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Chagas disease is a lethal, neglected tropical disease. Unfortunately, aggressive insecticide-spraying campaigns have not been able to eliminate domestic infestation of Triatoma dimidiata , the native vector in Guatemala. To target interventions toward houses most at risk of infestation, comprehensive socioeconomic and entomologic surveys were conducted in two towns in Jutiapa, Guatemala. Given the exhaustively large search space associated with combinations of risk factors, traditional statistics are limited in their ability to discover risk factor interactions. Two recently developed statistical evolutionary algorithms, specifically designed to accommodate risk factor interactions and heterogeneity, were applied to this large combinatorial search space and used in tandem to identify sets of risk factor combinations associated with infestation. The optimal model includes 10 risk factors in what is known as a third-order disjunctive normal form (i.e., infested households have chicken coops AND deteriorated bedroom walls OR an accumulation of objects AND dirt floors AND total number of occupants ≥ 5 AND years of electricity ≥ 5 OR poor hygienic condition ratings AND adobe walls AND deteriorated walls AND dogs). Houses with dirt floors and deteriorated walls have been reported previously as risk factors and align well with factors currently targeted by Ecohealth interventions to minimize infestation. However, the tandem evolutionary algorithms also identified two new socioeconomic risk factors (i.e., households having many occupants and years of electricity ≥ 5). Identifying key risk factors may help with the development of new Ecohealth interventions and/or reduce the survey time needed to identify houses most at risk.

Energy insecurity is a multi-dimensional construct that describes the interplay between physical conditions of housing, household energy expenditures and energy-related coping strategies. The present study uses an adapted grounded theory approach based on in-depth interviews with 72 low-income families to advance the concept of energy insecurity. Study results illustrate the layered components of energy insecurity by providing rich and nuanced narratives of the lived experiences of affected households. Defined as an inability to adequately meet basic household energy needs, this paper outlines the key dimensions of energy insecurity-economic, physical and behavioral- and related adverse environmental, health and social consequences. By thoroughly examining this understudied phenomenon, this article serves to raise awareness of an increasingly relevant issue that merits more attention in research and policy., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

We conducted a large epidemiologic case-control study in California to examine the association between childhood cancer risk and distance from the home address at birth to the nearest high-voltage overhead transmission line as a replication of the study of Draper et al. in the United Kingdom. We present a detailed description of the study design, methods of case ascertainment, control selection, exposure assessment and data analysis plan. A total of 5788 childhood leukemia cases and 3308 childhood central nervous system cancer cases (included for comparison) and matched controls were available for analysis. Birth and diagnosis addresses of cases and birth addresses of controls were geocoded. Distance from the home to nearby overhead transmission lines was ascertained on the basis of the electric power companies' geographic information system (GIS) databases, additional Google Earth aerial evaluation and site visits to selected residences. We evaluated distances to power lines up to 2000 m and included consideration of lower voltages (60-69 kV). Distance measures based on GIS and Google Earth evaluation showed close agreement (Pearson correlation >0.99). Our three-tiered approach to exposure assessment allowed us to achieve high specificity, which is crucial for studies of rare diseases with low exposure prevalence.

Pulse oximetry, a non-invasive method for accurate assessment of blood oxygen saturation (SPO2), is an important monitoring tool in health care facilities. However, it is often not available in many low-resource settings, due to expense, overly sophisticated design, a lack of organised procurement systems and inadequate medical device management and maintenance structures. Furthermore medical devices are often fragile and not designed to withstand the conditions of low-resource settings. In order to design a probe, better suited to the needs of health care facilities in low-resource settings this study aimed to document the site and nature of pulse oximeter probe breakages in a range of different probe designs in a low to middle income country. A retrospective review of job cards relating to the assessment and repair of damaged or faulty pulse oximeter probes was conducted at a medical device repair company based in Cape Town, South Africa, specializing in pulse oximeter probe repairs. 1,840 job cards relating to the assessment and repair of pulse oximeter probes were reviewed. 60.2 % of probes sent for assessment were finger-clip probes. For all probes, excluding the neonatal wrap probes, the most common point of failure was the probe wiring (>50 %). The neonatal wrap most commonly failed at the strap (51.5 %). The total cost for quoting on the broken pulse oximeter probes and for the subsequent repair of devices, excluding replacement components, amounted to an estimated ZAR 738,810 (USD $98,508). Improving the probe wiring would increase the life span of pulse oximeter probes. Increasing the life span of probes will make pulse oximetry more affordable and accessible. This is of high priority in low-resource settings where frequent repair or replacement of probes is unaffordable or impossible.

