Managing emerging transnational public health security threats: lessons learned from the 2014 West African Ebola outbreak.

BACKGROUND: Pandemics pose significant security/stability risks to nations with fragile infrastructures. We evaluated characteristics of the 2014 West African Ebola outbreak to elucidate lessons learned for managing transnational public health security threats. METHODS: We used publically available data to compare demographic and outbreak-specific data for Guinea, Sierra Leone, and Liberia, including key indicator data by the World Health Organization. Pearson correlation statistics were calculated to compare country-level infrastructure characteristics with outbreak size and duration. RESULTS: Hospital bed density was inversely correlated with longer EVD outbreak duration (r = - 0.99). Country-specific funding amount allocations were more likely associated with number of incident cases than the population at-risk or infrastructure needs. Key indicators demonstrating challenges for Guinea included: number of unsafe burials, percent of EVD-positive samples, and days between symptom onset and case hospitalization. Sierra Leone's primary key indicator was the number of districts with ≥1 security incident. Liberia controlled their outbreak before much of the key-indicator data were collected. CONCLUSION: Many of the country-level factors, particularly the WHO key indicators were associated with controlling the epidemic. The infrastructure of countries affected by communicable diseases should be assessed by international political and public health leaders.

Fume emissions from a low-cost 3-D printer with various filaments.

3-D printing is an additive manufacturing process involving the injection of melted thermoplastic polymers, which are then laid down in layers to achieve a pre-designed shape. The heated deposition process raises concerns of potential aerosol and volatile organic compounds (VOC) emission and exposure. The decreasing cost of desktop 3-D printers has made the use of 3-D printers more acceptable in non-industrial workplaces lacking sufficient ventilation. Meanwhile, little is known about the characteristics of 3-D printing fume emission. The objective of this study was to characterize aerosols and VOC emissions generated from various filaments used with a low-cost 3-D printer in an environmental testing chamber. A pre-designed object was printed in 1.25 hours using eight types of filaments. A scanning mobility particle sizer and an aerodynamic particle sizer were employed to measure the particle size distribution in sub-half-micron fraction (<0.5 µm) and super-half-micron fraction (0.5-20 µm), respectively. VOC concentration was monitored real-time by a photoionization detector and sampled with a tri-sorbent thermal desorption tube, and analyzed by thermal desorption gas chromatography mass spectrometry (TD-GC/MS). Results showed high levels of fume particles emission rate (1.0 × 107 to 1.2 × 1010 #/min) in the sub-half-micron range with mode sizes of 41-83 nm. Particle concentrations peaked during the heat-up and solid layer printing periods. Total VOC concentration in the chamber followed a first-order buildup, with predominant VOC species in the chamber were breakdown and reaction products of the filaments, such as styrene from ABS filaments. These findings and exposure scenario estimation suggest that although the VOC concentrations were much lower than occupational exposure limits, particles with size less than micron might be a concern for users of low-cost 3-D printers due to high respirablity, especially if used in settings without proper guidance and engineering control.

Incident-related television viewing and psychiatric disorders in Oklahoma City bombing survivors.

The objective of this study was to examine terrorism media coverage and psychiatric outcomes in directly-exposed terrorism survivors. The study used (1) self-report questionnaires to retrospectively assess event-related media behaviors and reactions in a cross sectional design and (2) longitudinal structured diagnostic interviews to assess psychopathologic outcomes. The participants were 99 directly-exposed Oklahoma City bombing survivors who were initially studied six months after the 1995 incident. Though a fear reaction to bombing-related television coverage and fear-driven discontinuation of bombing-related media contact were associated with diagnostic outcomes, the number of hours viewing bombing-related television coverage in the first week after the event was not associated with the prevalence of bombing-related posttraumatic stress disorder or post-bombing major depressive disorder during the seven years post event. The results raise doubt about the effects of quantified incident-related television viewing on clinically-significant emotional outcomes in directly-exposed terrorism survivors.

The normalisation of terror: the response of Israel's stock market to long periods of terrorism.

