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Resumen Antecedentes En la rehabilitacion de ninos y adolescentes con asma bronquial, a pesar de los buenos tratamientos farmacologicos existentes, se aprecian sobrecargas corporales y animicas, asi como falta de cooperacion terapeutica. Los pacientes desean abordajes no puramente farmacologicos y se preguntan sobre los metodos terapeuticos alternativos. Por lo tanto, era conveniente dilucidar si el tratamiento de acupuntura eficaz de la edad adulta tambien es aplicable a la infancia. Pacientes y metodos Mediante un diseno con repeticion triple de medidas (pre y postratamiento, y a los 4 meses) se estudiaron la intensidad de los sintomas, la funcion pulmonar, la calidad de vida relacionada con la enfermedad (PAQLQ) y el nivel de ansiedad (STAIC) de 43 pacientes tratados con acupuntura y 42 pacientes de referencia. Ademas de realizar ejercicios fisicos para el asma, terapia climatica y entrenamiento del comportamiento, el grupo de acupuntura la recibio segun un esquema estandarizado (12 sesiones de 30 min). Resultados Despues de la acupuntura, manteniendo o reduciendo la medicacion establecida, se observo una reduccion significativa (p 1 %). Conclusiones Tras la aplicacion aditiva de acupuntura se observaron cambios significativos en la funcion pulmonar en cuadros asmaticos graves, asi como una reduccion de la ansiedad que se mantuvo durante meses.

The National Space Biomedical Research Institute (NSBRI) Education and Public Outreach Program (EPOP) is supporting the National Aeronautics and Space Administration's (NASA) Strategic Education Framework's vision—“to capture the imagination of students … strengthen the nation's future workforce … and [improve] the overall teaching of science, technology, engineering and mathematics (STEM) disciplines”—through a comprehensive kindergarten through postdoctoral education program [S. O’Keefe, NASA, The New Age of Exploration: NASA's Direction for 2005 and Beyond, NASA Headquarters, Washington, DC, 2005]. The current NSBRI EPOP is comprised of four programs: kindergarten through undergraduate college (K-16); graduate and postdoctoral fellowship programs; and Space Medicine Grand Rounds and Aerospace Medicine Board Meetings, which are held at NASA's Johnson Space Center. The mission of the NSBRI EPOP is to train scientists and teachers, inspire and prepare students to pursue science careers, and promote public engagement in space exploration. This paper focuses on the accomplishments of the K-16 program and references ongoing efforts to strengthen the 21st Century US science workforce.

In the single vehicle routing allocation problem (SVRAP) we have a single vehicle, together with a set of customers, and the problem is one of deciding a route for the vehicle (starting and ending at given locations) such that it visits some of the customers. Customers not visited by the vehicle can either be allocated to a customer on the vehicle route, or they can be isolated. The objective is to minimize a weighted sum of routing, allocation and isolation costs. One special case of the general SVRAP is the median cycle problem, also known as the ring star problem, where no isolated vertices are allowed. Other special cases include the covering tour problem, the covering salesman problem and the shortest covering path problem. In this paper, we present a tabu search algorithm for the SVRAP. Our tabu search algorithm includes aspiration, path relinking and frequency-based diversification. Computational results are presented for test problems used previously in the literature and our algorithm is compared with the results obtained by other researchers. We also report results for much larger problems than have been considered by others.

The National Space Biomedical Research Institute (NSBRI) Education and Public Outreach Program (EPOP) is supporting the National Aeronautics and Space Administration's (NASA) new vision for space exploration by educating and inspiring the next generation of students through a seamless pipeline of kindergarten through postdoctoral education programs. NSBRI EPOP initiatives are designed to train scientists and to communicate the significance of NSBRI science, as well as other space exploration science, to schools, families and lay audiences. The NSBRI EPOP team is comprised of eight main partners: Baylor College of Medicine (BCM), Binghamton University–State University of New York (BUSUNY), Colorado Consortium for Earth and Space Science Education (CCESSE), Massachusetts Institute of Technology (MIT), Morehouse School of Medicine (MSM), Mount Sinai School of Medicine (MSSM), Rice University and the University of Texas Medical Branch (RU–UTMB), and Texas A&M University (TAMU). The current kindergarten through undergraduate college (K-16) team, which was funded through an open national competition in 2004, consolidates the past 7 years of K-16 education activities and expands the team's outreach activities to more museums and science centers across the nation. NSBRI also recently expanded its education mission to include doctoral and postdoctoral level programs. This paper describes select K-16 EPOP activities and products developed over the past 7 years, and reports on new activities planned for the next 3 years. The paper also describes plans for a doctoral program and reports on 1st-year outcomes of the new postdoctoral program.

