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PubMed1977

Chlorinated hydrocarbon insecticide residues in Tennessee honey and beeswax.

Several samples of commercial grade honey collected from different parts of tennessee during the summer of 1973 were analyzed for chlorinated hydrocarbon insecticide (CHI) residues. A "Modified Mill's Procedure" was used to cleanup the samples prior to gas chromatographic analysis using electron capture (EC) detection. The presence of CHI residues was confirmed by analysis on three different columns of widely varying polarity. Most of the samples contained CHI residues at 0.01-0.30 parts per billion (ppb) level. Beeswax produced during the same season contained several times higher levels of the residue than the honey samples. Recoveries of CHI residues varied from 81-95 percent by the procedure employed.

Bees↗
PubMed2005

Heavy metal concentrations in northern water snakes (Nerodia sipedon) from East Fork Poplar Creek and the Little River, East Tennessee, USA.

We compared the levels of arsenic, cadmium, chromium, lead, manganese, mercury, and selenium in the blood, kidney, liver, muscle, and skin of northern water snakes (Nerodia sipedon) collected from the upper reach of East Fork Poplar Creek (EFPC) within the United States Department of Energy's (USDOE's) Y-12 National Security Complex with concentrations in tissues of northern water snakes from a reference reach of the Little River downstream from the Great Smoky Mountains National Park in East Tennessee. Our objectives were to determine whether concentrations of these metals were higher in tissues of water snakes collected from EFPC compared with the reference site and if northern water snakes were suitable bioindicators of metal contamination. Except for chromium, metal levels were significantly higher in tissues (kidney, liver, muscle, and skin) of EFPC northern water snakes compared with those in tissues of snakes from the reference site. Although female northern water snakes were significantly larger than male snakes, their tissues did not contain significantly higher metal concentrations compared with those from male snakes, possibly because of maternal transfer of metals to eggs. This study was the first to examine the accumulation of contaminants resulting from the operations of the USDOE's Oak Ridge Reservation in snakes.

Animals↗
PubMed1992

A survey of ovine parasite control practices in Tennessee.

A sample of 126 sheep producers in Tennessee was randomly selected from the members of a statewide organization of sheep producers. Data about the participants' farms, sheep, parasite control practices and sources of information regarding ovine parasite control were obtained by a telephone survey. The response rate was 99%. The typical respondent kept 20 lambs, 20 ewes and 2 rams on three pastures totalling 20 acres. In order of decreasing frequency, anthelmintics were given according to a regular schedule, to coincide with breeding management procedures, or to treat clinical signs of parasitism. Proportions of producers deworming the various classes of sheep zero, one, two, three, four or more than four times annually were as follows: lambs--3, 28, 40, 16, 9 and 8%, respectively; ewes--3, 8, 20, 16, 34 and 22%, respectively; rams--1, 9, 19, 15, 38 and 19%, respectively. The majority of respondents planned to deworm lambs (89%) and ewes (82%) the same number of times in the following year. Of the producers who dewormed sheep two or more times during 1989, 39-49% (ranges include different proportions for lambs, ewes and rams) used the same anthelmintic exclusively, and 51-61% used two or more drug classes. Of the owners using a single anthelmintic exclusively, most (39-66%) used ivermectin, followed by levamisole (19-33%) and benzimidazoles (13-24%). One hundred and three of 124 (83%) producers intended to use the same anthelmintics in the future. Sixty-four of 124 (52%) producers had discontinued using at least one ovine anthelmintic. The most common reasons for discontinuance were dissatisfaction with the clinical response after treatment and inconvenience of administration. Sheep-oriented publications, other sheep producers and veterinarians were considered the most important sources of information about deworming programs and choice of anthelmintics.

Animals↗
PubMed1995

Risk factors associated with transmission of Toxoplasma gondii to sows kept in different management systems in Tennessee.