Man-made disasters such as acts of terrorism may affect a society's resiliency and sensitivity to prolonged physical and psychological stress. The Israeli Tel Aviv stock market TA-100 Index was used as an indicator of reactivity to suicide terror bombings. After accounting for factors such as world market changes and attack severity and intensity, the analysis reveals that although Israel's financial base remained sensitive to each act of terror across the entire period of the Second Intifada (2000-06), sustained psychological resilience was indicated with no apparent overall market shift. In other words, we saw a 'normalisation of terror' following an extended period of continued suicide bombings. The results suggest that investors responded to less transitory global market forces, indicating sustained resilience and long-term market confidence. Future studies directly measuring investor expectations and reactions to man-made disasters, such as terrorism, are warranted.

Patterns of Plasmodium vivax and Plasmodium falciparum malaria underscore importance of data collection from private health care facilities in India.

BACKGROUND: This study describes patterns of falciparum and vivax malaria in a private comprehensive-care, multi-specialty hospital in New Delhi from July 2006 to July 2008. METHODS: Malarial morbidity by Plasmodium species (Plasmodium falciparum, Plasmodium vivax, or Plasmodium sp.) was confirmed using microscopy and antigen tests. The influence of seasonal factors and selected patient demographics on morbidity was evaluated. The proportions of malaria cases caused by P. falciparum at the private facility were compared to data from India's National Vector Borne Disease Control Programme (NVBDCP) during the same period for the Delhi region. RESULTS: In New Delhi, P. faciparum was the dominant cause of cases requiring treatment in the private hospital during the period examined. The national data reported a smaller proportion of malaria cases caused by P. falciparum in the national capital region than was observed in a private facility within the region. Plasmodium vivax also caused a large proportion of the cases presenting clinically at the private hospital during the summer and monsoon seasons. CONCLUSION: The proportion of P. falciparum malaria cases tends to be greatest during the post-monsoon season while the proportion of P. vivax malaria cases tends to be greatest in the monsoon season. Private hospital data demonstrate an under-reporting of malaria case incidences in the data from India's national surveillance programme during the same period for the national capital region.

Simultaneous B and T cell acute lymphoblastic leukemias in zebrafish driven by transgenic MYC: implications for oncogenesis and lymphopoiesis.

Precursor-B cell acute lymphoblastic leukemia (pre-B ALL) is the most common pediatric cancer, but there are no useful zebrafish pre-B ALL models. We describe the first highly- penetrant zebrafish pre-B ALL, driven by human MYC. Leukemias express B lymphoblast-specific genes and are distinct from T cell ALL (T-ALL)-which these fish also develop. Zebrafish pre-B ALL shares in vivo features and expression profiles with human pre-B ALL, and these profiles differ from zebrafish T-ALL or normal B and T cells. These animals also exhibit aberrant lymphocyte development. As the only robust zebrafish pre-B ALL model and only example where T-ALL also develops, this model can reveal differences between MYC-driven pre-B vs. T-ALL and be exploited to discover novel pre-B ALL therapies.

Bacillus anthracis edema toxin activates nuclear glycogen synthase kinase 3beta.

Bacillus anthracis edema toxin (ET) generates high levels of cyclic AMP and impacts a complex network of signaling pathways in targeted cells. In the current study, we sought to identify kinase signaling pathways modulated by ET to better understand how this toxin alters cell physiology. Using a panel of small-molecule inhibitors of mammalian kinases, we found that inhibitors of glycogen synthase kinase 3 beta (GSK-3beta) protected cells from ET-induced changes in the cell cycle. GSK-3beta inhibitors prevented declines in cellular levels of cyclin D1 and c-Jun following treatment of macrophages with ET. Strikingly, cell fractionation experiments and confocal immunofluorescence microscopy revealed that ET activates a compartmentalized pool of GSK-3beta residing in the nuclei, but not in the cytoplasm, of macrophages. To investigate the outcome of this event, we examined the cellular location and activation state of beta-catenin, a critical substrate of GSK-3beta, and found that the protein was inactivated within the nucleus following intoxication with ET. To determine if ET could overcome the effects of stimuli that inactivate GSK-3beta, we examined the impact of the toxin on the Wnt signaling pathway. The results of these experiments revealed that by targeting GSK-3beta residing in the nucleus, ET circumvents the upstream cytoplasmic inactivation of GSK-3beta, which occurs following exposure to Wnt-3A. These findings suggest ET arrests the cell cycle by a mechanism involving activation of GSK-3beta residing in the nucleus, and by using this novel mechanism of intoxication, ET avoids cellular systems that would otherwise reverse the effects of the toxin.

