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PubMed2005

Genecology of Douglas fir in western Oregon and Washington.

BACKGROUND AND AIMS: Genecological knowledge is important for understanding evolutionary processes and for managing genetic resources. Previous studies of coastal Douglas fir (Pseudotsuga menziesii var. menziesii) have been inconclusive with respect to geographical patterns of variation, due in part to limited sample intensity and geographical and climatic representation. This study describes and maps patterns of genetic variation in adaptive traits in coastal Douglas fir in western Oregon and Washington, USA. METHODS: Traits of growth, phenology and partitioning were measured in seedlings of 1338 parents from 1048 locations grown in common gardens. Relations between traits and environments of seed sources were explored using regressions and canonical correlation analysis. Maps of genetic variation as related to the environment were developed using a geographical information system (GIS). KEY RESULTS: Populations differed considerably for adaptive traits, in particular for bud phenology and emergence. Variation in bud-set, emergence and growth was strongly related to elevation and cool-season temperatures. Variation in bud-burst and partitioning to stem diameter versus height was related to latitude and summer drought. Seedlings from the east side of the Washington Cascades were considerably smaller, set bud later and burst bud earlier than populations from the west side. CONCLUSIONS: Winter temperatures and frost dates are of overriding importance to the adaptation of Douglas fir to Pacific Northwest environments. Summer drought is of less importance. Maps generated using canonical correlation analysis and GIS allow easy visualization of a complex array of traits as related to a complex array of environments. The composite traits derived from canonical correlation analysis show two different patterns of variation associated with different gradients of cool-season temperatures and summer drought. The difference in growth and phenology between the westside and eastside Washington Cascades is hypothesized to be a consequence of the presence of interior variety (P. menziessii var. glauca) on the eastside.

Analysis of Variance↗
PubMed1999

Cluster of uterine mullerian adenosarcoma in the Washington, DC metropolitan area with high incidence of sarcomatous overgrowth.

Mullerian adenosarcoma is an uncommon variant of uterine sarcoma. Twelve uterine adenosarcomas were diagnosed during a 42-month period at the Washington Hospital Center in Washington, DC. Based on estimated incidence data derived from the US Department of Defense beneficiary population, an estimated relative risk of 15.4 (95% confidence interval, 7.7-31.0) was calculated, indicating a significantly increased incidence of adenosarcoma in the population studied (p<0.0000001). Among 10 patients who underwent hysterectomy, six (60%) of their tumors had sarcomatous overgrowth. In comparison with the previously reported proportion of adenosarcomas with sarcomatous overgrowth, approximately 16%, the proportion with sarcomatous overgrowth was significantly higher than expected (p<0.01). Mullerian adenosarcoma with sarcomatous overgrowth was first described in 1989 and suggests that the cluster of adenosarcomas reported herein may be due in part to the current classification of some uterine tumors as adenosarcoma with sarcomatous overgrowth that previously would have been classified as other types of uterine sarcoma. Nonetheless, even after reviewing and updating the classification of all sarcomas diagnosed at the Washington Hospital Center from 1985 to 1998, the ratio of adenosarcomas to uterine adenocarcinomas during the 1994-1998 period was 4.7 times (p<0.005) that of the 1985-1993 period, suggesting a more modest but real increase in the occurrence of this tumor. Correct classification of mullerian adenosarcomas with sarcomatous overgrowth is important because the limited available data suggest that the prognosis is notably worse than that for adenosarcomas without sarcomatous overgrowth.

Adenosarcoma↗
PubMed2005

Genome science: a video tour of the Washington University Genome Sequencing Center for high school and undergraduate students.

Sequencing of the human genome has ushered in a new era of biology. The technologies developed to facilitate the sequencing of the human genome are now being applied to the sequencing of other genomes. In 2004, a partnership was formed between Washington University School of Medicine Genome Sequencing Center's Outreach Program and Washington University Department of Biology Science Outreach to create a video tour depicting the processes involved in large-scale sequencing. "Sequencing a Genome: Inside the Washington University Genome Sequencing Center" is a tour of the laboratory that follows the steps in the sequencing pipeline, interspersed with animated explanations of the scientific procedures used at the facility. Accompanying interviews with the staff illustrate different entry levels for a career in genome science. This video project serves as an example of how research and academic institutions can provide teachers and students with access and exposure to innovative technologies at the forefront of biomedical research. Initial feedback on the video from undergraduate students, high school teachers, and high school students provides suggestions for use of this video in a classroom setting to supplement present curricula.