Of 3841 serum samples from sows received from the Tennessee State Diagnostic Laboratory in 1991-1992, 1130 were positive for Toxoplasma gondii antibody. The total number of farms sampled was 343. The observed seroprevalence was 36% for both years. A questionnaire that dealt with herd management practices was mailed to 303 of the swine farms that were sampled; 107 (35%) responses were returned and analyzed. There was no significant difference in the seroprevalence of T. gondii in the sows on the farms of respondents and non-respondents. From the analysis of the questionnaire, sows associated with cats were 2.6 times more likely to be seropositive for T. gondii than sows that were not associated with cats. Sows kept outdoors at any time were 23 times more likely to be seropositive than sows that were kept indoors. Sows on small farms (< 29 sows) were 4.5 times more likely to be seropositive than sows on large farms (> 29 sows).

Animal Husbandry↗
PubMedDate not supplied

Decline in inappropriate antibiotic use over a decade by pediatricians in a Tennessee community.

OBJECTIVE: Published data indicates that antibiotic use for pediatric respiratory tract infections has declined across the United States. We reviewed antibiotic use in 2 pediatrics practices in Memphis, Tennessee, to determine whether there has been a reduction in inappropriate antibiotic use in this region. METHODS: Randomly selected charts in 7 offices of 2 practices were reviewed for respiratory tract infection visits during alternate years between 1992 and 2002. Antibiotics were considered inappropriate for viral respiratory tract and other viral syndromes, asthma, allergic rhinitis, and otitis media with effusion. Changes in inappropriate prescribing were evaluated by generalized estimating equations with year of visit as the explanatory variable and visits clustered by practice. RESULTS: There were 1504 unique patient visits reviewed. The number of visits with an antibiotic prescription fell from 85% in 1992 to 67% in 2002. The likelihood of inappropriately prescribing an antibiotic declined between 1992 and 2002 (odds ratio 0.28, 95% confidence interval 0.20-0.38). Use of amoxicillin-clavulanic acid and azithromycin increased, and amoxicillin use decreased. CONCLUSIONS: There has been a marked decline in inappropriate antibiotic use in this region with high prescribing rates. Pediatricians have increased their use of broad-spectrum antibiotic agents for respiratory tract infections. Continuing education of physicians regarding appropriate use should continue to maintain and improve on the gains achieved in the last decade.

Anti-Bacterial Agents↗
PubMed2004

Species differences in contaminants in fish on and adjacent to the Oak Ridge Reservation, Tennessee.

Risks to humans and other organisms from consuming fish have become a national concern in the USA. In this paper, we examine the concentrations of 137Cs, arsenic, beryllium, cadmium, lead, mercury, and selenium in three species of fish from two river reaches adjacent to the US Department of Energy's Oak Ridge Reservation in Tennessee. We were interested in whether there were species and locational differences in radiocesium and metal concentrations and whether concentrations were sufficiently high to pose a potential health risk to humans or other receptors. Striped bass (Morone saxatilis) were significantly larger than white bass (M. chrysops), and crappie (Pomoxis spp.) were the smallest fish. Lead was significantly lower in striped bass, mercury was significantly higher in striped bass, and selenium was significantly higher in white bass compared to the other species. There were no other species differences in contaminants. White bass, the only species that was sufficiently abundant for a comparison, had significantly higher concentrations of cadmium, lead, and selenium in fillets from the Clinch River and significantly higher concentrations of mercury in fillets from Poplar Creek. The low concentrations of most contaminants in fish from the Clinch River do not appear to present a risk to humans or other consumers, although mercury concentrations in striped bass ranged as high as 0.79 ppm, well above the 0.5-ppm action level for human consumption of some US states.

Animals↗
PubMedDate not supplied

Hospital recruitment for the Smallpox Pre-Event Vaccination Program: experiences from Florida, Nebraska, New Jersey, and Tennessee, December 2002-June 2003.

The Smallpox Pre-Event Vaccination Program (SPVP) for public health and hospital-based health care workers began on January 24, 2003. This report summarizes efforts made by health officials in Florida, Nebraska, New Jersey, and Tennessee to facilitate the voluntary participation of acute care hospitals in the SPVP. Seven common characteristics contributed to the success of programs in these four states: (1) early planning, building on existing competencies, and state government support, (2) carrying the program forward on a planned timeline with experienced vaccination staff, (3) use of multifaceted training activities, (4) use of mock scenarios and field exercises to avoid early problems, (5) establishment and fostering of good relationships and lines of communication with stakeholders and the mass media, (6) addressing liability and workers' compensation concerns prior to initiation of the SPVP, and (7) attention to vaccination clinic logistics.