Hydrological modeling of geophysical parameters of arboviral and protozoan disease vectors in Internally Displaced People camps in Gulu, Uganda.

BACKGROUND: The aim of this study was to determine if remotely sensed data and Digital Elevation Model (DEM) can test relationships between Culex quinquefasciatus and Anopheles gambiae s.l. larval habitats and environmental parameters within Internally Displaced People (IDP) campgrounds in Gulu, Uganda. A total of 65 georeferenced aquatic habitats in various IDP camps were studied to compare the larval abundance of Cx. quinquefasciatus and An. gambiae s.l. The aquatic habitat dataset were overlaid onto Land Use Land Cover (LULC) maps retrieved from Landsat imagery with 150 m x 150 m grid cells stratified by levels of drainage. The LULC change was estimated over a period of 14 years. Poisson regression analyses and Moran's I statistics were used to model relationships between larval abundance and environmental predictors. Individual larval habitat data were further evaluated in terms of their covariations with spatial autocorrelation by regressing them on candidate spatial filter eigenvectors. Multispectral QuickBird imagery classification and DEM-based GIS methods were generated to evaluate stream flow direction and accumulation for identification of immature Cx. quinquefasciatus and An. gambiae s.l. and abundance. RESULTS: The main LULC change in urban Gulu IDP camps was non-urban to urban, which included about 71.5 % of the land cover. The regression models indicate that counts of An. gambiae s.l. larvae were associated with shade while Cx. quinquefasciatus were associated with floating vegetation. Moran's I and the General G statistics for mosquito density by species and instars, identified significant clusters of high densities of Anopheles; larvae, however, Culex are not consistently clustered. A stepwise negative binomial regression decomposed the immature An. gambiae s.l. data into empirical orthogonal bases. The data suggest the presence of roughly 11% to 28 % redundant information in the larval count samples. The DEM suggest a positive correlation for Culex (0.24) while for Anopheles there was a negative correlation (-0.23) for a local model distance to stream. CONCLUSION: These data demonstrate that optical remote sensing; geostatistics and DEMs can be used to identify parameters associated with Culex and Anopheles aquatic habitats.

Implications of public understanding of avian influenza for fostering effective risk communication.

Avian influenza has three of the four properties necessary to cause a pandemic. However, are we as individuals and communities prepared for a pandemic flu in the United States? To help answer this question, 12 focus groups (N = 60) were conducted in Tulsa, Oklahoma, to determine the level of awareness of avian and pandemic flu for the county health department to develop effective communication messages. The overall findings indicate that the general Tulsa public lacks information about avian influenza or pandemics, does not believe a pandemic will occur, and believes if one does occur the government will take care of it. Finally, the groups agreed that education would be the key to preventing widespread panic if a pandemic occurred. Five themes emerged: confusion about terminology, seriousness of avian influenza, disaster fatigue, appropriate precautions, and credibility of health information. Each should be considered in developing effective risk communication messages.

Media coverage and children's reactions to disaster with implications for primary care and public health.

To address the potential for media coverage of traumatic events to generate fear reactions in children, we examined exposure and reactions to media coverage of the 1995 Oklahoma City bombing in children attending a middle school 100 miles from the disaster site two and three years after the event. Many of the children studied recalled feeling "afraid," "sad," or "mad" in relation to initial media coverage. Overall exposure and reactions to bomb-related media coverage declined over the three years. However, these reactions persisted for some children and, when they did, the reactions were related to exposure to coverage right after the bombing. Approximately one-fourth of the children recalled that the bombing made them feel "a lot" less safe in their home, school, and/or neighborhood. These perceptions persisted for approximately 10% of the children. Our Findings suggest the importance of primary care and public health interventions to determine and monitor children's reactions.