Feedback↗
PubMed2005

Knowledge about the initial presentation of smallpox among emergency physicians in Washington, DC.

OBJECTIVES: To assess the current knowledge of full-time emergency physicians in Washington, DC, regarding the initial diagnosis of smallpox and the initial care of the patient with smallpox. METHODS: A written true/false test was prepared based on information accessed from the current Centers for Disease Control and Prevention (CDC) Web site on smallpox. The 20-question test was administered to full-time emergency physicians practicing emergency medicine in all seven adult civilian hospitals in Washington, DC. RESULTS: The overall response rate was 81% (52 of the 64 eligible full-time emergency physicians). The average score was 59% correct. The facts most likely to be known were 1) that the symptoms of smallpox begin with a two- to four-day prodrome of fever and myalgia (before the appearance of any rash), 2) that no antiviral treatment is of more proven value than vaccination of contacts, and 3) that a person with smallpox may be contagious before any rash appears (average, 90% correct). The facts least likely to be known were 1) that when dealing with a known case of smallpox, fit-tested N95 masks are not needed by treating personnel if they have been vaccinated; 2) that the rash of smallpox begins with 24-48 hours of flat, erythematous macules (not papules or vesicles); and 3) that very typically the rash of smallpox begins in the mouth (average, 22% correct). CONCLUSIONS: Some facts from the current CDC Web site on smallpox are known by a large majority of full-time emergency physicians in Washington, DC, whereas questions based on other facts were answered incorrectly by a majority of the physicians tested.

Academic Medical Centers↗
PubMed2006

Assessment of public health risks associated with atmospheric exposure to PM2.5 in Washington, DC, USA.

In this research, we investigated the public health risks associated with atmospheric exposure to PM2.5 for different subpopulations (black, white, Hispanic, youth, adults, and elderly) in the Washington, DC area. Washington, DC has long been considered a non-healthy place to live according to the American Lung Association due to its poor air quality. This recognition clearly includes the negative PM-related human health effects within the region. Specifically, DC fine particulate matter (PM2.5) [or particulate matter with an aerodynamic diameter less than 2.5 microm] poses notable health risks to subpopulations having an annual mean value of 16.70 microg/m(3) during the years 1999-2004, exceeding the EPA National Ambient Air Quality Standard (NAAQS) of 15 microg/m(3). Incessant exposure to significant levels of PM has previously been linked to deleterious health effects, such as heart and lung diseases. The environmental quality and public health statistics of Washington, DC indicate the need for higher-resolution measurements of emissions, both spatially and temporally, and increased analysis of PM-related health effects. Our findings show that there are significant risks of ward-specific pediatric asthma emergency room visits (ERV). Results also illustrate lifetime excess lung cancer risks, exceeding the 1 x 10(-6) threshold for the measured levels of particulate matter and heavy metals (chromium and arsenic) on behalf of numerous subpopulations in the DC selected wards.

Air Pollutants↗
PubMed2000

Information needs and uses of the public health workforce--Washington, 1997-1998.

Substantial efforts have been made to ensure that state and local public health agencies have the information technology and training needed for public health communications, information access, and data exchange. Numerous public health-related data and information resources are available on the World-Wide Web (e.g., MEDLINE, MMWR, CDC Prevention Guidelines Database, and Emerging Infectious Diseases); however, little systematic work has been done to understand the information needs of the public health workforce. To identify these needs and patterns of use and to set priorities for developing new online public health information resources, the University of Washington School of Public Health and Community Medicine (UW SPHCM) and the Washington State Department of Health (WSDoH) held structured and facilitated discussions with segments of the local public health workforce in Washington during 1997-1998. This report summarizes the results of those discussions, which indicate that different segments of the public health workforce have different information needs.

