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PubMed2000

Surveillance for possible estuary-associated syndrome--six states, 1998-1999.

Pfiesteria piscicida (Pp) is an alga that has been associated with fish kills in estuaries (where fresh water mixes with salty seawater) along the eastern seaboard and possibly with human health effects. Since June 1, 1998, surveillance for possible estuary-associated syndrome (PEAS), including possible Pp-related human illness, has been conducted in Delaware, Florida, Maryland, North Carolina, South Carolina, and Virginia. This report summarizes passive surveillance for PEAS during June 1, 1998-December 31, 1999, which indicated no persons had illnesses that met PEAS criteria.

Animals↗
PubMedDate not supplied

Eustrongylidiasis in eastern great blue herons (Ardea herodias).

The nematode Eustrongylides ignotus was found in peritoneal lesions of several great blue herons (Ardea herodias) submitted for necropsy from a wildlife rehabilitation center in northern Delaware. Prior to death, signs of disease included ataxia, emaciation, weakness, and anemia. Blood collection was not uniformly performed, but in cases where it was performed, affected birds demonstrated abnormal clinical hematology. Postmortem findings included numerous lesions associated with verminous peritonitis. Significant histologic granulomatous response to the presence of these organisms was noted, particularly in the proventricular specimens. Other organs involved included intestine, spleen, pancreas, and liver.

Animals↗
PubMedDate not supplied

Cardiovascular mortality--the hidden peril of heat waves.

OBJECTIVE: Define the mortality associated with extremely hot weather during the 04 July through 14 July, 1993 heat wave that struck the northeastern United States. METHODS: DESIGN--A rapid field assessment was used to compare mortality occurring during the heat wave to mortality occurring during a period in which there was no heat wave using copies of death certificates. The findings of the rapid field assessment were validated, and it was determined whether increases in mortality occurred in other metropolitan east-coast counties also affected by the heat wave, by reviewing computerized mortality files. SETTING--Information was collected on all deaths occurring in Baltimore City, Maryland; Baltimore County, Maryland; Essex County, New Jersey; Newcastle County, Delaware; and Philadelphia County, Pennsylvania; during these specified study periods: 08-18 June (comparison period) and 06-16 July (heat wave study period), 1993. MAIN OUTCOME MEASURES--Ratios for total mortality, cause-specific mortality, and variables such as age, sex, race, residence, and day and place of death, that were available from death certificates were calculated. RESULTS: From the rapid field assessment, the following were observed: a 26% increase in total mortality and a 98% increase in cardiovascular mortality associated with the heat wave in Philadelphia. Data from the computerized mortality files showed an increase in total mortality in four of five counties examined and an increase in cardiovascular mortality in all five counties. The risk for death for those dying from cardiovascular disease increased significantly for people older than 64 years, for both sexes, and all races. CONCLUSION: As initially indicated by the Philadelphia Medical Examiner, there was excess mortality associated with a heat wave in Philadelphia. All other nearby counties examined also experienced excess mortality associated with the heat wave, although this excess was not recognized by the local health officials. The true impact of a heat wave that causes excess preventable mortality must be appropriately and rapidly ascertained. Using a national standard to certify a death as heat-related will provide the needed information rapidly so that public health resources can be more effectively allocated and mobilized to prevent further heat-related illnesses and death.

Adolescent↗
PubMed2000

Developing an IDS-based disease-management program for the frail elderly.

IDSs that own a health plan or enter a full-risk-sharing contract with a payer are in an position to benefit from developing disease-management programs that reduce acute care admissions. Full-risk assumption allows an IDS to realize cost savings due to more cost-effective care management that offset revenue lost due to reduced acute care services. Crozer-Keystone Health System (CKHS) in Delaware County, Pennsylvania, implemented a disease-management program for frail elderly enrollees in its Medicare + Choice plan, MedCare Plus. Projected first-year savings were estimated at about $619,000 over 1,200 member months. First-year results showed a 36 percent reduction in acute care admissions, with savings of $242,749 over 613 member months. The difference between actual results and projected savings was attributed to social and other factors not accounted for in the cost-benefit analysis. Still, lost revenues from acute care admissions were more than offset by the savings realized.

Aged↗
PubMed2000

Abandoned infants can be brought to ED.

To reduce the number of abandoned newborns, a state law was passed in Texas that allows mothers to abandon infants anonymously in the ED and avoid criminal prosecution. Similar legislation has been introduced in Delaware, Alabama, California, Minnesota, and Georgia. Although the law aims to ensure children aren't abandoned in unsafe places, ED experts question whether it will be effective. Once it is determined a child is abandoned, the burden is on the ED staff to perform a medical evaluation with no background information. ED staff should educate pregnant women and young mothers about community resources in times of domestic crisis.