Electronic cigarette power affects count concentration and particle size distribution of vaping aerosol.

INTRODUCTION: Electronic cigarettes (EC) have evolved rapidly toward higher powered devices that produce more vaping aerosol and a more satisfying vaping experience. This research characterized the particle size distribution and estimated the mass concentration of vaping aerosols produced at power outputs spanning the operating range typical of second generation variable voltage EC devices. METHODS: EC aerosol was characterized from a single coil atomizer powered by a variable voltage EC battery at the minimum and maximum dial settings (3.3, 11.2 Watts, W), and a lab controlled power supply (3-11.9 W). Aerosol particle size distribution was measured by a Scanning Mobility Particle Sizer and Aerodynamic Particle Sizer, spanning 16 nm to 19.8 µm. A mouth puff was simulated using a 100 mL glass syringe. RESULTS: Consistent with prior studies, sub-micron EC aerosol size distributions were bimodal, with peaks at 40 and 200 nm, however a previously unreported third mode was observed at approximately 1000 nm. The ~1000 nm mode accounted for 7-20x the aerosol mass of the smaller modes. Increasing atomizer power decreased count concentration of particles <600 nm but increased particle count >600 nm. Particle mass distribution shifted toward micron sized particles with increasing power and increased the respirable fraction of aerosol, likely due to increased coagulation and condensation around nano-sized particles. CONCLUSIONS: Vaping power greatly affects EC aerosol count and mass distribution. Mouth puffed EC aerosol spans a much wider particle size range than previously reported, although the major portion of the mass is still well within the alveolar size range the larger particles will deposit within the oro-pharyngeal cavity at 2-3x greater efficiency than in alveoli. These observations have major clinical implications, as aerosol particle size distribution determines deposition sites along the respiratory tract. The results of this experiment stress the need for further research to inform the design, regulation and use of e-cigarette products.

Environmental abundance of Anopheles (Diptera: Culicidae) larval habitats on land cover change sites in Karima Village, Mwea Rice Scheme, Kenya.

A study was carried out at Karima Village in the Mwea Rice Irrigation Scheme in Kenya to assess the impact of rice husbandry and associated land cover change for mosquito larval abundance. A multi-temporal, land use land cover (LULC) classification dataset incorporating distributions of Anopheles arabiensis aquatic larval habitats was produced in ERDAS Imagine version 8.7 using combined images from IKONOS at 4m spatial resolution from 2005 and Landsat Thematic Mapper (TM)trade mark classification data at 30-meters spatial resolution from 1988 for Karima. Of 207 larval habitats sampled, most were either canals (53.4%) or paddies (45.9%), and only one habitat was classified as a seep (0.5%). The proportion of habitats that were poorly drained was 55.1% compared with 44.9% for the habitats that were well drained. An LULC base map was generated. A grid incorporating each rice paddy was overlaid over the LULC maps stratifying each cell based on levels of irrigation. Paddies/grid cells were classified as 1) well irrigated and 2) poorly irrigated. Early stages of rice growth showed peak larval production during the early part of the cropping cycle (rainy season). Total LULC change for Karima over 16 years was 59.8%. Of those areas in which change was detected, the LULC change for Karima was 4.30% for rice field to built environment, 8.74% for fallow to built environment, 7.19% for rice field to fallow, 19.03% built to fallow, 5.52% for fallow to rice field, and 8.35% for built environment to rice field. Of 207 aquatic habitats in Karima, 54.1 (n = 112) were located in LULC change sites and 45.9 (n = 95) were located in LULC non-change sites. Rice crop LULC maps derived from IKONOS and TM data in geographic information systems can be used to investigate the relationship between rice cultivation practices and higher anopheline larval habitat distribution.

Ambient air pollution and daily pediatric hospitalizations for asthma.

