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1.
J Econ Entomol ; 2024 Apr 12.
Article in English | MEDLINE | ID: mdl-38606526

ABSTRACT

Nutrition has been identified as a key driver of colony health and productivity. Yet, in honey bees, relatively little is known about how the vast variety of natural pollen sources impact larval development. The impact of the nutritional quality of 4 naturally occurring pollen sources, of importance to the Western Australian beekeeping industry, was tested on honey bee (Apis mellifera L.) development. Bee packages consisting of 800 g of bees and a mated sister queen were assigned to 40 nucleus hives and randomly allocated to one of the 4 feed treatments (10 colonies each) of marri (Corymbia calophylla Lindl.), jarrah (Eucalyptus marginata Sm.), clover (Trifolium repens L.), and canola (Brassica napus L.) pollen. Emerging bees were collected once the first bees started hatching on the assigned feed sources. Newly emerging bees were weighed individually, and body composition was measured in batches according to the feed treatment groups. Food consumption was recorded for the duration of the experiment. Nurse bees successfully raised young adult workers from the larval stage until emergence when fed with one of 4 pollen patties with different nutritional qualities. There was no difference in the body composition or weight of emerging bees fed on the different pollen types. However, the body weight of bees increased over time, most likely related to colony size and structure. With the type of pollen patties having little impact on larval development, the availability of pollen may be more important than its composition, providing bees have access to all essential nutrients.

2.
Rehabil Psychol ; 68(4): 351-361, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37470994

ABSTRACT

PURPOSE/OBJECTIVE: The COVID-19 pandemic has exacerbated existing health inequities for people with disabilities (PWD), including disparities in mental health needs and service use. The present study investigated prospective predisposing, enabling, and illness-related correlates of mental health service need and use among PWD during the COVID-19 pandemic. RESEARCH METHOD/DESIGN: Data were collected online at two time points: October-December 2020 and October-December 2021. U.S. adults with disabilities completed self-report measures on demographic and disability characteristics, pandemic-related stressors (e.g., worries about COVID-19), depression, anxiety, barriers to service use, and perceived mental health needs and service use. Two logistic regressions were used to examine the effect of predisposing, enabling, psychosocial barriers, and illness-related factors on perceived mental health service need and service use. RESULTS: Perceptions of mental health service needs were significantly predicted by gender (female-identified, transgender and gender diverse [TGD]), younger age, increased depressive symptoms, and presence of a prepandemic mental health condition. Among those who reported a perceived need, mental health service use was predicted by gender (female-identified and TGD), greater income, lower frequency of anticipated provider disability bias, and presence of a prepandemic mental health condition. CONCLUSIONS/IMPLICATIONS: This study provides vital descriptive data on the pattern of mental health service utilization among PWD during the COVID-19 pandemic, a uniquely disruptive, challenging time. Findings further underscore the necessity of providing disability competency training and bias reduction interventions to mental health professionals, as anticipated provider disability bias was a key factor in nonservice use of PWD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Subject(s)
COVID-19 , Disabled Persons , Mental Health Services , Adult , Humans , Female , Pandemics , Prospective Studies
3.
J Res Pers ; 101: 104302, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36185499

ABSTRACT

This study examines narrative identity among a large, diverse sample of people with disabilities (PWDs) in the United States during the "second wave" of the Covid-19 pandemic (October-December 2020). The study relied on abductive analyses, combining a purely inductive phase of inquiry followed by two rounds of investigation that filtered inductive insights through three theoretical lenses: social-ecological theory, the theory of narrative identity, and perspectives from the interdisciplinary field of disability studies. The central result was the identification of a particular configuration of self, one that was demonstrably interdependent with both immediate interpersonal contexts and with broader cultural contexts. This interdependent self was interpreted in both positive and negative ways by PWDs. These findings invite future inquiry into commonplace conceptualizations of an independent self at the center of personality research and suggest that dominant conceptualizations of "the good life" may overly emphasize independence.