Bioterrorism↗
PubMed2006

Binding, distribution, and plant uptake of mercury in a soil from Oak Ridge, Tennessee, USA.

A large amount of mercury has been discharged on the U.S. Department of Energy's Oak Ridge Site (Tennessee) as a part of the U.S. nuclear weapon program during the 1950s through the early 1960s. Increases in mercury concentration in fish and in lower East Fork Poplar Creek of Oak Ridge have been recently reported. This is an experimental study mimicking the initial stage of transformation and redistribution of mercury in soils, which are comparable to those of the Oak Ridge site. The objectives of this study were to investigate potential transformation, distribution, and plant uptake of mercury compounds in soils. Results show that the H(2)O(2)-oxidizable mercury fraction (organically bound mercury) was the major solid-phase fraction in soils freshly contaminated with soluble mercury compounds, while cinnabar fraction was the major solid phase fraction in soils contaminated with HgS. Langmuir relationships were found between mercury concentrations in plant shoots and in soil solid-phase components. Mercury in HgS-contaminated soils was to some extent phytoavailable to plants. Mercury transformation occurred from more labile fractions into more stable fractions, resulting in strong binding of mercury and decreasing its phytoavailability in soils. In addition, high mercury losses from soils contaminated with soluble mercury compounds were observed during a growing season through volatilization, accounting for 20-62% of the total initial mercury in soils.

Hydrogen Peroxide↗
PubMed2004

Prevalence of epilepsy and health status of adults with epilepsy in Georgia and Tennessee: Behavioral Risk Factor Surveillance System, 2002.

Behavioral risk factors associated with comorbidity in people with epilepsy are largely unknown. We studied a population-based sample of 8057 adults through the 2002 Behavioral Risk Factor Surveillance System, in Georgia and Tennessee, ascertaining a lifetime epilepsy prevalence of 2.1% in this population. This structured interview revealed that those with epilepsy had significantly worse self-reported fair or poor health status (39% vs 17% in adults without epilepsy), significantly greater cigarette smoking (38.8% vs 24.9% in other adults), and high rates of obesity (34.1% vs 23.7% in adults without epilepsy). Large percentages of adults with epilepsy reported currently symptomatic asthma and recent joint pain. Adults with epilepsy had lower educational attainment and lower household incomes, but a higher rate of medical insurance coverage, than did other adults. This type of population-based survey can serve to identify health disparities, behavioral risk factors for other chronic diseases, and unmet health care needs in individuals with epilepsy, and to track changes in these measures over time.

Adolescent↗
PubMed1999

Tennessee RN first assistant survey data--what types of perioperative education are needed?

Many nursing programs removed perioperative education from their curriculum as early as the late 1960s, and perioperative nursing is now experiencing the consequences. Fewer perioperatively educated graduates are available, the workforce of experienced perioperative nurses is aging, and multiple career opportunities are luring perioperative nurses from the OR and nursing in general. Surveys were conducted in Tennessee to determine the knowledge about perioperative nursing roles and responsibilities. These survey results demonstrate the need for nurses, nursing programs, and hospitals to collaborate in developing guidelines, programs, and evaluation processes based on national perioperative standards.

Adult↗
PubMed1998

Postdelivery mortality in Tennessee, 1989-1991.

OBJECTIVE: To describe postdelivery mortality rates among residents of Tennessee from 1989 through 1991 and to compare these rates with those of women who had not delivered a live or stillborn infant in the previous year. METHODS: Postdelivery deaths (those occurring within a year of delivery of a live or stillborn infant) were identified using a computerized linkage of birth and fetal death certificates to death certificates of female decedents aged 15-44 years. Each identified postdelivery death was reviewed and categorized as either pregnancy-related (temporally and causally related to pregnancy) or pregnancy-associated-but-not-related (temporally but not causally related to pregnancy). Cause-specific mortality rates were compared for women who died postdelivery with women who died but had not delivered in the previous year. RESULTS: We identified 129 postdelivery deaths, one quarter of which were classified as pregnancy-related. The rates of postdelivery pregnancy-related and of pregnancy-associated-but-not-related death were 14.6 and 58.7, respectively, per 100,000 women who had delivered. Nonwhite women were 6.9 times more likely to experience postdelivery pregnancy-related death and 2.0 times more likely to experience postdelivery pregnancy-associated-but-not-related death than were white women. The leading cause of death among both women who had delivered and women who had not delivered a live or stillborn infant in the previous year was injury, although the risk of death the year after delivery was lower than for women who had delivered. CONCLUSION: Women were less likely to die in the year after delivery than were women who had not delivered a live or stillborn infant in the previous year. However, regardless of their delivery status, injuries were the leading cause of death among women. Postdelivery mortality was statistically significantly higher in nonwhite than white women, especially for pregnancy-related deaths.

