Species diversity and qualitative assessment of ground beetles (Coleoptera: Carabidae) in three riparian habitats.

In a 3-yr study involving saltcedar-free, saltcedar-infested, and burned habitats in a riparian area at Lake Meredith, TX, the number of carabid species collected, diversity indices, and indicator species varied significantly among habitats. A 3-yr average of 15, 14, and 24 carabid species were collected from the saltcedar-free, saltcedar-infested, and burned habitats, respectively. Values for species richness, Shannon's and Simpson's diversity indices, and evenness index for pooled data collected from 2005 to 2007 were higher in the burned habitat followed by the saltcedar-free habitat and the saltcedar-infested habitat. Within-year parameters across the three habitats generally followed the pooled data results with some variation. Nonmetric multidimensional scaling analyses clearly indicated groups of carabid species preferred specific habitats. Five species in the burned area had indicator species percentage values >50% (Agonum punctiforme, Agonum texanum, Brachinus alternans, Harpalus pensylvanicus, and Poecilus chalcites). In the saltcedar-infested and saltcedar-free habitats, only one species in each habitat had indicator species percentage values that exceeded 50%: Calathus opaculus and Cicindela punctulata punctulata, respectively.

Emergency medicine and public health: new steps in old directions.

Emergency medicine and public health have opportunities to interact in at least 4 areas: surveillance of diseases, injuries, and health risks; monitoring health care access; delivering clinical preventive services; and developing policies to protect and improve the public's health. Recent, cross-cutting initiatives and innovations in these 4 areas follow pathways first explored more than a generation ago and provide an important impetus for future work. An analysis of recent contributions also points to various obstacles and challenges that must be addressed to take full advantage of existing and rapidly developing ties between emergency medicine and public health. The connections between these 2 fields will continue to create important partnership opportunities and the strong possibility of achieving new benefits for patients, the public, and the professionals who serve them.

Development of a monoclonal sandwich ELISA for the detection of animal and human Escherichia coli O157 strains.

AIMS: Production of a monoclonal antibody (MAb) to Escherichia coli O157 to develop a rapid test using a sandwich ELISA (sELISA) format. METHODS AND RESULTS: A MAb (7A6) was developed to the long-chain lipopolysaccharide of E. coli O157. A sELISA developed with the MAb reacted with 28 bovine and seven human enterohaemorrhagic E. coli (EHEC) O157 strains and also with two enterotoxigenic E. coli O157 strains. Cross-reaction to a rabbit diarrhoeal E.coli O15, Citrobacter freundii, Salmonella urbana and Vibrio cholerae O1 Inaba was detected. CONCLUSION: A MAb-based sELISA to detect E. coli O157 was produced. Its application to field samples is required to fully determine its prospective use for the detection of EHEC O157, to evaluate the non-specific interference of the cross-reacting strains. SIGNIFICANCE AND IMPACT OF THE STUDY: The assay produced is not wholly specific to EHEC O157, but has the potential to be used as a rapid method for screening large numbers of samples for E. coli O157.

Acceptability of emergency department-based screening and brief intervention for alcohol problems.

OBJECTIVES: To adapt screening and brief intervention for alcohol problems (SBI) to a high-volume emergency department (ED) setting and evaluate its acceptability to patients. METHODS: Patients at a large public-hospital ED were screened with the Alcohol Use Disorders Identification Test (AUDIT). Screen-positive drinkers (AUDIT score >/= 6) were provided brief, on-site counseling and referral as needed. Three months later, project staff blinded to baseline measures reassessed alcohol intake, alcohol-related harm, alcohol dependence symptoms, and readiness to change. RESULTS: Of 1, 034 patients approached, 78.3% (810) consented to participate (95% CI = 75.5% to 81.2%), and 21.2% (172) screened positive (95% CI = 18.4% to 24.0%). Of 88 patients with complete intervention data, 94.3% (83) accepted an intervention (95% CI = 89.5% to 99.2%), with acceptance rates ranging from 93% to 100% across four alcohol-problem-severity levels (p = 0.7). A majority (59.0%) set goals to decrease or stop drinking (95% CI = 48.4% to 69.6%). The group recontacted (n = 23) experienced statistically significant decreases in alcohol intake, alcohol-related harm, and dependence symptoms, with measures decreasing for 68%, 52%, and 61% of the patients. Readiness to change also showed statistically significant improvement, with scores increasing for 43% of the patients. Moreover, two-thirds of the patients (15/23) reported at follow-up that SBI was a helpful part of their ED visit. CONCLUSIONS: High rates of consent and acceptance of counseling for alcohol problems by patients across a wide range of problem severity indicate that this protocol was acceptable to at-risk patients in a public-hospital ED. Improvements in alcohol-related outcome measures at follow-up were strong enough to warrant controlled studies of intervention efficacy.

