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Objective: Enteroviral outbreaks involving athletic teams have been described, although the mode of transmission has been unclear. In September 1991, an outbreak of pleurodynia among high school football players provided an opportunity to identify possible modes of transmission.Design: Retrospective cohort outbreak investigation.Setting: Public high school in upstate New York.Results: Illness was reported by 17 (20%) of the football players. Behaviors involving contact with common water containers were associated with illness, including eating ice cubes from the team ice chest (relative risk [RR], 9.2; 95% confidence interval [CI], 1.3 to 65.5) and drinking water from the team cooler (RR, 6.3; 95% CI, 1.5 to 25.7). Coxsackievirus B1 was isolated in four (50%) of the eight stool specimens collected.Conclusions: Contamination of common water containers by an infected player may have contributed to or initiated the outbreak. In addition to discouraging direct oral contact with common drinking containers, use of individual water containers and ice packs for injuries was recommended. [ABSTRACT FROM AUTHOR]

Objectives: From 2004 through 2005, as part of a major strategic planning process called the Futures Initiative, the Centers for Disease Control and Prevention (CDC) developed a set of Health Protection Goals to make the best use of agency resources to achieve health impact. These goals were framed in terms of people, places, preparedness, and global health. This article presents a goals framework and a set of health outcome measures with historical trends and forecasts to track progress toward the Healthy People goals by life stage (Infants and Toddlers, Children, Adolescents, Adults, and Older Adults and Seniors)., Methods: Measurable key health outcomes were chosen for each life stage to capture the multidimensional aspects of health, including mortality, morbidity, perceived health, and lifestyle factors. Analytic methods involved identifying nationally representative data sources, reviewing 20-year trends generally ranging from 1984 through 2005, and using time-series techniques to forecast measures by life stage until 2015., Results: Improvements in measures of mortality and morbidity were noted among all life stages during the study period except Adults, who reported continued declining trends in perceived health status. Although certain behavioral indicators (e.g., prevalence of nonsmokers) revealed steady improvements among Adolescents, Adults, and Older Adults and Seniors, prevalence of the healthy weight indicator was declining steadily among Children and Adolescents and dramatically among Adults and Older Adults and Seniors., Conclusion: The health indicators for the Healthy People goals established a baseline assessment of population health, which will be monitored on an ongoing basis to measure progress in maximizing health and achieving one component of CDC's Health Protection Goals.

Planar array infrared (PA-IR) spectroscopy was used to study polyphenylene sulfide (PPS) at room temperature during the application of a sinusoidal elastic deformation. All of the intensity in the dynamic spectra was contained within the in-phase spectrum, which was expected since the measurements were carried out at room temperature, far below the glass transition temperature. The contributions of chain orientation, sample thinning, and stress-induced band shifts were separated in the dynamic spectra. It was found that the effects of chain orientation and sample thinning canceled each other out. Stress-induced band shifts far below the spectral resolution, on the order of 0.01 cm(-1), were quantified and used to calculate the stress optical coefficients and mode Gruneisen parameters for PPS.

Background: The relationship between domestic funding for selected conditions to the Centers for Disease Control and Prevention (CDC) and the burden of disease and disability in the United States was assessed systematically., Methods: Using mortality, years of potential life lost (YPLLs), disability-adjusted life years (DALYs), hospital days, hospital discharges, and direct medical costs of conditions, 34 high-burden conditions addressed by CDC programs were identified, and information was collected about the funds spent on each by CDC during fiscal year (FY) 2003. The 34 conditions were grouped into 15 categorical areas, and the relationship between budget and burden was analyzed using correlation and regression methods for each of the categorical areas and for each measure of burden., Results: Of CDC's total FY 2003 budget of $6.9 billion, 62% ($4.3 billion) of funding was allocated to one of the 34 conditions studied. A positive relationship between budget and burden was identified for all measures of burden, although the correlations varied for the different conditions., Conclusions: Although examination of the relationship of CDC's budget to burden measures provides insight into the agency's portfolio of investments, this exercise also highlights a number of limitations with this approach and the currently available burden measures. Assessment of key public health functions such as emergency preparedness and the collection of vital statistics require development of metrics different from the burden measures used in this analysis. Investment in the development of such metrics warrants consideration.