4.
Rehabil Psychol ; 67(2): 179-188, 2022 May.
Article in English | MEDLINE | ID: mdl-35084914

ABSTRACT

PURPOSE/OBJECTIVE: Emerging research has highlighted sources of magnified stress and trauma for people with disabilities during the COVID-19 pandemic, as compared to others in the general population. However, little research has examined the mental health impact of the pandemic on people with disabilities in relation to disability-related stigma, social isolation, and demographic characteristics. The present study therefore sought to identify predictors of depression and anxiety symptoms among U.S. adults with disabilities during the COVID-19 pandemic. RESEARCH METHOD/DESIGN: Data were collected online between October and December 2020. U.S. adults with disabilities (n = 441) completed self-report measures of depression, anxiety, psychosocial processes, and a range of demographic and disability characteristics. RESULTS: In our sample, 61.0% and 50.0% of participants met criteria for a probable diagnosis of major depressive disorder and generalized anxiety disorder, respectively. Participants also experienced significantly higher levels of disability-related stigma and social isolation compared to prepandemic norms. Hierarchical regression analyses identified higher social isolation, presence of chronic pain, younger age, higher disability-related stigma, and higher worries about contracting COVID-19 as significant predictors of both depression and anxiety symptoms. CONCLUSION/IMPLICATIONS: This study highlights important demographic and psychosocial predictors of mental health risks for people with disabilities in the context of COVID-19. Findings further underscore the need to attend to those at elevated risk within the disability community as rehabilitation professionals, disability organizations, and policy makers work to support people with disabilities in postpandemic recovery and create a more equitable response to ongoing and future public health crises. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
COVID-19 , Depressive Disorder, Major , Disabled Persons , Adult , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Depression/diagnosis , Depression/epidemiology , Depressive Disorder, Major/epidemiology , Humans , Pandemics , SARS-CoV-2
6.
Am J Orthopsychiatry ; 91(2): 294-301, 2021.
Article in English | MEDLINE | ID: mdl-33983776

ABSTRACT

Persons living with mental health challenges are at increased risk of stigma, social isolation, and social exclusion. Due to its emphasis on member participation and community, the clubhouse model of mental health may help address these issues. In this study, we examined experiences of social belonging and of various social determinants of mental health among members attending a psychosocial clubhouse. Twelve members of a large psychosocial clubhouse were interviewed regarding their experiences of community life and belonging. Phenomenological qualitative methods were utilized to examine the meaning and structure of these experiences. Members overwhelmingly experienced the clubhouse as a central site of belonging ("an oasis"), but members also recounted devastating portraits of life in the outside world ("a desert"). This world presented fundamental restrictions on their movement and speech and held deeply sedimented norms pertaining to who is considered valuable, productive, and even human, which they were reminded of through an endless tyranny of questions ("what do you do," "where do you live," etc.). Life in the clubhouse presented an alternative world for members to experience nourishment, dignity, reaffirmed personhood, and a sense of beauty. And yet, the desert outside remained. Implications of these findings for clubhouses, mental health practice, and sociopolitical and community engagement are discussed, including the need to address profound deprivations and power imbalances within the wider world, beyond the walls of humane spaces such as these. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Community Mental Health Services , Mental Disorders , Humans , Mental Health , Social Isolation , Social Support
7.
Environ Manage ; 68(1): 73-86, 2021 07.
Article in English | MEDLINE | ID: mdl-33991206

ABSTRACT

Visitation to parks will change with increasing climate changes. We examined how place attachment may influence different types of climate-induced displacement at both the park and park system level. Previous research suggests that visitors who have greater place attachment to parks within a system may be more likely to tolerate changed environmental conditions before they are displaced from the system entirely or change their choice of park or time of visit within it. Our study, based on the Vermont State Parks system (U.S.), used an on-site visitor questionnaire to examine potential system, spatial, and temporal displacements resulting from ranges of five regionally specific probable manifestations of climate change. As hypothesized, we found that those with lower place attachment were more likely to be displaced. Specifically, these visitors would be more likely to shift their visitation to more southern and lower elevation parks to avoid increased rainfall, earlier/later in the season to avoid higher day or night time temperatures, and out of the park system entirely with more days above 90 F or biting insects. Our approach to examining climate change, place attachment, and displacement has relevance for considering how these three areas impact tourism and visitor use management, as well as utility for managers of these destinations.


