Evidence of a range expansion in sunfish from 47 years of coastal sightings.

Almost nothing is known about the historical abundance of the ocean sunfish. Yet as an ecologically and functionally important taxa, understanding changes in abundance may be a useful indicator of how our seas are responding to anthropogenic changes including overfishing and climate change. Within this context, sightings from a coastal bird observatory (51.26 ∘ N, 9.30 ∘ W) over a 47 year period (from April to October 1971-2017) provided the first long-term index of sunfish abundance. Using a general linear mixed effect model with a hurdle to deal with imperfect detectability and to model trends, a higher probability of detecting sunfish was found in the 1990s and 2000s. Continuous Plankton Recorder (CPR) phytoplankton color indices and the annual mean position of the 13  ∘ C sea surface isotherm were significantly correlated with the probability of detecting sunfish. An increase in siphonophore abundance (as measured by the CPR) was also documented. However, this increase occurred 10-15 years after the sunfish increase and was not significantly correlated with sunfish abundance. Our results suggest that the observed increase in sunfish sightings is evidence of a range expansion because it was significantly correlated with the mean position of the 13 ∘ C isotherm which moved northwards by over 200 km. Furthermore, the observed increase in sunfish occured  10 years before sunfish sightings are documented in Icelandic and Norwegian waters, and was concurrent with well-known range expansions for other fish species during the 1990s. This study demonstrates how sustained citizen science projects can provide unique insights on the historical abundance of this enigmatic species. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00227-021-04005-8.

Cancer incidence surrounding the former Apollo nuclear facility 1990-2010.

Environmental radiation releases from a nuclear fuel fabrication facility in Apollo, Pennsylvania may have exposed the surrounding population to ionizing radiation. This study characterizes cancer incidence in the population living near the nuclear facility between 1990 and 2010. Cancer incidence in the minor civil divisions surrounding the Apollo facility was compared to a standard population of the state of Pennsylvania adjusted for calendar year, age, sex, and race. Bias due to residential misclassification was considered by adjustment of case count. We also evaluated whether birth cohort effects or changes in population distribution over time affected the standardized incidence rate ratio (SIR). From 1990 to 2010, the observed rate of cancer incidence among males in the Apollo area was 1.56 (95% CI 1.47-1.66) times the expected cancer rate, and among females was 1.38 (95% CI 1.30-1.47) times the expected cancer rate. Accounting for residential misclassification, the SIR for males and females combined was 1.16 (95% CI 1.10-1.21). Residents who were members of earlier birth cohorts had similar SIRs to those born later. This research suggests that cancer incidence among the population surrounding the former Apollo nuclear facility is greater than expected based on statewide rates.

Mishaps and unsafe conditions in recreational scuba diving and pre-dive checklist use: a prospective cohort study.

BACKGROUND: Recreational scuba diving involves the use of complex instruments and specialized skills in an unforgiving environment. Errors in dive preparation in such an environment may lead to unsafe conditions, mishaps, injuries and fatalities. Diving mishaps can be major and minor based on their potential to cause injury and the severity of the resulting injury. The objective of this study is to assess the incidence of diving mishaps and unsafe conditions, and their associations with the participants' routine use of their own checklists. METHODS: Between June and August 2012, 426 divers participated in the control group of a randomized trial to evaluate the effectiveness of an intervention pre-dive checklist. The current nested analysis prospectively follows the control participants, who did not receive the intervention checklist. Poisson regression models with generalized estimating equations were used to estimate rate ratios comparing written checklist use with memorized and no checklist use. RESULTS: The overall incidence of major mishaps and minor mishaps was 11.2 and 18.2 per 100 dives, respectively. Only 8% participants reported written checklist use, 71% reported using memorized checklists, and 21% did not use any checklist. The rate ratio for written checklist use as compared to using a memorized or no checklist was 0.47 (95%CI: 0.27, 0.83) for all mishaps (major and minor combined), and 0.31 (95% CI: 0.10, 0.93) for major mishaps. The rate of mishaps among memorized checklist users was similar to no checklist users. CONCLUSION: This study reinforces the utility of written checklists to prevent mishaps and, potentially, injuries and fatalities.

Assessing the Potential for Bias From Nonresponse to a Study Follow-up Interview: An Example From the Agricultural Health Study.