Background: As part of a major re-examination of its organization, in 2004, the Centers for Disease Control and Prevention (CDC) assessed the evidence base for the effectiveness of population-based public health intervention programs., Methods: For the leading causes of disease, injury, and disability, evidence was systematically reviewed for modifiable risk factors and their attributable fractions, and for public health interventions and their preventable fractions., Results: For 31 conditions, 194 modifiable risk factors were identified, and attributable fractions were found for 65 (33.5%). For 137 (70.6%) of the risk factors, 702 population-based interventions were found. Preventable fractions were found for 31 (4.4%) of the interventions., Conclusions: Despite considerable information about both modifiable risk factors and interventions designed to reduce the risks of the major causes of disease, injury, and disability, the evidence base that describes the effectiveness of these interventions is limited. The CDC is committed to support research that will set priorities for program development and identify effective public health interventions.

Objectives: We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users., Methods: We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories., Results: The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection., Conclusions: Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents.

Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.

For the first time, four different methods to determine the degree of molecular orientation from polarized Raman spectroscopy measurements are compared. The great influence of molecular orientation on the properties of polymers has driven the development of multiple experimental techniques and procedures. This study is based on the C(1)-C(4) ring stretching vibration of poly(propylene terephthalate) (PPT) at 1614 cm(-1). It is shown that simply ratioing the band intensity obtained with the polarization parallel and perpendicular to the unique axis of the sample provides a good qualitative method to observe the evolution of orientation in a series of similar samples. To quantitatively compare the degree of orientation one needs to utilize a more complex method yielding the second- and fourth-order parameters of the orientation distribution function (P(2) and P(4), respectively). To date, most studies have been based on the assumption of a cylindrically symmetric polarizibility tensor. It is shown that this assumption is highly questionable although this method has been used fairly successfully in the past. This method results in orientation parameters that are clearly different from those obtained with the two more complex procedures. The most complex method, both theoretically and experimentally, requires the most measurements per sample. Major problems have occurred when trying to calculate the desired parameters, in particular for samples with high birefringence. These problems are related to experimental complexities occurring for measurements when the samples are tilted with respect to the polarization direction of the incident light. These measurements are replaced by a simple determination of depolarization ratio in the third method. This method assumes that the depolarization ratio is independent of changes in molecular orientation and structure. It was found that this assumption is not correct. Thus, the most complex method is the method of choice to quantitatively determine the second- and fourth-order parameters of the orientation distribution function, unless one has knowledge of the depolarization ratio of each sample being studied. That knowledge permits the use of an experimentally simpler method to obtain the desired parameters.

A new method has been developed to determine an orientation-independent Raman scattered intensity based on various polarized Raman measurements. The equivalent term in infrared spectroscopy is the structural absorbance, which has existed for many years. As with the structural absorbance, the calculated Raman intensity allows one to observe spectral changes that are due uniquely to morphological changes in a set of different samples in the presence of orientation differences. The full theoretical development is presented, followed by an example based on a set of polymer fibers processed under different conditions leading to different morphologies and degrees of molecular orientation.

