Determination of Residual Triflumezopyrim Insecticide in Agricultural Products through a Modified QuEChERS Method.

A rapid and simple analytical method for triflumezopyrim, a new class of mesoionic insecticides and commercialized molecules from DuPont, was developed with a modified QuEChERS method. The pH adjustment was used to improve the extraction efficiency of acetonitrile solvent, and dispersive solid-phase extraction was employed for the clean-up process. The five selected food commodities were used to verify the present optimized method, which displayed good linearity with an excellent correlation coefficient (R2 = 0.9992-0.9998) in the 0.003-0.30 mg/kg calibration range. The method limits of detection (LOD) and quantification (LOQ) were determined to be a value of 0.003 and 0.01 mg/kg, respectively. The mean recovery for the triflumezopyrim was in the 89.7-104.3% range. The relative standard deviations were ≤9.8% for intra- (n = 5) and inter-day (n = 15) precisions at concentrations of 0.01, 0.1, and 0.5 mg/kg in the five representative samples. The matrix effect has been calculated to confirm the effect during ionization of the analyte in the UPLC-MS/MS. The matrix effects of the instrumental analysis showed that triflumezopyrim was less susceptible to matrices. The proposed analytical method in this study has effectively improved the accuracy, selectivity, and sensitivity for the determination of triflumezopyrim in agricultural commodities; therefore, it can serve as a reference method for the establishment of maximum residue limits (MRLs).

Acceptability of an inactivated influenza vaccine delivered by microneedle patch: Results from a phase I clinical trial of safety, reactogenicity, and immunogenicity.

OBJECTIVE: This study sought to evaluate the acceptability of inactivated influenza vaccine delivered by microneedle patch (MNP) in comparison to inactivated influenza vaccine (IIV) delivered by hypodermic needle. DESIGN, SETTING, AND PARTICIPANTS: From the general population of Atlanta, Georgia, we screened 112 and enrolled 100 healthy adult subjects ages 18 to 49 years. Main Outcome(s) and Measure(s). Our participants were randomized to 4 groups of 25 per arm: (1) IIV by MNP administered by healthcare worker (HCW), (2) IIV by MNP self-administered by study participants, (3) IIV by intramuscular (IM) injection administered by HCW or (4) placebo by MNP administered by HCW. We administered four questionnaires: at Day 0 before and after study product delivery, and at Days 8 and 28. RESULTS: At baseline, 98.6% of participants receiving MNP vaccination reported an overall positive experience with MNPs, compared to 86.4% for participants receiving IM vaccination. For future influenza vaccination, study participants (N = 99) preferred MNP (n = 65, 69.9%) to injections or nasal spray (n = 20, 21.5%), and the preference for MNP increased from Day 0 to Day 28. Factor analyses resulted in two scaled measures including MNP Use Perceptions (a = 0.799, n = 5 items) and MNP Perceived Convenience (a = 0.844, n = 4 items) that were included in longitudinal assessments; while findings reflect significant differences across treatment groups on mean scores for ease of use, MNP perceived protection, MNP reliability, and MNP selection knowledge, all groups reported their belief that influenza vaccination by MNP would be reliable and protective, as well as easy-to-use and convenient. CONCLUSIONS AND RELEVANCE: Most participants were accepting of IIV vaccination by MNP and preferred it to injection. Delivery of IIV by MNP may help increase vaccination coverage.

An interprofessional cohort analysis of student interest in medical ethics education: a survey-based quantitative study.

BACKGROUND: There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. METHODS: In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received (41% overall response rate) among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/(D) MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. RESULTS: The majority of respondents were female (333, 59.3%), white (326, 58.0%) and mid-20s in age (340, 60.5%). Almost half of respondents (47%) reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students (28%) were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. CONCLUSIONS: The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos.

Syphilis Trends in the Central Savannah River Area (CSRA) of Georgia and South Carolina, USA.

