to investigate factors that predict the early initiation of smoking in schoolchildren using a longitudinal approach. METHODS: A prospective study of smoking habits of children from the third and fourth grades through the eighth and ninth grades. The initial study population was 1970; 79.8% were white and 20.2% were African-American. Children were classified as "nonsmokers," "experimental smokers," or "current smokers" at five time points over 6 years. Multivariate regression models examined relationships of demographic and developmental factors with smoking initiation. RESULTS: Experimental smoking increased from 4% at Grades 3-4 to 42% at Grades 8-9, and current smoking prevalence rose from 0.4% to 9% over the same period. The mean age of initiation of smoking was 12.3 years. Smoking initiation (experimental smoking) was significantly different by racial group, socioeconomic status (SES), and pubertal development. White children and those of low SES were more likely to be experimental smokers, and also started earlier than African-American children and children of high SES. Once they started, white children advanced more rapidly to become current smokers. Boys had a higher prevalence of experimental smoking than girls at all time points. Children in rural areas were more likely than urban children to start smoking after age 12 years. Children who were at a higher pubertal stage than their peers were also more likely to experiment with smoking. CONCLUSIONS: Race, SES, and pubertal stage are important predictors of initiation of smoking in schoolchildren. This study indicates a need for smoking prevention classes in elementary and middle school, especially in areas with large numbers of white and low-SES youth. Also, smoking cessation programs, as well as smoking prevention classes, would be useful for middle school and high school students.

Comparison of a computerized physical activity recall with a triaxial motion sensor in middle-school youth.

PURPOSE: To develop and test a computerized activity recall (CAR) for capturing activity and energy expenditure (EE) in youth and to further our understanding of the use of the three-dimensional accelerometer (Tritrac) for studying activity and EE. METHODS: Forty-five students (25 girls and 20 boys) in grade 6-8, completed 5 consecutive days of the CAR and were randomly assigned to wear the Tritrac during 1 day in which they also completed the CAR. Twenty-two subjects also repeated 5 d of the CAR and 1 d of Tritrac monitoring 1-2 wk later. RESULTS: The correlation between CAR and Tritrac for total EE was significant (r = 0.510, P = 0.0003). However, the total EE computed from the Tritrac was significantly greater than the CAR (1941 +/- 273 kcal vs 1576 +/- 343 kcal (8.14 +/- 1.14 vs 6.60 +/- 1.44 MJ); P < 0.001). The EE of activities was similar for the Tritrac and CAR, approximately 670 kcal (2.80 MJ), suggesting that the difference between the two methods was their estimates of resting EE. Comparison of the CAR and Tritrac for classifying active and inactive subjects indicated that both methods similarly classified 35 of the 45 subjects or 78% (P = 0.0038). Although significant, the Kappa statistic (kappa = 0.398) indicated a low-level of agreement between methods. The Tritrac indicated 50.4 +/- 29.2 min.d-1 of activities of > or = 3 METs, whereas the CAR indicated 76.7 +/- 71.9 min.d-1 (P = 0.02). The week 1 vs 2 test-retest correlation was 0.0485 (P = 0.022) for the Tritrac and 0.820 (P = 0.0001) for the CAR. CONCLUSIONS: It appears that both methods have acceptable reliability. However, the validity of each method to measure total and activity EE remains unclear, as the Tritrac appears to overestimate resting energy expenditure, whereas the CAR overestimates total minutes of activity.

Ehrlichia phagocytophila genogroup rickettsiae in ixodid ticks from California collected in 1995 and 1996.

A total of 1,246 ixodid ticks collected in 1995 and 1996 from seven California counties were examined for the presence of Ehrlichia phagocytophila genogroup rickettsiae by using a nested PCR technique. Of 1,112 adult Ixodes pacificus Cooley and Kohls ticks tested, nine pools, each containing five ticks, were positive (minimum percentage of ticks harboring detectable ehrlichiae, 0.8%). Positive ticks were limited to four of the seven counties (Sonoma, El Dorado, Santa Cruz, and Orange). In Santa Cruz County, three positive pools were identified at the home of an individual with prior confirmed human granulocytic ehrlichiosis. In El Dorado County, positive ticks were found at sites where cases of granulocytic ehrlichiosis in a horse and a llama had recently occurred. Among 47 nymphal I. pacificus ticks collected in Sonoma County, one positive pool was identified. Fifty-seven adult Dermacentor occidentalis Marx and 30 adult D. variabilis Say ticks, collected chiefly in southern California, were negative. These data, although preliminary, suggest that the prevalence of E. phagocytophila genogroup rickettsiae in ixodid ticks of California may be lower than in cognate vector populations (i.e., I. scapularis Say = I. dammini Spielman, Clifford, Piesman, and Corwin) in the eastern and midwestern United States.

