A preliminary study of fingerprint aging using near infrared hyperspectral imaging (NIR-HSI).

Fingerprinting is one of the most commonly used techniques to obtain pieces of evidence for identification of individuals. An estimation of how long a trace has been left at a crime scene could represent an important improvement for criminal investigations. There is no reliable analytical method, however, to estimate the age of a fingerprint, since this is an uncontrolled process and changes are affected by factors such as environmental conditions. This study aims to better understand the aging process of fingerprints and identify the relevant variables and limitations of the fingerprint aging process using near infrared hyperspectral imaging (NIR-HSI). For this purpose, aging of the fingerprints of 13 volunteers was evaluated using partial least squares - discriminant analysis (PLS-DA) as a preliminary exploratory approach. Four different modelling approaches were evaluated. The percentage of correctly classified pixels varied from 20.92% to 66.67%. An analysis of the associated spectra found that during the first days of aging the degradation of fat-soluble components, as well as the elimination/absorption of water, seemed to follow non-uniform trends and vary in degradation rate from donor to donor. Better classification tended to occur over longer aging times.

White Light-Photolysis for the Removal of Polycyclic Aromatic Hydrocarbons from Proximity Firefighting Protective Clothing.

The presence of polycyclic aromatic hydrocarbons (PAHs) on firefighters' personal protective equipment is a concern. One form of preventing from these compounds is to decontaminate proximity firefighting protective clothing (PFPC). Traditional decontamination methods do not promote total removal of pollutants and alter the properties of PFPC. The objective of this work was to evaluate the effectiveness of white light-photolysis (WLP), an advanced oxidation process (AOP), for removing PAHs from PFPC, while maintaining the integrity of the fabric fibers. Experiments were carried out, varying reaction time and concentration of H2O2. With WLP (without H2O2), it was possible to remove more than 73% of the PAHs tested from the outer layer of PFPC in 3 days. The WLP provided the greatest removal of PAHs, compared with the most common mechanical decontamination techniques (laundering and wet-soap brushing). The fibers' integrity after exposure to the white light was evaluated with infrared spectroscopy and scanning electron microscopy/energy dispersive X-ray spectrometry. In addition, a tearing strength test was performed. No remarkable fabric degradation was observed, indicating a possible, routine-compatible, simple, and inexpensive method of decontamination of PFPC, based on photolysis, which is effective in the degradation of PAHs and maintains the integrity of fabric fibers.

Evaluation of an Ozone Chamber as a Routine Method to Decontaminate Firefighters' PPE.

Ozone chambers have emerged as an alternative method to decontaminate firefighters' Personal Protective Equipment (PPE) from toxic fire residues. This work evaluated the efficiency of using an ozone chamber to clean firefighters' PPE. This was achieved by studying the degradation of pyrene and 9-methylanthracene polycyclic aromatic hydrocarbons (PAHs). The following experiments were performed: (i) insufflating ozone into PAH solutions (homogeneous setup), and (ii) exposing pieces of PPE impregnated with the PAHs to an ozone atmosphere for up to one hour (heterogeneous setup). The ozonolysis products were assessed by Fourier Transform Infrared Spectroscopy (FTIR), Thin-Layer Chromatography (TLC), and Mass Spectrometry (MS) analysis. In the homogeneous experiments, compounds of a higher molecular weight were produced due to the incorporation of oxygen into the PAH structures. Some of these new compounds included 4-oxapyren-5-one (m/z 220) and phenanthrene-4,5-dicarboxaldehyde (m/z 234) from pyrene; or 9-anthracenecarboxaldehyde (m/z 207) and hydroxy-9,10-anthracenedione (m/z 225) from 9-methylanthracene. In the heterogeneous experiments, a lower oxidation was revealed, since no byproducts were detected using FTIR and TLC, but only using MS. However, in both experiments, significant amounts of the original PAHs were still present even after one hour of ozone treatment. Thus, although some partial chemical degradation was observed, the remaining PAH and the new oxygenated-PAH compounds (equally or more toxic than the initial molecules) alerted us of the risks to firefighters' health when using an ozone chamber as a unique decontamination method. These results do not prove the ozone-advertised efficiency of the ozone chambers for decontaminating (degrading the toxic combustion residues into innocuous compounds) firefighters' PPE.

