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Displaying 10 papers, 37 pages, start at 1, 32 Hits
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Fifty-two people completed the questionnaire, a response rate of 71%. They are mostly medical doctors (86 %) working in Universities (56%) or Prevention departments (21%) and directly involved in vaccinations (71%). The vast majority of respondents is in favor of the Italian mandatory vaccine Law (85%) and 65% believes that it should not be removed. Moreover, 83% or respondents is against the recent Government's proposal of introducing a "flexible" obligation. Among the alternative strategies to mandatory vaccinations, the favorite are vaccination promotion and information campaigns for the general population and organizational interventions to strengthen vaccination services. Nevertheless, 67% of respondents consider their implementation to be very difficult. Concerning the epidemiologic impact of mandatory vaccination, the majority or respondents agree that mandatory vaccination is able to increase vaccination coverage and reduce morbidity from vaccine-preventable infectious diseases. Concerning the social impact, the majority of respondents believes that mandatory vaccination encourages hesitant parents to vaccinate their children but exacerbate the quarrel with no vax movements. Finally, regarding the economic impact, the majority of respondents agree that mandatory vaccination will overall save health and social costs for the National Health System.
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In the last decade, the scope of public health (PH) surveillance has grown, and biosurveillance capacity has expanded in Duval County. In 2004, the Duval County Health Department (DCHD) implemented a standalone syndromic surveillance (SS) system, which required the manual classification and entry of emergency department (ED) chief complaints by hospital staff. At that time, this system, in conjunction with other external systems (e.g., CDC ILInet, FluStar and NRDM) were used to conduct surveillance for health events. Recommendations from a 2007 ISDS panel were used to strengthen surveillance within Duval County. Later that year, the Florida DOH moved to a statewide SS system and implemented ESSENCE, which has been expanded to include (1) ED record data from 176 hospitals (8 within Duval County); (2) reportable disease case records from Merlin; (3) Florida Poison Information Network consultations; and, (4) Florida Office of Vital Statistics death records (1) . ESSENCE has subsequently become a platform for rapid data analysis, mapping and visualization across several data sources (1) . As a result, ESSENCE has improved business processes within DCHD well beyond the initial scope of event detection. These improvements have included (1) expansion of the ability to create visualizations (e.g., epi-curves, charts and maps); (2) reduction in the time required to produce reports (e.g., newsletters and media responses); (3) reduction in staff training needs; and (4) augmentation of epidemiology processes (e.g., active case finding, emergency response and quality improvement [QI] ) and closing the PH surveillance loop.


Bolivia, Brazil, India, Indonesia and Singapore were chosen for analysis based on data availability and adequate search volume. For each country, a univariate linear model was built by fitting a time series of the fraction of Google search query volume for specific dengue-related queries from that country against a 'gold standard' time series of dengue case counts for a time-frame within 2003Á2010. The specific combination of queries used was chosen to maximize model fit. Spurious spikes in the data were also removed prior to model fitting. The final models, fit using a training subset of the data, were cross-validated against both the overall dataset and a holdout subset of the data. All search queries were fully anonymized. This methodology is similar to the approach used to develop Google flu trends (3) .
We considered 3 models of authority: (1) (emerging topic detection) ETD uniform (i.e., equal weight); (2) ETD PageRank; and (3) bellwether. For 1 and 2, we built a directed graph of user activity, using thread coparticipation to define edges. Each EIN post was text tokenized, POS-tagged, and had stop words removed. We use a time window t 0 5 days to aggregate messages terms and a decay parameter d0 60 days. We identified emerging terms using an energy threshold approach, where emerging is defined as any term where energy! k*m energy over the interval t, where k is some constant; we used k 0 1.3. Any term identified as emerging that occurs in the postsubject line is flagged as important. For the bellwether model, we algorithmically selected 80 and 90 authors from the year prior to the one under analysis and flagged threads as important when one of those bellwethers participated in it. We also conducted 1000 random trials of selecting subsets of 80 users to follow.
MCPHD and RI created a legal memorandum of understanding so that MCPHD could share the names and date of births of suspect cases to the programmers at RI. The alert went into effect in July of 2010. When a healthcare provider's search is also one of the suspected names, an alert appears on the screen informing the provider that this person should have a chest x-ray as part of a follow-up to a TB outbreak investigation. A phone number of a MCPHD nurse on call is provided. The suspect list is periodically updated to remove names of patients who have been located in other medical settings. The novel aspect of this system is that normal methods of locating these individual such as phone or address was not available. Additionally, other traditional public health methods to contact these patients had not proved successful.


