Draft Genome Sequences of Four Streptomycin-Sensitive Erwinia amylovora Strains Isolated from Commercial Apple Orchards in Ohio.

Erwinia amylovora is the causative agent of fire blight, a devastating disease of apples and pears worldwide. Here, we report draft genome sequences of four streptomycin-sensitive strains of E. amylovora that were isolated from diseased apple trees in Ohio.

A Study on the Knowledge, Awareness, Perceptions and Behaviour (KAPB) of Students of the University of the West Indies, St. Augustine (UWI-STA) Towards Climate Change and its Impact on Human Health

Climate change (CC) is defined as long-term weather changes in the Earth's climate. CC has been linked to increased global temperatures. This affects human health both directly and indirectly: Directly, via increased risk of cardiovascular, respiratory, and vector-borne diseases. Indirectly, via reduced agricultural crop yields and accessibility to healthcare due to extreme weather events. Studies show that spreading awareness on the health impacts of CC encourages motivation towards mitigation (1). Early awareness of climate change and its health impacts is necessary for future generations to mitigate its effects.

An investigation on the knowledge, attitudes and practice towards vaginal candidiasis amongst women of reproductive age attending the University of the West Indies, St. Augustine Campus

From 20th century, our views, understanding and treatment of pathogenic infections have drastically changed. Pathogenic organisms were discovered, classified and treatments were subsequently implemented. Candidiasis spp. was discovered and linked to the condition; Vulvovaginal Candidiasis (VVC), commonly known as yeast infection, which affects the female lower genital tract, vulva and vagina. Symtoms of such an infection include itching, burning, soreness and a creamy vaginal discharge. Given the nature, location and symptoms of such an infection, individuals are often self-conscious and hesitant to discus it or seek medical attention until symptoms become unbearable. VVC is one of the most common infections in reproductive age females with 75% of women experiencing infection at least once in their lives. Due to the qualitative gap in literature toward women affected by VVC in our country, this study aimed to highlight the knowledge, attitudes and practices towards VVC among reproductive age in Trinidad and Tobago.

Prevalence and risk factors of airflow obstruction in a Caribbean population.

SETTING: The prevalence of airflow obstruction (AO) in the Caribbean population is unknown.OBJECTIVE: To measure the prevalence of and risk factors for AO (post-bronchodilator ratio of forced expiratory volume in 1 sec to forced vital capacity of <0.7) in the Trinidad and Tobago general population using the Burden of Obstructive Lung Disease methodology.DESIGN: National cross-sectional, stratified, cluster sampling of adults aged ≥40 years.RESULTS: AO prevalence was 9.5% among 1104 participants, most of whom were unaware of this. Compared to those aged 40-49 years, the adjusted odds ratio of AO by age group was 2.73 (60-69 years) and 3.30 (≥70 years). Risk factors for AO were unemployment (OR 4.31), being retired (OR 2.17), smoking ≥20 pack-years (OR 1.88) and exposure to dusty jobs for more than 1 year (OR 2.06). Related symptoms were history of wheezing, unscheduled visits to the doctor or admission to hospital for breathing problems and in subjects with at least one respiratory symptom (OR 1.90), at least one risk factor (OR 2.81), either symptoms or risk factors (OR 3.71) and both symptoms and risk factors (OR 5.78) (P < 0.05 in all cases).CONCLUSION: AO prevalence in the general population of Trinidad and Tobago aged ≥40 years was 9.5%, almost all of which was undiagnosed. AO was associated with smoking, age >59 years, lack of employment and working in a dusty job.