Organic load removal and microbial disinfection of raw domestic sewage using SrSnO3/g-C3N4 with sunlight.

Sewage treatment and water reuse are, undoubtedly, one of the main points on scientific agenda of the 21st century. Many technologies for sewage treatment are available; however, it is still as an open issue that deserves much attention in order to facilitate their application, develop more effective methods and propose alternative treatment for unusual situations. Developing high performance materials for sewage treatment fits the idea of the development of efficient and alternative methods for microorganism removal and the high organic load of wastewater and is of fundamental importance. In this paper, a heterojunction with perovskite-type strontium stannate (SrSnO3) and graphitic carbon nitride (g-C3N4) - SrSnO3/g-C3N4 - was synthesized and used for photocatalytic treatment of domestic sewage using only sunlight. Results were accompanied by assessing the total organic carbon decrease and removal of pathogenic microorganisms. X-ray diffraction and X-ray excited photoelectron spectroscopy demonstrated that a heterostructure was successfully formed and photocatalytic tests showed an important activity in the visible range, i.e., under sunlight. Exposing raw sewage to 240 min (from 11 a.m. until 3 p.m.) in the presence of SrSnO3/g-C3N4, led to a 56.1% mineralization. This process was 2.5 more efficient than photolysis under sunlight. Moreover, the treated sewage showed no coliform growth (either fecal or total) or heterotrophic bacteria. This simple treatment makes sewage suitable and safe for reuse, for example, for agriculture purposes according to Brazilian regulations criteria and could be an alternative for isolated areas in which sewage treatment plants are not available.

Luminescent Marker for GSR: Evaluation of the Acute Oral and Inhalation Toxicity of the MOF [Eu(DPA)(HDPA)].

The metal-organic framework (MOF) [Eu(DPA)(HDPA)] (where DPA is dipicolinic acid) has been previously reported as an efficient marker for gunshot residues (GSRs). Since this marker will be in contact with various shooters, industrial workers, and the environment, however, it is important to identify its toxicity. In this work, the oral and the inhalation acute toxicities of the MOF [Eu(DPA)(HDPA)] (also called R-Marker) were evaluated in young Wistar rats using Guidelines 423 (oral) and 436 (inhalation) from the Organisation for Economic Co-operation and Development (OECD). Animal behavior; body weight, water, and food intake; and organ weight, as well as biochemical parameters were evaluated in both evaluations. For the inhalation test, a concentration of 1 mg·Lair-1·(4 h-1) was reached in a whole-body inhalation chamber. When the respiratory tract was analyzed, it was observed that part of the marker had been swallowed instead of inhaled by the animal. For the oral test, the highest administrated dose was 2000 mg/kg with no sign of toxicity. This marker has been classified in the least toxic category of the Globally Harmonized System (GHS; category 5), with an oral median lethal dose (LD50) of 5000 mg/kg. After the oral administration, the feces of the animals were collected using a metabolic cage. Luminescent feces were present up to 24 h after administration, indicating that the marker had been excreted by the organism without causing intoxication. This study has opened perspectives for drug delivery and toxicity studies, since it enables visual detection of the marker.

Analysis of Luminescent Gunshot Residue (LGSR) on Different Types of Fabrics.

The collection of gunshot residue on fabric can be an arduous task due to the microscopic size of particles (blind collection) and sheddability of some fabrics. The introduction of luminescent markers and consequent formation of luminescent gunshot residue (LGSR) can facilitate this analysis. In this study, different fabrics were analyzed in order to verify the persistence of the LGSR on them, the possibility of collecting and analyzing particles by video spectral comparator (VSC) and SEM/EDS. Also, different colored fabrics were used as targets in order to investigate influence of fabric color on LGSR visualization. Furthermore, the influence of the fabric type in the distribution of the LGSR deposited around the projectile´s hole entrance was evaluated. The fabric sheddability did not alter collection of the particles or analysis. It was possible to observe and collect LGSR on all tested fabrics, even after the fabric had been shaken, or in colored fabrics.

