Improving Outreach and Surveillance Efforts Following a Large-Scale Carbon Monoxide Poisoning in Wisconsin.

OBJECTIVE: In December 2014, the largest carbon monoxide (CO) poisoning in Wisconsin's history occurred at an ice arena. Following this event, the Wisconsin Environmental Public Health Tracking (WI EPHT) Program sought to improve outreach and surveillance efforts. METHODS: WI EPHT designed and distributed educational materials on CO poisoning prevention and surveyed stakeholders to gauge the effectiveness of outreach efforts. To enhance surveillance, WI EPHT utilized data from the Wisconsin Poison Center (WPC) to generate real-time alerts of anomalous numbers of CO-related calls. RESULTS: WI EPHT found that 42% of stakeholders reviewed the outreach materials, and 1 ice arena had installed a CO detector as a result. CO alerts were developed using WPC data and are now routinely used in statewide public health surveillance. CONCLUSION: WI EPHT staff improved CO poisoning prevention outreach and saw a positive response among stakeholders. This work demonstrates ways that health agencies can improve outreach and surveillance for CO poisoning. Improvements in these areas can bolster public health response and may prevent CO-related illness and injury.

Taking Action With Data: Improving Environmental Public Health at the Community Level.

CONTEXT: The Wisconsin Environmental Public Health Tracking Program (Wisconsin Tracking) compiles and provides data on health endpoints and related environmental exposures as a resource to local health departments, tribes, academia, and other stakeholders. The goal of providing these data is that stakeholders use them to develop projects that improve environmental health in their communities-that is, moving from "data to action." OBJECTIVE: To encourage use of Wisconsin Tracking data, we developed a minigrants program and issued a funding opportunity to local health departments and tribes. The opportunity requested proposals for small projects using our data, with the goal of making public health improvements in those communities. Wisconsin Tracking evaluated the minigrants program after its completion. DESIGN/SETTING: Eight local health departments in Wisconsin were awarded up to $10 500 to develop and implement projects over a 9-month period. METHODS: Wisconsin Tracking created a funding opportunity announcement requiring utilization of our data to develop projects by local health departments in Wisconsin. We reviewed and scored applications, evaluating proposals on a range of criteria. During the 9-month project period, Wisconsin Tracking staff members provided a variety of technical assistance to grantees. An evaluation of the overall program followed. RESULTS: Funded communities used Wisconsin Tracking data to improve public health infrastructure, leverage partnerships, establish new initiatives, respond to emergencies, improve communication with stakeholders and residents, and make a variety of public health improvements in their communities. CONCLUSIONS: Efforts to increase use of our data catalyzed development of small-scale environmental health projects. This minigrants program was successful at building relationships between local health departments and Wisconsin Tracking, increasing awareness of Wisconsin Tracking data and resources, and contributing to numerous documented public health improvements throughout Wisconsin.

Exposure to Elevated Carbon Monoxide Levels at an Indoor Ice Arena--Wisconsin, 2014.

On December 13, 2014, the emergency management system in Lake Delton, Wisconsin, was notified when a male hockey player aged 20 years lost consciousness after participation in an indoor hockey tournament that included approximately 50 hockey players and 100 other attendees. Elevated levels of carbon monoxide (CO) (range = 45 ppm-165 ppm) were detected by the fire department inside the arena. The emergency management system encouraged all players and attendees to seek medical evaluation for possible CO poisoning. The Wisconsin Department of Health Services (WDHS) conducted an epidemiologic investigation to determine what caused the exposure and to recommend preventive strategies. Investigators abstracted medical records from area emergency departments (EDs) for patients who sought care for CO exposure during December 13-14, 2014, conducted a follow-up survey of ED patients approximately 2 months after the event, and conducted informant interviews. Ninety-two persons sought ED evaluation for possible CO exposure, all of whom were tested for CO poisoning. Seventy-four (80%) patients had blood carboxyhemoglobin (COHb) levels consistent with CO poisoning; 32 (43%) CO poisoning cases were among hockey players. On December 15, the CO emissions from the propane-fueled ice resurfacer were demonstrated to be 4.8% of total emissions when actively resurfacing and 2.3% when idling, both above the optimal range of 0.5%-1.0%. Incomplete fuel combustion by the ice resurfacer was the most likely source of elevated CO. CO poisonings in ice arenas can be prevented through regular maintenance of ice resurfacers, installation of CO detectors, and provision of adequate ventilation.

Shotgun optical mapping of the entire Leishmania major Friedlin genome.

Leishmania is a group of protozoan parasites which causes a broad spectrum of diseases resulting in widespread human suffering and death, as well as economic loss from the infection of some domestic animals and wildlife. To further understand the fundamental genomic architecture of this parasite, and to accelerate the on-going sequencing project, a whole-genome XbaI restriction map was constructed using the optical mapping system. This map supplemented traditional physical maps that were generated by fingerprinting and hybridization of cosmid and P1 clone libraries. Thirty-six optical map contigs were constructed for the corresponding known 36 chromosomes of the Leishmania major Friedlin genome. The chromosome sizes ranged from 326.9 to 2821.3 kb, with a total genome size of 34.7 Mb; the average XbaI restriction fragment was 25.3 kb, and ranged from 15.7 to 77.8 kb on a per chromosomes basis. Comparison between the optical maps and the in silico maps of sequence drawn from completed, nearly finished, or large sequence contigs showed that optical maps served several useful functions within the path to create finished sequence by: guiding aspects of the sequence assembly, identifying misassemblies, detection of cosmid or PAC clones misplacements to chromosomes, and validation of sequence stemming from varying degrees of finishing. Our results also showed the potential use of optical maps as a means to detect and characterize map segmental duplication within genomes.