Hereditary hemorrhagic telangiectasia diagnosed by the ophthalmologist.

PURPOSE: To show the clinical features of a case of hereditary hemorrhagic telangiectasia in which the diagnosis was prompted by ophthalmologic examination. METHODS: A retrospective case review of a 56-year-old East Indian woman whose presentation to the eye clinic with a history of bloody tears and conjunctival vascular malformations prompted a systemic evaluation that resulted in the diagnosis of hereditary hemorrhagic telangiectasia. RESULTS: The diagnosis of hereditary hemorrhagic telangiectasia was eventually confirmed by gastrointestinal endoscopy and otorhinolaryngologic examination. CONCLUSION: Although hereditary hemorrhagic telangiectasia is typically diagnosed on the basis of gastrointestinal and otorhinolaryngologic history and examination, the ophthalmologic features of this case were striking enough to arouse suspicion of this disease.

Lethality of firearm-related injuries in the United States population.

STUDY OBJECTIVE: To characterize differences in the lethality of firearm-related injuries in selected demographic subgroups using national representative data on fatal and nonfatal firearm-related injuries. We also characterize the lethality of firearm-related injuries by intent of injury and anatomic location of the gunshot wound. METHODS: We analyzed case-fatality rates (CFRs) of firearm-related injuries in the United States by using death data from the National Vital Statistics System and data on nonfatal injuries treated in US hospital emergency departments from the National Electronic Injury Surveillance System. National estimates of crude and age-adjusted CFRs are presented by sex, race/ethnicity, age, intent, and primary body part affected. RESULTS: Each year during the study period (July 1992 through December 1995), an estimated 132,687 persons sustained gunshot wounds that resulted in death or treatment in an ED. The overall age-adjusted CFR among persons who sustained firearm-related injuries was 31.7% (95% confidence interval [CI] 27.7 to 35.6). The age-adjusted CFR for persons who were alive when they arrived for treatment in an ED (11. 3%; 95% CI 9.4 to 13.2) was about one third as large as the overall CFR. The age-adjusted CFR varied by sex, race/ethnicity, and age, but these differences depended on intent of injury. For assaultive injuries, the age-adjusted CFR was 1.4 times higher for females (28. 7%) than males (20.6%). For intentionally self-inflicted injuries, the age-adjusted CFR was 1.1 higher for males (77.7%) than females (69.1%). For assaults, the age-adjusted CFR was 1.5 times higher for whites (29.5%) than blacks (19.2%). For assaultive and intentionally self-inflicted injuries among persons 15 years and older, the age-specific CFR increased with age. Persons shot in the head (age-adjusted CFR, 61.0%) were 3.3 times as likely to die as those shot in other body parts (age-adjusted CFR, 18.7%). CONCLUSION: The lethality of firearm-related injuries was influenced strongly by the intent of injury and body part affected. The high lethality of firearm-related injuries relative to other major causes of injury emphasizes the need to continue prevention efforts and efforts to improve access to care and treatment (including emergency medical and acute care services) to reduce the number and increase survivability of firearm-related injuries.

Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985-1995.

STUDY OBJECTIVE: To characterize trends in annual estimates of nonfatal firearm-related injuries treated in US hospital emergency departments and to compare trends in quarterly rates of such injuries with those of firearm-related fatalities in the US population. METHODS: Data on nonfatal firearm-related injuries were obtained from the National Electronic Injury Surveillance System (NEISS) by review of medical records for June 1, 1992, through May 31, 1995. Data on firearm-related fatalities were obtained from the National Vital Statistics System for January 1, 1985, through December 31, 1995. NEISS comprises 91 hospitals that represent a stratified probability sample of all hospitals in the United States and its territories that have at least six beds and provide 24-hour emergency service. The main outcome measures were numbers, percentages, and quarterly population rates for nonfatal and fatal firearm-related injuries. RESULTS: An estimated 288,538 nonfatal firearm-related injuries (95% confidence interval [CI], 169,776 to 407,300) were treated in EDs during the 3-year study period. The annual number of non-fatal firearm-related injuries increased from 99,025 for June 1992 through May 1993 (95% CI, 58,266 to 139,784) to 101,669 for June 1993 through May 1994 (95% CI, 59,822 to 143,516), then decreased to 87,844 for June 1994 through May 1995 (95% CI, 51,687 to 124,001). Before the third quarter of 1993, quarterly nonfatal and fatal firearm-related injury rates in the total US population and quarterly nonfatal firearm assaultive injury and firearm homicide rates for males aged 15 to 24 years were observed to be on the rise. Since then, these rates have significantly declined. CONCLUSION: Analysis of national trends indicates that non-fatal and fatal firearm-related injuries are declining in the United States, although the rate of firearm-related deaths remains high, especially among males aged 15 to 24 years, in relation to other leading causes of injury death. An assessment of factors responsible for the decline in firearm-related injuries is needed to design further prevention efforts.