Evaluation of interferers in sampling materials used in explosive residue analysis by ion chromatography.

Analysis of explosive residues is of special interest in forensic science. It can be crucial for investigating acts of terrorism or robberies. Ion Chromatography (IC) is a standard technique used by many forensic labs in these cases. Due to the common nature of many explosives and the inherent dirtiness of samples from explosion scenes, sometimes inconclusive or false positive results are obtained by IC, making the identification of interferers extremely important. One possible source of interferer can be the sampling materials themselves, as investigated in this work. First of all, interferers from forensic swabs and syringe filters were evaluated, as these are commonly employed in explosive residue IC analysis. Among the 6 tested samples, only two syringe filters were considered free of interferers. Significant amounts (>0.2mg/L) of Na+, K+, Mg2+, Ca2+, Cl-, and SO42- were found in all forensic swabs and two syringe filters. Then, some ordinary commercial materials, such as cotton swabs, cotton balls, and cotton discs were also tested, as they are often employed in a forensic routine, also. These also showed significant amounts (>0.2mg/L) of Na+, K+, Cl-, NO3-, and SO42-. However, the total concentration of interferers in ordinary commercial materials was lower than in the forensic swabs. Then the effectiveness of removing interferers by washing sampling (swabs, and cotton balls, rolls and disk) and pre-processing (syringe filters) materials was evaluated. This revealed that the interferers could be removed with at least three washes. The results indicated that the sampling materials used for explosion scene analysis should be carefully addressed in forensic analysis. First, by making a previous analysis of the sampling material, preferably prior to use, to evaluate the presence of interferers to ensure that only material free of interferers is used. When it is not possible to perform a prior analysis of sampling materials, they should be analyzed concomitantly with the samples from the post-blast residue in order to estimate the presence of interferers. This would reduce the risk of false positives. Additionally, when interferers are detected, washing can be employed for more reliable routine analysis. We suggest at least 3 wash cycles. This method could be used for ordinary commercial materials, which are cheap and easily obtained.

Identification of Luminescent Markers for Gunshot Residues: Fluorescence, Raman Spectroscopy, and Chemometrics.

Gunshot residue (GSR) is an evidence of major importance in firearm-related crimes. The recent introduction of nontoxic ammunition has made impossible the characterization of GSR particles by the current methods employed by forensic experts. To overcome this drawback, the introduction of luminescent markers was proposed, allowing on-site visual detection of luminescent gunshot residue (LGSR) at the crime scene. Three different luminescent markers coordinated with europium for specific and selective encoding of ammunition have been proposed. To promote a variety of versatile tools for GSR analysis, spectroscopic techniques combined with chemometric methods can be applied to achieve a reliable, fast, and nondestructive means to identify LGSR and discriminate among the different markers. Luminescence (emission and excitation), normal, and resonance Raman spectroscopies associated with principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were evaluated. The classification model using the complementary information on emission and excitation spectra, a.k.a. data fusion, provided a 100% correct classification for all markers. A comprehensive study has been developed to show that the insertion of luminescent markers enables not only the easy localization of GSR residues but also the possibility of ammunition encoding through the use of multivariate classification methods.

[Importance of osteoporosis-related fractures for patients]. / Bedeutung osteoporosebedingter Frakturen für den Patienten.