Occupational dust exposure is independently associated with Chronic Obstructive Pulmonary Disease (COPD) in Trinidad and Tobago population

Objective: COPD is a leading cause of mortality and morbidity worldwide. Although cigarette smoking is a well-known risk factor for COPD, nonsmokers may account for one fourth to half of all cases. The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study objective was to measure the COPD prevalence and its risk factors in the local population aged 40 years and older. Design and Methodology: In this cross-sectional survey participants were selected using two-stage stratified-cluster sampling to represent the national population in terms of gender, age and ethnic distributions. Quality assured spirometry and questionnaires were administered. Results: Among the 1,104 participants, 36% reported occupational dust exposure for more than one year and about 40% of them were never-smokers. Overall 9.5% (95% CI: 7.78 to 11.23%) of the studied population showed COPD, accounting for an estimated 49,170 persons (95% CI = 40,267; 58,124) in Trinidad and Tobago. The majority (60%) of the diagnosed COPD was attributable to non-smoking causes, and more than half of them reported occupational dust exposure. Multiple logistic regression analysis confirmed COPD's independent association with working in a dusty job (OR 2.05; 95% CI=1.26, 3.35). Conclusions: Risk of COPD in the Trinidad and Tobago general population is significantly associated with occupational dust exposure which is probably contributing about one-third of current COPD burden. International studies showed that only about 15% of overall COPD could be ascribed to occupational risk factors. The higher occupational related COPD risk in the local population should be further studied prospectively.

Public perception of deceased organ donation in Trinidad

Objective: To investigate person's knowledge, attitude and practice (KAP) toward Deceased Organ Donation (DOD) in Trinidad. Design and Methodology: A cross-sectional study of patients attending four randomly selected health centres in Trinidad was conducted using a using quota sampling, to obtain equal numbers of males and females. Data was collected using a 41-item questionnaire, which was structured to test knowledge, attitude and practices. Chis-sq analysis was conducted using SPSS Version-23. Results: 273 respondents completed the questionnaire; 50.5% females; mean age 39.5 (SD15.1) years; 50.2% Indo-Caribbean and 24.5% African, 47.8% completed secondary education; and majority Christian (48.4%) or Hindu (31.5%). 81.3% had heard of the term organ donation". Respondents believed the most frequently reported organs for deceased organ transplant in Trinidad were kidney (76.1%), heart (48.2%) and liver (33.3%). When asked about their attitudes toward DOD, 52.3% of the respondents stated that they would donate their organs, 79% had not heard about the National Organ Transplant Unit (NOTU) and no respondent reported ever donating an organ, nor enquired about donor cards (80%), nor heard about support groups (68%). Conclusion: Most participants, though knowledgeable on the term DOD, were not familiar with the practice nor the major organ donation groups in Trinidad such as NOTU and the Kidney Recipients Support Group. However, participants were positive toward DOD, thus, raising greater awareness can lead to major cost-benefits for the public health system.

Indo-Caribbean population has lower vital capacities than Afro-Caribbean population in Trinidad and Tobago

Objective: Low forced vital capacity (FVC) is a good predictor of mortality and morbidity including cardiovascular disease, diabetes and chronic kidney disease in the general population. Objective of the current post-hoc analysis was to compare the FVCs among the major ethnic groups of Trinidad and Tobago. Design and Methodology: The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study was conducted to measure the COPD prevalence and its risk factors in the local population of 40 years and older by using questionnaires and quality assured spirometry. The participants were selected using two-stage stratified, cluster sampling to represent the national population in terms of gender, age and ethnic distributions. To avoid the influence of contentious international spirometry predictive values, FVC was used as a continuous variable after adjusting for age, gender, height and height square. Results: Among the 1,104 participants, 42% were Indo- Caribbeans, and 36% were Afro-Caribbeans. Indo- Caribbeans had a similar prevalence of abnormal waist circumference (57.0% vs. 58.7%; p=0.751), a lower prevalence of obesity (30.0% vs. 41.8%; p=0.008), but a higher prevalence of abnormal waist-hip ratio (74.1% vs. 57.5%; p<0.001) and diabetes (21% vs. 10%; p<0.001) than the Afro- Caribbeans. Multiple regression analysis indicated that FVC was independently associated with ethnicity and revealed lower volumes in Indo- Caribbean participants than Afro-Caribbeans (-180ml; 95%CI:-90ml,-269ml; p<0.001). Conclusions: The Indo-Caribbean population has a lower FVC than the Afro-Caribbean population which was independent of age, gender, and height. Healthrelated consequences of low FVC among local ethnic groups warrant further research using longitudinal studies.