Introduction A large local health department in Colorado partnered with 15 school districts to develop an approach to evaluate changes in access to healthy foods in reimbursable school lunches and a la carte offerings. Materials and Methods School district nutrition managers were engaged at the start of this project. Health department dietitians developed criteria to classify food items as “Lower Fat and less added Sugar” (LFS) and “Higher Fat and more added Sugar” (HFS) based on the percentage of calories from fat and grams of added sugar. Lunch production sheets were obtained for two time periods, food items and the number of planned servings recorded. LFS and HFS planned servings were summed for each time period, and a LFS to HFS ratio calculated by dividing LFS planned servings by HFS planned servings. Additional analyses included calculating LFS: HFS ratios by school district, and for a la carte offerings. Results In 2009, the LFS: HFS ratio was 2.08, in 2011, 3.71 (P

Fifteen employees became ill with headaches, nausea, and vomiting due to chemical poisoning at a Vermont community hospital on January 3, 1980. An epidemiologic and environmental investigation was conducted to determine the source of the illness. The investigation discovered that the vapors of a chemical called xylene, which had previously been disposed of down a drain, were drawn back through the sewer into specific work areas. These vapors were determined to be the most likely cause of the illnesses. This outbreak investigation was used to create an exercise that has been used in a variety of teaching settings.

Objective. A case-control and environmental study tested the hypothesis that purchasing and eating ground beef from a specific source was the cause of a cluster of cases of hemolytic uremic syndrome (HUS) and Escherichia coli ( E. coli) O157:H7 gastroenteritis. Methods. A case-control study comparing risk factors was conducted over the telephone on nine case-patients with 23 selected controls. An environmental investigation was conducted that consisted of reviewing beef handling practices at a specific local supermarket and obtaining ground beef samples from the store and two households with case-patients. Results. The analysis of the case-control study showed that eight case-patients (89%) purchased ground beef at Grocery Chain A compared with four controls who did not develop illness (17%) (matched odds ratio=undefined; 95% confidence interval 2.8, ∞; p=0.006). The environmental investigation showed that Grocery Chain A received meat from Meatpacker A. Laboratory analysis of meat samples from Meatpacker A and Grocery Chain A and stool samples from some patients recovered an identical strain of E. coli O157:H7 according to pulse-field gel electrophoresis. Conclusions. Both the case-control and environmental studies showed that purchasing ground beef at Grocery Chain A, which received ground beef from Meatpacker A, was the major risk factor for illness in eight case-patients; the ninth case-patient was found to be unrelated to the outbreak. Furthermore, meat from Meatpacker A was associated with a nationwide outbreak of E. coli O157:H7 illness that resulted in the second largest recall of beef in U.S. history at the time.

A study was conducted to evaluate the effects of acute and subacute locoweed exposure on serum swainsonine concentrations and selected serum constituents in sheep. Thirteen mixed-breed wethers (BW = 47.5 +/- 9.3 kg) were assigned randomly to 0.2, 0.4, or 0.8 mg of swainsonine x kg BW(-1) x d(-1) treatments. During acute (24 h) and subacute (19 d) exposure, serum swainsonine was detected in all treatments and was greatest (P < 0.03) in the 0.8 mg treatment. Serum alkaline phosphate (ALK-P) activity was increased (P < 0.01) for the 0.8 mg treatment compared with baseline (0 h) by 7 h and continued to increase throughout the initial 22 h following acute exposure to locoweed. A linear increase (P < 0.01) in serum ALK-P activity was noted, with the rate being 3.00 +/- 0.56 U x L(-1) x h(-1). Serum ALK-P activity was increased (P < 0.05) across treatments on d 7 over d -19, -12, 0, 1, 21, and 26; on d 14 over d -19, -12, 0, and 26; and on d 19 over d -19, -12, 0, 1, 21, and 26. By d 20, approximately 48 h after last exposure to swainsonine, serum ALK-P activities were no longer different (P = 0.13) than baseline (d -19, -12, and 0), and by d 26 values had generally returned to baseline. No linear (P = 0.98), quadratic (P = 0.63), or cubic effects of swainsonine with time from exposure were noted for serum aspartate aminotransferase. Similar to serum ALK-P activities, serum aspartate aminotransferase activities were increased (P < 0.05) across treatment levels on d 7, 14, 19, 20, 21, and 26 over those on d -19, -12, 0, and 1. Total serum Fe was decreased (P < 0.05) within the initial 22 h following the swainsonine exposure. On d 21 (48 h after swainsonine feeding ended), serum Fe increased to 472 mg/L. Concentrations of ceruloplasmin were lower (P < 0.10) on d 14 and 19 following exposure to locoweed. Recovery of ceruloplasmin levels coincided with similar changes in serum Fe. There was a linear (slope = 0.33 mg x dL(-1) x d(-1); P < 0.01) effect with time of exposure to locoweed (i.e., swainsonine) on serum triglyceride concentrations. Rapid changes in serum ALK-P and Fe concentrations without parallel changes in other damage markers indicate that acute exposure to swainsonine induces metabolic changes that may impair animal production and health before events of cytotoxicity thought to induce clinical manifestation of locoism.

