Standardization of Epidemiological Surveillance of Invasive Group A Streptococcal Infections.

Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections. This article includes clinical descriptions followed by case definitions, based on clinical and laboratory evidence, and case classifications (confirmed or probable, if applicable) for invasive Strep A infections and for 3 Strep A syndromes: streptococcal toxic shock syndrome, necrotizing fasciitis, and pregnancy-associated Strep A infection. Considerations of the type of surveillance are also presented, noting that most people who have invasive Strep A infections will present to hospital and that invasive Strep A is a notifiable disease in some countries. Minimal surveillance necessary for invasive Strep A infection is facility-based, passive surveillance. A resource-intensive but more informative approach is active case finding of laboratory-confirmed Strep A invasive infections among a large (eg, state-wide) and well defined population. Participant eligibility, surveillance population, and additional surveillance components such as the use of International Classification of Disease diagnosis codes, follow-up, period of surveillance, seasonality, and sample size are discussed. Finally, the core data elements to be collected on case report forms are presented.

Computed Tomographic Assessment of Individual Paranasal Sinus Compartment and Nasal Conchal Bulla Involvement in 300 Cases of Equine Sinonasal Disease.

Background: Computed tomographic (CT) imaging has allowed new anatomical studies and detailed clinical imaging of the complex, overlapping equine sinonasal structures. Despite the widespread use of CT, no study has specifically identified which compartments are most commonly affected with sinus disorders. CT has also shown the presence of intercurrent, ipsilateral nasal disorders, especially infection of the nasal conchal bullae (NCB) in many cases of sinus disease, but the frequency of intercurrent NCB infections has not been reported. Objectives: To identify which sinus compartments are most commonly affected in horses with clinical sinus disorders and to record the prevalence of NCB involvement in such cases. Study Design: Retrospective examination of CT images of horses with confirmed unilateral sinus disease. Methods: The CT images of 300 horses, from three different equine hospitals with clinically confirmed sinus disease [mainly dental (53%) and primary sinusitis (25.7%)] were retrospectively examined to determine which sinus compartments and NCBs were affected. Results: The rostral, more dependent sinus compartments were most commonly involved, i.e., the rostral maxillary sinus in 284/300 (94.7% affected) and the ventral conchal sinus (87% affected). The caudal maxillary sinus (65.3%), dorsal conchal sinus (52.7%), frontal sinus (26%), ethmoidal sinus (32%) and sphenopalatine sinus (28.7%) were less commonly affected. There was infection or destruction of the ipsilateral NCBs in 56% of horses with sinus disorders, including the ventral NCBs in 42.3%, dorsal NCBs in 29% and both NCBs in 18% of cases. Main Limitations: The horses with sinonasal disease that underwent head CT imaging include more problematic cases and horses of high value, rather than the general horse population. Conclusions: The more dependant (i.e., the RMS and VCS) sinus compartments are most commonly involved in sinus disorders, with the RMS involved in nearly every case. The more dorsally located sinuses (i.e., caudal group) are less commonly involved. Many horses with sinus disease also have disorders of their nasal conchal bullae and so the term sinonasal disease seems appropriate for these disorders.

Future dryness in the southwest US and the hydrology of the early 21st century drought.

Recently the Southwest has experienced a spate of dryness, which presents a challenge to the sustainability of current water use by human and natural systems in the region. In the Colorado River Basin, the early 21st century drought has been the most extreme in over a century of Colorado River flows, and might occur in any given century with probability of only 60%. However, hydrological model runs from downscaled Intergovernmental Panel on Climate Change Fourth Assessment climate change simulations suggest that the region is likely to become drier and experience more severe droughts than this. In the latter half of the 21st century the models produced considerably greater drought activity, particularly in the Colorado River Basin, as judged from soil moisture anomalies and other hydrological measures. As in the historical record, most of the simulated extreme droughts build up and persist over many years. Durations of depleted soil moisture over the historical record ranged from 4 to 10 years, but in the 21st century simulations, some of the dry events persisted for 12 years or more. Summers during the observed early 21st century drought were remarkably warm, a feature also evident in many simulated droughts of the 21st century. These severe future droughts are aggravated by enhanced, globally warmed temperatures that reduce spring snowpack and late spring and summer soil moisture. As the climate continues to warm and soil moisture deficits accumulate beyond historical levels, the model simulations suggest that sustaining water supplies in parts of the Southwest will be a challenge.

Selecting global climate models for regional climate change studies.