Prospective cohort studies are important tools for identifying causes of disease. However, these studies are susceptible to attrition. When information collected after enrollment is through interview or exam, attrition leads to missing information for nonrespondents. The Agricultural Health Study enrolled 52,394 farmers in 1993-1997 and collected additional information during subsequent interviews. Forty-six percent of enrolled farmers responded to the 2005-2010 interview; 7% of farmers died prior to the interview. We examined whether response was related to attributes measured at enrollment. To characterize potential bias from attrition, we evaluated differences in associations between smoking and incidence of 3 cancer types between the enrolled cohort and the subcohort of 2005-2010 respondents, using cancer registry information. In the subcohort we evaluated the ability of inverse probability weighting (IPW) to reduce bias. Response was related to age, state, race/ethnicity, education, marital status, smoking, and alcohol consumption. When exposure and outcome were associated and case response was differential by exposure, some bias was observed; IPW conditional on exposure and covariates failed to correct estimates. When response was nondifferential, subcohort and full-cohort estimates were similar, making IPW unnecessary. This example provides a demonstration of investigating the influence of attrition in cohort studies using information that has been self-reported after enrollment.

Hydrogen sulfide concentrations at three middle schools near industrial livestock facilities.

Safe school environments are essential for healthy development, yet some schools are near large-scale livestock facilities that emit air pollution. Hydrogen sulfide (H2S) from decomposing manure is an indicator of livestock-related air pollution. We measured outdoor concentrations of H2S at three public middle schools near livestock facilities in North Carolina. We used circular graphs to relate H2S detection and wind direction to geospatial distributions of nearby livestock barns. We also used logistic and linear regression to model H2S in relation to upwind, distance-weighted livestock barn area. Circular graphs suggested an association between upwind livestock barns and H2S detection. The log-odds of H2S detection per 1000 m2 increased with upwind weighted swine barn area (School A: ß-coefficient (ß)=0.43, SE=0.06; School B: ß=0.64, SE=0.24) and upwind weighted poultry barn area (School A: ß=0.05, SE=0.01), with stronger associations during periods of atmospheric stability than atmospheric instability (School A stable: ß=0.69, SE=0.11; School A unstable: ß=0.32, SE=0.09). H2S concentration also increased linearly with upwind swine barn area, with greater increases during stable atmospheric conditions (stable: ß=0.16 parts per billion (p.p.b.), SE=0.01; unstable: ß=0.05 p.p.b., SE=0.01). Off-site migration of pollutants from industrial livestock operations can decrease air quality at nearby schools.

Worker Alienation and Compensation at the Savannah River Site.

Corporations operating U.S. nuclear weapons plants for the federal government began tracking occupational exposures to ionizing radiation in 1943. However, workers, scholars, and policy makers have questioned the accuracy and completeness of radiation monitoring and its capacity to provide a basis for workers' compensation. We use interviews to explore the limitations of broad-scale, corporate epidemiological surveillance through worker accounts from the Savannah River Site nuclear weapons plant. Interviewees report inadequate monitoring, overbearing surveillance, limited venues to access medical support and exposure records, and administrative failure to report radiation and other exposures at the plant. The alienation of workers from their records and toil is relevant to worker compensation programs and the accuracy of radiation dose measurements used in epidemiologic studies of occupational radiation exposures at the Savannah River Site and other weapons plants.

Science for Reducing Health Inequalities Emerges From Social Justice Movements.

Although the health sciences have investigated economic and social inequalities in morbidity and mortality for hundreds of years, health inequalities persist and are, by some measures, increasing. This is not simply a situation in which the knowledge exists but is not implemented. Rather, science in general and epidemiology in particular have focused on quantifying the effects of specific agents considered in isolation. This approach is powerful, but, in the absence of ecological concepts that connect parts and wholes, contributes to maintaining health inequalities. By joining movements for human rights and social justice, health scientists can identify research questions that are relevant to public health, develop methods that are appropriate to answering those questions, and contribute to efforts to reduce health inequalities.

Fish Consumption Patterns and Mercury Advisory Knowledge Among Fishers in the Haw River Basin.

BACKGROUND: Fish consumption has numerous health benefits, with fish providing a source of protein as well as omega-3 fatty acids. However, some fish also contain contaminants that can impair human health. In North Carolina, the Department of Health and Human Services has issued fish consumption advisories due to methylmercury contamination in fish. Little is known about local fishers' consumption patterns and advisory adherence in North Carolina. METHODS: We surveyed a consecutive sample of 50 fishers (74.6% positive response rate) who reported eating fish caught from the Haw River Basin or Jordan Lake. They provided information on demographic characteristics, species caught, and the frequency of local fish consumption. Additionally, fishers provided information on their knowledge of fish consumption advisories and the impact of those advisories on their fishing and fish consumption patterns. RESULTS: The majority of participants were male (n = 44) and reported living in central North Carolina. Catfish, crappie, sunfish, and large-mouth bass were consumed more frequently than other species of fish. Of the fishers surveyed, 8 reported eating more than 1 fish meal high in mercury per week, which exceeds the North Carolina advisory recommendation. Most participants (n = 32) had no knowledge of local fish advisories, and only 4 fishers reported that advisories impacted their fishing practices. LIMITATIONS: We sampled 50 fishers at 11 locations. There is no enumeration of the dynamic population of fishers and no way to assess the representativeness of this sample. CONCLUSIONS: Additional outreach is needed to make local fishers aware of fish consumption advisories and the potential health impacts of eating high-mercury fish, which may also contain other persistent and bioaccumulative toxins.