There has been an alarming resurgence of early syphilis since 2000, especially in the southeast region, which has one of the highest rates of primary and secondary syphilis in the United States of America (USA). Although the Central Savannah River Area (CSRA) is the second most populous area in Georgia with a large presence of health care facilities, its counties have one of the lowest overall rankings in health outcomes. This study examined the syphilis rates and trends in the CSRA. Data from the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention's AtlasPlus was used. Cases of primary and secondary syphilis diagnosed during 2010⁻2015 were analyzed to describe reported syphilis among CSRA residents. In the CSRA, between 2010 and 2015, the incidence rate of primary and secondary syphilis increased from 5.9 to 9.4 cases per 100,000 population. The lowest rate of syphilis was observed in 2011 (2.7 cases per 100,000) and the highest rate in 2015. In 2015, the highest syphilis rates were observed among males (15.9 per 100,000), non-Hispanic blacks (16.9 per 100,000), and persons between the ages 20⁻24 years (34.5 per 100,000). The relevance of preventive measures has been widely communicated, yet it is clear that risk-taking sexual behavior is on the rise. Greater effort is warranted to reduce risky behaviors that promote the transmission of syphilis, including areas outside of major metropolitan areas.

Influences on Immunization Decision-Making among US Parents of Young Children.

Objectives This study assessed influences on vaccination decisions among parents of young children and examined common vaccination information and advice sources. Methods Using panel samples of parents of children under 7 years, web-based surveys were conducted in 2012 (n = 2603) and 2014 (n = 2518). A vaccine decision-making typology (non-hesitant acceptors, hesitant acceptors, delayers, and refusers) was established and weighted population estimates of potential factors influencing parental vaccination decision (e.g., provider influence, source of information and advice) were computed by year and decision type. Results Delayers and refusers were more likely than acceptors to know someone whose child experienced a severe reaction to a vaccine or delayed/refused vaccine(s). High proportions of delayers (2012: 33.4%, 2014: 33.9%) and refusers (2012: 49.6%, 2014: 58.6%) reported selecting their healthcare provider based on whether the provider would allow them to delay/refuse vaccines. Providers were the most frequently reported trusted vaccine information source among all parents, though more often by acceptors than refusers (2012, 2014: p < 0.01). We found differing patterns of provider advice-seeking and internet as a reliable vaccine information source by group. Among those who had considered delay/refusal, trust in their healthcare provider's advice was the most common reason cited for their decision reversal. Conclusions for Practice Provider trust and communication along with varying degrees of personal-network influences likely contribute to immunization decisions of parents. Vaccine hesitant parents often seek providers amenable to accommodating their vaccine beliefs. Providers may benefit from vaccine communication training as their recommendations may influence hesitant parents to immunize their children.

Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States.

BACKGROUND: Although black women experienced greater cervical cancer incidence and mortality rate reduction in recent years, they continue to have higher incidence rates than whites. Great variations also exist among geographic regions of the US, with the South having both the highest incidence and mortality rates compared to other regions. The present study explores the question of whether living in the South is associated with greater racial disparity in cervical cancer incidence and mortality by examining race- and region-specific rates and the trend between 2000 and 2012. METHODS: The Surveillance, Epidemiology, and End Results (SEER) 18 Program data was used. Cervical cancer incidence and mortality rates, annual percent changes, and disparity ratios were calculated using SEER*Stat software and Joinpoint regression for four groups: US14-Non-Hispanic White (NHW), US14-Non-Hispanic Black (NHB), South-NHW, and South-NHB, where South included 4 registries from Georgia and Louisiana and US14 were 14 US registries except the four South registries. RESULTS: The average age-adjusted cervical cancer incidence rate was the highest among South-NHBs (11.1) and mortality rate was the highest among US14-NHBs (5.4). In 2012, the degree of racial disparities between South-NHBs and South-NHWs was greater in terms of mortality rates (NHB:NHW = 1.80:1.35) than incidence rates (NHB:NHW = 1.45:1.15). While mortality disparity ratios decreased from 2000-2012 for US14-NHB (APC: -1.9(-2.3,-1.4), mortality disparity ratios for South-NHWs (although lower than NHBs) increased compared to US14-NHW. Incidence rates for NHBs continued to increase with increasing age, whereas rates for NHWs decreased after age 40. Mortality rates for NHBs dramatically increased at age 65 compared to a relatively stable trend for NHWs. The increasing racial disparity with increasing age in terms of cervical cancer incidence rates became more pronounced when corrected for hysterectomy prevalence. CONCLUSIONS: Black race and South region were associated with higher cervical cancer incidence and mortality. Cervical cancer rates uncorrected for hysterectomy may underestimate regional and racial disparities. Increasing incidence rates for older NHBs compared to NHWs warrant further research to determine whether screening should continue for NHBs over age 65.

Trends in HIV Testing among Adults in Georgia: Analysis of the 2011-2015 BRFSS Data.