Subject(s)
Climate Change , Recreation , Parks, Recreational , Seasons , Surveys and Questionnaires , Temperature
8.
Hypertension ; 75(5): 1251-1259, 2020 05.
Article in English | MEDLINE | ID: mdl-32172621

ABSTRACT

Primary aldosteronism is a frequent cause of resistant hypertension and is associated with an increased risk of developing diabetes mellitus. Aldosterone impairs insulin secretion in isolated islets, and insulin secretion is increased in aldosterone synthase-deficient mice. We hypothesized that treatment for primary aldosteronism increases insulin secretion and insulin sensitivity in humans. We conducted a prospective cohort study in patients with primary aldosteronism, with assessment of glucose metabolism before and 3 to 12 months after treatment. Participants underwent treatment for primary aldosteronism with adrenalectomy or a mineralocorticoid receptor antagonist at the discretion of their treating physician. We assessed insulin secretion and insulin sensitivity by hyperglycemic and hyperinsulinemic-euglycemic clamps, respectively, on 2 study days after a 5-day standardized diet. After treatment, the C-peptide and insulin response during the hyperglycemic clamp increased compared with pretreatment (ΔC-peptide at 90-120 minutes +530.5±384.1 pmol/L, P=0.004; Δinsulin 90-120 minutes +183.0±122.6, P=0.004). During hyperinsulinemic-euglycemic clamps, insulin sensitivity decreased after treatment (insulin sensitivity index 30.7±6.2 versus 18.5±4.7 nmol·kg-1·min-1·pmol-1·L; P=0.02). Insulin clearance decreased after treatment (872.8±207.6 versus 632.3±178.6 mL/min; P=0.03), and disposition index was unchanged. We conclude that the insulin response to glucose increases and insulin clearance decreases after treatment for primary aldosteronism, and these effects were not due to alterations in creatinine clearance or plasma cortisol. These studies may provide further insight into the mechanism of increased diabetes mellitus risk in primary aldosteronism.


Subject(s)
Hyperaldosteronism/physiopathology , Insulin Secretion , Insulin/metabolism , Adolescent , Adrenalectomy , Adult , Aged , Blood Glucose/analysis , Body Composition/drug effects , C-Peptide/blood , Diet , Energy Metabolism/drug effects , Female , Glucose/metabolism , Glucose Clamp Technique , Humans , Hydrocortisone/blood , Hyperaldosteronism/blood , Hyperaldosteronism/drug therapy , Hyperaldosteronism/surgery , Hyperglycemia/blood , Hyperglycemia/physiopathology , Insulin Resistance , Male , Middle Aged , Mineralocorticoid Receptor Antagonists/therapeutic use , Potassium/blood , Prospective Studies , Sodium, Dietary/administration & dosage , Young Adult
9.
PLoS One ; 13(12): e0203515, 2018.
Article in English | MEDLINE | ID: mdl-30557372