Ziel der vorliegenden Studie war die Untersuchung der Reproduzierbarkeit und der Auswerterkonkordanz digitaler 2D-Videobildvermessungen mit dem Computerprogramm SIMI°MoStill (SIMI Reality Motion Systems GmbH). Untersucht wurden die maximalen Flexions- und Extensionswinkel des rechten Huft- und Kniegelenks von 16 Probanden (8 Frauen, 8 Manner) im Alter zwischen 21–34 Jahren beim Gehen auf einem Laufbandergometer (Bandgeschwindigkeit 1,25 m/s). Die Videoaufzeichnungen erfolgten in der Lateralansicht unter Verwendung eines handelsublichen digitalen Video-Camcorders (Canon MV 430i). Zur Bestimmung der Test-Retest-Reliabilitat wurden durch einen Auswerter im Abstand von 7 Tagen wiederholte Standbildvermessungen durchgefuhrt. Die Objektivitat des Verfahrens wurde anhand der Konkordanz von 4 unabhangigen Untersuchern uberpruft. Die im Rahmen der Test-Retest-Videobildvermessung ermittelten Korrelationskoeffizienten weisen auf eine hohe lineare Beziehung zwischen den wiederholten Winkelmessungen hin (r≥0.89; p

This chapter discusses the current environment of online learning in business and industry, followed by a case study from one of Intel Corporation's training organizations.

Tri-County Health Department studied needlestick injury (NSI) risks in pandemic influenza A (H1N1) mass vaccination clinics through incident reports and an Internet-based vaccinator survey. The mass vaccination clinic NSI rate was 4.9 times the mean rate observed during Tri-County Health Department's 2003 to 2009 routine vaccination clinics. There was also a trend of increased risk for NSI with vaccination inexperience. These findings can be used to improve future mass vaccination clinic safety.

The Escherichia coli genome encodes approximately 30 two-component systems that are required for sensing and responding to a variety of environmental and physiological cues. Recent studies have revealed numerous regulatory connections between two-component systems and small noncoding RNAs (sRNAs), which posttranscriptionally regulate gene expression by base pairing with target mRNAs. In this study, we investigated the role of sRNAs in the CpxAR two-component system, which detects and mediates an adaptive response to potentially lethal protein misfolding in the Gram-negative bacterial envelope. Here, we showed for the first time that sRNAs are members of the Cpx regulon. We found that CpxR binds to the promoter regions and regulates expression of two sRNA genes, cyaR and rprA . We also investigated the roles that these sRNAs play in the Cpx response. Cpx repression of cyaR expression creates a feed-forward loop, in which CpxAR increases expression of the inner membrane protein YqaE both directly at the transcriptional level and indirectly at the translational level. Moreover, we found that RprA exerts negative feedback on the Cpx response, reducing Cpx activity in a manner that is dependent on the response regulator CpxR but independent of all of RprA's previously described targets. sRNAs therefore permit the fine-tuning of Cpx pathway activity and its regulation of target genes, which could assist bacterial survival in the face of envelope stress.