Recognition of a common mycobacterial T-cell epitope in MPB59 of Mycobacterium bovis.

Bovine tuberculosis, which persists as a residual level of infection in many European countries, has implications not only for the economy of farming communities but also for human health. The aim of this study was to identify a common mycobacterial antigen which was recognized in bovine tuberculosis and to characterize the response to this antigen at the epitope level. A T-cell clone, phenotype CD4+, raised from an animal experimentally infected with Mycobacterium bovis was shown to proliferate in response to a panel of sonicates derived from different mycobacterial species indicating recognition of an antigen with broad specificity. This antigen was subsequently shown to be MPB59. Recognition of MPB59 at the epitope level was determined in experimental and field cases of bovine tuberculosis using a panel of synthetic peptides (20-mers with 10-residue overlaps) incorporating the signal sequence and mature protein. The results showed that in vitro interferon-gamma was predominantly produced in response to adjacent peptides numbers 10 and 11, suggesting that the dominant epitope was contained in the overlap, correlating to residues 101-110 (YYQSGLSIVM). This epitope was recognized by 54% of tuberculous cattle of mixed breeds, which suggests that it may be genetically permissive in terms of major histocompatibility complex presentation. Sequence analysis confirmed that there were only minor differences in the amino acid composition within this region for various mycobacterial species, which could explain the common T-cell recognition described in this study. Common recognition of this epitope indicates that it would have limited potential for use as a diagnostic reagent per se but may have potential for inclusion in a subunit vaccine.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

The status of the trauma coordinator position: a national survey.

The trauma coordinator (TC) position is a vital link in the development and operations of trauma care systems. In 1992 and 1993, the American Trauma Society conducted a national survey of TCs to describe the roles and characteristics of the persons who hold those positions. Of 354 trauma coordinators identified in 46 states, more than three-fourths were employed by large hospitals designated as trauma centers. The typical TC was a woman 26 to 59 years old who held at least a bachelor's degree in nursing. Although new as TCs (mean, 3 years as TCs), the respondents averaged 14 years experience in nursing. Both full-time and part-time TCs worked longer hours than scheduled, often had supervisory responsibilities, and generally were in the nursing administration or the emergency department structure. Most TCs worked with computerized trauma registries that were used routinely in quality of care reviews.

Dynamic changes in circulating and antigen-responsive T-cell subpopulations post-Mycobacterium bovis infection in cattle.

Bovine tuberculosis is a threat to animal and human health in several countries. Greater understanding of the immunology of the disease is required to develop improved tests and vaccines. This study has used a model of bovine tuberculosis, established in the natural host, to investigate the dynamic changes that occur in the circulating T-cell subpopulations after infection. When the phenotypic composition of the peripheral blood lymphocytes was determined pre- and post-experimental infection, the response to disease comprised three phases. Firstly, the WC1/gamma delta T cells decreased and then increased, suggesting localization to developing lesions and clonal expansion. Secondly, the CD4:CD8 ratio increased. Thirdly, the CD4:CD8 ratio decreased to less than pre-infection measurements. The latter changes suggested sequential involvement of CD4 and then CD8 T cells. The proportion of cells expressing interleukin-2 receptor (IL-2R) also increased. Panels of T-cell clones were established at various stages post-infection and all clones that exhibited antigen responsiveness were phenotyped. T-cell clones from early infection were WC1/gamma delta and CD4 in phenotype, while CD8 clones appeared later in infection, eventually becoming dominant. Therefore, from in vivo and in vitro evidence, it was suggested that there is a dynamic progression in the T-cell subpopulations involved dominantly in responses to mycobacteria.

Indocyanine green angiography for recurrent choroidal neovascularization in age-related macular degeneration.