GOAL, SCOPE AND BACKGROUND: A series of severe air pollution episodes in Europe and North America prior to 1960 have focused scientific and regulatory attention on the adverse effects of air pollution on human health. As a consequence of significant reductions in ambient air pollution levels in the intervening years, scientists and public health officials have become more concerned with the potential health effects of exposure to routine concentrations of air pollution. Several recent time series studies conducted worldwide have found relatively low levels of air pollutants that are below national standards were associated with adverse effects on mortality and morbidity. This study examined the effects of ambient air pollution indicators on the daily rate of pediatric hospital admissions for asthma in the Oklahoma City Metropolitan area from 2001-2003. METHODS: Data were collected for the number of children < or = 14 years old hospitalized for asthma on a daily basis (N = 1270) and ambient concentrations of NO2, O3, PM2.5, mold and pollen concentrations, and meso-scale meteorological conditions. Results. Negative binomial regression analysis revealed significant relationships between the total number of hospitalizations per day and the one-hour maximum NO2 level, the proportion of susceptible children < 5 years old, and the ratio of temperature to humidity. DISCUSSION: This study of the total number of children aged < or = 14 years old experiencing hospitalizations on a daily basis in the Oklahoma City area from 2001-2003 underscores factors other than ambient air pollution, especially when concentrations are low, affect hospitalizations for pediatric asthma. For example, information related to indoor air quality, health care, family history, and exposure to environmental tobacco smoke and other irritants are not obtainable. Yet, those factors are risk drivers for asthma. Similarly, health privacy requirements prevented obtaining data on physiological factors specific to each child such as differentials in airways functional capacity or other impairments influenced asthma exacerbation. This makes calculating relative risk inappropriate. CONCLUSIONS: Although ambient air pollution concentrations and meteorological conditions influence pediatric asthma hospitalizations, they are not the major predictors in the Oklahoma City metropolitan area. This is consistent with other research that finds limited effects associated with low levels for concentrations of the criteria pollutants. RECOMMENDATIONS AND PERSPECTIVES: Although limiting concentrations for criteria air pollutants to levels below human health-based standards exhibited beneficial effects, other factors also need to be identified and addressed in order to reduce pediatric hospitalizations for asthma.

Irradiation of sorbents by ions of polymorphic metals for modeling 90strontium sedimentation.

BACKGROUND, AIMS AND SCOPE: Advances in radioecology can support improvements in environmental remediation technologies, especially by illuminating interaction processes between polymorphic metal radionuclides and various materials and their ions in aqueous solutions. This study modeled interaction processes of 90Sr with transitive metals to delineate the behavior of polymorphic metal radionuclides. Experimental and modeling results confirmed Sr sedimentation was sensitive to the physical impact of radionuclides on various sorbents and possible chemical reactions occurring between the radionuclides and sorbents. METHODS: Models were developed to simulate 90Sr sedimentation process, and the potential physical and chemical reactions accompanying the process. Models were verified, inorganic salts were used as sorbents to absorb metal cations, activity levels were recorded before and after mixing the inorganic salts while the efficiency of sedimentation using the heavy metals composites was quantified. RESULTS AND DISCUSSION: This research demonstrates that the process of the sedimentation is complex and occurs in several stages. Micro-structural analysis shows that zones of interaction between the sorbent and source metal are formed during the irradiation of the target's metal surface. Electrical-microscopic analysis indicates that the composition of the formed zones of interaction of Ti (Sr) with target metals has various structures. Roentgenophase analysis indicates that the interaction of the ions of a precipitable source and a target occurs according to constitution diagrams of equilibrium systems. The results indicate that application of inorganic salts composites based on modeling increases the efficiency of the deactivation of aqueous solutions when compared to standard aluminum sulfate composite. CONCLUSIONS: Experimental and modeling results confirm 90Sr sedimentation is sensitive to the physical impact of radionuclides on various sorbents and possible chemical reactions occurring between the radionuclides and sorbents. The models support estimation of the physical impact of polymorphic metal radionuclides on various components of sorbents and possible chemical reactions occurring between the radionuclides and sorbents during the interaction. Inorganic salt composites deactivate and clear 90Sr and Sr+2 from water.

Characterization of Particulate Fume and Oxides Emission from Stainless Steel Plasma Cutting.

