Counter-stereotypical messaging and partisan cues: Moving the needle on vaccines in a polarized United States.

This paper reports results from a large-scale randomized controlled trial assessing whether counter-stereotypical messaging and partisan cues can induce people to get COVID-19 vaccines. The study used a 27-s video compilation of Donald Trump's comments about the vaccine from Fox News interviews and presented the video to millions of U.S. YouTube users through a $100,000 advertising campaign in October 2021. Results indicate that the number of vaccines increased in the average treated county by 103 (with a one-tailed P value of 0.097). Based on this average treatment effect and totaling across our 1014 treated counties, the total estimated effect was 104,036 vaccines.

Elite rhetoric can undermine democratic norms.

Democratic stability depends on citizens on the losing side accepting election outcomes. Can rhetoric by political leaders undermine this norm? Using a panel survey experiment, we evaluate the effects of exposure to multiple statements from former president Donald Trump attacking the legitimacy of the 2020 US presidential election. Although exposure to these statements does not measurably affect general support for political violence or belief in democracy, it erodes trust and confidence in elections and increases belief that the election is rigged among people who approve of Trump's job performance. These results suggest that rhetoric from political elites can undermine respect for critical democratic norms among their supporters.

Measuring the cost and effect of current community consultation and public disclosure techniques in emergency care research.

AIM: U.S. federal regulations for research involving exception from informed consent (EFIC) include stipulations for community consultation (CC) and public disclosure (PD) (FDA 21 CFR 50.24). Published descriptions of PD campaigns include letters to community leaders, media outreach, paid advertising, and community meetings. Whether or not these activities provide measurable impact is unknown, as few prior works have evaluated PD activities with probabilistic polling. The aim of this study is to use polling to assess how much public awareness PD efforts generate. METHODS: A 3-month PD campaign similar in scope and scale to PD campaigns described in several recent publications was implemented across a large urban county (pop. 2.55 million). PD included a study website (www.evktrial.org), letters to 300 community leaders/organizations, bilingual media outreach and also phased roll-outs, weeks apart, of newspaper advertisements, mass e-mail messaging, and paid advertising in Facebook® and Twitter® augmented by volunteer social media outreach. During PD we used repeated zip code-targeted online polling via Google Consumer Surveys® to assess community awareness of the proposed EFIC study. RESULTS: Over 3-months all-source exposures to >1 million individuals were estimated, generating ∼5,000 website visits (12-month cumulative, ∼9000). However, general community awareness evaluated through repeated county-wide polling never rose above baseline measurements. CC/PD campaign costs were estimated at $60,000 (USD). CONCLUSION: A PD campaign in scope and scale common for EFIC studies may not provide measurable impact in a community. Investigators, review boards and regulators could consider these findings when re-examining and/or creating policies for PD for EFIC studies.

Factors Associated with Early Thrombosis after Arteriovenous Fistula Creation.

BACKGROUND: Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence and identify factors associated with early thrombosis of AVF and to determine salvage rates following thrombosis, at a high-volume hemodialysis access center. METHODS: Retrospective review of autologous AVF was created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery. RESULTS: There were 291 AVFs. The median age was 54.7 years, and 192 patients (66%) were male. Early postoperative AVF thrombosis was noted in 5 (1.7%) cases. Factors associated with early thrombosis on univariate analysis included previous access surgery (P = 0.02) and absence of a good intraoperative thrill (P = 0.006). Intraoperative protamine use trended toward significance (P = 0.06). Factors that were not significant included gender, diabetes, dialysis at time of surgery, fistula configuration, and systemic heparin use. None of the thrombosed fistulas were salvaged. CONCLUSIONS: Early thrombosis is a relatively rare complication of AVF creation at a high-volume center. Previous access surgery and absence of good thrill at conclusion of the procedure are associated with early thrombosis.

Improved hearing protector attenuation through the use of a lubricant.

