Workplace Determinants of Depression, Anxiety, and Stress in U.S. Mariners during the COVID-19 Pandemic.

United States (U.S.) mariners continued sailing throughout COVID-19. Many aspects of their work could make them prone to adverse mental health outcomes but research on workplace determinants of their mental health during COVID-19 is limited. Between January and July 2021 an online survey assessed the outcomes of increased depressive symptoms, increased anxiety symptoms, and increased perceived stress in addition to concerns, worries, and experiences when sailing during COVID-19, job satisfaction, and safety climate in n = 1384 U.S. mariners. Demographic measures were also collected. Logistic regression models (for depression and anxiety) and a linear regression model (for stress) were developed. We found that increased COVID-19 concerns and poor self-reported mental health were related to increased odds of likely depression and anxiety and higher stress. Mariners who experienced more adverse experiences aboard a vessel had increased stress and increased odds of depression. Poor sleep quality was also related to increased odds of depression, and poor vessel support/safety culture was related to higher stress. Differences in outcomes were seen by vessel type, age, and credential in regression analyses. Results from this study will help to prioritize interventions to minimize the mental health impacts of COVID-19, and influence evidence-based recommendations to improve the mental health of mariners going forward.

Public health branch incident management and support as part of the Federal Government response during the emergency phase of Hurricanes Irma and Maria in Puerto Rico and the US Virgin Islands.

On September 6 and 20, 2017, Hurricanes Irma and Maria made landfall as major hurricanes in the US Caribbean Territories of the Virgin Islands and Puerto Rico with devastating effects. As part of the initial response, a public health team (PHT) was initially deployed as part of the US Department of Health and Human Services Incident Response Coordination Team. As a result of increased demands for additional expertise and resources, a public health branch (PHB) was established for coordinating a broad spectrum of public health response activities in support of the affected territories. This paper describes the conceptual framework for organizing these activities; summarizes some key public health activities and roles; outlines partner support and coordination with key agencies; and defines best practices and areas for improvement in disaster future operations.

Fatal chlorine gas exposure at a metal recycling facility: Case report.

At least four workers at a metal recycling facility were hospitalized and one died after exposure to chlorine gas when it was accidentally released from an intact, closed-valved cylinder being processed for scrap metal. This unintentional chlorine gas release marks at least the third such incident at a metal recycling facility in the United States since 2010. We describe the fatal case of the worker whose clinical course was consistent with acute respiratory distress syndrome (ARDS) following exposure to high concentrations of chlorine gas. This case report emphasizes the potential risk of chlorine gas exposure to metal recycling workers by accepting and processing intact, closed-valved containers. The metal recycling industry should take steps to increase awareness of this established risk to prevent future chlorine gas releases. Additionally, public health practitioners and clinicians should be aware that metal recycling workers are at risk for chlorine gas exposure.

Morbidity and Health Risk Factors Among New Mexico Miners: A Comparison Across Mining Sectors.

OBJECTIVE: This study examines differences in chronic health outcomes between coal, uranium, metal, and nonmetal miners. METHODS: In a cross-sectional study using data from a health screening program for current and former New Mexico miners, log-binomial logistic regression models were used to estimate relative risks of respiratory and heart disease, cancer, osteoarthritis, and back pain associated with mining in each sector as compared with coal, adjusting for other relevant risk factors. RESULTS: Differential risks in angina, pulmonary symptoms, asthma, cancer, osteoarthritis, and back pain between mining sectors were found. CONCLUSIONS: New Mexico miners experience different chronic health challenges across sectors. These results demonstrate the importance of using comparable data to understand how health risks differ across mining sectors. Further investigation among a broader geographic population of miners will help identify the health priorities and needs in each sector.

Medical Response to a Vinyl Chloride Release From a Train Derailment: New Jersey, 2012.

OBJECTIVE: The objective of this investigation was to examine the health impact of and medical response to a mass casualty chemical incident caused by a vinyl chloride release. METHODS: Key staff at area hospitals were interviewed about communication during the response, the number of patients treated and care required, and lessons learned. Clinical information related to the incident and medical history were abstracted from hospital charts. RESULTS: Hospital interviews identified a desire for more thorough and timely incident-specific information and an under-utilization of regionally available resources. Two hundred fifty-six hospital visits (96.2%) were at the facility closest to the site of the derailment. Of 237 initial visits at which the patient was examined by a physician, 231 patients (97.5%) were treated in the emergency department (ED) and 6 patients (2.5%) were admitted; 5 admitted patients (83.3%) had preexisting medical conditions. Thirteen of 14 asymptomatic ED patients were children under the age of 10 years. One hundred forty-five patients (62.8%) discharged from the ED were diagnosed solely with exposure to vinyl chloride. CONCLUSIONS: Continuous emergency response planning might facilitate communication and better distribution of patient surge across hospitals. Individuals with multiple medical conditions and parents and caretakers of children may serve as target groups for risk communication following acute chemical releases. (Disaster Med Public Health Preparedness. 2017;11:538-544).