As automation in surveillance activities has increased, participation rates of facilities improved as well. Hospital staff became more engaged when there was a more defined purpose to reporting ED visits and admissions (e.g., The Republican National Convention and the H1N1 Novel Influenza A outbreak). Based on the improvements observed, the state is undertaking a project to move all NJ EDs into a real-time, syndromic surveillance system. This implementation is expected to further enhance data reporting and increase response rates beyond the current 86.4%.


Weekly case numbers were obtained from CDESS and counted patients with Shigella who had diagnosis or specimen collection dated between January 1, 2006, and December 31, 2010. Six statistical models were applied to the weekly case numbers in generating signals to identify outbreaks, and signals were compared to the actual outbreak to evaluate their detection powers. Outbreak-related cases from CDESS were removed for the modeling purpose except for the cumulative sum-related methods, which used all cases. The sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the performance of each method.
This project will investigate tools that can be used to support ingestion and translation of public health meaningful use data in the HL7 formats. Open source tools, such as Mirth, have been identified as early candidates to support this function. After the necessary translations have been made, this project will investigate transfer methods to move the meaningful use data from a public health department to a cloud environment. With data available in the cloud, the project will then investigate methods for putting the ESSENCE system in a cloud environment as well. This will provide the collaborative team a platform to evaluate the utility of both the meaningful use data and potentially the value of having regional and national data sharing aspects available to the public health users. Finally, the team will determine the scalability and performance of a cloud environment for disseminating these tools to other jurisdictions across the country.


Electronic medical records for public health; meaningful use; interoperability; cloud Introduction Domains go through phases of existence, and the electronic disease surveillance domain is no different. This domain has gone from an experimental phase, where initial prototyping and research tried to define what was possible, to a utility phase where the focus was on determining what tools and data were solving problems for users, to an integration phase where disparate systems that solve individual problems are tied together to solve larger, more complex problems or solve existing problems more efficiently. With the integration phase comes the desire to standardize on many aspects of the problem across these tools, data sets and organizations. This desire to standardize is based on the assumption that if all parties are using similar language or technology, then it will be easier for users and developers to move them from one place to another.


We used data from the MMWR. It contains weekly syphilis counts per state. We consider the time period from 1995 to 2009. We removed week 53 when present, due to inconsistencies in reporting. We considered 53 locations: the 50 states plus Puerto Rico, and the cities of New York City and Washington DC. To predict disease activity in each state, we constructed a series of linear lagged regression models that used several states as covariates. To benchmark our models, we constructed a basic ARIMA model with one autocorrelation term. All the models were constructed to forecast 4 weeks in advance. Prediction at week t was performed by fitting the models using all past data prior to week tÁ4. To identify bellwether states, we proceeded as follows. First, we repeatedly fitted 2-covariate models to forecast each state and obtained the top 5 most frequent bellwether states for each state. Then, we obtained the most frequent bellwether states from the above lists.


The EBPH movement identifies three types of evidence along a continuum to inform population health interventions: Type 1 (something should be done), Type 2 (this should be done) and Type 3 (how it should be done) (3). Type 2 evidence consists of a classification scheme for interventions (emerging, promising, effective and evidence based) (3). To illustrate typology use with an example: the need for population health interventions for aging populations is well known (Type 1 evidence), many studies show that smart home technologies can support aging in place (Type 2 evidence), but there are few, if any, examples of smart homes as population health interventions to support aging in place (Type 3 evidence).
The spread of infectious diseases is facilitated by human travel. Disease is often introduced by travelers and then spread among susceptible individuals. Likewise, uninfected susceptible travelers can move into populations sustaining the spread of an infectious disease.
Several disease-modeling efforts have incorporated travel and census data in an effort to better understand the spread of disease. Unfortunately, most travel data are not fine grained enough to capture individual movements over long periods and large spaces. Alternative methods (e.g., tracking currency movements or cell phone signals) have been suggested to measure how people move with higher resolution but these are often sparse, expensive and not readily available to researchers.


Sixty-eight million geocoded entries (tweets and check-ins) from 3.2 million users were collected from the Twitter streaming API for the period from September 11, 2010 through January 28, 2011. The Twitter API provides a random sample of tweets; nongeocoded tweets or tweets originating from outside the United States were discarded. In addition, users with fewer than 6 records, or those who check in too frequently (more than once in 5 seconds) or travel too quickly (faster than 1800 km/hr) were removed to exclude automated bots or other location spam.