Child, Abandoned↗
PubMed2000

Update: West Nile Virus activity--Eastern United States, 2000.

Data reported to CDC through the West Nile Virus (WNV) Surveillance System have shown an increase in the geographic range of WNV activity in 2000 compared with 1999, the first year that WNV was reported in the Western Hemisphere. In response to this occurrence of WNV, 17 states along the Atlantic and Gulf coasts, New York City, and the District of Columbia conducted WNV surveillance, which included monitoring mosquitoes, sentinel chicken flocks, wild birds, and potentially susceptible mammals (e.g., horses and humans). In 1999, WNV was detected in four states (Connecticut, Maryland, New Jersey, and New York) . In 2000, epizootic activity in birds and/or mosquitoes was reported from 12 states (Connecticut, Delaware, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, and Virginia) and the District of Columbia. Of the 13 jurisdictions, seven also reported severe neurologic WNV infections in humans, horses, and/or other mammal species. This report presents surveillance data reported to CDC from January 1 through November 15.

Adult↗
PubMed2000

The spatial variation of the weekday/weekend differences in the Baltimore area.

This study examined the spatial distribution of the weekday/weekend difference in Baltimore, MD, and vicinity. The difference in Baltimore was characterized by having approximately 39% more NOx, approximately 59% more CO, and approximately 27% more volatile organic compounds (VOCs) on the average weekday, but there was approximately 13% more O3 on the weekend day. Spatially, the difference was elongated in the northeast-southwest direction. It decreased from 13% more O3 in Baltimore to 6% at approximately 20 km west of Baltimore and to 4% at approximately 40 km south of Baltimore. It also appeared to decrease to the east, but the magnitude of the decrease could not be determined because of the lack of data east of the Chesapeake Bay. However, the difference increased to the north, reaching a value of almost 18% at a northern Delaware site.

Air Pollution↗
PubMed2000

Training for the twenty-first century in a state psychiatric facility.

This article analyzes some of the major factors affecting the content and process of training paraprofessionals in state-run psychiatric hospitals. It reflects on the challenge of providing the relevant knowledge and skills for staff members with limited or no clinical experience yet who are expected to provide the highest quality of care in a rapidly changing field. The author uses her own experience at the only state-run psychiatric hospital in Delaware to present ideas of how to create a learning environment for paraprofessionals that could be transferred to similar facilities.

Hospitals, Psychiatric↗
PubMedDate not supplied

Molecular characterization of an infectious bronchitis virus strain isolated from an outbreak in vaccinated layers.

An infectious bronchitis virus (IBV) strain CT/7852/97 was isolated from a commercial layer flock experiencing decreased egg production and poor egg quality. Reciprocal virus neutralization test demonstrated that the isolate was closely related to Massachusetts, Arkansas, and JMK. With the use of both reverse transcription-polymerase chain reaction-restriction fragment length polymorphism and multiplex polymerase chain reaction methods, results consistently showed that CT/7852/97 isolate was Massachusetts serotype specific only. The nucleotide sequence of S1 polypeptide coding region of CT/7852/97 was determined and compared with the published sequences of 12 IBV strains from North America. The highest nucleotide homology with H120 (97%) and the least homology (62%) with Delaware (De/072/92) were observed. Massachusetts 41 and Beaudette shared 94% and 93%, respectively, nucleotide similarity with CT/7852/97, and Connecticut, JMK, and Arkansas 99 had 94%, 83%, and 78%, respectively, nucleotide similarity with CT/7852/97. Furthermore, no possible recombination site on S1 gene among Massachusetts 41, Arkansas 99, and JMK was detected in the isolate.

Amino Acid Sequence↗
PubMed2001

Ochlerotatus japonicus collected from natural rockpools in New Jersey.

Ochlerotatus japonicus larvae were collected from natural rockpools in New Jersey within the Delaware Water Gap National Recreational Area. Previously reported collections of Oc. japonicus in the United States have been limited to artificial containers and an occasional treehole.

Aedes↗
PubMed1995

Anomalous carbonate precipitates: is the Precambrian the key to the Permian?