Background: The September 11, 2001, terrorist attacks on the World Trade Center in New York City, New York, prompted an unprecedented rescue and recovery response. Operations were conducted around the clock, involved over 5000 workers per day, and extended into months following the attacks. The City of New York Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention implemented prospective surveillance to characterize rescue worker-related injury and illness and to help guide public health interventions., Methods: From September 11 to October 11, 2001, personnel reviewed medical records at four Manhattan hospital emergency departments (EDs), and healthcare providers completed data collection forms at five temporary Disaster Medical Assistance Team (DMAT) facilities located at the site. Rescue workers included construction workers, police officers, firefighters, emergency medical service technicians, or Urban Search and Rescue workers. Data collected included demographic characteristics, injury type, illness, and disposition., Results: Of 5222 rescue worker visits, 89% were to DMAT facilities and 12% to EDs. Musculoskeletal conditions were the leading cause of visits (19%), followed by respiratory (16%) and eye (13%) disorders. Incidence rates were estimated based on total injuries and/or illnesses reported times 200,000 (100 equivalent full-time workers in 1 year at 40 hours per week x 50 weeks per year), then divided by the total number of hours worked. Eye disorders (59.7) accounted for the highest estimated injury and illness rate, followed by headache (46.8). One death, 52 hospital admissions, and 55 transports were reported. Findings underscored the need to coordinate distribution and enforcement of personal protective equipment use, purchase of diagnostic equipment to diagnose corneal abrasions, and distribution of health advisories., Conclusions: This system provided objective, timely information that helped guide public health interventions in the immediate aftermath of the attacks and during the prolonged rescue and recovery operations. Lessons learned can be used to guide future surveillance efforts.

Background: Firearm ownership has often been used to measure access to weapons. However, persons who own a firearm may not have access to it and conversely, persons who do not own a firearm may be able to access one quickly., Objectives: To examine whether using firearm ownership is a reasonable proxy for access by describing the demographic characteristics associated with ownership and access., Methods: Data are from the 1994 Injury Control and Risk Survey, a national, random digit dial survey. Information about household firearm ownership and ready access to a loaded firearm were collected and weighted to provide national estimates. Adjusted odds ratios for three separate models were calculated using logistic regression., Results: A total of 1353 (27.9%) respondents reported both having a firearm in the household and ready access to one. An additional 313 respondents (8.1%) reported having a firearm, but were not able to access these weapons. Another 421 respondents (7.2%) did not have a firearm in or around their home, yet reported being able to retrieve and fire one within 10 minutes. Based on the logistic regression findings, the demographic characteristics of this latter group are quite different from those who report ownership. Those who do not have a firearm, but report ready access to one, are more likely to be ethnic minorities, single, and living in attached homes., Conclusions: Asking only about the presence of a firearm in a household may miss some respondents with ready access to a loaded firearm. More importantly, those who do not own a firearm, but report ready access to one, appear to be qualitatively different from those who report ownership. Caution should be exercised when using measures of ownership as a proxy for access.

Objectives: To estimate the national prevalence of youth access to alcohol, a gun, or both alcohol and a gun, in their home and to describe the demographic characteristics associated with access to either alcohol or a gun., Methods: Cross sectional data from the 1995 in-home survey of the National Longitudinal Study of Adolescent Health, which used a nationally representative randomly selected school based sample (n=18 924) of adolescents in grades 7-12, were analyzed. The current analyses were restricted to those adolescents 12-18 years of age (n=18 454). Crude logistic regression analyses was used to determine the demographic characteristics associated with access to alcohol or a gun in the home., Results: Overall, 28.7% of US adolescents reported having easy access to alcohol in the home. Availability of alcohol was associated with race/ethnicity, mother's education, family structure, and welfare status. Similarly, 24.3% of US adolescents reported easy access to a gun in the home. Availability of a gun in the home was associated with gender, race/ethnicity, mother's education, family structure, and welfare status. Among those that reported that a gun was available in their home, most reported availability of a shotgun (63.0%) followed by a rifle (61.3%), handgun (57.3%), and other gun (16.4%). Ten per cent of adolescents reported availability of both alcohol and a gun in their home., Conclusions: One quarter of US adolescents reported easy access to either alcohol or a gun in their home. Given the risks associated with the misuse of alcohol and guns among adolescents, efforts to increase public awareness of the availability of alcohol and guns in the home are needed.