ABSTRACT

Increasing development such as roads and houses will alter future landscapes and result in biological, social, and economic trade-offs. Managing development requires information on the public's acceptability of development and understanding which factors shape acceptability. In this study, we examined three questions: 1) What is the public's acceptability of development? 2) Is acceptability of development influenced by wildlife information? and 3) Is the maximum amount of acceptable development influenced by views about wildlife, involvement in outdoor recreation, and demographic factors? We conducted a visual-preference survey of 9,000 households in Vermont, USA that asked about acceptable levels of development, acceptability of wildlife, involvement in recreation, and individual and town demographics. The survey response rate was 44%. Maximum acceptable condition (MAC) for development was 41 houses/km2 and not meaningfully influenced by broader consequences of development on seven common wildlife species. MAC was influenced by views on individual species, including bear and coyote, but not by other species such as deer, fox, and bobcat. Respondents with a positive attitude toward bear favored less development, whereas the opposite relationship existed for coyote. Similarly, MAC was negatively influenced by involvement in birding and hunting, but not by other common recreational activities. Among demographic factors, respondents that were younger and not born in Vermont were more accepting of development. Population density also positively influenced development acceptability. Results provide measures of the public's acceptability of development that can help guide decision-making about development, wildlife, and recreation management.


Subject(s)
Coyotes , Forests , Information Centers , Parks, Recreational , Ursidae , Animals , Demography , Vermont
11.
Sci Rep ; 8(1): 4882, 2018 03 20.
Article in English | MEDLINE | ID: mdl-29559729

ABSTRACT

We use Monte Carlo simulation to quantify the change in cyclization J-factor within a dramatically simplified model of DNA that involves parameters for uniform stiffnesses, intrinsic twist, and intrinsic bending (including nonplanar bending). Plots of J versus DNA length over multiple periods of helical repeat are fit to a simple functional form in order to project the behavior of J over a broad range of these model parameters. In some instances, this process allows us to find families of DNA molecules (within our model) with quite different material properties, but very similar plots of J versus length, so similar as to likely to be indistinguishable by experiments. This effect is seen both for the parameter-pair of bend angle and stiffness scaling, as well as for the parameter-trio of helical repeat, bend angle, and bend non-planarity.


Subject(s)
DNA/chemistry , DNA/physiology , Glycoproteins/genetics , Base Pairing , Computer Simulation , Cyclization , DNA/ultrastructure , DNA, Circular , Glycoproteins/metabolism , Humans , Models, Molecular , Monte Carlo Method , Nucleic Acid Conformation
12.
Br J Haematol ; 180(3): 374-380, 2018 02.
Article in English | MEDLINE | ID: mdl-29181840

ABSTRACT

MYD88 mutations are present in 95% of Waldenstrom Macroglobulinaemia (WM) patients, and support diagnostic discrimination from other IgM-secreting B-cell malignancies. Diagnostic discrimination can be difficult among suspected wild-type MYD88 (MYD88WT ) WM cases. We systematically reviewed the clinical, pathological and laboratory studies for 64 suspected MYD88WT WM patients. World Health Organization and WM consensus guidelines were used to establish clinicopathological diagnosis. Up to 30% of suspected MYD88WT WM cases had an alternative clinicopathological diagnosis, including IgM multiple myeloma. The estimated 10-year survival was 73% (95% confidence interval [CI] 52-86%) for MYD88WT versus 90% (95% CI 82-95%) for mutated (MYD88MUT ) WM patients (Log-rank P < 0·001). Multivariate analysis only showed MYD88 mutation status (P < 0·001) as a significant determinant for overall survival. Diffuse large B-cell lymphoma (DLBCL) was diagnosed in 7 (15·2%) and 2 (0·76%) of MYD88WT and MYD88MUT patients, respectively (Odds ratio 23·3; 95% CI 4·2-233·8; P < 0·001). Overall survival was shorter among MYD88WT patients with an associated DLBCL event (Log-rank P = 0·08). The findings show that among suspected MYD88WT WM cases, an alternative clinicopathological diagnosis is common and can impact clinical care. WM patients with MYD88WT disease have a high incidence of associated DLBCL events and significantly shorter survival versus those with MYD88MUT disease.