BACKGROUND: Osteoporosis is a common disease that affects both women and men. Due to a reduced bone mineral density and increasing age, the risk for atraumatic fractures increases. These fractures cause pain due to the fracture itself and also have far-reaching sequelae in nearly all areas of life of patients. OBJECTIVE: The aim of this article is to summarize the consequences of osteoporotic fractures from the patient's point of view and to highlight the consequences of osteoporosis for the patient. The necessity for timely diagnostics and treatment after a fracture event is explained. MATERIAL AND METHODS: For each term a literature search was performed using key topic-related terms and the results are presented as a narrative review. RESULTS: Various areas of importance for patients were identified. A direct assessment of the patient's point of view was not feasible using a literature search; however, studies with surveys of patients could be identified and therefore, the patient's point of view could be integrated. Areas of interest that could be identified in the literature were pain, psychological well-being, cognitive abilities, mortality and long-term need for nursing. CONCLUSION: The effects of osteoporosis and fractures are multifactorial and often severe for the patient. The measures for prevention of osteoporotic fractures should be consistently implemented in the daily clinical routine and the necessary diagnostics and treatment should be rapidly initiated.

[Establishment of fracture liaison services in Germany]. / Etablierung von Frakturnetzwerken in Deutschland.

BACKGROUND: Osteoporosis results in fragility fractures that are associated with a high morbidity and mortality as well as an increased risk for subsequent fragility fractures. Thus, the first fragility fracture should be the last. To achieve this goal patients need treatment of osteoporosis according to the prevailing clinical guidelines. OBJECTIVE: This article presents the current clinical care situation of patients with a manifest osteoporosis in Germany and the accompanying risks. As a possible solution the concept of a fracture liaison service (FLS) as a new intersectoral care concept is presented and options for the establishment of FLS in Germany are provided. MATERIAL AND METHODS: A literature search (PubMed) was conducted using key terms. The practical experiences of the authors in the context of establishing an FLS were also considered. RESULTS: Compared to other countries, in Germany only a minority of patients receive treatment for osteoporosis after fragility fractures. To improve the care situation an intersectoral FLS provides a coordinated referral of patients with fragility fractures from inpatient care in hospitals to specialists in private practice. This enables the strict identification and treatment of high-risk patients according to the prevailing clinical guidelines. In Germany, different options exist to structure an FLS under consideration of the local circumstances. CONCLUSION: In Germany, FLS should be established nationwide and according to uniform standards. This would significantly improve the quality of clinical care of patients with manifest osteoporosis.

Toxicological study of the degradation products of antineoplastic agent etoposide in commercial formulation treated by heterogeneous photocatalysis using SrSnO3.

Etoposide is an antineoplastic agent used for treating lung cancer, testicular cancer, breast cancer, pediatric cancers, and lymphomas. It is a pollutant due to its mutagenic and carcinogenic potential. Disposal of waste from this drug is still insufficiently safe, and there is no appropriate waste treatment. Therefore, it is important to use advanced oxidative processes (AOPs) for the treatment and disposal of medicines like this. The use of strontium stannate (SrSnO3) as a catalyst in heterogeneous photocatalysis reactions has emerged as an alternative for the removal of organic pollutants. In our study, SrSnO3 was synthesized by the combustion method and characterized by X-ray diffraction (XRD), Raman, UV-Vis, and scanning electron microscopy (SEM) techniques, obtaining a surface area of 3.28 m2 g-1 with cubic and well-organized crystallinity and a band gap of 4.06 eV. The experimental conditions optimized for degradation of an etoposide solution (0.4 mg L-1) were pH 5 and catalyst concentration of 1 g L-1. The results showed that the degradation processes using SrSnO3 combined with H2O2 (0.338 mol L-1) obtained total organic carbon removal from the etoposide solution, 97.98% (± 4.03 × 10-3), compared with TiO2, which obtained a mineralization rate of 72.41% (± 6.95 × 10-3). After photodegradation, the degraded solution showed no toxicity to zebrafish embryos through embryotoxicity test (OECD, 236), and no genotoxicity using comet assay and micronucleus test.

Solid-state NMR analysis of the sodium pump Krokinobacter rhodopsin 2 and its H30A mutant.