Asymptomatic 'normal' subjects may have a respiratory health burden as assessed by the St Georges Respiratory Questionnaire (SGRQ)

Objectives: The Burden of Obstructive Lung Disease study in Trinidad and Tobago identified subjects with obstruction and no symptoms in approximately 5% of the general population over 40 years old. We reviewed data from a previously published study involving asymptomatic subjects to determine respiratory health burden and relation to lung function. Results: Subject characteristics were: 16 (64%) males, Mean (SD) age 64.8 (6.78) years, forced expiratory volume (FEV1) 2.25 (0.77)L, forced vital capacity (FVC) 2.91 (1.02) L, FEV1/FVC 78.1 (8.31)%. Parameters assessed were FEV1 (1.21 to 3.69 L); FVC (1.32 to 4.88 L); FEV1/FVC (65.2 - 94.7%); SGRQ Total Score (0 to 20.8). Three subjects (12%) had a FEV1/FVC ratio of less than 70%. The correlations (rho, p) of total SGRQ scores were FEV1 (-0.62, 0.001), FEV1% (-0.52, 0.008); FVC (-0.69, < 0.001). Conclusion: Asymptomatic normal elderly subjects had significant respiratory health burden as measured by the SGRQ and this was worse in those with a lower FEV1%. This may apply to elderly persons in the general population.

Sex and social class inequities in physical and mental health: an analysis using data from the Burden of Obstructive Lung Disease Trinidad and Tobago (BOLD-TT) study

Objectives: To examine sex and social class differences in physical and mental health in the Trinidad and Tobago population aged ≥40 years. Design and Methodology: Data from the BOLD-TT study, which included a stratified cluster sample of 1104 persons, were analysed. The Veteran Rand (VR)-12 instrument assessed physical (general health, physical functioning and role playing and bodily pain) and mental health (vitality, role-emotional, mental health and social functioning); using a physical health component (PCS) and mental health component (MCS) scores. Highest level of education attained, and employment status were used as measures of social class. General Linear Models were used to examine differences in PCS and MCS by sex, education and employment, controlling for age. Results: Mean age of the participants was 54.1 (SD10.8) years; 59.9% were females; 47% had no/primary education; 56% were employed. Mean PCS and MCS (SEM) scores were 47.8 (0.3) and 54.7 (0.3). Females had lower mean PCS and MCS than males (p<.001 in each case). There were significant mean differences in PCS (p<.001) and MCS (p=.04) by employment status. Persons who were not working had lower mean PCS (p<.001) and MCS (p=.002) than those employed. There were differences in PCS by education (p=.019); persons with no/primary education had lower PCS than those with post-secondary and university education. Multiple regression identified employment (p<.001) and education (p=.097) as independent predictors of PCS while sex (p=.002) and employment (p=.021) predicted MCS. Conclusion: The VR-12 provided initial results indicating health inequities i.e. poorer health status among females, the unemployed and uneducated.

Factors associated with quality of life impairment among asthma patients attending specialty clinics in Trinidad

Objectives: To examine factors associated with asthma related quality of life impairment (AQLI) among patient attending asthma clinics in Trinidad. Design and Methodology: A consecutive sample of 428 patients, ≥18 years, attending asthma clinics in Trinidad were recruited. Data were collected using intervieweradministered questionnaires which captured demography, comorbidities, triggers, hospital admissions and emergency department (ED) visits. AQLI was evaluated using the Juniper Mini AQL questionnaire to capture both the physical and emotional impact of the disease. The data were analysed using Chi-square test and multivariable logistic regression (SPSS Version 25). Results: Majority of patients were female (81%), ≥40 years (80.4%), of Indo-Caribbean descent (61.9%), and overweight (71.7%). The most commonly reported health conditions were gastrooesophageal reflux (53.0%), hypertension (47.2%), allergic rhinitis (45.1%), anxiety (42.8%), sleep apnoea (35.0%), and depression (32.5%). Environmental allergens (73.8%) were the most commonly reported trigger factor. The prevalence of moderate to severe AQLI was 60% and significantly associated variables were: age group (p=.0003), ethnicity (p<.0001), trigger factors (p=.013), sleep apnoea (OR=3.07, p=.001), gastrooesophageal reflux (OR=2, p=.014), depression (OR=3.59, p=.001) and anxiety (OR=2.52, p=.003), frequent (two or more) exacerbations (OR=4.07, p<.001) and having ever visited the ED (OR=4.78, p<.001) in the last 12 months. Independent predictors of AQLI were age, ethnicity, sleep apnoea and ED visits (Nagelkerke's pseudo R2=41%). Conclusion: Asthmatics demonstrate a high prevalence of moderate to severe quality of life impairment associated with demography and co-morbidities. Understanding these factors may improve doctor patient interactions, treatment and management.