Plasma cutting is a metal fabrication process that employs an electrically conductive plasma arc to cut metals. The metal fume emitted from stainless steel plasma cutting may consist of hexavalent chromium (Cr6+), which is a carcinogen, and other toxicants. Overexposure to plasma cutting fume may cause pulmonary toxicity and other health effects. This study was to evaluate the effects of operation parameters (arc current and arc time) on the fume formation rates, Cr6+ and other oxides concentrations, particle size distributions (PSD), and particle morphology. A fume chamber and high-volume pump were used to collect fume produced from cutting ER308L stainless steel plates with arc currents varying between 20 and 50 A. The amount of fume collected on glass fiber filters was gravimetrically determined and normalized to arc time. Cr6+ and other oxides in the fume were analyzed using ion chromatography. PSD of the fume was examined using a scanning mobility particle sizer and an aerodynamic particle sizer for fine and coarse fractions, respectively. The particle morphology was imaged through a transmission electron microscope (TEM). Total fume generation rate increased with arc current and ranged from 16.5 mg min-1 at 20 A to 119.0 mg min-1 at 50 A. Cr6+ emissions (219.8-480.0 µg min-1) from the plasma cutting were higher than welding fume in a previous study. Nitrogen oxides level can be an indicator of oxidation level and Cr6+ formation (R = 0.93). Both PSD measurement and TEM images confirmed a multimodal size distribution. A high concentration of a fine fraction of particles with geometric mean sizes from 96 to 235 nm was observed. Higher arc current yielded more particles, while lower arc current was not able to penetrate the metal plates. Hence, the worker should optimize the arc current to balance cut performance and fume emission. The findings indicated that arc current was the dominant factor in fume emission from plasma cutting. Appropriate ventilation and respiratory protection should be used to reduce workers' exposure.

Spatially targeting Culex quinquefasciatus aquatic habitats on modified land cover for implementing an Integrated Vector Management (IVM) program in three villages within the Mwea Rice Scheme, Kenya.

BACKGROUND: Continuous land cover modification is an important part of spatial epidemiology because it can help identify environmental factors and Culex mosquitoes associated with arbovirus transmission and thus guide control intervention. The aim of this study was to determine whether remotely sensed data could be used to identify rice-related Culex quinquefasciatus breeding habitats in three rice-villages within the Mwea Rice Scheme, Kenya. We examined whether a land use land cover (LULC) classification based on two scenes, IKONOS at 4 m and Landsat Thematic Mapper at 30 m could be used to map different land uses and rice planted at different times (cohorts), and to infer which LULC change were correlated to high density Cx. quinquefasciatus aquatic habitats. We performed a maximum likelihood unsupervised classification in Erdas Imagine V8.7 and generated three land cover classifications, rice field, fallow and built environment. Differentially corrected global positioning systems (DGPS) ground coordinates of Cx. quinquefasciatus aquatic habitats were overlaid onto the LULC maps generated in ArcInfo 9.1. Grid cells were stratified by levels of irrigation (well-irrigated and poorly-irrigated) and varied according to size of the paddy. RESULTS: Total LULC change between 1988-2005 was 42.1 % in Kangichiri, 52.8 % in Kiuria and and 50.6 % Rurumi. The most frequent LULC changes was rice field to fallow and fallow to rice field. The proportion of aquatic habitats positive for Culex larvae in LULC change sites was 77.5% in Kangichiri, 72.9% in Kiuria and 73.7% in Rurumi. Poorly - irrigated grid cells displayed 63.3% of aquatic habitats among all LULC change sites. CONCLUSION: We demonstrate that optical remote sensing can identify rice cultivation LULC sites associated with high Culex oviposition. We argue that the regions of higher Culex abundance based on oviposition surveillance sites reflect underlying differences in abundance of larval habitats which is where limited control resources could be concentrated to reduce vector larval abundance.

Evaluation of environmental data for identification of Anopheles (Diptera: Culicidae) aquatic larval habitats in Kisumu and Malindi, Kenya.