The purpose of this study was to retrospectively assess the objective and subjective neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis (AHS).Memory and executive functions were evaluated at baseline and at follow-up in 11 surgically treated patients and compared with 8 pharmacologically treated patients with temporal lobe epilepsy and bilateral AHS. The median follow-up duration was 16 months in the surgically treated patients and 80.5 months in the pharmacologically treated group. Subjective outcome was evaluated by questionnaires and included mood, quality of life, subjective memory, and activities of daily living.At the follow-up assessment, 82% of the surgically treated patients as opposed to 0% of the nonsurgery patients were seizure free. In the surgical group, nonverbal memory performance did not change significantly in any patient after surgery, but there was a floor effect in 55% of the surgical patients. Regarding verbal memory, 9% of the surgical patients improved while 73% declined, despite severe impairments already evident at baseline. In the nonsurgery control group, 13% of the patients declined in nonverbal memory (floor effect in 63%) and 25% declined in verbal memory (floor effect in 25%) at follow-up. None of the controls improved at follow-up. Executive functions remained unchanged on an impaired level in both groups. At follow-up, the patient groups did not differ significantly with respect to mood, quality of life, subjective memory, or activities of daily living. However, in most aspects, surgically treated patients reported a slightly better subjective outcome than pharmacologically treated patients and a significantly improved quality of life.These results suggest that beyond benefits concerning seizure control, surgically treated patients with bilateral AHS, despite already poor baseline performance, are still at risk for severe postoperative decline in memory. In the light of predominantly minor benefits on a subjective level, the findings put the overall outcome of epilepsy surgery in bilateral AHS patients into perspective.

Exercise-related public health recommendations and research for increased fitness and health had long focused on vigorous exercise or the lack thereof. Recently scientific interest in possible effects of sedentary behaviour (SB) (sitting) independent of moderate-vigorous intensity exercise has been growing.We conducted a selective literature search in Pubmed and the Sedentary Research Database with the outcomes SB, risk factors, mortality and morbidity in adults. We included only reviews and systematic reviews.Observational studies suggest an association between SB and all-cause and cardiovascular, but not cancer mortality. SB also seems to be associated with diabetes and overweight/weight gain. Evidence for other diseases, such as cardiovascular diseases, hypertension, cancer, and mental diseases is limited also because of the heterogeneity and poor methodology of the -studies. Intervention studies found inconsistent evidence that SB is associated with detrimental effects on markers of cardiometabolic risk.The evidence on the detrimental effects of sedentary behaviour is decreasingly convincing with the endpoints of mortality, -morbidity, and markers of metabolic risk, in that order. Higher TV and screen time, but not total SB seems to be associated with higher all-cause and cardiovascular, but not cancer mortality. Further intervention studies are needed to establish -dose-response relationships and potentially protective effects of cardiorespiratory fitness and physical activity.

The study explored the interdependence of changes in oxygen uptake, quality of life and cancer-related side-effect fatigue during a 4-month exercise intervention. Participants were during adjuvant (curative) or palliative therapy and post-adjuvant therapy (finished within the previous 12 months). Aerobic exercise capacity (VO2 peak), quality of life and fatigue symptom (EORTC QLQ-C30) were obtained in 101 cancer patients (30-77 years). After initial examination, patients participated in supervised and/or home-based training interventions. Patients were re-examined after 16-20 weeks and stratified into 3 subgroups (terciles) with respect to the absolute change in VO2 peak. The ANCOVA, with significant covariate effect for pretest fatigue score (F(5,101) = 8.150, P0.001), indicated significant differences between groups in outcome measures (P0.001). Based on the absolute change of VO2 peak (1.9 ± 1.7; 1.8 ± 0.8; 5.7 ± 2.8 ml/kg/min) there were significant differences in the quality of life improvement (17.2 ± 15.1 vs. 4.8 ± 22.0 points, P0.05) and cancer-related fatigue reduction (-6.1 ± 30.7; -11.5 ± 20.9; -21.2 ± 21.4 points) between upper and lower tercile. The findings point towards a relationship of exercise capacity enhancement, quality of life improvement and fatigue symptom reduction during and shortly after cancer treatment.