Effectiveness of Using Cellular Phones to Transmit Real-Time Shelter Morbidity Surveillance Data After Hurricane Sandy, New Jersey, October to November, 2012.

Timely morbidity surveillance of sheltered populations is crucial for identifying and addressing their immediate needs, and accurate surveillance allows us to better prepare for future disasters. However, disasters often create travel and communication challenges that complicate the collection and transmission of surveillance data. We describe a surveillance project conducted in New Jersey shelters after Hurricane Sandy, which occurred in November 2012, that successfully used cellular phones for remote real-time reporting. This project demonstrated that, when supported with just-in-time morbidity surveillance training, cellular phone reporting was a successful, sustainable, and less labor-intensive methodology than in-person shelter visits to capture morbidity data from multiple locations and opened a two-way communication channel with shelters. (Disaster Med Public Health Preparedness. 2015;10:525-528).

Exposures and symptoms among workers after an offsite train derailment and vinyl chloride release.

OBJECTIVE: In 2012 in New Jersey, a train derailment resulted in the puncture of a tanker car carrying liquid vinyl chloride under pressure, and a resulting airborne vinyl chloride plume drifted onto the grounds of a nearby refinery. This report details the investigation of exposures and symptoms among refinery workers. DESIGN AND SETTING: The investigation team met with refinery workers to discuss their experience after the derailment and provided workers a self-administered survey to document symptoms and worker responses during the incident. Associations among categorical variables and experiencing symptoms were evaluated using Fisher's exact test. PARTICIPANTS: Twenty-six of 155 (17 percent) workers present at the refinery or driving on the access road the date the spill occurred completed the survey. MAIN OUTCOME MEASURE(S): Any self-reported symptom following exposure from the vinyl chloride release. RESULTS: Fifteen workers (58 percent) reported ≥1 symptom, most commonly headache (12, 46 percent). Three (12 percent) reported using respiratory protection. No differences in reporting symptoms were observed by location during the incident or by the building in which workers sheltered. Workers who moved from one shelter to another during the incident (ie, broke shelter) were more likely to report symptoms (Fisher's exact test, p=0.03); however, there are only limited data regarding vinyl chloride concentrations in shelters versus outside. CONCLUSIONS: Breaking shelter might result in greater exposures, and managers and health and safety officers of vulnerable facilities with limited physical access should consider developing robust shelter-in-place plans and alternate emergency egress plans. Workers should consider using respiratory protection if exiting a shelter is necessary during a chemical incident.

First Use of a Serogroup B Meningococcal Vaccine in the US in Response to a University Outbreak.

BACKGROUND: In 2013-2014, an outbreak of serogroup B meningococcal disease occurred among persons linked to a New Jersey university (University A). In the absence of a licensed serogroup B meningococcal (MenB) vaccine in the United States, the Food and Drug Administration authorized use of an investigational MenB vaccine to control the outbreak. An investigation of the outbreak and response was undertaken to determine the population at risk and assess vaccination coverage. METHODS: The epidemiologic investigation relied on compilation and review of case and population data, laboratory typing of meningococcal isolates, and unstructured interviews with university staff. Vaccination coverage data were collected during the vaccination campaign held under an expanded-access Investigational New Drug protocol. RESULTS: Between March 25, 2013, and March 10, 2014, 9 cases of serogroup B meningococcal disease occurred in persons linked to University A. Laboratory typing results were identical for all 8 isolates available. Through May 14, 2014, 89.1% coverage with the 2-dose vaccination series was achieved in the target population. From the initiation of MenB vaccination through February 1, 2015, no additional cases of serogroup B meningococcal disease occurred in University A students. However, the ninth case occurred in March 2014 in an unvaccinated close contact of University A students. CONCLUSIONS: No serogroup B meningococcal disease cases occurred in persons who received 1 or more doses of 4CMenB vaccine, suggesting 4CMenB may have protected vaccinated individuals from disease. However, the ninth case demonstrates that carriage of serogroup B Neisseria meningitidis among vaccinated persons was not eliminated.