Congresses as Topic↗
PubMed1985

Neighborhood revitalization and racial change: the case of Washington, D.C.

Using 1970 and 1980 census block data for Washington, D.C., we test several hypotheses about the racial residential consequences of neighborhood revitalization. Areas located in the revitalizing core of the city have a) become whiter in both absolute and proportional terms, consistent with the displacement hypothesis, and b) experienced substantial though difficult to interpret shifts in segregation. The types of racial changes occurring in the core are not apparent elsewhere in Washington, and tract data for 1940-1980 show the core changes to be temporally as well as spatially specific. Because different racial residential trends have accompanied revitalization in other cities, we treat Washington as an exceptional case that helps specify the conditions under which conventional wisdom about neighborhood change is least applicable.

Black or African American↗
PubMed1976

General Washington and the patriot soldiers. They won a war with little food. A Bicentennial study.

The troops in the first action of the American Revolution in Massachusetts were well provisioned through the efforts of Joseph Trumbull of Connecticut, whom the Second Continental Congress appointed Commissary General, at General Washingtion's request. The ration, as ordered, would have provided-by today's standards-more calories, twice as much protein, and adequate minerals and vitamins, except possible vitamin A and ascorbic acid. Unfortunately, all items in the ration were seldom available to the soldiers. Each man was issued his ration and was responsible for cooking it. Trumbull held his post for two years, with little support from the Congress and no departmental organization. When the Army moved to New York, difficulties in provisioning the troops on the march began-and continued until 1781. Following the retreat to Morristown, New Jersey, in 1776, flour and beef, but little else, were available during the winter and into the following summer. Washington pleaded with the Congress for help with food supplies, but to no avail. Finally, Trumbull resigned. Thereafter, followed a series of four reorganizations of the commissariat by the Congress-each disastrously conceived-which brought no relief to the ill-fed soldiers, whose physical condition progressively worsened. Finally, a fifth reorganization in 1781 put into operation a contract plan of procuring food; no longer was it necessary for Washington to order impressment of food from farmers or for the troops to live off the land. The Continental Army "starved, not because the country could not furnish the food, but becasue the people were unwilling to endure taxation and Congress did not understand the importance of administrative centralization; ...the greater part of the hardships" were avoidable. Yes, General Washington and the patriot soldiers won the war with little food.

Cooking↗
PubMedDate not supplied

Heroic medicine, bloodletting, and the sad fate of George Washington.

Bloodletting was an established medical treatment for more than two millennia, yet its greatest impact in the United States is undoubtedly the role it played in the treatment of President George Washington. The theoretical justification for bloodletting is provided, followed by a detailed description of the treatment Washington received, reflecting the role played by heroic medicine in the American president's demise. The arguments of bloodletting's critics emerge as well founded; indeed, Washington and many others might have suffered less had heroic medicine not been applied.

Bloodletting↗
PubMed2005

Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington State from 1989 to 2001.

This retrospective cohort study evaluated the risk of adverse pregnancy outcomes following motor vehicle crashes during pregnancy. The authors assessed outcomes of pregnant women hospitalized for motor vehicle crashes in Washington State from 1989 to 2001 (n = 582). They used the Injury Severity Score (ISS) to classify 84 severely injured (ISS > or =9), 309 non-severely injured (ISS 1-8), and 189 uninjured (ISS 0) pregnant women and compared them with pregnant women who had not been hospitalized for a motor vehicle crash (n = 17,274). Of pregnant women in motor vehicle crashes, 82.9% were hospitalized and discharged without delivering, and 17.1% delivered at hospitalization. Compared with women not in motor vehicle crashes, severely and non-severely injured women were at increased risk of placental abruption and cesarean delivery, and their infants were at increased risk of respiratory distress syndrome and fetal death. Uninjured women were also at increased risk of preterm labor (relative risk = 7.9, 95% confidence interval: 6.4, 9.8) and placental abruption (relative risk = 6.6, 95% confidence interval: 3.9, 11.2) compared with women not in motor vehicle crashes. Pregnant women hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, regardless of the presence or severity of injuries.

Accidents, Traffic↗
PubMed2001

Hospitalizations for pediatric intoxication in Washington State, 1987-1997.