Regional or local climate change modeling studies currently require starting with a global climate model, then downscaling to the region of interest. How should global models be chosen for such studies, and what effect do such choices have? This question is addressed in the context of a regional climate detection and attribution (D&A) study of January-February-March (JFM) temperature over the western U.S. Models are often selected for a regional D&A analysis based on the quality of the simulated regional climate. Accordingly, 42 performance metrics based on seasonal temperature and precipitation, the El Nino/Southern Oscillation (ENSO), and the Pacific Decadal Oscillation are constructed and applied to 21 global models. However, no strong relationship is found between the score of the models on the metrics and results of the D&A analysis. Instead, the importance of having ensembles of runs with enough realizations to reduce the effects of natural internal climate variability is emphasized. Also, the superiority of the multimodel ensemble average (MM) to any 1 individual model, already found in global studies examining the mean climate, is true in this regional study that includes measures of variability as well. Evidence is shown that this superiority is largely caused by the cancellation of offsetting errors in the individual global models. Results with both the MM and models picked randomly confirm the original D&A results of anthropogenically forced JFM temperature changes in the western U.S. Future projections of temperature do not depend on model performance until the 2080s, after which the better performing models show warmer temperatures.

Sustainable water deliveries from the Colorado River in a changing climate.

The Colorado River supplies water to 27 million users in 7 states and 2 countries and irrigates over 3 million acres of farmland. Global climate models almost unanimously project that human-induced climate change will reduce runoff in this region by 10-30%. This work explores whether currently scheduled future water deliveries from the Colorado River system are sustainable under different climate-change scenarios. If climate change reduces runoff by 10%, scheduled deliveries will be missed approximately 58% of the time by 2050. If runoff reduces 20%, they will be missed approximately 88% of the time. The mean shortfall when full deliveries cannot be met increases from approximately 0.5-0.7 billion cubic meters per year (bcm/yr) in 2025 to approximately 1.2-1.9 bcm/yr by 2050 out of a request of approximately 17.3 bcm/yr. Such values are small enough to be manageable. The chance of a year with deliveries <14.5 bcm/yr increases to 21% by midcentury if runoff reduces 20%, but such low deliveries could be largely avoided by reducing scheduled deliveries. These results are computed by using estimates of Colorado River flow from the 20th century, which was unusually wet; if the river reverts to its long-term mean, shortfalls increase another 1-1.5 bcm/yr. With either climate-change or long-term mean flows, currently scheduled future water deliveries from the Colorado River are not sustainable. However, the ability of the system to mitigate droughts can be maintained if the various users of the river find a way to reduce average deliveries.

Human-induced changes in the hydrology of the western United States.

Observations have shown that the hydrological cycle of the western United States changed significantly over the last half of the 20th century. We present a regional, multivariable climate change detection and attribution study, using a high-resolution hydrologic model forced by global climate models, focusing on the changes that have already affected this primarily arid region with a large and growing population. The results show that up to 60% of the climate-related trends of river flow, winter air temperature, and snow pack between 1950 and 1999 are human-induced. These results are robust to perturbation of study variates and methods. They portend, in conjunction with previous work, a coming crisis in water supply for the western United States.

Perceived organizational support and perceived external prestige: predicting organizational attachment for university faculty, staff, and administrators.

The present article introduces a social-exchange model of organizational attachment incorporating both direct exchange and indirect exchange. Participants were 325 university employees. The present results indicated that perceived organizational support (POS) and perceived external prestige (PEP) both contribute to organizational attachment. Further, the results showed that the extent to which POS and PEP are related to organizational attachment is moderated by occupational proxies of cosmopolitan-local role orientation. POS was more strongly related to the affective commitment and withdrawal cognitions of staff and administrators than to those of faculty. PEP was more strongly related to affective commitment and withdrawal cognitions of university faculty than to those of university staff and administrators. The authors discussed the need to incorporate relational variables such as PEP into other social-exchange frameworks.

Penetration of human-induced warming into the world's oceans.

A warming signal has penetrated into the world's oceans over the past 40 years. The signal is complex, with a vertical structure that varies widely by ocean; it cannot be explained by natural internal climate variability or solar and volcanic forcing, but is well simulated by two anthropogenically forced climate models. We conclude that it is of human origin, a conclusion robust to observational sampling and model differences. Changes in advection combine with surface forcing to give the overall warming pattern. The implications of this study suggest that society needs to seriously consider model predictions of future climate change.