A study of 40 novice hearing protection users was conducted to determine if the use of a lubricant with hearing protective plugs would enhance their attenuation. Three types of hearing protection devices (i.e., earplugs) were evaluated: roll-down PVC foam, mushroom-style polyurethane foam, and elastomeric flanged. For each earplug type, the right and left ear (dry and lubricated, respectively) personal attenuation rating was determined using a commercially available microphone in real-ear apparatus. Earplug efficacy was observed to increase in the presence of a lubricant for all 3 plug types, with average mean elevations by earplug type ranging from 1.5-5.1 dB. Two of three earplug types saw statistically significant improvements when used with lubrication, demonstrating heightened mean personal attenuation ratings of 2.8 dB and 5.1 dB. The issues of handedness and gender differences (vis à vis ear canal size) are explored, and the importance of proper fitting is discussed in detail. Several specific questions yet to be answered are posed, and directions for further research indicated.

Significance of Blunted Venous Waveforms Seen on Upper Extremity Ultrasound.

BACKGROUND: Current guidelines recommend vascular mapping ultrasound (US) prior to arteriovenous fistula creation. Blunted venous waveforms (BVWs) suggest central venous stenosis; however, this relationship and one between BVWs and the presence of a central venous catheter (CVC) remain unclear. METHODS: All patients who received upper extremity vascular mapping US between January 2013 and October 2014 at a single institution were retrospectively reviewed. Patient demographics, comorbidities, US results, pacemaker history, and CVC status were collected. Waveforms were assessed at the proximal subclavian vein/distal axillary vein and interpreted by radiologists. Patients were determined to have central venous stenosis (CVS) if detected by venography within 6 months of US. RESULTS: There were 342 patients, of which 165 (48%) had a current CVC and 29 (8.5%) had BVW of at least 1 arm. Right-sided BVW were associated with a history of a prior ipsilateral CVC (odds ratio [OR] = 4.5, 95% confidence interval [CI] = 1.6-12.6, P = 0.009). Of the 342 patients, 69 (20%) had a venogram within 6 months. Seventeen (25%) of the 69 patients had CVS, with 7 involving the left subclavian vein, 8 the right subclavian vein, and 3 the superior vena cava (one patient had tandem stenoses). A BVW on the left side was not associated with any CVS. A BVW on the right side was associated with an ipsilateral CVS (OR = 5.8, 95% CI = 1.2-27.4, P = 0.04). This association persisted in the setting of a prior CVC (relative risk = 1.3, 95% CI = 0.9-2, P = 0.01). CONCLUSIONS: There are associations between right-sided BVW and an ipsilateral subclavian vein stenosis. We recommend that hemodialysis access planning includes venography to rule out central vein stenosis in patients with BVW, especially if right-sided and in the setting of a prior CVC.

Community-associated methicillin-resistant Staphylococcus aureus in college residential halls.

Methicillin-resistant Staphylococcus aureus (MRSA) was once a predominantly hospital-acquired organism but community-associated MRSA (CA-MRSA) has become a concern in athletics, prisons, and other nonclinical closed populations. As such, college residential hall occupants and workers may be at elevated risk of spreading or contracting MRSA. Environmental samples were obtained to identify the occurrence of MRSA on surfaces in bathrooms of 15 university residential halls. Sterile swabs and BBL CHROMagar plates were used to sample seven categories of potentially contaminated surfaces in each location. Frequencies and descriptive statistics were prepared. All sites had at least one positive sample for MRSA, and shower floors displayed the greatest prevalence (50%). These results indicate areas for heightened sanitation, and illustrate CA-MRSA potential from such surfaces. The need for hygiene education of affected persons about skin and soft tissue infections like MRSA, and intervention opportunities for public health professionals, are discussed.

Dominant microbial volatile organic compounds in 23 US homes.