BACKGROUND: Intoxication (or poisoning) that necessitates hospitalization remains an important source of morbidity in children. OBJECTIVE: To determine changes, during an 11-year period (1987-1997), in the incidence of hospitalization due to intoxication among children in Washington State and circumstances of ingestion, agents used, hospital length of stay, charges, and mortality. METHODS: A computerized database of all hospital discharges (Comprehensive Hospital Abstract Reporting System [CHARS] database) in Washington was used. Cases included all children younger than 19 years with a primary or secondary diagnosis for an intoxication or with an external cause of injury code (E code) for an intoxication from 1987 to 1997. RESULTS: There were 7322 hospitalizations (45 per 100 000 children per year); the annual rate significantly decreased during the study period. Most patients (75%) were teenagers. Sixty-five percent were female. Pharmaceutical agents were used in 80% of cases. Analgesics were the most commonly used (34%), followed by antidepressants (12%) and psychotropic drugs (8%). Nonpharmaceutical agents were more prevalent in children younger than 12 years than in teenagers. Self-inflicted intoxication was the most frequent cause identified by E codes (47%). Median length of stay was 1 day, and median hospital charges were $2096. Mortality was low (0.2%) and did not change significantly over time. CONCLUSIONS: Acute intoxication continues to be an important cause of hospitalization in children. The type of agent involved did not change significantly over time. Teenage girls continue as the highest risk group for suicide attempt from ingestions. Self-inflicted intoxications were associated with higher costs, length of stay, and readmissions. Although preventive measures and development of poison centers have contributed to decrease mortality from acute intoxication in children in the last 50 years, efforts need to be targeted toward suicide prevention, especially among teenage girls.

Adolescent↗
PubMed2002

Childhood immunization registries: gaps between knowledge and action among family practice physicians and pediatricians in Washington state, 1998.

OBJECTIVES: To assess the availability and use of Washington State's CHILD (Children's Health, Immunization, Linkages, and Development) Profile and other computerized immunization tracking systems, to determine physicians' attitudes about these systems, and to identify factors associated with using them. DESIGN: Randomized, population-based, cross-sectional survey. PARTICIPANTS: Washington family physician and pediatrician specialty organization members providing childhood immunizations in 1998 (N = 2472). MAIN OUTCOME MEASURE: Reported CHILD Profile and other computerized systems use. RESULTS: The adjusted response rate was 75% (n = 1331). Overall, 37.7% of respondents had heard of CHILD Profile, 6.3% used it, and 24.9% used other systems. Groups significantly more likely not to use computerized systems than referent pediatricians in areas fully implementing CHILD Profile were family physicians (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.0), private physicians (aOR, 8.0; 95% CI, 3.2-20.1), physicians taking fewest opportunities to immunize (aOR, 2.3; 95% CI, 1.4-3.7), and physicians practicing in local health jurisdiction areas with CHILD Profile marketing activity (aOR, 2.1; 95% CI, 1.2-3.9) or in those areas with little or no registry activity (aOR, 2.6; 95% CI, 1.6-4.4). Those with systems agreed that they save time (71.0%), make status checks easier (87.1%), and increase immunization coverage (88.6%). Those without systems agreed that they help practices (90.3%) and increase efficiency (76.5%), but fewer agreed that they reduce costs (30.2%). CONCLUSIONS: Although most physicians agreed that computerized systems are useful, few had them or used them. Provider-based systems can improve immunization coverage, but the feasibility and effectiveness of communitywide and statewide systems remain unexplored. Because these systems depend on participation, more understanding is needed to help organizations implement them. Interventions to increase availability and use should address provider and health organization needs.

Adult↗
PubMed2002

Trends in pediatric hospitalizations of children in washington state by insurance and chronic condition status, 1991-1998.