Variability in plasma concentrations of methylprednisolone 6 days after intrasynovial injection of methylprednisolone acetate in racing horses: A field study.

BACKGROUND: Methylprednisolone (MP) acetate is a commonly used corticosteroid for suppression of inflammation in synovial structures in horses. Its use is often regulated in equine sports by plasma MP concentrations. OBJECTIVES: To describe variability in MP plasma concentrations after MP acetate injection in different synovial structures and with co-administration with hyaluronic acid (HA). STUDY DESIGN: Field study in actively racing horses in three disciplines (Thoroughbred, Standardbred and Quarter Horse). METHODS: Seventy-six horses (15 Thoroughbreds, 20 Standardbreds and 41 Quarter Horses) were included in the study. Injection of any synovial structure with a total body dose of 100 mg MP acetate was permitted, data were grouped according to the synovial structure injected and co-administration with HA. Plasma was collected before injection and at 6 days post-injection. Per cent censored data (below the limit of quantification) for each synovial structure were determined, and summary statistics generated by Robust Regression on Order. Differences between synovial structures and co-administration with HA were identified by ANOVA with Tukey's post hoc testing. RESULTS: The MP plasma concentration at 6 days for injection for the entire group (mean ± standard deviation [s.d.], pg/mL) was 96 ± 104. Metacarpophalangeal (MCP) plasma concentrations contained 86% censored data and could not be included in the statistical analysis. The carpal joints (CJO) group had a lower plasma MP concentration (P<0.05) than the distal tarsal joints (DTJ) or medial femorotibial (MFT), the no HA (NHA) group had a lower plasma MP concentration (P<0.05) than HA. MAIN LIMITATIONS: The synovial structures injected varied by racing discipline, so this study was unable to identify any differences between disciplines. CONCLUSIONS: Practitioners should be aware that injection of DTJ, CS and MFT joints, and combining MP acetate with HA may prolong its clearance, and withdrawal times for competition in regulated equine sports.

Predicting the risk of cucurbit downy mildew in the eastern United States using an integrated aerobiological model.

Cucurbit downy mildew caused by the obligate oomycete, Pseudoperonospora cubensis, is considered one of the most economically important diseases of cucurbits worldwide. In the continental United States, the pathogen overwinters in southern Florida and along the coast of the Gulf of Mexico. Outbreaks of the disease in northern states occur annually via long-distance aerial transport of sporangia from infected source fields. An integrated aerobiological modeling system has been developed to predict the risk of disease occurrence and to facilitate timely use of fungicides for disease management. The forecasting system, which combines information on known inoculum sources, long-distance atmospheric spore transport and spore deposition modules, was tested to determine its accuracy in predicting risk of disease outbreak. Rainwater samples at disease monitoring sites in Alabama, Georgia, Louisiana, New York, North Carolina, Ohio, Pennsylvania and South Carolina were collected weekly from planting to the first appearance of symptoms at the field sites during the 2013, 2014, and 2015 growing seasons. A conventional PCR assay with primers specific to P. cubensis was used to detect the presence of sporangia in rain water samples. Disease forecasts were monitored and recorded for each site after each rain event until initial disease symptoms appeared. The pathogen was detected in 38 of the 187 rainwater samples collected during the study period. The forecasting system correctly predicted the risk of disease outbreak based on the presence of sporangia or appearance of initial disease symptoms with an overall accuracy rate of 66 and 75%, respectively. In addition, the probability that the forecasting system correctly classified the presence or absence of disease was ≥ 73%. The true skill statistic calculated based on the appearance of disease symptoms in cucurbit field plantings ranged from 0.42 to 0.58, indicating that the disease forecasting system had an acceptable to good performance in predicting the risk of cucurbit downy mildew outbreak in the eastern United States.