This research evaluates the extent to which use of environmental data acquired from field and satellite surveys enhances predictions of urban mosquito counts. Mosquito larval habitats were sampled, and multispectral thermal imager (MTI) satellite data in the visible spectrum at 5-m resolution were acquired for Kisumu and Malindi, Kenya, during February and March 2001. All entomological parameters were collected from January to May 2001, June to August 2002, and June to August 2003. In a Poisson model specification, for Anopheles funestus Giles, shade was the best predictor, whereas substrate was the best predictor for Anopheles gambiae, and vegetation for Anopheles arabensis Patton. The top predictors found with a logistic regression model specification were habitat size for An. gambiae Giles, pollution for An. arabensis, and shade for An. funestus. All other coefficients for canopy, debris, habitat nature, permanency, emergent plants, algae, pollution, turbidity, organic materials, all MTI waveband frequencies, distance to the nearest house, distance to the nearest domestic animal, and all land use land cover changes were nonsignificant. MTI data at 5-m spatial resolution do not have an additional predictive value for mosquito counts when adjusted for field-based ecological data.

Anopheles gambiae s.l. and Anopheles funestus mosquito distributions at 30 villages along the Kenyan coast.

This study investigated whether Anopheles gambiae s.l. and Anopheles funestus Giles mosquito populations were distributed randomly among houses on the coast of Kenya. Sample means and variances of mosquitoes were estimated from bimonthly pyrethrum spray collections at 30 villages from July 1997 through May 1998. In total, 5,476 An. gambiae s.l. and 3,461 An. funestus were collected. The number of An. gambiae s.l. collected was highest in November/December and lowest in May. The number of An. funestus collected was highest during September/October and lowest during May. As the density of mosquitoes decreased, there was a tendency toward randomness in the distribution. The proportion of An. gambiae s.l. and An. funestus mosquitoes collected per house for each sampling period also showed patterns of clustering, with 80% of An. gambiae s.l. collected from <30% of the houses and 80% of An. funestus collected from <20% of the total houses. The total number of mosquitoes collected from any one house ranged from 0 to 121 for An. gambiae s.l. and from 0 to 152 for An. funestus. This coupled with the results of the variance to mean ratio plots suggests extensive clustering in the distribution of An. gambiae s.l. and An. funestus mosquito populations throughout the year along the coast of Kenya.

Regional Variation in Causes of Injuries among Terrorism Victims for Mass Casualty Events.

The efficient allocation of medical resources to prepare for and respond to mass casualty events (MCEs) attributable to intentional acts of terrorism is a major challenge confronting disaster planners and emergency personnel. This research article examines variation in regional patterns in the causes of injures associated with 77,258 successful terrorist attacks that occurred between 1970 and 2013 involving the use of explosives, firearms, and/or incendiaries. The objective of this research is to estimate regional variation in the use of different conventional weapons in successful terrorist attacks in each world region on variation in injury cause distributions. Indeed, we find that the distributions of the number of injuries attributable to specific weapons types (i.e., by cause) vary greatly among the 13 world regions identified within the Global Terrorism Database.

A geographic sampling strategy for studying relationships between human activity and malaria vectors in urban Africa.

This paper describes a geographic sampling strategy for ecologic studies and describes the relationship between human activities and anopheline larval ecology in urban areas. Kisumu and Malindi, Kenya were mapped using global positioning systems, and a geographic information system was used to overlay a measured grid, which served as a sampling frame. Grid cells were stratified and randomly selected according to levels of planning and drainage. A cross-sectional survey was conducted in April and May 2001 to collect entomologic and human ecologic data. Multivariate regression analysis was used to test the relationship between the abundance of potential larval habitats, and house density, socioeconomic status, and planning and drainage. In Kisumu, 98 aquatic habitats were identified, 65% of which were human made and 39% were positive for anopheline larvae. In Malindi, 91 aquatic habitats were identified, of which, 93% were human made and 65% were harboring anopheline larvae. The regression model explains 82% of the variance associated with the abundance of potential larval habitats in Kisumu. In Malindi, 59% of the variance was explained. As the number of households increased, the number of larval habitats increased correspondingly to a point. Beyond a critical threshold, the density of households appeared to suppress the development of aquatic habitats. The proportion of high-income households and the planning and drainage variables tested insignificant in both locations. The integration of social and biologic sciences will allow local mosquito and malaria control groups an opportunity to assess the risk of encountering potentially infectious mosquitoes in a given area, and concentrate resources accordingly.