Sustained year-round oceanographic measurements from Rothera Research Station, Antarctica, 1997-2017.

Oceanographic changes adjacent to Antarctica have global climatic and ecological impacts. However, this is the most challenging place in the world to obtain marine data due to its remoteness and inhospitable nature, especially in winter. Here, we present more than 2000 Conductivity-Temperature-Depth (CTD) profiles and associated water sample data collected with (almost uniquely) full year-round coverage from the British Antarctic Survey Rothera Research Station at the west Antarctic Peninsula. Sampling is conducted from a small boat or a sled, depending on the sea ice conditions. When conditions allow, sampling is twice weekly in summer and weekly in winter, with profiling to nominally 500 m and with discrete water samples taken at 15 m water depth. Daily observations are made of the sea ice conditions in the area. This paper presents the first 20 years of data collection, 1997-2017. This time series represents a unique and valuable resource for investigations of the high-latitude ocean's role in climate change, ocean/ice interactions, and marine biogeochemistry and carbon drawdown.

Prevalence and dental professional awareness of antibiotic self-medication among older adults: Implications for dental education.

OBJECTIVE: Antibiotic stewardship has been recognized as an essential component of dental education. A notable threat to stewardship is the growing trend toward self-medication with nonprescribed antibiotics (SMNPA), particularly among older adults who may be at increased risk for adverse outcomes. This study aimed to assess the need to incorporate SMNPA into dental education by researching (1) professional awareness and (2) self-medication behaviors among older adults. METHODS: A SMNPA awareness survey was administered to dentists in Arizona with 148 respondents including general dentists, dental school faculty, and public health clinicians. A second survey was distributed to 410 households in an independent and assisted living facility. RESULTS: The dentists were aware of sources of SMNPA such as friends/family, leftover prescriptions, as well as sources outside of the United States; however, most (>80%) were not aware that ornamental fish antibiotics could be obtained online or in pet stores. The survey response rate for the older adults was 46.3%, of which 68.3% reported antibiotic use within the past 2 years (several for dental premedication) and 6.4% (n = 12) admitted to SMNPA for treating cold symptoms or pain. The main reason given for self-treatment was the belief that antibiotics had resolved similar symptoms in the past. One-third of the older adult respondents were unaware that antibiotics only treat bacterial infections. CONCLUSION: Approximately 1 in 16 older adults surveyed reported SMNPA. Dental professionals reported some knowledge of SMNPA but were unaware of all sources. This study highlights the need for SMNPA education, awareness, and implementation within dental curricula.

A case report of self-medication with over-the-counter fish antibiotic: Implications for pharmacists.

OBJECTIVE: The human use of over-the-counter antibiotics intended for the treatment of pet animals has been recognized as a potential barrier to antibiotic stewardship efforts. The objective of this report is to describe a case of self-medication with a fish antibiotic resulting in delayed medical treatment and provide recommendations for pharmacists practicing in outpatient settings on how to best identify and manage nonprescription antibiotic use. CASE SUMMARY: A 24-year-old man experienced dental pain and "flu-like" symptoms for which he attempted self-treatment with oral amoxicillin 250 mg daily purchased by a family member from a pet store. The amoxicillin was marketed for the treatment of bacterial infection in pet fish. After several days of increasing tooth pain despite the self-medication, the patient presented to an outpatient clinic where he was found to have a molar abscess requiring tooth extraction. The patient responded well to therapy and was counseled to discontinue antibiotic self-treatment. PRACTICE IMPLICATIONS: Undocumented use of nonprescription antibiotics represents a threat to patient safety. Potential deleterious outcomes include resistance, adverse drug events, and delays in definitive infection treatment. Pharmacists should screen patients for nonprescription antibiotic use, provide them counseling on appropriate antibiotic use, and educate other health care professionals on underrecognized sources of nonprescription antibiotics to increase awareness of this growing issue. Furthermore, antibiotic resistance should be considered when recommending an antibiotic agent for the treatment of infections.

Social Contexts in Medicine: A Patient-Centered Curriculum Empowering Medical Students to Provide Contextualized Care.

INTRODUCTION: Social Contexts in Medicine (SCIM) is an 18-month program that connects medical students, patients, and physicians for a longitudinal learning experience. SCIM was developed for first- and second-year medical students and seeks to supplement students' biomedical education with practical experiences built around community and continuity. The program increases students' awareness of, and skills to address, social determinants of health via a seminar series, a home visit program, and a mentoring component. METHODS: The program begins with a seminar series covering communication skills and the basics of social determinants of health, providing the foundation for successful home visits. Students are then paired with a patient for home visits to learn firsthand about the complex social factors that affect health and illness, patient participation in health care systems, and the doctor-patient relationship. In conjunction with the home visits, students obtain guidance from a physician mentor. RESULTS: The SCIM program has been successful during its first 3 years at our institution. Analysis of changes in student attitudes using Crandall's Medical Student Attitudes Toward the Underserved survey has shown that SCIM students develop more positive attitudes toward the underserved than do their peers completing traditional clinic-based preceptorships. Additionally, in student surveys, the average response to the statement "I learned something valuable I would not have otherwise learned in my classes" has been 4.5 out of 5. DISCUSSION: These findings suggest that the SCIM model contributes to medical education by broadening students' understanding about the influence of social factors on health and disease.