Gram-negative bacteria possess several envelope stress responses that detect and respond to damage to this critical cellular compartment. The σ(E) envelope stress response senses the misfolding of outer membrane proteins (OMPs), while the Cpx two-component system is believed to detect the misfolding of periplasmic and inner membrane proteins. Recent studies in several Gram-negative organisms found that deletion of hfq, encoding a small RNA chaperone protein, activates the σ(E) envelope stress response. In this study, we assessed the effects of deleting hfq upon activity of the σ(E) and Cpx responses in non-pathogenic and enteropathogenic (EPEC) strains of Escherichia coli. We found that the σ(E) response was activated in Δhfq mutants of all E. coli strains tested, resulting from the misregulation of OMPs. The Cpx response was activated by loss of hfq in EPEC, but not in E. coli K-12. Cpx pathway activation resulted in part from overexpression of the bundle-forming pilus (BFP) in EPEC Δhfq. We found that Hfq repressed expression of the BFP via PerA, a master regulator of virulence in EPEC. This study shows that Hfq has a more extensive role in regulating the expression of envelope proteins and horizontally acquired virulence genes in E. coli than previously recognized.

Arsenite, the most likely environmental carcinogenic form of arsenic, is not significantly mutagenic at non-toxic concentrations, but is able to enhance the mutagenicity of other agents. Evidence suggests that this comutagenic effect of arsenite is due to inhibition of DNA repair, but no specific repair enzyme has been found to be sensitive to low (1 microM) concentrations of arsenite. To determine whether arsenite affects signaling which might alter DNA repair, this study assesses the effect of arsenite on p53-related signal transduction pathways after ionizing radiation. Long-term (14 day) low dose (0.1 microM) arsenite caused a modest increase in p53 expression in WI38 normal human fibroblasts, while only toxic (50 microM) concentrations increased p53 levels after short-term (18 h) exposure. When cells were irradiated (6 Gy), p53 and p21 protein concentrations were increased after 4h, as expected. Both long-term, low dose and short-term, high dose exposure to arsenite greatly suppressed the radiation-induced increase in p21 abundance. In addition, long-term, low dose (but not short-term, high dose) exposure to arsenite resulted in increased expression of cyclin D1. These results show that in cells treated with arsenite, p53-dependent increase in p21 expression, normally a block to cell cycle progression after DNA damage, is deficient. At the same time, low (non-toxic) exposure to arsenite enhances positive growth signaling. We suggest that the absence of normal p53 functioning, along with increased positive growth signaling in the presence of DNA damage may result in defective DNA repair and account for the comutagenic effects of arsenite.

Laboratory-supported, community-based local surveillance systems for influenza can act as early warning systems in identifying the initial entry points of different influenza strains into the community. Unfortunately, local health departments often have limited resources to implement this type of surveillance. We developed and evaluated an active, local influenza surveillance system in 3 metropolitan Denver, Colo, counties that enabled timely case ascertainment and strain identification at little cost. When compared with Colorado’s surveillance system, our system detected cases 7 to 8 weeks earlier than the state’s electronic disease reporting system.

We report a cluster of 3 cases of invasive salmonellosis without gastroenteritis among prisoners, in the absence of a gastroenteritis outbreak. Raw foods illicitly taken from the prison kitchen and improperly stored and prepared were possible sources of infection. We describe the investigation of this cluster and discuss the unique implications of invasive, nongastroenteritis salmonellosis in the prison setting, both for clinicians and for public health agencies that seek to control infections in prisons.

Tri-County Health Department and Boulder County Public Health conducted a follow-up study of all nonfatal West Nile virus (WNV) cases reported during 2003 in 4 metropolitan Denver, Colorado, counties. Self-reported patient information was obtained approximately 6 months after onset. A total of 656 (81.2%) eligible WNV patients are included in this study.

Physical activities are particularly health effective when they are structured and systematically organized, for example, with respect to a dose-response relationship or to psychosocial aspects. Which insights can be gained from scientific knowledge on the structure of physical activities? Which health-related goals can be sought with different physical activities in the field of sport? Which target groups can be reached with these kinds of sport? These questions are addressed in this article on the basis of current scientific knowledge-to promote the development of health-enhancing physical activities especially in sport federations, but also to create a communication platform between the sport and the health sector. The work of researchers in this field is focused mainly on health-enhancing physical activity, but they are also engaged in health-related scientific organizations and in sport federations.