Subject(s)
Myeloid Differentiation Factor 88/genetics , Waldenstrom Macroglobulinemia/diagnosis , Waldenstrom Macroglobulinemia/genetics , Adult , Aged , Aged, 80 and over , Biomarkers , Bone Marrow/pathology , Cell Transformation, Neoplastic , DNA Mutational Analysis , Diagnosis, Differential , Female , Genotype , Humans , Immunophenotyping , Kaplan-Meier Estimate , Male , Middle Aged , Mutation , Prognosis , Proportional Hazards Models , Waldenstrom Macroglobulinemia/mortality
13.
Opt Lett ; 42(17): 3486-3489, 2017 Sep 01.
Article in English | MEDLINE | ID: mdl-28957069

ABSTRACT

We propose a novel self-homodyne optical-electrical-optical clock recovery technique for binary phase-shift keying (BPSK) signals using commercial optical and electrical components. We present the principle of operation as well as a proof-of-concept experiment for a 10.7 Gb/s BPSK signal clock recovery transmitted over a dispersion-compensated link of 20 km of single-mode fiber. Suppression of pattern-related frequency noise at the output of the recovered clock is shown. The timing jitter of the recovered clock at 10.7 GHz was measured to be ∼450 fs (integration range: 100 Hz-10 MHz).

14.
J Chem Theory Comput ; 13(4): 1539-1555, 2017 Apr 11.
Article in English | MEDLINE | ID: mdl-28029797

ABSTRACT

A Monte Carlo code applied to the cgDNA coarse-grain rigid-base model of B-form double-stranded DNA is used to predict a sequence-averaged persistence length of lF = 53.5 nm in the sense of Flory, and of lp = 160 bp or 53.5 nm in the sense of apparent tangent-tangent correlation decay. These estimates are slightly higher than the consensus experimental values of 150 bp or 50 nm, but we believe the agreement to be good given that the cgDNA model is itself parametrized from molecular dynamics simulations of short fragments of length 10-20 bp, with no explicit fit to persistence length. Our Monte Carlo simulations further predict that there can be substantial dependence of persistence lengths on the specific sequence [Formula: see text] of a fragment. We propose, and confirm the numerical accuracy of, a simple factorization that separates the part of the apparent tangent-tangent correlation decay [Formula: see text] attributable to intrinsic shape, from a part [Formula: see text] attributable purely to stiffness, i.e., a sequence-dependent version of what has been called sequence-averaged dynamic persistence length l̅d (=58.8 nm within the cgDNA model). For ensembles of both random and λ-phage fragments, the apparent persistence length [Formula: see text] has a standard deviation of 4 nm over sequence, whereas our dynamic persistence length [Formula: see text] has a standard deviation of only 1 nm. However, there are notable dynamic persistence length outliers, including poly(A) (exceptionally straight and stiff), poly(TA) (tightly coiled and exceptionally soft), and phased A-tract sequence motifs (exceptionally bent and stiff). The results of our numerical simulations agree reasonably well with both molecular dynamics simulation and diverse experimental data including minicircle cyclization rates and stereo cryo-electron microscopy images.


Subject(s)
DNA/chemistry , Molecular Dynamics Simulation , Monte Carlo Method
15.
Br J Haematol ; 175(4): 623-630, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27468978

ABSTRACT

The incidence and prognostic impact of nephropathy related to Waldenström macroglobulinaemia (WM) is currently unknown. We performed a retrospective study to assess biopsy-confirmed WM-related nephropathy in a cohort of 1391 WM patients seen at a single academic institution. A total of 44 cases were identified, the estimated cumulative incidence was 5·1% at 15 years. There was a wide variation in kidney pathology, some directly related to the WM: amyloidosis (n = 11, 25%), monoclonal-IgM deposition disease/cryoglobulinaemia (n = 10, 23%), lymphoplasmacytic lymphoma infiltration (n = 8, 18%), light-chain deposition disease (n = 4, 9%) and light-chain cast nephropathy (n = 4, 9%), and some probably related to the WM: thrombotic microangiopathy (TMA) (n = 3, 7%), minimal change disease (n = 2, 5%), membranous nephropathy (n = 1, 2%) and crystal-storing tubulopathy (n = 1, 2%). The median overall survival in patients with biopsy-confirmed WM-related nephropathy was 11·5 years, shorter than for the rest of the cohort (16 years, P = 0·03). Survival was better in patients with stable or improved renal function after treatment (P = 0·05). Based on these findings, monitoring for renal disease in WM patients should be considered and a kidney biopsy pursued in those presenting with otherwise unexplained renal failure and/or nephrotic syndrome.