Krokinobacter eikastus rhodopsin 2 (KR2) is a pentameric, light-driven ion pump, which selectively transports sodium or protons. The mechanism of ion selectivity and transfer is unknown. By using conventional as well as dynamic nuclear polarization (DNP)-enhanced solid-state NMR, we were able to analyse the retinal polyene chain between positions C10 and C15 as well as the Schiff base nitrogen in the KR2 resting state. In addition, 50% of the KR2 13C and 15N resonances could be assigned by multidimensional high-field solid-state NMR experiments. Assigned residues include part of the NDQ motif as well as sodium binding sites. Based on these data, the structural effects of the H30A mutation, which seems to shift the ion selectivity of KR2 primarily to Na+, could be analysed. Our data show that it causes long-range effects within the retinal binding pocket and at the extracellular Na+ binding site, which can be explained by perturbations of interactions across the protomer interfaces within the KR2 complex. This study is complemented by data from time-resolved optical spectroscopy.

Investigation of the use of luminescent markers as gunshot residue indicators.

The addition of luminescent markers into ammunition cartridges is an appealing proposal to achieve a greater individual identification of the ammunition. The lanthanide elements present in these luminescent materials act as characteristic chemical markers that, also, offer the great benefit of making gunshot residues (GSR) collection easier. Although the use of luminescent markers offers numerous advantages, and can be a reliable future option in the cartridge ammunition market, little or nothing is known about the interaction of the marker with the ammunition compounds after the shot. For the forensic laboratories, it is of utmost importance to anticipate the commercialization of tagged luminescent ammunition by knowing the type of particles produced after the discharge. That is, to investigate if markers merge with GSR to form single particles or, on the contrary, they form individual particles that travel separately from the GSR particles. In this work, conventional ammunition cartridges tagged with two types of luminescent markers were shot. Then, the particles produced were visualized under UV light on the floor, clothing targets and the shooter. The luminescent particles spread over the floor determined the shooter position and the bullet trajectory. The illumination of the shot targets allows the visualization of the GSR patterns only using a portable UV lamp, avoiding the use of colorimetric test. The GSR particles were collected and subjected to SEM-EDX and Raman spectroscopy analysis to get information about their inorganic and organic composition. The results indicated that part of the marker and the GSR merge and travel together. With this, particles composed by the marker and propellant organic compounds can be identified by Raman spectroscopy, and the unequivocal identification of the GSR and the marker can be achieved by SEM-EDX. Consequently, the luminescent particles detected under UV light improve the evidence collection and offer information about the GSR and the marker. Additionally, this study support the use of luminescent ammunition to study, for example, the transfer or persistence of GSR.

Proteorhodopsin Photocycle Kinetics Between pH 5 and pH 9.

The retinal protein proteorhodopsin is a homolog of the well-characterized light-driven proton pump bacteriorhodopsin. Basic mechanisms of proton transport seem to be conserved, but there are noticeable differences in the pH ranges of proton transport. Proton transport and protonation state of a carboxylic acid side chain, the primary proton acceptor, are correlated. In case of proteorhodopsin, the pKa of the primary proton acceptor Asp-97 (pKa  ≈ 7.5) is unexpectedly close to environmental pH (pH ≈ 8). A significant fraction of proteorhodopsin is possibly inactive at natural pH, in contrast to bacteriorhodopsin. We investigated photoinduced kinetics of proteorhodopsin between pH 5 and pH 9 by time resolved UV/vis absorption spectroscopy. Kinetics is inhomogeneous within that pH region and can be considered as a superposition of two fractions. These fractions are correlated with the Asp-97 titration curve. Beside Asp-97, protonation equilibria of other groups influence kinetics, but the observations do not point toward major differences of primary proton acceptor function in proteorhodopsin and bacteriorhodopsin. The pKa of proteorhodopsin and some of its variants is suspected to be an example of molecular adaptation to the physiology of the original organisms.

Lanthanide-Organic Gels as a Multifunctional Supramolecular Smart Platform.

A multifunctional smart supramolecular platform based on a lanthanide-organic hydrogel is presented. This platform, which provides unique biocompatibility and tunable optical properties, is synthesized by a simple, fast, and reproducible eco-friendly microwave-assisted route. Photoluminescent properties enable the production of coated light-emitting diodes (LED), unique luminescent barcodes dependent on the excitation wavelength and thin-films for use in tamper seals. Moreover, piroxicam entrapped in hydrogel acts as a transdermal drug release device efficient in inhibiting edemas as compared to a commercial reference.