The purpose was to evaluate the interventional effects of activity trails (courses) on fall risk factors and health-related quality of life (hrQoL).A total of 94 subjects (67.7 ± 5.7 years; 29 men, 65 women) completed the following measurements prior to and 12 weeks after the initiation of the activity trail intervention: maximum isometric leg extensors force (Fmax, m3 diagnoses©), gait velocity (GV), and static postural stability (STAB, Zebris FDM©), fall-associated self-efficacy (FALL, FES-I), and hrQoL (SF-36).During the 12-week intervention period, the participants increased Fmax (1.63 ± 0.6 vs. 1.70 ± 0.6 N•kg(-1)) and GV (1.06 ± 0.25 vs. 1.11 ± 0.18m•s(-1); p 0.05). Neither FALL (19.44 ± 3.6 vs. 19.41 ± 4.3 points) nor STAB (84.3 ± 56.4 vs. 79.7 ± 63.1 mm(2)) changed. Additionally, significant improvements in hrQoL regarding vitality (56.3 ± 17.2 vs. 63.2 ± 18.3 points) and mental health (69.4 ± 18.7 vs. 75.5 ± 16.5 points; p 0.05) were found.The improvements in fall-related risk factors and hrQoL may be expected to contribute to fall prevention and psychosocial quality of life.

On September 11, 1992, Hurricane Iniki struck Kauai leaving all residents without electricity and telephone services and damaging 70% of the homes. This study examined the hypothesis that Hurricane Iniki increased the mortality of Kauai residents by comparing mortality data for the 5 years preceding Hurricane Iniki with mortality data for the 12 months immediately following. Although the overall mortality rate was increased in the post-Iniki period, the only significant increase was in the rate of diabetes mellitus-related deaths (relative risk = 2.61, 95% confidence interval 1.44-4.74). Hurricane Iniki did not appear to significantly increase the risk of dying of Kauai residents in the 12 months immediately following the disaster.

The effectiveness of the required overseas tuberculosis (TB) screening for immigrants and refugees to the United States has not been evaluated since new guidelines were introduced in 1991. Using data from the Hawaii State TB register for 1992-1993, patient records, and data from the U.S. government notifications of suspect TB among aliens, we determined the percentage of persons either classified as having active TB (B1), inactive TB (B2), or considered "normal" overseas, who were evaluated and subsequently diagnosed with active TB within 1 yr of arrival in the United States. Of the 124 TB cases among immigrants and refugees evaluated within 1 yr of arrival, 78 (63%) had been classified overseas as B1, 17 (14%) as B2, and 29 (23%) as "normal." The proportion of TB cases diagnosed after arrival in the United States was 14.0% for B1s and 2.1% for B2s. This proportion decreased with increasing age. A positive skin test was a strong predictor (OR: 10.7; 95% CI: 1.4-80.1) of culture-confirmed TB. These data document that immigrants and refugees with B1 and B2 TB status have a high prevalence of active TB. They should be promptly evaluated after arrival in the United States to determine the need for curative or preventive therapy.

Exercise induced asthma (EIA) common in endurance and other athletes limits physical activity. Although a correlation between recurrent childhood bronchitis and the development of asthma has been reported, its relation to EIA in adult athletes has not been assessed. The study evaluates the EIA risk after recurrent childhood wheezing (RCW) and its aggravating influence on the known risk factors outdoor and professional sports.To evaluate the effect of RCW on EIA, 570 multiple choice questionnaires were evaluated, assessing the history of RCW and the EIA occurrence. The latter was defined either according to physician-derived diagnosis, by typical symptoms or by decrease of the 1-second forced expiratory volume after a 6-minute running test. Contingency tables and a logistic regression model were worked out to describe referring parameters of EIA incidence.Almost one quarter of the athletes with RCW were attributed positive for EIA. Contingency calculations revealed a 2.6 times higher chance of symptoms of EIA after RCW which further increased in outdoor sports on a professional level. The duration of sports participation, cold environment and self-limiting of symptoms are predicting factors of a higher risk of EIA, being responsible for 53% of the prevalence variance.The results point towards a facilitating effect of recurrent affections of the respiratory tract in young age in addition to generally accepted factors of EIA in adults. For safe sports participation, the athlete, as well as involved caregivers (parents, coach) should have an adequate knowledge of EIA and prevention/intervention strategies like warming up or the use of inhalers.