Family member discrepancies in report of a child's race.

This paper describes the types of discrepancies in self report of a child's race in a research study of cardiovascular health in school age children. Researchers sometimes make conclusions based on the percentage of subjects from each racial group included in the study. This is particular concern because in intervention studies researchers may report differing responses to treatment based on the race variable. This study increases awareness of issues surrounding assigning race of children participating in research studies.

Spatial and circadian oviposition patterns in an urban population of Culex quinquefasciatus.

A transect of infusion-baited oviposition tubs was used at the Orange County (CA) Vector Control District facility to determine the circadian periodicity and the influence of urban habitat factors, such as buildings, ornamental plantings, and mercury vapor lights on Culex quinquefasciatus oviposition activity. The peak oviposition activity occurred during the first 2 h after sunset. Nearly 80% of egg rafts deposited were laid within the first 4 h after sunset and no morning ovipositional peak was detected. Urban and physical habitat factors considered had no effect on tub selection by ovipositing females. Linear analysis indicated that eggs were laid randomly among tubs. Eighty-eight percent of the rafts collected were Cx. quinquefasciatus. The remaining egg rafts were laid by Culex tarsalis, Culex stigmatosoma, and Culieseta incidens.

Mark-release-recapture studies with Culex mosquitoes (Diptera: Culicidae) in Southern California.

Cohorts of Culex adults were marked uniquely with date- and site-specific fluorescent dust colors and were released at centrally located residences and at peripheral breeding sources to study population dispersal, size, additions, and deletions. The recapture rate of Cx. quinquefasciatus females was higher and the mean distance dispersed was lower in residential than in agricultural or park habitats. Dispersal was associated with host-seeking activity and ranged from 0.6 to 1.0 km/d. Survivorship ranged from 0.65 to 0.84 per day, and population density ranged from 36,612 to 671,634 females per km2. The sampling efficiency of CO2-baited traps in residential habitats increased coincidentally with increasing population density. Gravid traps were most effective in residential habitats where there were few competitive oviposition sites. Teneral Cx. stigmatosoma were extremely dispersive, and few marked females were recaptured. Unmarked females were more abundant at CO2-baited traps in residential habitats than at traps near productive peripheral breeding sources. Few Cx. tarsalis were released, and the recapture rate in residential habitats was low when compared with rural sites.

Antibody prevalence of St. Louis encephalitis virus in avian hosts in Los Angeles, California, 1986.

A study was conducted to determine the pattern of St. Louis encephalitis (SLE) virus activity in the avian populations of the Los Angeles metropolitan area in 1986. In total, 679 birds of 42 species were captured at 7 study sites. The overall prevalence of SLE neutralizing (N) antibody of 3% indicated enzootic transmission. Antibody prevalences were higher in birds sampled in the central part of the metropolitan area, which was consistent with other epidemiologic data. The use of specific avian species as sentinels for future surveillance of SLE virus activity was suggested.

A study of relations between the absorption of amino acids, dipeptides, water and electrolytes in the normal human jejunum.

1. A double-lumen perfusion technique was used to study the effect of a wide range of concentrations of the dipeptide glycyl-L-alanine and its constituent amino acids on water and electrolyte absorption from iso-osmotic solutions in the upper jejunum of normal human subjects. 2. There was no significant absorption of water and electrolytes from sodium chloride solution (150 mmol/l) but the presence of the dipeptide or its constituent amino acids stimulated water and electrolyte absorption. 3. Water absorption reached a peak at increasing amino acid and dipeptide concentrations and then tailed off. Our data suggest that the tailing off is not solely due to the diminished sodium content of the solutions. 4. During perfusion of the dipeptide-sodium chloride and amino acid-sodium chloride solutions solute and water were absorbed as an iso-osmotic solution. Analysis of the results indicates that this could occur at high dipeptide concentrations only if the majority of the dipeptide enters the cell intact.