Application of the Metal-Organic Framework [Eu(BTC)] as a Luminescent Marker for Gunshot Residues: A Synthesis, Characterization, and Toxicity Study.

The 3D metal-organic framework (MOF) [Eu(BTC)] (where BTC = trimesic acid) was synthesized in 20 min by a microwave-assisted hydrothermal method with a yield of 89%. A structural and spectroscopic study, performed by X-ray diffraction, thermogravimetry, and photoluminescence spectroscopy, showed that this framework has high crystallinity, thermal stability, and luminescence. This MOF had a red-orange luminescence when excited with ultraviolet (UV) radiation (λ = 254 nm) and a high potential for use as a luminescent marker for gunshot residues (GSR). When added to 9 mm nontoxic ammunition, it greatly improved quality of the crime scene investigation, allowing for direct visualization of the luminescent GSR on the shooter's hand and firearm and at the firing range using only a portable UV lamp. The marked luminescent GSR was easily collected and characterized by nondestructive techniques, including with a Video Spectral Comparator and scanning electron microscopy/energy-dispersive spectroscopy, wherein the presence of Eu3+ ions was confirmed. Furthermore, the oral acute toxicity of this MOF was assessed in adult female Wistar rats using the Organisation for Economic Cooperation and Development 423 guidelines. This study classified the MOF [Eu(BTC)] in a less toxic Globally Harmonized System category (category 5), with a LD50 (lethal dose) of 5000 mg/kg, ensuring a wide security range for its application.

Psychosocial outcomes and counselee satisfaction following genetic counseling for hereditary breast and ovarian cancer: A patient-reported outcome study.

OBJECTIVE: We investigated the psychosocial consequences of genetic counseling and testing (GCT) for hereditary breast and ovarian cancer (HBOC) at follow-up in a "real-life" sample of counselees at an Austrian tertiary care center. METHODS: The study cohort included counselees who had undergone genetic counseling for HBOC and completed a follow-up self-report questionnaire battery on psychosocial outcomes (quality of life, psychological distress, satisfaction with counseling and decisions). For comparison of distress, we recruited a reference sample of breast cancer survivors (BCS; n=665) who had not requested GCT in the same setting. RESULTS: Overall, counselees did not exhibit increased levels of anxiety and depression when compared to BCS. No specific follow-up deleterious psychosocial consequences were detected among the former group. Of the 137 counselees, 22.6% and 9.8% experienced clinically relevant levels of anxiety and depression, respectively, at an average follow-up time of 1.8years. However, both anxiety and depression significantly decreased with time and were alike between counselees with and without cancer diagnosis. Follow-up cancer worry seems to be significantly higher among counselees who had not undergone genetic testing or were undecided about it than among counselees who had been tested. CONCLUSION: Our results strongly support GCT as part of routine care for patients with HBOC. The risk factors of increased distress in specific subgroups of counselees, such as recent cancer diagnosis or uncertainty about testing, warrant further exploration and specific attention in clinical routines. Particularly, the psychological needs of undecided counselees warrant ongoing attention and potential follow-ups.

High prevalence of BRCA1 stop mutation c.4183C>T in the Tyrolean population: implications for genetic testing.