We describe methods for screening the E. coliASKA overexpression library for clones that lead to altered expression of reporter genes. First, a promoter of interest is cloned upstream of either the lacZor luxCDABEgenes to yield reporter genes in which transcription is proportional to the levels of β-galactosidase or luminescence produced by strains carrying the reporter. The ASKA library is then condensed into two 96-well plates resulting in mixed preparations of 12 plasmids in each well. The plasmids in each well are transformed into the reporter strain and transformants are screened for either altered β-galactosidase or light production. The genes contained in ASKA clones that result in altered reporter gene expression are amplified and sequenced and the ASKA clone for the gene identified is retransformed into the parent reporter strain to confirm the effect. We have used screens like this one to look for new E. coligenes that, when over-expressed, result in the altered expression of promoters that are regulated by the envelope stress response. The identity of the clones can yield information about the nature of inducing cues and/or additional regulatory molecules. The techniques are broadly applicable to any microbial function of interest.

In 2010, 41 patients ill with Escherichia coli O157:H7 isolates determined to be indistinguishable by pulsed-field gel electrophoresis were identified among residents of five Southwestern U.S. states. A majority of patients reported consuming complimentary samples of aged raw-milk Gouda cheese at national warehouse chain store locations; sampling Gouda cheese was significantly associated with illness (odds ratio, 9.0; 95 % confidence interval, 1.7 to 47). Several Gouda samples yielded the O157:H7 outbreak strain, confirming the food vehicle and source of infections. Implicated retail food-sampling operations were inconsistently regulated among affected states, and sanitation deficiencies were common among sampling venues. Inspection of the cheese manufacturer indicated deficient sanitation practices and insufficient cheese curing times. Policymakers should continue to reexamine the adequacy and enforcement of existing rules intended to ensure the safety of raw-milk cheeses and retail food sampling. Additional research is necessary to clarify the food safety hazards posed to patrons who consume free food samples while shopping.

Health Impact Assessment (HIA) is a tool that is increasingly utilized in the U.S. to shape policies that may impact the public's health. Domestic examples of HIAs and the process by which they were conducted, however, are rarely documented in the peer-reviewed literature. Through an existing relationship with the planning department in Commerce City, Colorado, Tri-County Health Department (TCHD) was able to identify a proposed redevelopment plan as a candidate for an HIA. The HIA focused on potential effects of the proposed redevelopment of Commerce City's historic Derby District on residents' physical activity and nutrition-related behaviors. This article describes the HIA process used by TCHD. Several sources of data were used, including participatory community input on walkability and safety, local health behavior data, and maps of health-influencing environmental characteristics. Using a variety of information sources including community input and local health behavior data can be useful in conducting HIAs and impacting policies. Local health departments should consider cultivating ongoing collaborative partnerships with municipal planning departments and community groups to conduct HIAs and to implement recommendations.

Although strong evidence suggests that unemployment increases health risks and physical activity results in significant health benefits, the participation rate in prevention programs among unemployed men is still low. For this reason, a sports medical counseling service was implemented at regional job centers in 2006 to refer unemployed persons into local sports for health programs. The participation rate from 741 long-term unemployed persons was analyzed with respect to gender, health, and physical activity status. Women were more active than men (p = 0.038). Among men, physically active persons differed from non-active persons in BMI, activity status, and self-reported health status (p0.05). Especially men with lower fitness, health, and activity status could be motivated for more physical activity (p0.001). The odds ratio for program participation of men with lower fitness, health, and activity status is 2.8 (95% confidence interval 1.8-4.3) compared to persons with lower risk factors. Sports medical counseling at job centers seems to be a promising and feasible intervention approach.

There is an increasing interest in demand-side management (DSM) by utilities and regulators throughout the USA. With this interest, there is an increasing need for DSM evaluation. Regulators expect utility engineers to use least cost planning and integrated resource planning approaches to adjust their generation capacity plans to reflect DSM. Increasingly, utilities are considering DSM to affect their T&D capacity plans. However, major utility DSM programs are less than a decade old. This leaves many utility engineers uneasy. How do they know that DSM will be there when they really need it? To verify and improve the contribution of DSM programs, utility analysts have developed a set of methodologies and procedures for evaluating DSM. The purpose of this panel session was to review these state of the art evaluations and the lessons learned from them so far. The authors explore the differences inherent in evaluating DSM at the T&D level versus the generation level, and review DSM's persistence and reliability in the residential, commercial, and industrial sectors. >

BACKGROUND Shiga toxin-producing Escherichia coli (STEC) O26:H11 is an emerging cause of disease with serious potential consequences in children. The epidemiology and clinical spectrum of O26:H11 are incompletely understood. We investigated an outbreak of O26:H11 infection among children younger than 48 months of age and employees at a child care center. METHODS Every employee at the center (n = 20) and every child