OBJECTIVE: To examine the possible impact of changes in the organization and management of the Medicaid program on hospitalization patterns for children with chronic and nonchronic conditions between January 1, 1991, and December 31, 1998. DESIGN: Longitudinal retrospective study of hospitalization patterns of children in 4 strata: Medicaid, non-Medicaid, chronic conditions, and nonchronic conditions. SETTING: Washington State. PATIENTS: Hospital discharge abstract records for all children aged 0 to 17 years profiled into those with and without a chronic condition, Medicaid, and non-Medicaid using a diagnosis-based classification system. MAIN OUTCOME MEASURES: Hospitalization and multiple hospitalization rates and length of hospital stay. RESULTS: In 1991, hospitalization and multiple hospitalization rates were higher for all Medicaid vs non-Medicaid children. From 1991 to 1998, there was a decrease in the hospitalization and multiple hospitalization rates for Medicaid children only. By 1998, rates for Medicaid children approximated those for non-Medicaid children. This decrease was greater for nonchronically ill children than for chronically ill children. Total hospitalizations in Medicaid children decreased by 4.5%. The mean length of stay in 1991 for all Medicaid hospitalized children was higher than that for non-Medicaid children (6.1 vs 5.1 days). By 1998, the length of stay decreased for both groups (5.7 vs 4.9 days). CONCLUSION: The declines in hospitalization and multiple hospitalization rates observed in Washington State Medicaid children from 1991 to 1998 may be the result of many statewide efforts to increase access and improve management for this population.

Adolescent↗
PubMed1994

Infant injury death in Washington State, 1981 through 1990.

OBJECTIVE: To measure annual rates of infant injury death in Washington State and identify potential risk factors for infant injury death. METHODS: A population-based case-control study using a linked file of birth and death certificates for the years 1981 through 1990. RESULTS: The leading causes of infant injury death, per 100,000 live births, were intentional injury (9.1); suffocation, choking, or hanging (6.9); motor vehicle crashes (4.4); and drowning (3.2). Unintentional injury death rates fell steeply during the 1970s but remained steady during the 1980s. Infanticide rates rose during the 1980s. Young maternal age (odds ratio, 9.0; 95% confidence interval, 4.5 to 17.9, for age < 20 years vs age > 30 years) and higher parity (odds ratio, 5.0; 95% confidence interval, 3.1 to 8.3, for parity of two or more vs parity of zero) were associated with infant injury death. There was a twofold increase in the risk of infant injury death if the mother smoked, was black, or lived in a rural area. Male sex of the infant, late prenatal care, and low income were associated only with intentional deaths, while higher parity was more strongly associated with unintentional injury deaths. CONCLUSIONS: During 1981 through 1990, infant mortality caused by injuries increased in Washington State. Young maternal age and higher parity were strongly associated with infant injury death.

Accidents↗
PubMed1995

Kawasaki syndrome in Washington State. Race-specific incidence rates and residential proximity to water.

OBJECTIVES: To calculate race-specific incidence rates of Kawasaki syndrome (KS) and to assess the association of KS with residential proximity to water in Washington State. DESIGN: Incidence study over 4 1/2 years, using cases identified with a new statewide hospital data set and a case-control study. SETTING: King, Pierce, and Snohomish counties in Washington State. PATIENTS: One hundred twelve population-based incident cases meeting Centers for Disease Control and Prevention criteria for KS. MAIN OUTCOME MEASURES: Race-specific KS incidence rates and distance to permanent bodies of water among KS cases and matched controls. RESULTS: For the years 1985 through 1986 and 1987 through 1989, the annual KS incidence rates were 6.5 and 15.2 per 100,000 children younger than 5 years, respectively. Rates were highest among Asian Americans (33.3 per 100,000 children younger than 5 years in the 1987-1989 period), followed by blacks and whites (23.4 and 12.7 per 100,000 children younger than 5 years, respectively). The median distance to water did not differ between cases and controls and the proportion of cases living within 150 yd (135 m) of water was no greater than that of controls (odds ratio, 1.0; 95% confidence interval, 0.1 to 20.9). CONCLUSIONS: With complete ascertainment of incident-hospitalized cases of KS, the race-specific rates are among the highest documented in the United States. The rate among Asian Americans was less than that found in Japan, perhaps due to differences in environmental exposures or variations in susceptibility among different Asian ethnic groups. Although we found no association with permanent bodies of water, future studies of KS should include home inspection to assess exposure to temporary collections of standing water.