Georgia is ranked fifth highest among states for rates of human immunodeficiency virus (HIV) diagnosis. About 4% of persons living with HIV infection in the United States reside in Georgia, and almost 19% of these people do not know their HIV status. The present study examined the trends and associated factors of HIV testing among adults in Georgia between 2011 and 2015 by analyzing data of the Behavioral Risk Factor Surveillance System (BRFSS). A total of 31,094 persons aged ≥18 years were identified who responded to the question "Have you ever been tested for HIV?" Overall, there were 11,286 (44.2%) respondents who had been tested for HIV, compared to 19,808 (55.8%) who had not. There was a slight decrease in the percentage of respondents who have ever tested for HIV, from 45.6% in 2011 to 43.7% in 2015 (APC (annual percent change) = -0.98, not significant). Factors associated with HIV testing were being female (p = 0.004), black (p < 0.001), younger than 55 years (p < 0.001), single (p < 0.001), attaining education level above high school (p < 0.001), and earning annual income of $50,000 or less (p = 0.028). Overall in Georgia, there has been a slight decline in the temporal trend of HIV testing, and more than half of adults have never been tested for HIV. For reducing HIV transmission in Georgia, enhancing access and utilization of HIV testing should be a public health priority.

Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication.

OBJECTIVE: We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions. METHODS: We conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility. RESULTS: Most parents received a VIS (77.2%; [95% CI: 74.5-79.7%]), 59.7% [56.6-62.7%] before vaccination but 14.5% [12.5-16.8%] reported receiving it after their child's immunization; 15.1% [13.0-17.6%] were unsure of receipt status or timing; another 10.7% [9.0-12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8-97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions. CONCLUSIONS: Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.

Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys.

OBJECTIVE: Understanding the current status of parents' vaccine decision making is crucial to inform public policy. We sought to assess changes in vaccine decisions among parents of young children. METHODS: We conducted a web-based national poll of parents of children <7years in 2012 and 2014. Participants reported vaccine decisions for their youngest child. We calculated survey-weighted population estimates of overall immunizations decisions, and delay/refusal rates for specific vaccines. RESULTS: In 2012, 89.2% (95% CI, 87.3-90.8%) reported accepting or planning to accept all recommended non-influenza childhood vaccines, 5.5% (4.5-6.6%) reported intentionally delaying one or more, and 5.4% (4.1-6.9%) reported refusing one or more vaccines. In 2014, the acceptance, delay, and refusal rates were 90.8% (89.3-92.1%), 5.6% (4.6-6.9%), and 3.6% (2.8-4.5%), respectively. Between 2012 and 2014, intentional vaccine refusal decreased slightly among parents of older children (2-6years) but not younger children (0-1years). The proportion of parents working to catch up on all vaccines increased while those refusing some but not all vaccines decreased. The South experienced a significant increase in estimated acceptance (90.1-94.1%) and a significant decrease in intentional ongoing refusal (5.0-2.1%). Vaccine delay increased in the Northeast (3.2-8.8%). CONCLUSIONS: Nationally, acceptance and ongoing intentional delay of recommended non-influenza childhood vaccines were stable. These findings suggest that more effort is warranted to counter persistent vaccine hesitancy, particularly at the local level. Longitudinal monitoring of immunization attitudes is also warranted to evaluate temporal shifts over time and geographically.

A randomized trial of maternal influenza immunization decision-making: A test of persuasive messaging models.