Late Permian reefs of the Capitan complex, west Texas; the Magnesian Limestone, England; Chuenmuping reef, south China; and elsewhere contain anomalously large volumes of aragonite and calcite marine cements and sea-floor crusts, as well as abundant microbial precipitates. These components strongly influenced reef growth and may have been responsible for the construction of rigid, open reefal frames in which bryozoans and sponges became encrusted and structurally reinforced. In some cases, such as the upper biostrome of the Magnesian Limestone, precipitated microbialites and inorganic crusts were the primary constituents of the reef core. These microbial and inorganic reefs do not have modern marine counterparts; on the contrary, their textures and genesis are best understood through comparison with the older rock record, particularly that of the early Precambrian. Early Precambrian reefal facies are interpreted to have formed in a stratified ocean with anoxic deep waters enriched in carbonate alkalinity. Upwelling mixed deep and surface waters, resulting in massive seafloor precipitation of aragonite and calcite. During Mesoproterozoic and early Neoproterozoic time, the ocean became more fully oxidized, and seafloor carbonate precipitation was significantly reduced. However, during the late Neoproterozoic, sizeable volumes of deep ocean water once again became anoxic for protracted intervals; the distinctive "cap carbonates" found above Neoproterozoic tillites attest to renewed upwelling of anoxic bottom water enriched in carbonate alkalinity and 12C. Anomalous late Permian seafloor precipitates are interpreted as the product, at least in part, of similar processes. Massive carbonate precipitation was favored by: 1) reduced shelf space for carbonate precipitation, 2) increased flux of Ca to the oceans during increased continental erosion, 3) deep basinal anoxia that generated upwelling waters with elevated alkalinities, and 4) further evolution of ocean water in the restricted Delaware, Zechstein, and other basins. Temporal coincidence of these processes resulted in surface seawater that was greatly supersaturated by Phanerozoic standards and whose only precedents occurred in Precambrian oceans.

Animals↗
PubMed2001

Update: Investigation of bioterrorism-related anthrax, 2001.

This report updates the investigation of bioterrorism-related anthrax and the provision of antimicrobial prophylaxis to exposed persons and highlights CDC assistance to other countries investigating cases of bioterrorism-related anthrax. Since November 7, 2001, CDC and state and local public health agencies have identified no new cases of bioterrorism-related anthrax. As of November 14, a total of 22 cases of anthrax has met the CDC case definition; 10 were confirmed inhalational anthrax, and 12 (seven confirmed and five suspected) were cutaneous anthrax. Investigation of a case of inhalational anthrax in a hospital stock room worker aged 61 years in New York City (NYC) found no evidence of anthrax contamination at the work site or home; the source of exposure is unknown. Environmental clean-up of contaminated facilities continues, and surveillance for newcases of bioterrorism-related anthrax is ongoing in Delaware (DE), District of Columbia (DC), Florida (FL), Maryland (MD), New Jersey (NJ), NYC, Pennsylvania (PA), Virginia (VA), and other states.

Anthrax↗
PubMed2001

Development of antibodies to topical bovine thrombin after abdominal hysterectomy. A case report.

BACKGROUND: Topical thrombin spray is frequently used as a hemostatic agent in surgery, particularly following cardiovascular, orthopedic and neurologic surgery. Acquired coagulation factor inhibitors to thrombin and factor V may develop following gynecologic surgery with repeat topical thrombin use. CASE: A 45-year-old woman underwent total abdominal hysterectomy/bilateral salpingo-oophorectomy. Her past medical history included idiopathic thrombocytopenic purpura and Marfan's syndrome and past surgery included splenectomy and aortic valve replacement with a three-vessel coronary artery bypass graft. She was converted from Coumadin (DuPont Pharmaceuticals, Wilmington, Delaware) to heparin preoperatively, and heparin was stopped six hours before surgery, with normalization of her prothrombin time (PT) and partial thromboplastin time (PTT). Topical bovine thrombin spray was applied to the surgical field in anticipation of early resumption of heparin anticoagulation. Seven days after surgery, after recovering from some acute bleeding problems, the patient began to have elevation of her PT in spite of being off Coumadin for 10 days. Her PT and international normalized ratio (INR) continued to rise, reaching peak values of 31.4 and 6.99, respectively. A mixing study did not correct the problem, confirming the presence of coagulation inhibitors. The patient was given intravenous immunoglobulins and corticosteroids, and her PT/PTT and INR values slowly normalized. CONCLUSION: Acquired coagulation factor may develop following gynecologic surgery with topical thrombin use. This potential complication should be strongly considered in any patient prior to using topical bovine thrombin, especially those with a prior exposure or history of surgical procedures in which bovine thrombin is commonly used.

Abdomen↗
PubMed2001

Adverse events and deaths associated with laboratory errors at a hospital--Pennsylvania, 2001.