Reported gastrointestinal infections in the U.S. Air Force, 2000-2012.

During 2000-2012, U.S. Air Force Public Health Offices reported 3,429 cases of gastrointestinal infection (GI) diagnosed at Air Force medical treatment facilities. The four most commonly reported specific etiologies of GIs accounted for 86.7% of all GI cases (n=2,972). Salmonellosis accounted for 41.4% (n=1,420) of all cases. The next most commonly reported events were associated with Campylobacter infection, shigellosis, and giardiasis. The majority of GI cases were reported among dependents, most notably among those aged 0-5 years. Campylobacter infections represented a significantly larger proportion of GI reported from locations outside the continental United States (OCONUS) (n=222, 33.7%) compared to continental U.S. (CONUS) locations (n=363, 13.1%). CONUS locations reported higher proportions of salmonellosis, shigellosis, and giardiasis infections compared to OCONUS locations. Annual numbers of reported cases of GI peaked in 2002, declined to much lower numbers during 2004-2007, and then began to climb until the end of the surveillance period.

Reported vectorborne and zoonotic diseases, U.S. Air Force, 2000-2011.

During 2000-2011, U.S. Air Force Public Health Officers reported 770 cases of vectorborne and zoonotic diseases diagnosed at Air Force medical treatment facilities. Cases of Lyme disease accounted for 70 percent (n=538) of all cases and most cases of Lyme disease (57%) were reported from bases in the northeastern U.S. and in Germany. The annual numbers of reported Lyme disease cases were much higher during the last four years than earlier in the surveillance period. The next most commonly reported events were malaria (74 cases), Rocky Mountain spotted fever (RMSF) (41), Q fever (33), dengue (23), and leishmaniasis (20). These five infections and Lyme disease accounted for 95 percent of the reported conditions. Military service members accounted for a majority of the reported cases for most of the conditions, but family members and retirees accounted for most of the cases of Lyme disease and RMSF. Most reports of vectorborne and zoonotic diseases did not include mentions of recent travel.

Norovirus outbreak associated with person-to-person transmission, U.S. Air Force Academy, July 2011.

In July 2011, the U.S. Air Force School of Aerospace Medicine (USAFSAM) Epidemiology Consult Service investigated an ongoing outbreak of acute gastrointestinal (GI) illness--characterized by vomiting, nausea, diarrhea, and stomach cramps--that affected cadets and support personnel at a field training location at the U.S. Air Force Academy. Six outbreak-related stool specimens were confirmed by RT-PCR to be infected with norovirus, genogroup I. Overall, 290 cases (suspected and confirmed) of norovirus-related GI illness were recorded; the estimated attack rate among 1,359 cadets was 18%. The investigation suggested that norovirus was introduced into the field dining facility by one or more food service workers, possibly transmitted via common use serving utensils, and then further spread among cadets by person-to-person contact. Numbers of new cases sharply declined after ill cadets were segregated in separate tents for convalescence, and after all cadets moved from field billets (i.e., tents) to dormitories after completing the field training.

Cluster of sylvatic epidemic typhus cases associated with flying squirrels, 2004-2006.

In February 2006, a diagnosis of sylvatic epidemic typhus in a counselor at a wilderness camp in Pennsylvania prompted a retrospective investigation. From January 2004 through January 2006, 3 more cases were identified. All had been counselors at the camp and had experienced febrile illness with myalgia, chills, and sweats; 2 had been hospitalized. All patients had slept in the same cabin and reported having seen and heard flying squirrels inside the wall adjacent to their bed. Serum from each patient had evidence of infection with Rickettsia prowazekii. Analysis of blood and tissue from 14 southern flying squirrels trapped in the woodlands around the cabin indicated that 71% were infected with R. prowazekii. Education and control measures to exclude flying squirrels from housing are essential to reduce the likelihood of sylvatic epidemic typhus.

Older Chinese people's views on food: implications for supportive cancer care.