Associating Microbial Volatile Organic Compounds (MVOCs) with the species producing them may open the path to more rapid and reliable chemical methods to detect mold problems, especially for mold hidden in wall cavities or small enclosed spaces. This study associated the dominant MVOCs in a convenience sample of 23 homes with the mold species present. Three semi-quantitative predictors of mold growth ("MOW scores") were assessed in the homes through a comparison of basement to main floor areas. MVOC samples were collected and analyzed by GC/MS. Aerotek N-6 samplers were co-located with the MVOC samplers to collect bioaerosols. Concentration and prevalence data for 19 definitive MVOCs were compared with the bioaerosol data. Mold predictor scores were elevated in basement locations as compared with main floor areas. Of the 23 mold genera identified, the predominant genera (ranked occurrences) were Cladosporium, Penicillium, Basidiomycetes, and Aspergilli. The MVOCs 2-octen-1-ol, 3-octenone, 2-heptanone, 1-octen-3-ol, and 1-butanol showed the highest average concentrations (11-37 µg m(-3)), but no single MVOC was significantly elevated in basement locations as compared with main floor living areas in these non-problematic homes. Using a less conservative one-tail test of significance, average 2-octen-1-ol concentrations in basements were higher (p<0.040), and both 3-octenone and 1-octen-3-ol were elevated (p<0.095). Differences in MVOC occurrence were greatest between homes, with MVOCs found in basement locations typically detected in living areas at similar concentrations and frequencies. Based on these findings, the C(8) MVOCs show promise as gross indicators of fungal growth related to the most frequently found mold genera.

Residential carbon monoxide detector failure rates in the United States.

There are more than 38 million residential carbon monoxide detectors installed in the United States. We tested 30 detectors in use and found that more than half failed to function properly, alarming too early or too late. Forty percent of detectors failed to alarm in hazardous concentrations, despite outward indications that they were operating as intended. Public health professionals should consider community education concerning detector use and should work with stakeholders to improve the reliability and accuracy of these devices.

Prevalence of community-associated methicillin-resistant Staphylococcus aureus in high school wrestling environments.

Methicillin-resistant Staphylococcus Aureus (MRSA) was predominantly a hospital-acquired organism; recently, however, community-associated MRSA (CA-MRSA) has been causing outbreaks in otherwise healthy individuals involved in athletics. As such, CA-MRSA is of emerging concern to sanitarians and public health officials. Secondary school athletic trainers and student athletes may be at elevated risk of spreading or contracting MRSA. The absence of proper hygiene protocols or equipment may further increase this risk. In the study discussed in this article, environmental samples were obtained to identify the prevalence of MRSA on surfaces in high school athletic training and wrestling facilities mats in nine rural Ohio high schools. Frequencies and descriptive statistics were prepared. All nine (100%) of the sites tested had at least one positive sample for the presence of MRSA. The need for heightened sanitation, hygiene education of affected persons about skin and soft tissue infections like MRSA, and intervention opportunities for public health professionals are discussed.

Assessment of athletic health care facility surfaces for MRSA in the secondary school setting.

Methicillin-resistant Staphylococcus aureus (MRSA) was once largely a hospital-acquired infection, but increasingly, community-associated MRSA (CA-MRSA) is causing outbreaks among otherwise healthy people in athletic settings. Secondary school athletic trainers, student athletes, and the general student population may be at elevated risk of MRSA infection. To identify the prevalence of MRSA on surfaces in high school athletic training settings, 10 rural high school athletic training facilities and locker rooms were sampled for MRSA. Results showed 90% of facilities had two or more positive MRSA surfaces, while one school had no recoverable MRSA colonies. Of all surfaces tested (N=90), 46.7% produced a positive result. From this limited sample, it is evident that significant exposure opportunities to MRSA exist in athletic training clinics and adjacent facilities for both the patient and the clinician. Furthermore, the findings point to the need for community hygiene education about skin and soft tissue infections like MRSA.

Video exposure assessments demonstrate excessive laboratory formaldehyde exposures.