Prevalence of COPD in Trinidad and Tobago - A National Study

Purpose: Chronic Obstructive Pulmonary Disease (COPD) is preventable and treatable, yet it is the third leading cause of death and fifth leading cause of disability globally. Local studies in restricted settings have reported about 20% COPD prevalence, but the national prevalence and risk factors are unknown. We aimed to measure the prevalence of COPD and its risk factors in Trinidad and Tobago as part of the multicentre Burden of Obstructive Lung Disease (BOLD) Study. Research Design and Methodology Used: A cross-sectional study was conducted during 2014-2015 using the BOLD standardised protocol. A stratified cluster sample of non-institutionalised males and females aged ≥ 40 years (N = 1104) and a sample of 18-39 year olds (N = 807) were selected. Questionnaires on respiratory symptoms, health status, and exposure to COPD risk factors were administered and spirometry conducted before and after bronchodilator. Spirometry quality control measures utilised were (1) direct spirometer feedback and (2) BOLD international centre review. Spirometry readings below international standards required technician retraining. Post- bronchodilator forced expiratory volume in the first second of expiration (FEV1) was expressed as a percentile of the forced vital capacity (FVC). COPD was defined by FEV1/FVC < 70% and a smoker as having smoked >200 cigarettes in a lifetime. Logistic regression was used to examine associations a (expressed as Odds Ratios (OR) and multivariate logistic regression to determine independent risk factors. Findings: There was a 95% response rate The mean age (SD) of these participants was 54 (11) years and Body Mass Index (BMI) 29 (7) kg/m2; with N (%) males, 443 (40) males; Afro-Trinidadians 400 (37), Indos 454(42), Mixed 234 (21), ever-smokers 302 (27), current smokers 157 (14), Adverse events 13(<1%)]. The prevalence of COPD was 9.5%, Of those with COPD, only 4% reported a previous doctor diagnosed COPD. COPD was more likely among those aged 60-69 years or over 70 (OR=4.15 and 5.88 respectively, p<0.001), among males (OR=1.64, p=0.023), ever smokers (OR=1.72, p=.016), retirees and the unemployed (OR=4.41 and 3.59 respectively, p<.001), with BMI<21 (OR=2.64, p=.001), asthma (OR=5.20, p<.001) or wheezing (OR=3.48, p<.001). Multivariate analysis showed significant risk factors for COPD were: older age groups, low BMI, working over a year in dusty jobs, cigarette or cannabis smoking. There was no non-responder bias in age, gender, ethnicity, smoking or BMI but unacceptable spirometry was more likely in the elderly and smokers. Among the 807 participants aged 18-39 years old, 23% smoked with the prevalence of smoking in males being 32% vs. 11.7% in females (p < 0.001). Conclusions: COPD is prevalent yet under-diagnosed in the general population. Health care education and use of spirometry for prevention of COPD should target males, the elderly, smokers, those working in dusty jobs and those with a history of asthma or wheeze. We suggest spirometry measurements be available at all district health facilities.

Leading causes of cancer-specific mortality in the English and Dutch-speaking Caribbean region

OBJECTIVE: This study examined cancer-related mortality rates among the 21 Caribbean countries that submitted mortality data to the Caribbean Public Health Agency. METHODS: We calculated proportions and age-standardized mortality rates (ASMR) by cancer site and gender for each country using the most recent five years of mortality data available from 2003 to 2013. Calculations were completed using SEER*Stat software and the world (Segi 1960) standard million population. RESULTS: Age-standardized mortality rates for all cancers combined ranged from 46.1 to 139.3 per 100 000. Among males, prostate cancer was the most common cause of cancer deaths in all countries, accounting for 18.4–47.4% of cancer deaths, and an ASMR of 15.1 to 74.1 per 100000. Lung cancer (4.6–34.0 per 100 000) was the second or third leading cause of cancer deaths among males in most countries. Among females, breast cancer was the most common cause of cancer deaths in 16 of 18 countries(with > 6 reported cases), accounting for 16.1–30% of cancer deaths and an ASMR of 10.0 to 27.3 per 100 000. The ASMR of cervical cancer was higher than the world average (6.8 per 100 000) in 11 countries, and accounted for 4.5–18.2% of cancer deaths. CONCLUSION: There is great variability in cancer-specific mortality rates within the Caribbean region; however, prostate and breast cancers are consistently the leading causes of cancer-related deaths among males and females, respectively. Lung and cervical cancers–cancers for which World Health Organization “best buy” interventions exist–are also important causes of mortality in many countries.