Although the advent of the ONCs 'meaningful use' criteria has added significant new incentives for healthcare organizations to provide the necessary data for implementing syndromic surveillance, incentives alone are not sufficient to sustain a robust community of practice that engages public health and healthcare practitioners working together to fully achieve meaningful use objectives. The process for building a successful community of practice around syndromic surveillance is primarily applicationagnostic. The business process has many of the same characteristics regardless of application features and can be incrementally customized for each community based on the unique needs and opportunities and the functional characteristics of the application. This presentation will explore lessons-learned in the north central Texas region with BioSense 1 and ESSENCE over the past 6 years and will describe the multiphase process currently underway for BioSense 2.0. Key program process steps and success criteria for public health and healthcare practitioners will be described. This road map will enable other local health department jurisdictions to replicate proven methodologies in their own communities. The presentation will also highlight what it takes for an existing community of practice with a home-grown system to move processes and protocols to the cloud.


During the third week of July 2011, Ohio experienced a heat wave with multiple heat advisories throughout its various cities. The total ED visits related to HRI peaked on July 21 (n0170, 107 males, 63 females), which was also the day with the highest maximum temperature (97.4 F). A time-series chart of these ED visits by age group is shown below. The data show that the most sensitive populations (ages 0-5 and 65 and older) were the least affected and likely were adhering to the heat advisories. The 18Á 39-and 40Á64-year-old age groups were most affected by the heat. Pearson correlation showed a strong relationship between HRI visits and mean temperature and dew point (r00.76 and r00.66), p B0.0001. Multiple linear regression analyses were completed to determine which weather variables were the best predictors with HRI. The best model showed that for every 1 unit increase in ED visits, there was a 3.88 unit increase in mean temperature, independent of mean humidity and wind speed, p B0.0001. The addition of mean dew point caused the model to have a high colinearity and was removed from the model.
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Reveal LINQTM wireless cardiac device were obtained via donation following explantation from human patients and the battery life assessed prior to use in each canine patient using a Medtronic CarelinkÒ programmer with appropriate software loaded. An area on the left lateral thorax was clipped and alcohol was used to remove oils. Adhesive electro-conductive gel pads were applied underneath the device and it was placed within the 4th intercostal space parallel to the ribs and then slowly moved in a grid pattern to find the most consistent electrocardiogram (ECG) on the programmer screen. The device was then secured to the thorax using TegadermTM film, gauze, and ElastikonÒ. It was then taped around the thorax with 2 inch white tape and VetrapTM and the patients were fitted with a Holter monitor vest to reduce likelihood of device tampering or consumption of bandage materials and device. The device was programmed with the patient's information and the pre-programmed manufacturer heart rate parameters Patients wore the ICM for 4 to 5 days and owners were asked to activate the monitor manually for 4 total recordings during different activities and to keep a diary. Accuracy was assessed based on quality of ECG tracings (consistent ability to measure heart rate, visualization of entire p-QRS-T waves) and presence of a recording during manual activation. Two dogs were fitted with 24 hour Holter monitors as a control.
Of the sixteen patients, two were unable to be fitted with a device due to a weak signal, one client terminated the study after 1 day, and the device moved out of place and stopped recording on one dog. The remaining twelve dogs had at least 3 out of 4 interpretable tracings from manually activated recordings. The auto-activated recordings triggered by pre-set parameters were of good quality. After each set of auto-activated recordings were reviewed, the parameters were adjusted to define the outer range of normal and recorded rhythms were reclassified. Over the course of the study patient heart rates did not exceed 222 bpm for 32 beats or reach 30 bpm for 12 consecutive beats. Fewer auto-activations occurred per dog when the pause parameter was set at 4.5 seconds than 3 seconds. One symptomatic patient had three episodes while wearing the device however there was no indication of a rhythm abnormality in the manually activated recordings. The other symptomatic patient did not have an episode while wearing the monitor and the device incorrectly logged an atrial fibrillation episode. During this time period, the ECG from the ICM was not of sufficient quality to identify p waves but the control Holter recording clearly showed a sinus arrhythmia was present. The device was still recording at time of removal in all but one dog. Five dogs had self-limiting, mild skin irritation after removal of the device.