Black or African American↗
PubMed1997

Change in the use of breast-conserving surgery in western Washington after the 1990 NIH Consensus Development Conference.

OBJECTIVE: To evaluate the use of breast-conserving surgery in western Washington before and after the National Institutes of Health Consensus Development Conference (June 18-21, 1990) during which breast-conserving surgery was recommended for most women with early invasive breast cancer. DESIGN: Survey. SETTING: Population-based cancer registry in the Seattle-Puget Sound (Washington) region. PARTICIPANTS: The survey included 13541 women in whom American Joint Committee on Cancer stage I or II breast cancer was diagnosed between January 1, 1983, and December 31, 1993. MAIN OUTCOME MEASURE: Proportion of participants who underwent breast-conserving surgery. RESULTS: From April 1985, after results of a US randomized controlled trial showing equivalent survival in women undergoing mastectomy or breast-conserving surgery were published, to the time of the Conference, breast-conserving surgery was performed on 44.8% of women with stage I and 25.8% with stage II breast cancer. These percentages increased to 54.9% and 35.2%, respectively, during the post-Conference period. While women with stage II breast cancer were less likely than women with stage I breast cancer to undergo breast-conserving surgery before and after the Conference, trends for age and education were attenuated after the Conference. Differences in the use of breast-conserving surgery observed before the Conference between countries of residence and among hospital types were also reduced after the Conference. CONCLUSIONS: These findings suggest that the Conference recommendations had an effect on the adoption of breast-conserving surgery, particularly among groups who were previously least likely to undergo such surgery. Despite progress toward the Conference recommendation that the majority of women with early invasive breast cancer undergo breast-conserving surgery, the majority of women with stage II breast cancer undergo mastectomy.

Aged↗
PubMed1996

Fatal and nonfatal injuries related to violence in Washington workplaces, 1992.

This study describes injuries related to assaults and violence that occurred in Washington State workplaces in 1992. Nonfatal injuries are emphasized. High-risk industries and occupations are described. Fatalities caused by work-related violence were identified using the 1992 U.S. Department of Labor Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries. Nonfatal injuries were identified using the BLS Annual Survey of Occupational Injuries and Illnesses and the Washington State workers' compensation system. Thirteen occupational fatalities resulted from assaults or violent acts in 1992. BLS data identified 784 nonfatal injuries that resulted in one or more day off work; workers' compensation data identified 2,395 claims. Industries experiencing the highest claim rates were Social Services (148 per 10,000) and Health Services (106 per 10,000). Nonfatal violent injuries were common and appeared to have different risk factors than fatal injuries. Industries in which injuries occurred were often predictable and suggested specific strategies for prevention efforts.

Absenteeism↗
PubMed1998

Occupational injuries among adolescents in Washington State, 1988-1991.

BACKGROUND: To characterize work-related injuries and illnesses in minors. METHODS: We analyzed Washington State workers' compensation claims from 1988 through 1991. RESULTS: There were 17,800 claims among adolescents from age 11 through 17 years accepted in the 4-year period, including three occupational fatalities, 22 amputations, and 464 fractures; 89% of all injuries occurred among the 16- and 17-year-olds. Claims were most frequent in restaurants, food stores, service industry, other retail and wholesale trade, and agriculture. Washington State census data were used for denominator in calculating injury rates for adolescents and adults. The crude injury rate for 16- and 17-year-olds employed at the time of the census was similar to that seen among adults (9.0 vs 10.4 per 100 workers), despite that minors work fewer hours per year. The rate among boys was almost twice that seen among girls (11.7 vs. 6.4 per 100 workers). Highest rates, per 100 workers, were in public administration (27.0), construction (21.1), agriculture (11.4), and restaurants (11.0). Using census data for those working anytime over the course of the year and adjusted for the number of hours worked, the injury rate for 16- and 17-year-olds was 19.4/100 full time equivalents compared with 10.6 of 100 full-time equivalents for adults. Most injuries were lacerations, sprains and strains, contusions, and burns. CONCLUSIONS: Public health policy and injury prevention strategies for working adolescents should be developed and implemented.

Accidents, Occupational↗