Comparison of emergency department and hospital admissions data for air pollution time-series studies.

BACKGROUND: Emergency department (ED) visit and hospital admissions (HA) data have been an indispensible resource for assessing acute morbidity impacts of air pollution. ED visits and HAs are types of health care visits with similarities, but also potentially important differences. Little previous information is available regarding the impact of health care visit type on observed acute air pollution-health associations from studies conducted for the same location, time period, outcome definitions and model specifications. METHODS: As part of a broader study of air pollution and health in St. Louis, individual-level ED and HA data were obtained for a 6.5 year period for acute care hospitals in the eight Missouri counties of the St. Louis metropolitan area. Patient demographic characteristics and diagnostic code distributions were compared for four visit types including ED visits, HAs, HAs that came through the ED, and non-elective HAs. Time-series analyses of the relationship between daily ambient ozone and PM2.5 and selected cardiorespiratory outcomes were conducted for each visit type. RESULTS: Our results indicate that, compared with ED patients, HA patients tended to be older, had evidence of greater severity for some outcomes, and had a different mix of specific outcomes. Consideration of 'HA through ED' appeared to more effectively select acute visits than consideration of 'non-elective HA'. While outcomes with the strongest observed temporal associations with air pollutants tended to show strong associations for all visit types, we found some differences in observed associations for ED visits and HAs. For example, risk ratios for the respiratory disease-ozone association were 1.020 for ED visits and 1.004 for 'HA through ED'; risk ratios for the asthma/wheeze-ozone association were 1.069 for ED visits and 1.106 for 'HA through ED'. Several factors (e.g. age) were identified that may be responsible, in part, for the differences in observed associations. CONCLUSIONS: Demographic and diagnostic differences between visit types may lead to preference for one visit type over another for some questions and populations. The strengths of observed associations with air pollutants sometimes varied between different health care visit types, but the relative strengths of association generally were specific to the pollutant-outcome combination.

Outbreak of campylobacteriosis at a senior center.

OBJECTIVES: In August 1997, campylobacteriosis was diagnosed in four older persons in one Connecticut town. We investigated this outbreak to determine its cause and to identify appropriate preventive measures. We also analyzed surveillance data to assess the impact of campylobacteriosis among persons age 65 years and older in Connecticut. DESIGN: The outbreak was investigated through a case-control study and an environmental investigation. Surveillance data were from population-based, active foodborne disease surveillance. SETTING: The outbreak and environmental studies were conducted at a senior center identified as the one eating place common to all four patients. Active surveillance data were from three Connecticut counties during 1996/1997. PARTICIPANTS: We administered a questionnaire to senior center attendees. A case was defined as onset of diarrhea with fever or abdominal cramps during August 20-25 in a person who ate at the senior center during August 18-20. Respondents without illness meeting the case definition who ate at the senior center during August 18-20 were controls. MEASUREMENTS: Case-control study participants were asked about symptoms of gastrointestinal illness and meals and foods eaten at the center. The environmental investigation gathered information about food preparation procedures and facilities. Active surveillance data were analyzed to determine age-specific annual campylobacteriosis incidence rates and proportions of cases involving hospitalization. RESULTS: For the case-control study, there were 66 respondents (16 case patients, 50 controls), representing approximately 52% of August 18-20 attendees. Case patients were more likely than controls to have eaten at a Hawaiian luau at the center. The most strongly implicated food was sweet potatoes. Review of food preparation procedures identified multiple opportunities for cross-contamination from raw meats to other foods. In Connecticut's active surveillance area during 1996/1997, the annual campylobacteriosis incidence rate was highest among young adults, but the proportion of hospitalized cases was highest among persons age 70 years and older. CONCLUSION: Campylobacter transmission occurred at the luau, likely because of cross-contamination in the kitchen. This investigation emphasizes the importance of strict separation of raw meats from other foods during preparation. Careful attention to these measures is particularly important when an older population is served.

Varicella outbreak at a summer camp for human immunodeficiency virus-infected children.

OBJECTIVES: Varicella can result in severe, persistent, or recurrent disease in human immunodeficiency virus (HIV)-infected children. In the summer of 1997, we were notified of a suspected varicella outbreak among attendees of a summer camp for HIV-infected children. We investigated this outbreak to determine the extent and sequelae of the outbreak, and to identify factors that contributed to the outbreak to identify measures for preventing such outbreaks at the camp in the future. DESIGN: To identify varicella-susceptible persons and those developing varicella after camp and to evaluate the camp's varicella prevention measures, we reviewed camp records for the 110 campers and 96 staff at the implicated camp session, mailed questionnaires to the campers' parents/guardians and physicians, and interviewed susceptible staff. We defined a case as varicella in a person who attended the session with onset

Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).

This report updates 1999 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (MMWR 1999;48[No. RR-4]: 1-29). These recommendations include five principal changes: a) the age for universal vaccination has been lowered to 50 years from 65 years; b) scheduling of large, organized vaccination campaigns after mid-October may be considered because the availability of vaccine in any location cannot be assured consistently in the early fall; c) 2000-2001 trivalent vaccine virus strains are A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Beijing/184/93-like strains; d) information on neuraminidase-inhibitor antiviral drugs has been added; and e) a list of other influenza-related infection control documents for special populations has been added. This report and other information on influenza can be accessed at the website for the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC at .

An engineered ribonuclease preferring phosphorothioate RNA.