The effect of using a pre-dive checklist on the incidence of diving mishaps in recreational scuba diving: a cluster-randomized trial.

BACKGROUND: Scuba diving mishaps, caused by equipment problems or human errors, increase the occurrence of injuries and fatalities while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers. METHODS: A multi-location cluster-randomized trial with parallel groups and allocation concealment was conducted between 1 June and 17 August 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received a pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates per 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol and marginal structural model analyses were conducted. RESULTS: A total of 1043 divers (intervention = 617; control = 426) made 2041 dives, on 70 location-days (intervention = 40; control = 30) at four locations. Compared with the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26% and all mishaps by 32%. On average, there was one fewer mishap in every 25 intervention dives. CONCLUSIONS: In this trial, pre-dive checklist use prevented mishaps which could lead to injuries and fatalities. Pre-dive checklists can increase diving safety and their use should be promoted. Trial Registration: ClinicalTrials.gov ID NCT01960738.

Factors influencing adherence to pre-dive checklists among recreational scuba divers.

Pre-dive checklists can prevent mishaps, injuries, and deaths in recreational scuba diving. However, the prevalence of checklist use remains low. Understanding the environmental and individual factors influencing a diver's checklist use may help in promoting checklists. In the summer of 2012, 617 divers were enrolled in the intervention group of a cluster randomized trial. The divers received an intervention pre-dive checklist to use before they made dives. Logistic regression analyses were used to model adherence to pre-dive checklist with generalized estimating equations. About 70% divers (n=430) adhered to the intervention pre-dive checklist. Factors associated with greater adherence were the use of a diver's own written self-checklist - odds ratio (OR) = 2.48 (95% confidence interval: 0.95, 6.44), older age (⟩ 35 years) - OR = 1.67 (1.15, 2.42), and higher average annual dives (6-10 dives vs. 0-5 dives) - OR = 1.87 (1.09, 3.21). Factors associated with lower adherence were diving in North Carolina as compared to the Caribbean - OR = 0.42 (0.20, 0.85), non-white race - OR = 0.54 (0.27, 1.09), and female gender - OR = 0.77 (0.54, 1.12). Checklist adherence is also a function of risk perception, facilitators, and barriers. Future studies should try to understand diver risk perceptions, promote facilitators, and reduce barriers to foster the use of pre-dive checklists.

Pig-2-Bac as a biomarker of occupational exposure to pigs and livestock-associated Staphylococcus aureus among industrial hog operation workers.

Over 50 million hogs are raised annually in the United States for consumption, mostly on industrial hog operations (IHOs). Workers at IHOs are exposed to airborne particulates, zoonotic pathogens, and other workplace hazards, but lack of access to IHOs can hinder exposure assessment in epidemiologic studies. Here, we demonstrate the utility of pig-specific Bacteroidales (Pig-2-Bac) as a biomarker of exposure to pigs and pig waste and to help identify sources of Staphylococcus aureus carriage among IHO workers.

Data quality from a longitudinal study of adolescent health at schools near industrial livestock facilities.

PURPOSE: Longitudinal designs enable examination of temporal relationships between exposures and health outcomes, but extended participation can cause study fatigue. We present an approach for analyzing data quality and study fatigue in a participatory, longitudinal study of adolescents. METHODS: Participants (n = 340) in the Rural Air Pollutants and Children's Health study completed daily diaries for 3 to 5 weeks in 2009 while we monitored outdoor pollutant concentrations. We used regression models to examine established associations between disease, symptoms, anthropometrics, and lung function as indicators of internal consistency and external validity. We modeled temporal trends in data completeness, lung function, environmental odors, and symptoms to assess study fatigue. RESULTS: Of 5728 records, 94.2% were complete. Asthma and allergy status were associated with asthma-related symptoms at baseline and during follow-up, for example, prevalence ratio = 8.77 (95% confidence interval: 4.33-17.80) for awakening with wheeze among diagnosed asthmatics versus nonasthmatics. Sex, height, and age predicted mean lung function. Plots depicting outcome reporting over time and associated linear trends showed time-dependent declines for most outcomes. CONCLUSIONS: We achieved data completeness, internal consistency, and external validity, yet still observed study fatigue, despite efforts to maintain participant engagement. Future investigators should model time trends in reporting to monitor longitudinal data quality.