Screening for founder mutations in BRCA1 and BRCA2 has been discussed as a cost-effective testing strategy in certain populations. In this study, comprehensive BRCA1 and BRCA2 testing was performed in a routine diagnostic setting. The prevalence of the BRCA1 stop mutation c.4183C>T, p.(Gln1395Ter), was determined in unselected breast and ovarian cancer patients from different regions in the Tyrol. Cancer registry data were used to evaluate the impact of this mutation on regional cancer incidence. The mutation c.4183C>T was detected in 30.4% of hereditary BRCA1-associated breast and ovarian cancer patients in our cohort. It was also identified in 4.1% of unselected (26% of unselected triple negative) Tyrolean breast cancer patients and 6.8% of unselected ovarian cancer patients from the Lower Inn Valley (LIV) region. Cancer incidences showed a region-specific increase in age-stratified breast and ovarian cancer risk with standardized incidence ratios of 1.23 and 2.13, respectively. We, thus, report a Tyrolean BRCA1 founder mutation that correlates to a local increase in the breast and ovarian cancer risks. On the basis of its high prevalence, we suggest that targeted genetic analysis should be offered to all women with breast or ovarian cancer and ancestry from the LIV region.

Clinical recognition and management of tularemia in Missouri: a retrospective records review of 121 cases.

BACKGROUND: Clinical recognition of tularemia is essential for prompt initiation of appropriate antibiotic treatment. Although fluoroquinolones have desirable attributes as a treatment option, limited data on efficacy in the US setting exist. METHODS: To define the epidemiology of tularemia in Missouri, and to evaluate practices and outcomes of tularemia management in general, we conducted a detailed retrospective review and analysis of clinical records for patients reported to the state from 2000 to 2007. RESULTS: We reviewed records of 121 of 190 patients (64%) reported with tularemia; 79 (65%) were males; the median age was 37 years. Most patients presented with ulceroglandular (37%) and glandular (25%) forms of tularemia, followed by pneumonic (12%), typhoidal (10%), oculoglandular (3%), and oropharyngeal (2%) forms. Most cases (69%) were attributed to tick bites. Median incubation period was 3 days (range, 1-9 days), and patients sought care after a median of 3 days of illness (range, 0-44 days). Systemic disease occurred more commonly in older patients. Patients were prescribed tetracyclines (49%), aminoglycosides (47%), and fluoroquinolones (41%). Nine of 10 patients treated with ciprofloxacin for ≥10 days recovered uneventfully, without accompanying aminoglycosides or tetracyclines. CONCLUSIONS: Tularemia is frequently initially misdiagnosed. A thorough exposure history, particularly for tick bites, and awareness of clinical features may prompt clinicians to consider tularemia and facilitate appropriate testing. Promising success with oral fluoroquinolones could provide an acceptable alternative to intravenous aminoglycosides or long courses of tetracyclines where clinically appropriate.

Zoonotic infections among employees from Great Smoky Mountains and Rocky Mountain National Parks, 2008-2009.

U.S. National Park Service employees may have prolonged exposure to wildlife and arthropods, placing them at increased risk of infection with endemic zoonoses. To evaluate possible zoonotic risks present at both Great Smoky Mountains (GRSM) and Rocky Mountain (ROMO) National Parks, we assessed park employees for baseline seroprevalence to specific zoonotic pathogens, followed by evaluation of incident infections over a 1-year study period. Park personnel showed evidence of prior infection with a variety of zoonotic agents, including California serogroup bunyaviruses (31.9%), Bartonella henselae (26.7%), spotted fever group rickettsiae (22.2%), Toxoplasma gondii (11.1%), Anaplasma phagocytophilum (8.1%), Brucella spp. (8.9%), flaviviruses (2.2%), and Bacillus anthracis (1.5%). Over a 1-year study period, we detected incident infections with leptospirosis (5.7%), B. henselae (5.7%), spotted fever group rickettsiae (1.5%), T. gondii (1.5%), B. anthracis (1.5%), and La Crosse virus (1.5%) in staff members at GRSM, and with spotted fever group rickettsiae (8.5%) and B. henselae (4.3%) in staff at ROMO. The risk of any incident infection was greater for employees who worked as resource managers (OR 7.4; 95% CI 1.4,37.5; p=0.02), and as law enforcement rangers/rescue crew (OR 6.5; 95% CI 1.1,36.5; p=0.03), relative to those who worked primarily in administration or management. The results of this study increase our understanding of the pathogens circulating within both parks, and can be used to inform the development of effective guidelines and interventions to increase visitor and staff awareness and help prevent exposure to zoonotic agents.