Adolescent↗
PubMed2002

Fishing along the Clinch River arm of Watts Bar reservoir adjacent to the Oak Ridge Reservation, Tennessee: behavior, knowledge and risk perception.

Catching and eating fish is usually viewed as a fun, healthy and safe activity. However, with continuing increases in fish consumption advisories due to the contamination of our environment, anglers have to decide whether or not to eat the fish they catch. The Clinch River arm of Watts Bar Reservoir is under a fish consumption advisory because of elevated PCB concentrations in striped bass (Morone saxatilis), catfish (Ictalurus spp.) and sauger (Stizostedion canadense) due in part from contaminants released from the US Department of Energy's (USDOE's) Oak Ridge Reservation (ORR) in East Tennessee. To obtain information about the demographics, fishing behavior, knowledge, fish consumption and risk perception of anglers, a survey was conducted of 202 people actively fishing either on land or by boat along the Clinch River arm of Watts Bar Reservoir adjacent to the ORR from Melton Hill Dam to the Poplar Creek confluence or on Poplar Creek within ORR boundaries from mid-March to early November 2001. Even though 81% of people interviewed knew about the fish consumption advisories for the study area, 48% of them thought the fish were safe to eat, while 38% ate the fish that they caught from the study area. Approximately 36% of anglers who had knowledge of the fish consumption warnings ate fish from the study area. Providing confirmation that people fish for many reasons, 35% of anglers interviewed did not eat fish at all. The majority of anglers interviewed knew about the fish consumption advisories because of the signs posted throughout the study area. However, few people knew the correct fish advisories. Significantly fewer blacks had knowledge of the fish consumption warnings than whites. Information resulting from this study could be used to design a program with the objective of reaching the people who may be most at risk from eating fish caught from the Clinch River arm of Watts Bar Reservoir.

Adult↗
PubMed2002

Stabilization of penicillin resistance among Streptococcus pneumoniae isolated in Eastern Tennessee.

Penicillin resistance among Eastern Tennessee isolates of Streptococcus pneumoniae has been increasing since the early 1990s. To maintain active surveillance of the prevalence of penicillin resistance among pneumococci isolated at our institution, antibiotic susceptibility testing was performed for 95 consecutive isolates and results were compared with those of strains examined 2 years earlier. The prevalence of penicillin resistance among local pneumococcal isolates may have stabilized in recent years.

Adolescent↗
PubMed1995

Balancing collaboration and competition: the Kingsport, Tennessee experience.

BACKGROUND: In 1988, business, health care, and community leaders in Kingsport, Tennessee, initiated the Kingsport Area Health Improvement Project (KAHIP) to improve the health status of local citizens. The community has good conditions for collaboration: (1) a large employer that was a 1993 winner of the Malcolm Baldrige National Quality Award, (2) community structures for the implementation of collaborative efforts, (3) relative stability in community employment and income, (4) adequate medical resources, (5) outside support from foundations and national organization, and (6) the confidence and commitment of its leaders to make quality efforts work. BARRIERS TO IMPROVEMENT: Barriers to improvement have included 1) two large acute care hospitals competing for many of the same physicians and patients, 2) the uncertainties introduced by the restructuring of the community's largest employer, and 3) ongoing moves in the managed care arena by some key players, which have left a degree of anger and mistrust. Realizing that the approach taken in the late 1980s and early 1990s was no longer working in the new competitive environment, KAHIP reconstituted itself in 1994. Providers now have a greater leadership role in community improvement efforts. As a result, improvement efforts in Kingsport include the institution of interventions to reduce injuries to children/adolescents resulting from motor vehicular accidents, the establishment of a primary care health center for the uninsured/underserved, and development of a smoking-cessation program. LESSONS LEARNED: The keys to continued leadership are 1) explicit faith in the continuous quality improvement approach, 2) commitment to communitywide change, 3) willingness to continue to engage in dialogue, 4) willingness to try new organizational alliances and structures to revitalize the effort, and 5) willingness to address those issues that individuals and institutions can agree to work on and set aside those they cannot agree on.