Source tracking swine fecal waste in surface water proximal to swine concentrated animal feeding operations.

Swine farming has gone through many changes in the last few decades, resulting in operations with a high animal density known as confined animal feeding operations (CAFOs). These operations produce a large quantity of fecal waste whose environmental impacts are not well understood. The purpose of this study was to investigate microbial water quality in surface waters proximal to swine CAFOs including microbial source tracking of fecal microbes specific to swine. For one year, surface water samples at up- and downstream sites proximal to swine CAFO lagoon waste land application sites were tested for fecal indicator bacteria (fecal coliforms, Escherichia coli and Enterococcus) and candidate swine-specific microbial source-tracking (MST) markers (Bacteroidales Pig-1-Bac, Pig-2-Bac, and Pig-Bac-2, and methanogen P23-2). Testing of 187 samples showed high fecal indicator bacteria concentrations at both up- and downstream sites. Overall, 40%, 23%, and 61% of samples exceeded state and federal recreational water quality guidelines for fecal coliforms, E. coli, and Enterococcus, respectively. Pig-1-Bac and Pig-2-Bac showed the highest specificity to swine fecal wastes and were 2.47 (95% confidence interval [CI]=1.03, 5.94) and 2.30 times (95% CI=0.90, 5.88) as prevalent proximal down- than proximal upstream of swine CAFOs, respectively. Pig-1-Bac and Pig-2-Bac were also 2.87 (95% CI=1.21, 6.80) and 3.36 (95% CI=1.34, 8.41) times as prevalent when 48 hour antecedent rainfall was greater than versus less than the mean, respectively. Results suggest diffuse and overall poor sanitary quality of surface waters where swine CAFO density is high. Pig-1-Bac and Pig-2-Bac are useful for tracking off-site conveyance of swine fecal wastes into surface waters proximal to and downstream of swine CAFOs and during rain events.

Persistence of livestock-associated antibiotic-resistant Staphylococcus aureus among industrial hog operation workers in North Carolina over 14 days.

OBJECTIVES: This study aimed to evaluate the persistence of nasal carriage of Staphylococcus aureus, methicillin-resistant S. aureus and multidrug-resistant S. aureus over 14 days of follow-up among industrial hog operation workers in North Carolina. METHODS: Workers anticipating at least 24 h away from work were enrolled June-August 2012. Participants self-collected a nasal swab and completed a study journal on the evening of day 1, and each morning and evening on days 2-7 and 14 of the study. S. aureus isolated from nasal swabs were assessed for antibiotic susceptibility, spa type and absence of the scn gene. Livestock association was defined by absence of scn. RESULTS: Twenty-two workers provided 327 samples. S. aureus carriage end points did not change with time away from work (mean 49 h; range >0-96 h). Ten workers were persistent and six were intermittent carriers of livestock-associated S. aureus. Six workers were persistent and three intermittent carriers of livestock-associated multidrug-resistant S. aureus. One worker persistently carried livestock-associated methicillin-resistant S. aureus. Six workers were non-carriers of livestock-associated S. aureus. Eighty-two per cent of livestock-associated S. aureus demonstrated resistance to tetracycline. A majority of livestock-associated S. aureus isolates (n=169) were CC398 (68%) while 31% were CC9. No CC398 and one CC9 isolate was detected among scn-positive isolates. CONCLUSIONS: Nasal carriage of livestock-associated S. aureus, multidrug-resistant S. aureus and methicillin-resistant S. aureus can persist among industrial hog operation workers over a 14-day period, which included up to 96 h away from work.

Odors from sewage sludge and livestock: associations with self-reported health.