CSF samples from 175 pure or mixed breed dogs were submitted to Colorado State University ( from either the Washington State University Neurology Department between January 2012 and September 2014 or the Colorado State University Veterinary Teaching Hospital between January 2012 and September 2015. The CSF samples were stored at À80°C until evaluated in this study. Dogs with neurologic examinations consistent with focal and multifocal neurologic dysfunction and CSF pleocytosis (total nucleated cell count >5 nucleated cells/µL and red blood cell <4,000 cells/µL) were included. Animals with normal neurologic examinations were also included if their CSF met our criteria. The CSF was thawed and centrifuged at 10,000 X g for 15 minutes. The supernatant was removed and the pellet assayed in a previously published PCR assay that targets the 16S-23S rRNA intergenic region. All positive amplicons were sequenced to determine the infective Bartonella spp.


Data were first assessed as independent events by analyzing only the results of the first serum biochemistry profile obtained for each cat (n = 1314). The median lipase value in the group of cats with creatinine values above reference interval (>190 µmol/L, n = 162) was 18.5 U/L (range 7-594 U/L), which was higher (P < 0.001) than the median lipase value of 14 U/L (range 5-747 U/L) in the group of cats with creatinine values ≤190 (n = 1152), although ranges overlapped substantially. The same trend (P = 0.06) was observed for PLI in these respective groups: median was 16.6 µg/L (range 1.5-50 µg/L) for cats with creatinine >190 µmol/L (n = 9); median was 3.85 µg/L (range 0.5-50 µg/L) for cats with creatinine ≤190 µm/L (n = 55). There was a significant, but weak, correlation between creatinine and lipase values across all cats (rho=0.2, P < 0.001, n = 1314), but no correlation was present for the group of cats with creatinine values >190 µmol/L (n = 162). There was no correlation between creatinine and PLI. Multivariate linear regression was used to assess the influence of creatinine, hydration, and body condition on lipase over all cats for which this information was available (n = 313); none of these variables demonstrated a significant effect (P = 0.09, 0.22, and 0.97, for creatinine, hydration, and body condition, respectively). The data were next assessed by MANOVA for variation over time within individual cats for which repeat serum biochemistries and medical record data were available (n = 279). Hydration demonstrated a significant effect on creatinine (P < 0.001), and a trend towards effect on lipase (P = 0.07). Creatinine did not demonstrate any further relationship with lipase (P = 0.39). PLI was repeated in 15 cats; values moved in the same direction as creatinine in only 4 cases.


In this crossover study, units of blood were collected from 8 healthy dogs. In half of the units, leukocytes and platelets were removed via leukoreduction. Units of pRBCs were then created via centrifugation and stored for 10 or 21 days. Initial baseline plasma samples were collected after processing and before storage (Day 0). Additional samples were collected following storage for 10 or 21 days, both after removal from refrigeration and again after 5 hours at room temperature (to simulate transfusion conditions). Concentrations (ng/mL) of arachidonic acid (AA), prostaglandin E 2 (PGE 2 ), prostaglandin D 2 (PGD 2 ), prostaglandin F 2a (PGF 2a ), thromboxane B 2 (TXB 2 , stable metabolite of TXA 2 ), 6-keto-prostaglandin F 1a (6-keto-PGF 1a , stable metabolite of prostacyclin) and leukotriene B 4 (LTB 4 ) were quantified by liquid chromatography-mass spectrometry.
Once the testing methodology was codified, and a Standard Operating Procedure (SOP) written, testing for the DEA 5 antigen moved into phase two, blind clinical testing. Two closed canine colonies were tested for the DEA 5 antigen, one comprised entirely of unrelated greyhounds, the other of mixed canines. Previously, a portion of these mixed canines had been typed for the DEA 5 antigen, so the sample set had known positives mixed with unknowns. Samples were blinded via identification number. All canines were infectious disease screened, up to date on vaccinations and physical examinations. Testing on the two canine colonies revealed an interesting find. Previously, it was thought that greyhounds had up to a 30% incidence rate of the DEA 5 antigen 3 . However, in testing of the closed greyhound colony, the incidence rate proved to be zero. In a mixed breed closed canine colony, the incidence of the DEA 5 antigen proved to be 21.6%. All previously known DEA 5 antigen positive mixed canines were correctly identified by laboratory technicians.