Collection and laboratory methods for dried blood spots for hemoglobin A1c and total and high-density lipoprotein cholesterol in population-based surveys.

BACKGROUND: The Health Measures at Home Study was a study designed to evaluate the feasibility of incorporating dried blood spots (DBS) collection into the National Health Interview Survey and to compare the proficiencies between field interviewers and health technicians in obtaining DBS. METHODS: DBS collection and venipuncture were attempted on 125 participants. The DBS were collected in the participant's home and venous blood was collected in the National Health and Nutrition Examination Survey (NHANES) mobile examination center. The DBS results were compared to venous results in the NHANES for the measurements of hemoglobin A1c (HbA1c) and total and high-density lipoprotein (HDL) cholesterol. RESULTS: Field interviewers and health technicians were able to collect the DBS for greater than 95% of participants. For DBS, health technicians and field interviewers were highly correlated for HbA1c (r=0.92) and total cholesterol (r=0.89), but not for HDL cholesterol (r=0.72). The DBS results of interviewers and health technicians compared to the venous method for HbA1c (r=0.90), but did not compare well for HDL cholesterol (r=0.64-0.66) and total cholesterol (r=0.65-0.67). CONCLUSION: DBS was comparable to venous HbA1c, but not for total and HDL cholesterol. Health technicians and field interviewers had similar performance for DBS methods, except HDL cholesterol.

Strength and body weight in US children and adolescents.

BACKGROUND AND OBJECTIVES: Regular aerobic and muscle-strengthening physical activity in youth has been positively associated with health and may help prevent obesity. The purpose of this study is to provide reference values on 4 core, upper, and lower body measures of muscle strength among US children and adolescents and to investigate the association between these measures of strength and weight status. METHODS: We assessed muscular strength using 4 different tests (plank, modified pull-up, knee extension, and grip strength) in 1224 youth aged 6 to 15 years collected during the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Mean and median estimates are provided by gender, age, and weight status. Weight status was defined based on standard categories of obesity, overweight, normal weight, and underweight using the gender-specific BMI-for-age Centers for Disease Control and Prevention growth charts. RESULTS: There were significant positive trends with age for each of the strength tests (P < .001) except the modified pull-up among girls. The length of time the plank was held decreased as weight status increased for both girls and boys (P < .001). As weight status increased the number of modified pull-ups decreased (P < .001 boys and girls). Scores on the knee extension increased as weight status increased (P < .01). Grip strength increased as weight status increased (P < .01). CONCLUSIONS: Increasing weight status had a negative association with measures of strength that involved lifting the body, but was associated with improved performances on tests that did not involve lifting the body.

Comparison of in-home collection of physical measurements and biospecimens with collection in a standardized setting: the health measures at home study.

OBJECTIVES: Collection of physical measurements and biospecimens in the home may be an efficient way to obtain objective health measurements. This study assesses differences between collection in the home and a standardized setting. METHODS: Participants had physical measurements and biospecimens taken in the National Health and Nutrition Examination Survey mobile examination center (MEC). Then, they had height and weight measured in the MEC using portable equipment. In the home, participants had height, weight, and blood pressure measured and dried blood spots collected using portable equipment. Two complete examinations were done in the home: one by a health technician and one by a field interviewer. RESULTS: Home environments were less standardized and presented more challenges to examiners. Correlations between all four height measurements and all four weight measurements were higher than 99%. Mean differences in height (0.3 cm) and weight (0.4 kg) were small but statistically significant. The home measurements perfectly or near-perfectly classified participants as obese relative to the standardized MEC examination. CONCLUSIONS: The selected physical measurements can be collected in the home by field interviewers using portable equipment. Before adding home collection of physical measurements to household interview surveys, further research should be done to examine the impact of these changes on interviewer training, participant recruitment, and participant response rates.