OBJECTIVE: We sought to examine the effectiveness of persuasive communication interventions on influenza vaccination uptake among black/African American pregnant women in Atlanta, Georgia. METHODS: We recruited black/African American pregnant women ages 18 to 50 y from Atlanta, GA to participate in a prospective, randomized controlled trial of influenza immunization messaging conducted from January to April 2013. Eligible participants were randomized to 3 study arms. We conducted follow-up questionnaires on influenza immunization at 30-days post-partum with all groups. Chi-square and t tests evaluated group differences, and outcome intention-to-treat assessment utilized log-binomial regression models. RESULTS: Of the 106 enrolled, 95 women completed the study (90% retention), of which 31 were randomly assigned to affective messaging intervention ("Pregnant Pause" video), 30 to cognitive messaging intervention ("Vaccines for a Healthy Pregnancy" video), and 34 to a comparison condition (receipt of the Influenza Vaccine Information Statement). The three groups were balanced on baseline demographic characteristics and reported health behaviors. At baseline, most women (63%, n = 60) reported no receipt of seasonal influenza immunization during the previous 5 y. They expressed a low likelihood (2.1 ± 2.8 on 0-10 scale) of obtaining influenza immunization during their current pregnancy. At 30-days postpartum follow-up, influenza immunization was low among all participants (7-13%) demonstrating no effect after a single exposure to either affective messaging (RR = 1.10; 95% CI: 0.30-4.01) or cognitive messaging interventions (RR = 0.57; 95% CI: 0.11-2.88). Women cited various reasons for not obtaining maternal influenza immunizations. These included concern about vaccine harm (47%, n = 40), low perceived influenza infection risk (31%, n = 26), and a history of immunization nonreceipt (24%, n = 20). CONCLUSION: The findings reflect the limitations associated with a single exposure to varying maternal influenza immunization message approaches on vaccine behavior. For this population, repeated influenza immunization exposures may be warranted with alterations in message format, content, and relevance for coverage improvement.

Determinants of adherence to nutrition-related cancer prevention guidelines among African American breast cancer survivors.

BACKGROUND: Mortality rate for breast cancer is higher among African American (AA) women than for women of other racial/ethnic groups. Obesity, also higher among AA women, may increase the risk of breast cancer development and recurrence. Lifestyle factors such as healthy nutrition can reduce the rate of obesity and breast cancer. This study examined the determinants of adherence to nutrition-related cancer prevention guidelines among AA breast cancer survivors. METHODS: AA breast cancer survivors (n=240) were recruited from a breast cancer support group to complete a lifestyle assessment tool for this cross-sectional study. Chi-square test and ordinal logistic regression analysis were used to examine the relationship between adherence to nutrition-related cancer prevention guidelines and potential predictors of adherence. RESULTS: Majority of the survivors met the guideline for red and processed meat (n=191, 83.4%), but did not meet the guideline for fruits and vegetables (n=189, 80.4%). For survivors with annual household incomes < $25,000, the odds of meeting or partially meeting the guideline for fruits and vegetables was 75.4% less than for participants with incomes > $50,000 (OR= 0.25, 95% CI: 0.08, 0.80). Poor physical functioning (OR= 38.48, 95% CI: 2.26, 656.58), sleep disturbances (OR= 60.84, 95% CI: 1.61, 2296.02), and income > $50,000 (OR= 51.02, 95% CI: 1.13, 2311.70) were associated with meeting the guideline for red and processed meat. CONCLUSIONS: Many AA breast cancer survivors are not meeting the nutrition-related cancer prevention guidelines. For this population, more interventions that enhance access to and consumption of healthy diets are needed.

Selective colorimetric sensing of anions in aqueous media through reversible covalent bonding.

Selective colorimetric sensing of anions in aqueous media has been studied, which involves reversible covalent bonding as key binding interactions. By introducing a simple nitro chromophore into an o-(carboxamido)trifluoroacetophenone ionophore that recognizes anions through reversible covalent bonding, we have realized a complete selectivity in colorimetric sensing of cyanide among competing anions such as fluoride, acetate, and dihydrogen phosphate in aqueous media. Such selectivity is explained by dominant reversible covalent bonding over hydrogen bonding, which leads to indirect internal charge transfer. The sensing system is readily converted into a polymeric analogue, demonstrating its potential applicability to develop a naked eye detection material for highly toxic cyanide ions.

N-acyl triazenes as tunable and selective chemodosimeters toward cyanide ion.

A novel type of chemodosimeters has been developed on the basis of a displacement reaction. N-Acyl-triazenes are found to be highly selective and tunable chemodosimeters toward cyanide. When N-acetyl-triazene 1a was titrated with various anions (-CN, F-, Cl-, AcO-, H2PO4-, -SCN, ClO4-, and HSO4-) in acetonitrile, significant absorption changes (from colorless to deep purple) resulted in the cases of -CN and F-, and small changes in the cases of AcO- and H2PO4-. N-Isopropanoyl-triazene 1b showed significant response only toward -CN, weaker response toward F-, and little response toward other anions in acetonitrile. Both of the triazenes 1a and 1b responded only to -CN in methanol-water, because of the analyte's strong nucleophilicity toward the acyl group and weak hydrogen-bonding ability as compared to other anions examined. The N-acyl-triazenes can be used for the naked eye detection of cyanide.