On August 3, CDC was contacted by the Pennsylvania Department of Health (PADOH) to assist with an investigation of laboratory errors that may have contributed to the deaths of two persons taking the anticoagulant drug warfarin (Coumadin) (DuPont Pharmaceuticals Company, Wilmington, Delaware). The Food and Drug Administration (FDA) also is conducting an investigation of these incidents. Warfarin inhibits blood clotting and is prescribed for the management and prevention of conditions such as strokes, clots in the veins, and heart attacks. Physicians routinely monitor warfarin's anticoagulation effect on the blood by following two laboratory results: the prothrombin time (PT) and the International Normalized Ratio (INR). The INR is a numeric value calculated from the PT; the World Health Organization recommends the INR to standardize PT results from various manufacturers' devices and testing reagents. Physicians use INR to compare test results performed at different laboratories.

Humans↗
PubMedDate not supplied

Neonatal response to control of noise inside the incubator.

PURPOSE: The purpose of this study was to test the effect of acoustical foam on the level of noise inside the incubator and examine neonatal response behaviors to changes in environmental noise. METHOD: The study used a repeated measure, within subject, comparative design. Data on 65 premature neonates were collected over a 14-month period at a large teaching hospital in Delaware. Sound levels, oxygen saturation, and infant states were measured and recorded during three study conditions: pre-study neonate in incubator, neonate in incubator with 5 x 5 x 1 inch acoustical foam pieces placed in each of four corners, and post-study recovery of neonate in incubator with foam removed. All state assessments were measured with oxygen saturation and sound level measurements every 2 minutes of the study for a total 40 minutes. FINDINGS: The findings demonstrate a significant treatment effect of acoustical foam on decreasing environmental noise measurements inside the incubator (p = 0.006). Findings also demonstrate significantly changed neonatal state response behaviors with decreasing environmental noise measurements inside the incubator (p = 0.00). CONCLUSIONS: The results of this study support the use of acoustical foam as one method of environmental noise management in the intensive care nursery. Because there was a significant correlation between higher noise levels and oxygen support therapy, the findings suggest that special nursing considerations should be taken when caring for ventilator-dependent infants. Noise control protocols should focus on essential environmental interventions for care of these infants.

Acoustics↗
PubMed2002

Evaluation of two automated methods for measurement of the ristocetin cofactor activity of von Willebrand factor.

We have evaluated two automated methods for measuring ristocetin cofactor activity (VWF:RCo) on an automated coagulation analyzer (STAR, Diagnostica Stago Inc., Parsippany, NJ). A modification of the BC von Willebrand Reagent method (Dade Behring Inc., Newark, Delaware) was compared with a standard method using a platelet aggregometer, and an in-house automated method was developed using commercially available components. The STAR measures the change in optical density (OD) caused by agglutination of platelets. Change in OD was linear for plasma dilutions between .25 and .04 U/mL. Coefficient of variation compared favorably with that of the standard method. In 123 normal women, the correlation coefficient (r) = .905. In menorrhagia cases, r = .901. In 20 VWD patients, r = .93. The CDC in-house method was compared to the BC Reagent method in 79 additional menorrhagia cases, with r = .94. The automated methods produced results equivalent or superior to those of traditional methods of measuring VWF:RCo.

Electronic Data Processing↗
PubMed2002

Outbreak of listeriosis--northeastern United States, 2002.

A multistate outbreak of Listeria monocytogenes infections with 46 culture-confirmed cases, seven deaths, and three stillbirths or miscarriages in eight states has been linked to eating sliceable turkey deli meat. Cases have been reported from Pennsylvania (14 cases), New York (11 in New York City and seven in other locations), New Jersey (five), Delaware (four), Maryland (two), Connecticut (one), Massachusetts (one), and Michigan (one). Culture dates ranged from July 18 to September 30, 2002; case-finding is ongoing. Outbreak isolates share a relatively uncommon pulsed-field gel electrophoresis (PFGE) pattern.

Disease Outbreaks↗
PubMed2002

Clean indoor air: where, why, and how.

Clean indoor air policies are an effective way to eliminate exposure to second hand smoke and reduce smoking among youth and adults; they are strongly recommended by the Surgeon General and the Task Force on Community Preventive Services. How these policies are put into effect and at what level of government can make a difference. Legislation that preempts local action prevents communities from enacting more stringent laws or tailoring laws to address community-specific issues. Preemptive state laws also can be a barrier to local enforcement because communities not involved in decision making may be less aware of laws, may have no enforcement mechanism, and thus may be less complaint. Preemption is clearly a tobacco industry strategy to take away local control, usually in exchange for a weak law offering little protection from second hand smoke. As communities across the country continue to pass stronger local ordinances, eliminating preemptive laws becomes more important. During 2002, Delaware became the first state to repeal clean air preemption. In Iowa, the attorney general's office has been involved in the determination of whether the state clean air law prevents communities from passing more stringent ordinances. And although Minnesota's pioneer Clean Indoor Air Act does not preempt local laws, the debate over preemption there has not ended but instead has taken new forms.

Air Pollution, Indoor↗