Subject(s)
Kidney Diseases/epidemiology , Kidney Diseases/etiology , Waldenstrom Macroglobulinemia/complications , Waldenstrom Macroglobulinemia/epidemiology , Aged , Aged, 80 and over , Biomarkers , Biopsy , Female , Humans , Incidence , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Kidney Function Tests , Male , Middle Aged , Patient Outcome Assessment , Prognosis , Retrospective Studies , Survival Analysis , Treatment Outcome , Waldenstrom Macroglobulinemia/therapy
16.
Blood ; 128(6): 827-38, 2016 08 11.
Article in English | MEDLINE | ID: mdl-27301862

ABSTRACT

Whole-genome sequencing has identified highly prevalent somatic mutations including MYD88, CXCR4, and ARID1A in Waldenström macroglobulinemia (WM). The impact of these and other somatic mutations on transcriptional regulation in WM remains to be clarified. We performed next-generation transcriptional profiling in 57 WM patients and compared findings to healthy donor B cells. Compared with healthy donors, WM patient samples showed greatly enhanced expression of the VDJ recombination genes DNTT, RAG1, and RAG2, but not AICDA Genes related to CXCR4 signaling were also upregulated and included CXCR4, CXCL12, and VCAM1 regardless of CXCR4 mutation status, indicating a potential role for CXCR4 signaling in all WM patients. The WM transcriptional profile was equally dissimilar to healthy memory B cells and circulating B cells likely due increased differentiation rather than cellular origin. The profile for CXCR4 mutations corresponded to diminished B-cell differentiation and suppression of tumor suppressors upregulated by MYD88 mutations in a manner associated with the suppression of TLR4 signaling relative to those mutated for MYD88 alone. Promoter methylation studies of top findings failed to explain this suppressive effect but identified aberrant methylation patterns in MYD88 wild-type patients. CXCR4 and MYD88 transcription were negatively correlated, demonstrated allele-specific transcription bias, and, along with CXCL13, were associated with bone marrow disease involvement. Distinct gene expression profiles for patients with wild-type MYD88, mutated ARID1A, familial predisposition to WM, chr6q deletions, chr3q amplifications, and trisomy 4 are also described. The findings provide novel insights into the molecular pathogenesis and opportunities for targeted therapeutic strategies for WM.


Subject(s)
Transcriptome , Waldenstrom Macroglobulinemia/genetics , Adult , Aged , Alleles , B-Lymphocytes/metabolism , B-Lymphocytes/pathology , DNA Methylation , Female , Gene Expression Regulation, Neoplastic , Genetic Variation , Humans , Male , Middle Aged , Mutation , Myeloid Differentiation Factor 88/genetics , Promoter Regions, Genetic , Receptors, CXCR4/genetics , V(D)J Recombination , Waldenstrom Macroglobulinemia/pathology
18.
Opt Express ; 23(17): 21678-89, 2015 Aug 24.
Article in English | MEDLINE | ID: mdl-26368147

ABSTRACT

We report a unidirectional frequency dissemination scheme for high-fidelity optical carriers deployable over telecommunication networks. For the first time, a 10 Gb/s Binary Phase Shift Keying (BPSK) signal from an ultra-narrow linewidth laser was transmitted through a field-installed optical fibre with round-trip length of 124 km between Cork City and town of Clonakilty, without inline optical amplification. At the receiver, using coherent communication techniques and optical injection-locking the carrier was recovered with noise suppression. The beat signal between the original carrier at the transmitter and recovered carrier at the receiver shows a linewidth of 2.8 kHz. Long term stability measurements revealed fractional instabilities (True Allan deviation) of 3.3 × 10(-14) for 1 s averaging time, prior to phase noise cancellation.