Measures of muscular strength in U.S. children and adolescents, 2012.

KEY FINDINGS: Data from the National Health and Nutrition Examination Survey, National Youth Fitness Survey. There were no significant differences by sex in core, lower, or upper body measures of strength for younger boys and girls. In contrast, adolescent boys had higher values than adolescent girls on all measures of strength. Adolescent boys and girls had higher scores than younger boys and girls on the core and lower body strength measures and upper body strength as measured by the grip strength test. Adolescent boys completed more modified pull-ups, a measure of upper body strength, than younger boys. There was no significant difference in the number of modified pull-ups completed between adolescent and younger girls. In 2008, the federal government released the Physical Activity Guidelines for Americans, which provide guidance on the types and amounts of physical activities that provide substantial health benefits for Americans of all ages. Regular physical activity reduces the risk of many adverse health outcomes and helps control the percentage of body fat in children and adolescents (1). This report provides the first nationally representative data on core, upper body, and lower body measures of muscle strength among U.S. children and adolescents aged 6-15 years by sex and age group.

Assessing the efficacy of pre-harvest, chlorine-based sanitizers against human pathogen indicator microorganisms and Phytophthora capsici in non-recycled surface irrigation water.

Many factors must be considered in order to develop and implement treatment systems to improve the microbial quality of surface water and prevent the accidental introduction of plant and human pathogens into vegetable crops. The efficacy of chlorine gas (Cl2(g)) and chlorine dioxide (ClO2) injection systems in combination with rapid sand filtration (RSF) was evaluated in killing fecal indicator microorganisms in irrigation water in a vegetable-intensive production area. The efficacy of ClO2 and Cl2(g) was variable throughout the distribution systems and coliform bacteria never dropped below levels required by the United States Environmental Protection Agency for recreational waters. Sampling date and sampling point had a significant effect on the abundance of coliforms in Cl2(g)- and ClO2-treated water. Sampling date and sampling point also had a significant effect on the abundance of generic Escherichia coli in Cl2(g) treated water but only sampling point was significant in ClO2 treated water. Although the waterborne plant pathogen Phytophthora capsici was detected in five different sources of surface irrigation water using baiting and P. capsici-specific PCR, in vitro studies indicated that ClO2 at concentrations similar to those used to treat irrigation water did not reduce mycelial growth or direct germination of P. capsici sporangia and reduced zoospore populations by less than 50%. This study concludes that injection of ClO2 and Cl2(g) into surface water prior to rapid sand filtration is inadequate in reducing fecal indicator microorganism populations and ClO2 ineffectively kills infectious propagules of P. capsici. Additional research is needed to design a system that effectively targets and significantly reduces both plant and human pathogens that are present in surface irrigation water. A model for a multiple barrier approach to treating surface water for irrigation is proposed.

Assessment of medical student clinical reasoning by "lay" vs physician raters: inter-rater reliability using a scoring guide in a multidisciplinary objective structured clinical examination.

BACKGROUND: To determine whether a "lay" rater could assess clinical reasoning, interrater reliability was measured between physician and lay raters of patient notes written by medical students as part of an 8-station objective structured clinical examination. METHODS: Seventy-five notes were rated on core elements of clinical reasoning by physician and lay raters independently, using a scoring guide developed by physician consensus. Twenty-five notes were rerated by a 2nd physician rater as an expert control. Kappa statistics and simple percentage agreement were calculated in 3 areas: evidence for and against each diagnosis and diagnostic workup. RESULTS: Agreement between physician and lay raters for the top diagnosis was as follows: supporting evidence, 89% (κ = .72); evidence against, 89% (κ = .81); and diagnostic workup, 79% (κ = .58). Physician rater agreement was 83% (κ = .59), 92% (κ = .87), and 96% (κ = .87), respectively. CONCLUSIONS: Using a comprehensive scoring guide, interrater reliability for physician and lay raters was comparable with reliability between 2 expert physician raters.