An epidemiological study of paediatric cancers in relation with various environmental factors is currently being carried out in France. One of these factors is the proximity of children's residences to high voltage overhead lines (63-400 kV). This possible influence will be studied following three criteria, namely 'distance', 'distance-voltage' and 'calculated residential exposure' to extremely low frequency magnetic field (ELF-MF). This paper describes methods for generating and characterising these three criteria of increasing complexity and characterises the influence of the input data in terms of uncertainties in the exposure to ELF-MF assigned to subjects. The method developed for the 'calculated residential exposure' criterion is based on a limited number of configurations of overhead lines, selected to have a representative sample of the French high voltage (HV) network. The calculated exposure is then fitted to each subject and each neighbouring overhead line, taking into account the yearly mean current flowing in the line and the distance of the residence from the power line. All variability factors introduced by this simplified representation have been analysed, classified and quantified to give the best assessment and associated confidence interval of the residential ELF-MF exposure of the subjects. The overall 1σ uncertainty of the calculated residential exposure excluding geo-coding uncertainties is around 8% for subjects living close to power lines with a known current load and 17% for the others.

Trees are a major threat to power line security across forested regions of the world. We developed a decision support system for identifying locations in Connecticut, USA where trees have grown tall enough to make contact with transmission lines during storms. We used the Random Forest algorithm, danger tree presence/absence data, and 25 raster environmental datasets to develop (1) an understanding of the abiotic environmental settings that host danger trees and (2) a spatially explicit map of danger tree distributions across Connecticut power line corridors. Danger trees were prevalent in locations (1) with an infrequent history of storms; (2) forested and residential land uses; and (3) low to middle elevations. Products from this research can be transferred to adaptive right-of-way management because they present managers with key information on where danger trees are likely to occur, and the methods presented herein have great potential for future application to other regions managers seek to identify high priority areas for danger tree removal.

Objective: To estimate the prevalence of exposure to magnetic fields generated by transmission lines (TL) and characterize the exposed population., Methods: Information about TL in the metropolitan region of São Paulo, Southeastern Brazil, was provided by the electricity companies and mapped out using geographic information system (GIS). Demographic and socioeconomic data were obtained from the 2000 Census and added to the GIS in another layer. Households and their inhabitants that were located at a distance from the TL that was sufficient to generate a magnetic field 0.3 microT (microteslas) were deemed to be exposed. The prevalence was estimated according to the area of the corridors of exposure along the TL. Two approaches were used to delimit the corridor width: one consisted of widths that were predefined by the TL voltage, and the other consisted of calculation of the magnetic field. The socioeconomic information on the exposed and non-exposed populations were compared by applying the two-proportion test (alpha= 5%)., Results: In the corridors with predefined widths, the prevalence of exposure was 2.4%, and in the calculated corridors, the prevalence was 1.4%. Both methods indicated higher prevalence of exposure among the younger population, and among individuals with lower education and income levels (p < 0.001)., Conclusions: The prevalence of exposure to magnetic fields generated by TL in the metropolitan region of São Paulo was lower than what has been observed in other countries. The results indicate inequality in the exposure to magnetic fields in this urban area, with greater risk to vulnerable populations such as children and socioeconomically less favored individuals.