19.
J Environ Manage ; 162: 53-62, 2015 Oct 01.
Article in English | MEDLINE | ID: mdl-26225933

ABSTRACT

The unmanaged impacts of recreation and tourism can often result in unacceptable changes in resource conditions and quality of the visitor experience. Minimum impact visitor education programs aim to reduce the impacts of recreation by altering visitor behaviors. Specifically, education seeks to reduce impacts resulting from lack of knowledge both about the consequences of one's actions and impact-minimizing best practices. In this study, three different on-site minimum impact education strategies ("treatments") and a control condition were applied on the trails and summit area of Sargent Mountain in Acadia National Park, Maine. Treatment conditions were designed to encourage visitors to stay on marked trails and minimize off-trail travel. Treatments included a message delivered via personal contact, and both an ecological-based message and an amenity-based message posted on signs located alongside the trail. A control condition of current trail markings and directional signs was also assessed. The efficacy of the messaging was evaluated through the use of Global Positioning System (GPS) tracking of visitor spatial behavior on/off trails. Spatial analysis of GPS tracks revealed statistically significant differences among treatments, with the personal contact treatment yielding significantly less dispersion of visitors on the mountain summit. Results also indicate that the signs deployed in the study were ineffective at limiting off-trail use beyond what can be accomplished with trail markers and directional signs. These findings suggest that personal contact by a uniformed ranger or volunteer may be the most effective means of message delivery for on-site minimum impact education.


Subject(s)
Conservation of Natural Resources/methods , Ecology/education , Education, Nonprofessional/methods , Recreation/psychology , Geographic Information Systems , Humans , Knowledge , Maine , Spatial Analysis , Spatial Behavior , Travel
20.
J Infect Dev Ctries ; 8(9): 1148-59, 2014 Sep 12.
Article in English | MEDLINE | ID: mdl-25212079

ABSTRACT

INTRODUCTION: Viral hemorrhagic fever (VHF) outbreaks, with high mortality rates, have often been amplified in African health institutions due to person-to-person transmission via infected body fluids.  By collating and analyzing epidemiological data from documented outbreaks, we observed that diagnostic delay contributes to epidemic size for Ebola and Marburg hemorrhagic fever outbreaks. METHODOLOGY: We used a susceptible-exposed-infectious-removed (SEIR) model and data from the 1995 outbreak in Kikwit, Democratic Republic of Congo, to simulate Ebola hemorrhagic fever epidemics. Our model allows us to describe the dynamics for hospital staff separately from that for the general population, and to implement health worker-specific interventions. RESULTS: The model illustrates that implementing World Health Organization/US Centers for Disease Control and Prevention guidelines of isolating patients who do not respond to antimalarial and antibacterial chemotherapy reduces total outbreak size, from a median of 236, by 90% or more. Routinely employing diagnostic testing in post-mortems of patients that died of refractory fevers reduces the median outbreak size by a further 60%. Even greater reductions in outbreak size were seen when all febrile patients were tested for endemic infections or when febrile health-care workers were tested.  The effect of testing strategies was not impaired by the 1-3 day delay that would occur if testing were performed by a reference laboratory. CONCLUSION: In addition to improving the quality of care for common causes of febrile infections, increased and strategic use of laboratory diagnostics for fever could reduce the chance of hospital amplification of VHFs in resource-limited African health systems.


Subject(s)
Communicable Disease Control/methods , Diagnostic Tests, Routine/methods , Disease Outbreaks/prevention & control , Epidemics/prevention & control , Hemorrhagic Fever, Ebola/diagnosis , Hemorrhagic Fever, Ebola/prevention & control , Computer Simulation , Democratic Republic of the Congo/epidemiology , Hemorrhagic Fever, Ebola/epidemiology , Humans
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