BACKGROUND AND OBJECTIVE: Recurrence of choroidal neovascular membranes (CNV) occurs frequently following laser photocoagulation. Recurrent CNV can be difficult to treat because they may not be well defined by fluorescein angiography. PATIENTS AND METHODS: The fluorescein and indocyanine green (ICG) angiograms of 58 eyes of 57 patients who presented with clinically suspected recurrence were evaluated retrospectively. RESULTS: In 14 eyes (24%), a well-defined recurrent CNV could be identified by evaluating the fluorescein angiogram. In 6 (14%) of the remaining 44 eyes, a well-defined recurrent CNV was identifiable by ICG angiography. CONCLUSION: A role for ICG angiography in the care of patients with suspected recurrent CNV is discussed.

Temporal and geographic trends in the autopsy frequency of blunt and penetrating trauma deaths in the United States.

OBJECTIVE: To examine national trends in the percentage of blunt and penetrating trauma deaths autopsied. DESIGN, SETTING, AND PARTICIPANTS: For each year from 1980 through 1989, we used national mortality data files to determine the autopsy frequency (percentage of deaths autopsied) of all deaths in the United States. We analyzed variation in the autopsy frequency of blunt and penetrating trauma deaths by cause of injury and place of occurrence of death. RESULTS: The autopsy frequency of blunt and penetrating trauma deaths in the United States increased by 14.3% during the 1980s to 58.9% in 1989 (62,004 of 105,309 deaths autopsied), while the autopsy frequency of all deaths decreased by 23.6% during the same period to 11.5% in 1989 (248,272 of 2,153,859 deaths autopsied). Among trauma deaths, homicides remained far more likely to be autopsied than nonhomicides (deaths due to unintentional injuries, suicides, and injuries of undetermined intentionality). The autopsy frequency of homicidal trauma deaths in 1989 was 90.0% or higher in 44 states and ranged from 79.6% in Mississippi to 100.0% in six states. The autopsy frequency of nonhomicidal trauma deaths in 1989 was 90.0% or higher in two states and ranged from 10.3% in Oklahoma to 94.5% in Hawaii. Nationwide, we found significant differences in the autopsy frequency of trauma deaths in 1989 between metropolitan and nonmetropolitan counties, both for homicides (97.7% vs 89.3%; P < .001) and nonhomicides (58.2% vs 29.9%; P < .001). CONCLUSIONS: The percentage of blunt and penetrating trauma deaths autopsied has increased recently in the United States, but extensive geographic variation in autopsy frequency suggests that the benefits of autopsy findings for trauma care quality improvement and public health surveillance of injuries are distributed unevenly throughout the nation.

Misclassification of deaths caused by cocaine. An assessment by survey.

The use of U.S. vital statistics for surveillance of drug-related mortality may be limited by the way in which certifiers complete death certificates and by the constraints of the International classification of diseases, Ninth Revision (ICD-9). ICD-9 is the system used by the National Center for Health Statistics (NCHS) to compile national, cause-specific mortality data from information reported on death certificates. To investigate the extent of variability in certification practices among medical examiners (MEs), we conducted a mailout survey in which we asked a national sample of 49 MEs to review summaries of 28 death scenarios and, for each death, assign the cause and manner of death. Cocaine use was the unequivocal cause of death for 17 of the 28 deaths. We then asked a nosologist at NCHS to code the verbatim survey responses in accordance with the rules and rubrics of the ICD-9 system. Of the 20 MEs who responded, 14 provided complete cause and manner determinations. For the cocaine-caused deaths, the 14 respondents provided 238 cause-of-death statements; 220 (92.4%) explicitly mentioned cocaine. However, only 45 of the 238 responses (18.9%) led to a cocaine-specific ICD-9 code for the underlying cause of death. Our findings illustrate how death certification practices, coupled with the ambiguities of the ICD-9 system, may lead to substantial loss of detail about cocaine-caused deaths and misclassification of these deaths in official compilations of mortality statistics.

Diagnostic application of monoclonal antibodies to outer membrane protein for rapid detection of Salmonella.

Monoclonal antibodies produced to Salmonella enteritidis outer membrane proteins were screened against 57 Salmonella serovars and several related enterobacteria. Those detecting all Salmonella serovars and none of the related enterobacteria were used in a microtitre plate antigen capture ELISA to screen clinical samples. Sixty-one of 2100 samples yielded salmonellas after incubation for 24 h in selective media by conventional culture. Of these 58 were detected by the ELISA. Sixty-five false positives by ELISA were found to be Enterobacter spp. The results show the potential of this ELISA to eliminate a large proportion of the salmonella-negative cultures at an early stage.