Assessment of emergency responders after a vinyl chloride release from a train derailment - New Jersey, 2012.

On November 30, 2012, at approximately 7:00 am, a freight train derailed near a small town in New Jersey. Four tank cars, including a breached tank car carrying vinyl chloride, landed in a tidal creek. Vinyl chloride, a colorless gas with a mild, sweet odor, is used in plastics manufacture. Acute exposure can cause respiratory irritation and headache, drowsiness, and dizziness; chronic occupational exposure can result in liver damage, accumulation of fat in the liver, and tumors (including angiosarcoma of the liver). Because health effects associated with acute exposures have not been well studied, the New Jersey Department of Health requested assistance from the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC. On December 11, teams from these agencies deployed to assist the New Jersey Department of Health in conducting an assessment of exposures in the community as well as the occupational health and safety of emergency personnel who responded to the incident. This report describes the results of the investigation of emergency personnel. A survey of 93 emergency responders found that 26% of respondents experienced headache and upper respiratory symptoms during the response. A minority (22%) reported using respiratory protection during the incident. Twenty-one (23%) of 92 respondents sought medical evaluation. Based on these findings, CDC recommended that response agencies 1) implement the Emergency Responder Health Monitoring and Surveillance (ERHMS) system for ongoing health monitoring of the emergency responders involved in the train derailment response and 2) ensure that in future incidents, respiratory protection is used when exposure levels are unknown or above the established occupational exposure limits.

Disruptive selection maintains variable pheromone blends in the bark beetle Ips pini.

The presence of heritable variation is a prerequisite for evolution, but natural selection typically reduces genetic variation. Variation can be maintained in traits under selection through spatial or temporal variation in fitness surfaces, frequency-dependent selection, or disruptive selection. We evaluated the maintenance of variation in the enantiomeric blend of pheromones employed by the bark beetle Ips pini (Say). In natural populations, we quantified fitness surfaces for mating success and progeny production. We investigated the effects of paternal pheromone blend on offspring survival by comparing the spatial scales at which pheromone blends and larval mortality agents vary. Males with extreme pheromone blends obtained up to 1.8 times as many mates who each laid equivalent numbers of eggs, producing strong disruptive selection on male pheromone blend. In combination with imperfect assortative mating that continually produces intermediate genotypes, this fitness surface is sufficient to maintain variation in a heritable trait that is strongly linked to fitness. The ultimate explanation for female preference is unknown but could be because of selection for reduced mortality from specialist predators that prefer common prey pheromone blends. Selection is most likely occurring at the scale of small resource patches within pine stands. Selection at coarser scales (pine stands) is unlikely because pheromone blends did not vary among pine stands. Selection at finer scales (within logs) is unlikely because males of similar enantiomeric blends were not aggregated on logs, and male pheromone blend did not affect the spacing to neighboring galleries. This study documents a rare case of diversifying selection in natural populations.

Expression profiling and local adaptation of Boechera holboellii populations for water use efficiency across a naturally occurring water stress gradient.

We studied the physiological basis of local adaptation to drought in Boechera holboellii, a perennial relative of Arabidopsis thaliana, and used cDNA-AFLPs to identify candidate genes showing differential expression in these populations. We compared two populations of B. holboellii from contrasting water environments in a reciprocal transplant experiment, as well as in a laboratory dry-down experiment. We continuously measured the water content of soils using time domain reflectometery (TDR). We compared populations for their water use efficiency (WUE), root/shoot ratios (R:S) and leaf mass per unit area (LMA) in the field and in the laboratory, and identified candidate genes that (i) responded plastically to water stress and (ii) were differentially expressed between the two populations. Genotypes from the drier site had higher WUE, which was attributable to a large reduction in transpirational water loss. The xeric-adapted population also had increased investment in root biomass and greater leaf mass per unit area. Reciprocal transplants in the field had significantly greater survival in their native habitat. In total, 450 cDNA-AFLP fragments showed significant changes between drought and control treatments. Furthermore, some genes showed genotype (population)-specific patterns of up- or down-regulation in response to drought. Three hundred cDNA-AFLP bands were sequenced leading to the identification of cDNAs coding for proteins involved in signal transduction, transcriptional regulation, redox regulation, oxidative stress and pathways involved in stress adaptation. Some of these proteins could contribute a physiological advantage under drought, making them potential targets for natural selection.