Osteoporosis is a widespread chronic bone disease leading to an increased risk of bone fractures. The most common clinical consequences are back pain, hyperkyphosis, limitations of physical functioning and activities of daily living as well as reduced quality of life. Furthermore, osteoporosis is associated with decreased strength and deficits of gait and balance, all together resulting in an increased risk of falls and a subsequent aggravation of fracture risk. Besides pharmaceutical and exercise therapy, back orthoses are increasingly being used in the therapy of osteoporosis and rehabilitation after vertebral fractures. Previous studies have shown that wearing a spinal orthosis results in a reduction of pain as well as improvements of posture and back extensor strength. To date there is no study that has evaluated the effects of a spinal orthosis on gait stability and physical functioning in patients with osteoporosis. Therefore the purpose of the present study was to assess the effects of a spinal orthosis on gait and pain-induced limitations of activities of daily living (ADL) in women with osteoporosis.A total of 69 postmenopausal osteoporotic women with and without vertebral fractures were randomly assigned to receive either a spinal orthosis (Thämert Osteo-med intervention group n=35; average age 74 ± 8.3 years, height 158.3 ± 6.3 cm, weight 62.8 ± 9.6 kg, t-score -2.6 ± 1.0, number of vertebral fractures 1.4 ± 2.0) or to a waiting list control group (n= 34, age 74.1 ± 7.7 years, height 159.6 ± 5.9 cm, weight 65.4 ± 11.3 kg, t-score -2.9± 0.8, number of vertebral fractures: 0.9 ± 1.2). The following outcome measures were collected at baseline and at 3 and 6 months follow-up: gait parameters including gait analysis: velocity, stride length and width, double support time (% of gait cycle) and perceived limitations in activities of daily living (numeric rating scale 1-10; 1=best, 10= worst situation).The ANCOVA indicated a significant reduction of the double support time at 6 months in the intervention group (p 0.05) without a significant influence of the covariate vertebral fractures status. The other parameters remained unchanged (p0 .05). Regarding the pain-related ADL limitations there were significant differences in the amount of change over the study period depending on the baseline value. Stratified into terciles (≤ 2.5; 2.6-5.0;5) patients with initially high values showed a significantly greater reduction in perceived ADL restrictions compared to patients in the lowest tercile (-2.7 ± 2.7 versus 1.5 ± 2.1).The study demonstrated that wearing a spinal orthosis introduced a reduction in double support time associated with a beneficial impact on gait stability. Furthermore, there was a positive effect on pain-related restrictions of ADL evident in women with a high level of limitations at baseline. Besides previously shown reductions in pain, improvements in back extensor strength and correction of posture, the application of a spinal orthosis may induce advantages for gait stability and physical functioning in women with postmenopausal osteoporosis. Future studies should consider a longer follow-up to evaluate possible effects on the risk of falling and fractures.

The stringent response is a regulatory system that allows bacteria to sense and adapt to nutrient-poor environments. The central mediator of the stringent response is the molecule guanosine 3′,5′-bispyrophosphate (ppGpp), which is synthesized by the enzymes RelA and SpoT and which is also degraded by SpoT. Our laboratory previously demonstrated that a relA mutant of Pseudomonas aeruginosa , the principal cause of lung infections in cystic fibrosis patients, was attenuated in virulence in a Drosophila melanogaster feeding model of infection. In this study, we examined the role of spoT in P. aeruginosa virulence. We generated an insertion mutation in spoT within the previously constructed relA mutant, thereby producing a ppGpp-devoid strain. The relA spoT double mutant was unable to establish a chronic infection in D. melanogaster and was also avirulent in the rat lung agar bead model of infection, a model in which the relA mutant is fully virulent. Synthesis of the virulence determinants pyocyanin, elastase, protease, and siderophores was impaired in the relA spoT double mutant. This mutant was also defective in swarming and twitching, but not in swimming motility. The relA spoT mutant and, to a lesser extent, the relA mutant were less able to withstand stresses such as heat shock and oxidative stress than the wild-type strain PAO1, which may partially account for the inability of the relA spoT mutant to successfully colonize the rat lung. Our results indicate that the stringent response, and SpoT in particular, is a crucial regulator of virulence processes in P. aeruginosa .