The POCKIT Ò iiPCR system was quick to learn, portable, and had a short run time of approximately 1 hour. There were few false-positive results, indicating that positive results are likely to represent true infections when tested in high-risk animals. Approximately 10-15% of infected dogs would be missed by the POCKIT Ò iiPCR system. However, the portability and speed with which results can be obtained may result in more infected dogs being diagnosed than in the current situation in which testing is rarely performed in dog-fighting cases due to cost and logistics of sending samples to outside laboratories. This system may also be used for B. gibsoni treatment monitoring using a hybrid approach. For example, following initial diagnosis with either the POCKIT Ò system or a commercial laboratory, the POCKIT Ò system could be used for testing during treatment. Once a negative result was obtained, a sample could be submitted to a commercial laboratory to confirm treatment efficacy. Although this study focused on mass screening for B. gibsoni, the portable iiPCR platform has potential to aid in rapid detection of a variety of infections under field conditions. The efficacy of sarolaner (Simparica TM , Zoetis) to prevent transmission of Borrelia burgdorferi and Anaplasma phagocytophilum from infected wild-caught Ixodes scapularis to dogs was evaluated in a well-controlled laboratory study. Twenty-four purpose-bred laboratory Beagle dogs seronegative for B. burgdorferi and A. phagocytophilum antibody were allocated randomly to one of three oral treatment groups: placebo administered on Days 0 and 7, sarolaner administered on Day 0 (28 days prior to tick infestation), or sarolaner administered on Day 7 (21 days prior to tick infestation). Sarolaner tablets were shaved and/or sanded based on each dog's individual bodyweight to provide a dosage of 2 mg/kg. On Day 28 each dog was infested with approximately 25 female and 25 male wild caught adult I. scapularis that were determined by random sampling to have infection rates of 57% for B. burgdorferi and 6.7% for A. phagocytophilum by PCR. In situ tick counts were conducted on Days 29 and 30. On Day 33, all ticks were counted and removed. Blood samples collected from each dog on Days 27, 49, 63, 77, 91 and 104 were tested for the presence of B. burgdorferi and A. phagocytophilum antibodies using the SNAP Ò 4Dx Ò Plus Test, and quantitatively assayed for B. burgdorferi antibodies using an ELISA test. Skin biopsies collected on Day 104 were tested for the presence of B. burgdorferi by bacterial culture and PCR. Acaricidal efficacy was calculated based on the reduction of geometric mean live tick counts in the sarolaner-treated groups compared to the placebo-treated group for each tick count.


Significantly increased mean concentrations of IL12(p40) (1191 AE 484.9 versus 219.6 AE 393.3 pg/mL; P < 0.0001), SDF1 (2015 AE 1131 versus 528.7 AE 1002 pg/mL; P = 0.002), and IL18 (483.8 AE 468.8 versus 92.03 AE 272.6 pg/mL; P = 0.02) were detected in the serum of cats with IC compared to unaffected cats. Further studies are necessary to evaluate the diagnostic and prognostic utility of serum cytokine biomarkers in cats with IC. The most common radiopaque cystoliths in cats are composed of struvite or calcium oxalate minerals. Struvite cystoliths have been shown to dissolve with dietary management whereas calcium oxalate cystoliths must be removed surgically. The commercially available diet, PurinaÒ Pro PlanÒ Veterinary Diets UR UrinaryÒ St/OxÒ, has been formulated for the dissolution of struvite cystoliths and to lessen the recurrence of both struvite and oxalate cystoliths. The purpose of this study was to describe the clinical and laboratory findings in cats with radiopaque cystoliths fed this commercially available diet.


We successfully purified mature feline erythrocytes from whole blood with a combination of centrifugation and leukoreduction with a specialized filter. This removed a majority of the reticulocytes, white blood cells and platelets, however a final purification step utilizing magnetic beads coated with antibodies was subsequently used to ensure a pure mature population of erythrocytes. For this immune-depletion step, antibodies were initially tested for reactivity in the feline, then biotinylated for use within the columns. The antibodies used in this study were: anti-CD71 (anti-transferrin receptor to remove reticulocytes); anti-CD18 (anti-beta2 integrin to remove leukocytes) and anti-CD61 (anti-beta 3 integrin to remove platelets). Assessment of the mature red blood cell preparation purity was performed with an automated flow cytometry-based hematology analyzer to identify the presence of leukocytes, platelets and reticulocytes.


For this purpose, eight healthy adult mixed-breed horses were subjected to small colon distension using a surgically implanted latex ball in the lumen (Ethical approval: CEBEA-Protocol #007568-09). Blood and peritoneal fluid samples were obtained before intestinal distension (M0), after 4 hours of distension (M4when the ball was deflated and removed) and 72 hours after decompression (M72). Twelve hours after the ball removal was also collected peritoneal fluid sample for neutrophils count. Data were submitted to Friedman's test followed by post-hoc Dunn's Multiple Comparison Test.