We used mutants of RNase T1 and the Rp isomer of a thiosubstituted substrate to determine stereospecific thioeffects on catalysis. The analysis reveals subtle structural and functional changes in the intermolecular transition state interactions. Tyr 38 contributes to catalysis through a hydrogen bond with the pro-Rp oxygen. Y38F RNase T1 prefers the Rp thiosubstituted analog over the natural phosphodiester substrate that is favored by the wild type enzyme.

Evaluation of the cytocentrifuge Gram stain as a screening test for bacteriuria in specimens from specific patient populations.

To assess the usefulness of the cytocentrifuge Gram stain as a urine screening test in the clinical microbiology laboratory for the elimination of culture for screen-negative specimens, we compared the results of the cytocentrifuge Gram stain to the results of culture for 1,171 urine specimens. The data were analyzed separately for specimens from males (inpatients) and females (inpatients and outpatients), as well as for catheterized and voided specimens. Overall, the cytocentrifuge Gram stain had excellent negative predictive value (97.7%) and sensitivity (92.3%) at a culture threshold of 10(5) colony-forming units per milliliter or more. The negative predictive value and sensitivity decreased at lower culture thresholds in all populations. The negative predictive value decreased most markedly for female outpatients. Because of low positive predictive value and specificity, this test is not reliable as a sole indicator for presumptive therapy in many cases with positive results. If its limitations are recognized, the cytocentrifuge Gram stain is a useful screening test for the rapid exclusion of bacteriuria.

Expression and localization of Trypanosoma cruzi hsp60.

A 60-kDa heat shock protein (hsp60) is involved in mitochondrial protein folding and assembly of oligomeric protein complexes in the mitochondrial matrix. Here we report the isolation of Trypanosoma cruzi hsp60 cDNAs, the determination of the organization and chromosomal location of the genes, and the assessment of the heat-regulated expression and subcellular location of the protein. T. cruzi hsp60 is encoded by a multigene family organized in two allelic direct tandem arrays on a chromosome of 1.6 Mb. The regulation of hsp60 expression by heat is complex. While the hsp60 mRNA level is 6-fold higher at 37 degrees C than at either 26 degrees C, the hsp60 protein level remains essentially constant across all temperatures examined. Further analysis of the protein by two-dimensional immunoblotting revealed the existence of multiple isoforms that, with increasing temperature, shift in relative abundance from the more basic to the more acidic. A combination of immunofluorescence microscopy and cell fractionation was used to show that hsp60 is distributed throughout the matrix of the mitochondrion--a location distinct from that of the 70-kDa mitochondrial hsp, mtp70, which is associated with the kinetoplast.

Molecular cloning and characterization of the 78-kilodalton glucose-regulated protein of Trypanosoma cruzi.

The protozoan Trypanosoma cruzi is the etiologic agent of Chagas' disease, an illness responsible for morbidity and death among millions of Latin Americans. Mice also develop this disease when infected with T. cruzi and are a useful model organism for the study of parasite-specific immune responses. To identify immunogenic T. cruzi antigens, serum from an infected mouse was used to isolate clones from a T. cruzi epimastigote cDNA expression library. One of these clones was found to encode the 78-kDa glucose-regulated protein (grp78), the endoplasmic reticular member of the 70-kDa heat shock protein (hsp70) family. Like the mammalian and yeast grp78s, the T. cruzi protein contains an endoplasmic reticular leader peptide and a carboxyl-terminal endoplasmic reticular retention sequence. T. cruzi grp78 is encoded by a tandemly arranged family of three genes located on a chromosome of 1.6 Mb. The effects on grp78 expression of heat shock and tunicamycin treatment, the latter of which specifically stimulates mammalian grp78, were investigated. While the level of the grp78 protein remained constant under all circumstances, grp78 mRNA was unaffected by heat shock but induced fivefold by tunicamycin. Finally, we found that grp78 is the most immunogenic of the T. cruzi heat shock proteins we have characterized, reacting strongly in immunoblots with sera from infected mice.

Molecular and biochemical comparison of the 70-kDa heat shock proteins of Trypanosoma cruzi.

An analysis of the genetic organization, regulated expression and biochemical properties of the cytoplasmic/nuclear (hsp70) and mitochondrial (mtp70) 70-kDa heat shock proteins of Trypanosoma cruzi is presented. The two proteins are encoded by tandemly arranged gene families that are located on different chromosomes. Both are mildly heat-inducible but have different optimal temperatures for expression. During the switch from proliferation to differentiation that occurs during the growth of T. cruzi in culture, the hsp70 level decreases dramatically while the mtp70 level falls only slightly. The subcellular locations of the two proteins differ during heat shock. While mtp70 remains associated with the kinetoplast at all temperatures, hsp70 becomes more concentrated in the nucleus at higher temperatures. Biochemical analysis of hsp70 and mtp70 revealed both to be potent ATPases. Each protein binds ATP with a Km of about 70 microM and hydrolyzes ATP with a kcat of about 100 min-1, 100 times greater than the kcat of human hsp70. The high ATPase activities of hsp70 and mtp70 are further stimulated by incubation with peptides, suggesting that these trypanosome heat shock proteins have protein chaperone activity. Finally, mtp70, but not hsp70, was found to possess autophosphorylation activity in vitro, a property that it shares with prokaryotic hsp70. These findings demonstrate unique cellular and biochemical characteristics of T. cruzi mtp70 and hsp70 that suggest that they play distinct physiologic roles in the biology of the cell.