OBJECTIVES: Class B treated sewage sludge (TSS) contains microbes and toxicants and is applied to land in areas where livestock wastes may be present. We evaluated relationships of reports of TSS and livestock odors with acute symptoms and excessive flies. METHODS: A total of 158 adults living near liquid TSS application sites, 85 living near cake TSS application sites, and 188 living in comparison areas responded to a household survey regarding odors, health, and demographics. We identified symptom groups using factor analysis. We used generalized estimating equations to fit linear models for associations between factor scores and odors, and Poisson models for associations with specific symptoms. RESULTS: Most factor scores were similar between exposure groups. Covariate-adjusted z-scores for lower respiratory symptoms were 0.28 (95% confidence interval [CI] -0.10, 0.65) higher among residents who reported moderate to very strong liquid TSS odor than among residents in comparison areas, and 0.28 (95% CI 0.05, 0.50) higher among residents who reported moderate to very strong livestock odor compared with residents reporting no or faint livestock odor. The factor score for dermatologic conditions was higher among residents who reported higher liquid sludge odor (0.27, 95% CI -0.13, 0.68), primarily due to skin rash (prevalence ratio = 2.21, 95% CI 1.13, 4.32). Excessive flies were reported twice as commonly among respondents who reported moderate to very strong TSS odor than among other residents. CONCLUSIONS: Reported odors from TSS and livestock were associated with some acute symptoms. Health departments should monitor land applications of human and animal wastes and conduct surveillance of health problems reported by neighbors.

Challenges and benefits of conducting environmental justice research in a school setting.

Environmental justice (EJ) research requires attention to consequences for research participants beyond those typically considered by institutional review boards. The imbalance of power between impacted communities and those who create and regulate pollution creates challenges for participation, yet research can also benefit those involved. Our community-academic partnership designed the Rural Air Pollutants and Children's Health (RAPCH) study to provide positive impacts while measuring health effects at three low-resource public middle schools near concentrated animal feeding operations (CAFOs) in North Carolina. We evaluated perceived benefits and challenges of study involvement by interviewing school staff and community liaisons who facilitated data collection. Reported benefits included enhancement of students' academic environment and increased community environmental awareness; challenges were associated mainly with some participants' immaturity. Leadership from a strong community-based organization was crucial to recruitment, yet our approach entailed minimal focus on EJ, which may have limited opportunities for community education or organizing for environmental health.

A case control study of environmental and occupational exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region.

BACKGROUND: Distinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina. METHODS: MRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). Participants were interviewed about recent environmental and occupational exposures. Home addresses were geocoded and publicly available data were used to estimate the density of swine in residential census block groups of residence. Conditional logistic regression models were used to derive odds ratio (OR) estimates and 95% confidence intervals (CI). Presence of the scn gene in MRSA isolates was assessed. In addition, multi locus sequence typing (MLST) of the MRSA isolates was performed, and the Diversilab® system was used to match the isolates to USA pulsed field gel electrophoresis types. RESULTS: From July - December 2011, 117 cases and 119 controls were enrolled. A higher proportion of controls than cases were current workforce members (41.2% vs. 31.6%) Cases had a higher odds of living in census block groups with medium densities of swine (OR: 4.76, 95% CI: 1.36-16.69) and of reporting the ability to smell odor from a farm with animals when they were home (OR: 1.51, 95% CI: 0.80-2.86). Of 49 culture positive MRSA isolates, all were scn positive. Twenty-two isolates belonged to clonal complex 5. CONCLUSIONS: Absence of livestock workers in this study precluded evaluation of occupational exposures. Higher odds of MRSA in medium swine density areas could reflect environmental exposure to swine or poultry.

Medical and household characteristics associated with methicillin resistant Staphylococcus aureus nasal carriage among patients admitted to a rural tertiary care hospital.

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) poses a threat to patient safety and public health. Understanding how MRSA is acquired is important for prevention efforts. This study investigates risk factors for MRSA nasal carriage among patients at an eastern North Carolina hospital in 2011. METHODS: Using a case-control design, hospitalized patients ages 18 - 65 years were enrolled between July 25, 2011 and December 15, 2011 at Vidant Medical Center, a tertiary care hospital that screens all admitted patients for nasal MRSA carriage. Cases, defined as MRSA nasal carriers, were age and gender matched to controls, non-MRSA carriers. In-hospital interviews were conducted, and medical records were reviewed to obtain information on medical and household exposures. Multivariable conditional logistic regression was used to derive odds ratio (OR) estimates of association between MRSA carriage and medical and household exposures. RESULTS: In total, 117 cases and 119 controls were recruited to participate. Risk factors for MRSA carriage included having household members who took antibiotics or were hospitalized (OR: 3.27; 95% Confidence Interval (CI): 1.24-8.57) and prior hospitalization with a positive MRSA screen (OR: 3.21; 95% CI: 1.12-9.23). A lower proportion of cases than controls were previously hospitalized without a past positive MRSA screen (OR: 0.40; 95% CI: 0.19-0.87). CONCLUSION: These findings suggest that household exposures are important determinants of MRSA nasal carriage in hospitalized patients screened at admission.