Environmental justice is the consideration of whether minority and/or lower-income residents in a geographic area are likely to have disproportionately higher exposures to environmental toxins than those living elsewhere. Such situations have been identified for a variety of factors, such as air pollution, hazardous waste, water quality, noise, residential crowding, and housing quality. This study investigates the application of this concept to high-voltage electric power transmission lines (HVTL), which some perceive as a health risk because of the magnetic fields they generate, and also as esthetically unpleasing. We mapped all 345 kV and higher voltage HVTL in New York State and extracted and summarized proximate US Census sociodemographic and housing characteristic data into four categories on the basis of distances from HVTL. Contrary to our expectation, people living within 2000 ft from HVTL were more likely to be exposed to magnetic fields, white, of higher income, more educated and home owners, than those living farther away, particularly in urban areas. Possible explanations for these patterns include the desire for the open space created by the rights-of-way, the preference for new homes/subdivisions that are often located near HVTL, and moving closer to HVTL before EMFs were considered a risk. This study suggests that environmental justice may not apply to all environmental risk factors and that one must be cautious in generalizing. In addition, it shows the utility of geographical information system methodology for summarizing information from extremely large populations, often a challenge in epidemiology.

Background: Medical errors have been increasingly identified as a major source of morbidity and mortality in both outpatient and acute care settings. Central to the evaluation of many medical problems, the 12-lead electrocardiogram (ECG) is susceptible to both technical and interpretative errors. Proper interpretation, however, is dependent on the quality and accuracy of the acquired ECG., Methods: We evaluated the impact of both a newly designed electrocardiograph and a newly developed automated computer algorithm on the incidence and detection of electrode cable reversals (lead reversals). The study tested the association of the incidence of electrode cable reversals and the design of the connection terminal. The study was performed during a 7-month period preceding (53,875 ECGs) and after (53,344 ECGs) the implementation of the new system. Electrode cable reversals occurring in various sites of the medical center were tabulated and compared. We then sought to determine if computer detection algorithms could increase point-of-care detection of electrode cable reversals and, thereby, offset the influence of cardiograph design changes. Two commercially available automated detection algorithms were compared for their abilities to identify electrode cable reversals in our study population., Results: During the 7-month postimplementation period, there was a significant increase in the incidence in electrode cable reversals (0.5% vs 0.1%, P < .001). The incidence of reversals for ECGs obtained in the emergency department was twice that of those obtained within the hospital (0.79% vs 0.38%, P < .01). Automated detection of electrode cable reversals from the 7-month study period increased from 38% to 71% (P < or = .0001), using a recently released automated algorithm supplied by the manufacturer., Conclusions: Electrode cable reversals are a prevalent source of medical errors that receives very little attention by the clinical community. The association of an increase in electrode cable reversals with an altered electrode cable connection terminal, coupled with an increased ability to detect electrode cable reversals using the manufacturer's recently developed algorithms, emphasizes the importance of ongoing research efforts to identify technical errors in electrocardiography.

Some experimental and epidemiologic evidence suggests that residential exposure to power-frequency magnetic fields can increase breast cancer risk. This association was investigated in a nested case-control study of female breast cancer within a cohort of African Americans, Latinas, and Caucasians in Los Angeles County, California. Incident breast cancer was ascertained from 1993 to 1999 by linkage to county and state tumor registries. Controls were selected from a random sample of cohort members without breast cancer at baseline. Exposure was assessed in 1995-2001 by means of wiring configuration coding (an indirect measure of magnetic field exposure that has been associated with increased risk of childhood leukemia in Los Angeles and elsewhere in North America) in all homes occupied over the previous 10 years for 743 cases and 699 controls and by measurement of magnetic fields in the bedroom over a 7-day period for 347 cases and 286 controls. The estimated risk of breast cancer was not higher among women with wiring configuration codes associated with the highest magnetic fields (for a very high current configuration relative to very low, the adjusted odds ratio was 0.76 (95% confidence interval: 0.49, 1.18)). Stronger measured fields were not significantly associated with increased risk. These data suggest that residential magnetic field exposures commonly experienced by US women do not influence risk of breast cancer.