OBJECTIVES: As people face cancer and the end of life, the social, cultural and therapeutic role of food takes on an increasing significance. As part of a larger study involving older Chinese people resident in the UK, we investigated their beliefs about the influence of food on cancer and its role in supportive cancer care. DESIGN: A two-phase qualitative research study involved older Chinese people identified via Chinese community groups. In phase one, 46 older Chinese people participated in seven focus group discussions. In phase two, semi-structured interviews were conducted in Cantonese or Mandarin with 46 different older Chinese people to elicit their understandings of the role of food in health and illness generally and specifically for those with cancer. RESULTS: The analyses revealed four main themes: (1) food as 'therapeutic'; (2) food as 'risky'; (3) food as supportive and comforting; and (4) beliefs about the lack of culturally appropriate and acceptable food in hospitals. Expectations about the lack of Chinese food and the poor quality and perceived unsuitability of 'western' food were regarded as major concerns in relation to hospital admission. DISCUSSION: Understanding the perceived cultural and therapeutic significance of food and its functions in social exchange is one important aspect of promoting supportive and end-of-life cancer care for minority communities. These views helped explain the diversity and salience of food use in illness for older Chinese people resident in the UK.

Hospice or home? Expectations of end-of-life care among white and Chinese older people in the UK.

This paper presents findings from two linked studies of white (n = 77) and Chinese (n = 92) older adults living in the UK, which sought their views about end-of-life care. We focus particularly on experiences and expectations in relation to the provision of end-of-life care at home and in hospices. White elders perceived hospices in idealised terms which resonate with a 'revivalist' discourse of the 'good death'. In marked comparison, for those Chinese elders who had heard of them, hospices were regarded as repositories of 'inauspicious' care in which opportunities for achieving an appropriate or good death were limited. They instead expressed preference for the medicalised environment of the hospital. Among both groups these different preferences for instututional death seemed to be related to shared concerns about the demands on the family that may flow from having to manage pain, suffering and the dying body within the domestic space. These concerns, which appeared to be based on largely practical considerations among the white elders, were expressed by Chinese elders as beliefs about 'contamination' of the domestic home (and, by implication, of the family) by the dying and dead body.

Rocky mountain spotted fever in the United States, 1997-2002.

The increased incidence of Rocky Mountain spotted fever (RMSF) in 1997-2002 compared with previous years may be related to enhanced awareness and reporting of RMSF as well as changes in human-vector interaction. However, reports on RMSF mortality underscore the need for physician vigilance in considering a diagnosis of RMSF for febrile individuals potentially exposed to ticks and stress the importance of treating such persons regardless of the presence of a rash.

Rocky Mountain spotted fever in the United States, 1997-2002.

Rocky Mountain spotted fever (RMSF) is the most commonly reported fatal tick-borne disease in the United States. During 1997-2002, 3,649 cases of RMSF were reported to the Centers for Disease Control and Prevention via the National Electronic Telecommunications System for Surveillance; 2,589 case report forms, providing supplemental information, were also submitted. The average annual RMSF incidence during 1997-2002 was 2.2 cases/million persons. The annual incidence increased during 1997-2002 to a rate of 3.8 cases/million persons in 2002. The incidence was lowest among persons aged<5 and 10-29 years, and highest among adults aged 60-69 years. The overall case-fatality rate was 1.4%; the rate peaked in 1998 at 2.9% and declined to 0.7% in 2001 and 2002. Children<5 years of age had a case-fatality rate (5%) that was significantly greater than the rates for age groups<60 years of age, except for that for 40-49 years of age. Continued national surveillance is needed to assess the effectiveness of prevention efforts and early treatment in decreasing severe morbidity and mortality associated with RMSF.

Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals.

Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low cost, effective antimicrobial therapy. The greatest challenge to clinicians is the difficult diagnostic dilemma posed by these infections early in their clinical course, when antibiotic therapy is most effective. Early signs and symptoms of these illnesses are notoriously nonspecific or mimic benign viral illnesses, making diagnosis difficult. In October 2004, CDC's Viral and Rickettsial Zoonoses Branch, in consultation with 11 clinical and academic specialists of Rocky Mountain spotted fever, human granulocytotropic anaplasmosis, and human monocytotropic ehrlichiosis, developed guidelines to address the need for a consolidated source for the diagnosis and management of TBRD. The preparers focused on the practical aspects of epidemiology, clinical assessment, treatment, and laboratory diagnosis of TBRD. This report will assist clinicians and other health-care and public health professionals to 1) recognize epidemiologic features and clinical manifestations of TBRD, 2) develop a differential diagnosis that includes and ranks TBRD, 3) understand that the recommendations for doxycycline are the treatment of choice for both adults and children, 4) understand that early empiric antibiotic therapy can prevent severe morbidity and death, and 5) report suspect or confirmed cases of TBRD to local public health authorities to assist them with control measures and public health education efforts.