Video exposure assessments were conducted in a comparative anatomy laboratory using formaldehyde-preserved sharks and cats. Work in the facility using time-integrated samplers indicated personal and area concentrations generally below the current OSHA permissible exposure limit. However, complaints about room air quality were frequent and routine. Using a photoionization detector with an integral data logger, total ionizables present were sampled as a surrogate for formaldehyde. After synchronizing time tracks from the datalogger concentrations with simultaneously created videotapes of laboratory tasks, composite video exposure overlays were generated. Use of this video exposure method revealed very short-lived, excessively high peak exposure events, whereas conventional time-weighted averages indicated the majority (30/32) of personal exposures were below the OSHA limit of 0.75 ppm. These legally acceptable exposure levels were associated with self-reported symptoms of burning nose and eyes and eye irritation. Thus, transient peak formaldehyde concentrations not detected by longer term averaging studies could be responsible for the health effects reported. The video exposure monitoring method demonstrated that close dissection work, opening peritoneal cavities, and specimen selection activities were most likely the causes of elevated student exposures. Teaching assistants' exposures were the highest, exceeding OSHA limits on several occasions. The utility of the video monitoring method for conducting enhanced, critical task exposure assessments is discussed.

Survey of waste comminglers' VOC exposures.

Twelve U.S. universities performing hazardous waste solvent commingling operations were surveyed for waste handler exposures to 45 U.S. Environmental Protection Agency (EPA)-designated volatile organic compounds (VOCs). Personal exposures (n = 33) and area concentrations (n = 30) were determined using gas chromatography/ mass spectrometry (GC/MS) analysis of passively collected samples. Air monitoring data were used to determine the veracity of laboratory-generated reports of waste container contents. Participants completed a questionnaire concerning the use of personal protective equipment, ventilation, and other appropriate safety equipment for their specific commingling operation. Follow-up telephone interviews were conducted to elucidate safeguards in place. Results showed that personal exposures exceeded area concentrations in 70% of operations. For the contaminant concentrations reported, 17% of personal samples exceeded Occupational Safety & Health Administration (OSHA) time-weighted average or ceiling limit values. Methylene chloride was a frequently seen airborne contaminant not listed on drum inventory sheets. When airborne constituents were compared with container content tags, 44% of the chemicals detected in air were omitted from the waste tags. This study concluded that the most frequently necessary safeguard is respiratory protection, preferably a supplied-air-type. The use of local exhaust ventilation systems rather than dilution or natural systems and facility operation in a totally explosion-safe manner are also recommended.

VOC exposures in a mixed-use university art building.

Despite a sizable educational art enterprise in the United States there is a dearth of rigorously performed studies of exposures to persons engaged in such activities. Exposures to 45 EPA-designated volatile organic compounds were examined in printmakers in a mixed-use university art school served by a 100% exhausted mechanical ventilation system. Personal exposures (n = 90) were compared with area concentrations (n = 36) in the studio area and at a second location at the same facility. For personal exposure assessments a cohort of 12 students wore passive dosimeters twice weekly over a 6-week period. Numerous compounds were found, the most prevalent being toluene at an average concentration of 64.6 microg/m3 (17.1 ppb; range < 1-319 ppb); 1,1,1, trichloroethane at 40.5 microg/m3 (7.5 ppb; range < 1-211 ppb); xylenes at 8.0 microg/m3 (1.8 ppb; range < 1-43 ppb); 1,3,5-trimethyl benzene at 6.2 microg/m3 (1.3 ppb; range < .3-32 ppb); propyl benzene at 5.0 microg/m3 (1.0 ppb; range < .5-27 ppb); methylene chloride at 4.9 microg/m3 (1.4 ppb; range < 1-10 ppb); and ethyl benzene at 4.5 microg/m3 (1.1 ppb; range < .4-23 ppb). Personal exposures were considerably higher than average area air concentrations, with the exception of methylene chloride concentrations, which were five times higher at the print cleaning operation. Floors where solvents were not used had no detectable exposures (typical lower limit of detection approximately 1 ppb) and were free of solvent odors. Despite frequent solvent contact with skin, personal protective equipment was seldom used. Results indicate that in mixed-use facilities such as this, nonrecirculating general ventilation systems can effectively eliminate indoor air quality issues between floors, despite perceptible odors on solvent use floors. For total exposure assessments in such processes, contact exposures from printmaking solvents during cleaning procedures are a potentially important consideration.