Community Health Planning↗
PubMed1998

Rebuilding community and regional collaboration: the Kingsport, Tennessee experience.

BACKGROUND: In 1988, business, health care, and community leaders in Kingsport, Tennessee, initiated the Kingsport Area Health Improvement Project (KAHIP) to improve the health status of local citizens. KAHIP's efforts continued to move, albeit slowly, until late 1993, when managed care organizations began to deselect hospitals and physicians and competition began to overcome hopes for collaboration. In 1994 KAHIP and other community leaders reaffirmed seven principles, including the need for continued dialogue and collaboration. By early 1998 ten community improvement teams were functioning, six chartered by KAHIP. MATURE PROJECTS: Four established projects have continued to expand either in scope or through institutionalization in the community or both, including Drive Smart, a collaborative learning project concerned with reducing preventable injuries and death among youth from motor vehicle crashes, and the Network of Employers for Traffic Safety, a public-private partnership dedicated to reducing the number of deaths and injuries in the workforce. NEW TEAMS: Four other teams are operating in Kingsport. One, the Kingsport Community Alliance Linking Enforcement, Responsibility and Treatment (ALERT), is dedicated to reducing the impact of substance abuse. Another, the Community Database Team, works on developing a database focused on community health status information. LESSONS LEARNED: In a community with widespread knowledge of continuous improvement philosophy and techniques, it makes sense to encourage other agencies to take the initiative and the credit and not worry about whether a specific process is adopted. The role of the public health system in health assessment, policy assessment, and quality improvement in an era of managed care and reduced government should be encouraged.

Commerce↗
PubMedDate not supplied

Impact of interdisciplinary education in underserved areas: health professions collaboration in Tennessee.

A community-based interdisciplinary health professions education project, involving the Colleges of Medicine, Nursing and Public and Allied Health, was implemented at the undergraduate level at East Tennessee State University from 1990 to the present. The outcomes of this project and the extension of the project into graduate health profession programs are described. Committed leadership, effective communication, and genuine community involvement are identified as essential to the success of community-based, interdisciplinary health professions training programs.

Communication↗
PubMed2025

Investigation of a Mycobacterium fortuitum prosthetic joint infection outbreak at two ambulatory surgery centers in Tennessee.

OBJECTIVE: This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge. METHODS: Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire. RESULTS: IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16-985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing. CONCLUSION: The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.

Humans↗
PubMed2002

Quantitative characterization of trace levels of PFOS and PFOA in the Tennessee River.

Although there is evidence of widespread distribution of organic fluorochemicals such as perfluorooctane sulfonate and perfluorooctanoate, in the environment, the versatility of these compounds in industrial and commercial applications complicates characterization of pathways into the environment. A solid-phase extraction method coupled with HPLC-negative-ion electrospray tandem mass spectrometry was developed to quantitatively measure trace levels of organic fluorochemicals in drinking water and surface water. Using this method, certain fluorochemicals can be quantitatively measured in water samples down to 25 ppt, a level well below calculated drinking water advisory levels. To assess fluorochemical distribution in a localized geography and to ascertain whether fluorochemical manufacturing facilities contribute to environmental levels of fluorochemicals, 40 water samples were collected on an 80-mi stretch of the Tennessee River, near a fluorochemical manufacturing site in Decatur, AL. Low levels (ppt) of perfluorooctane sulfonate were determined throughout the stretch of river sampled. Concentrations of the measured fluorochemicals increased downstream of the fluorochemical manufacturing facility, indicating that effluent from manufacturing is one likely source of organic fluorochemicals into the river.

Alkanesulfonic Acids↗