In case-control studies, determination of alcohol consumption by cases immediately prior to the injury event is often conceptually straightforward. However, determination of consumption status by controls is difficult because they lack a reference point, especially when cases and controls are not individually matched. We describe a method of assigning alcohol consumption status to controls using a 24-hour drinking history, the distribution in time of case events, and the random assignment of a specific time period to each control subject. This methodology offers a practical approach for determining alcohol consumption status among control subjects immediately prior to a case event, when controls lack a reference point and have not been individually matched to cases. Published in 2001 by John Wiley & Sons, Ltd.

In response to the magnitude of violence in the United States, a number of violence-prevention programs have been implemented throughout the country. However, relatively few have been rigorously evaluated for effectiveness. To encourage development and evaluation of violence-prevention interventions that focus on young children and their families, the Centers for Disease Control and Prevention (CDC) provided funding to four projects in 1996. This paper briefly describes the rationale for funding these projects, which is based on our understanding of the development of aggressive and violent behavior and on the literature regarding promising approaches to prevent problem behavior in this age group. We provide an overview of the four specific projects funded by the CDC as well as a short discussion of some of the many challenges encountered during their implementation.

The association between help-seeking and nearly lethal suicide attempts was evaluated using data from a population-based, case-control study of 153 13- to 34-year-old suicide attempt case-patients treated at emergency departments in Houston, Texas, and a random sample of 513 control-subjects. Measures of help-seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case-patients were less likely than control-subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3-0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95%CI = 0.29-0.8). Among those who sought help, case-patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2-5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2-43.2). Our findings suggest that efforts to better understand the role of help-seeking in suicide prevention, including help sought from family and friends, deserves further attention.

Physical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population-based, case-control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case- and 513 control-subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random-digit-dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12-4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87-12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI-0.62-4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.

This article details the research methods and measurements used in conducting a population-based, case-control study of nearly lethal suicide attempts among persons aged 13-34 years, residing in Houston, Texas. From November 1992 to July 1995, we interviewed 153 case subjects presenting at one of three participating hospital emergency departments and used random digit dialing to identify 513 control subjects residing in the same catchment area in which cases were enlisted. Unlike most research in this area, this study was designed to extend our understanding of suicidal behavior and prevention activities beyond identification and treatment of depression and other mental illnesses. We discuss the overall strengths and weaknesses of our study design and conclude that this methodology is well suited for studying rare outcomes such as nearly lethal suicide.

This paper reviews research which discusses the risk and protective functions that families and other caregivers provide in influencing the development of aggressive behavior in youth. Currently, there is an emphasis on providing violence prevention programs in the school environment, typically with little parental or caregiver involvement. By enhancing the role of families and caregivers in youth violence prevention programs, we assert that an unique opportunity exists to both address specific risk factors for violence while enhancing the protective features of the family. Relatedly, the risk literature on youth violence indicates that the most influential risk factors (i.e., the family, community, and peers) have their principle impact on youth aggression outside the school. We suggest a shift in the focus of violence prevention programming that is more inclusive of families as both a risk and protective agent. In support of this position, relevant theory and reviews of exemplary family-involved programs are offered. Challenges to involving youth caregivers are identified and recommendations for overcoming those challenges suggested. Last, recommendations for future research and public policy in the prevention of youth violence are offered.

During 1994, the Centers for Disease Control and Prevention (CDC) funded seven states to develop and evaluate surveillance systems for firearm-related injuries. In addition, New York City and California had related experience with firearm-related injury surveillance. At the time these nine jurisdictions began developing their surveillance systems, no standardized definitions or recommendations were available about the best methods or procedures of collecting data or suggested data elements of a firearm-related injury surveillance system. The nine jurisdictions and CDC developed a list of recommended data elements (RDEs) for fatal and nonfatal firearm-related injuries. We describe the process used to develop the RDEs, the 21 data elements suggested by the funded projects, the data sources that may be able to provide those data elements, and an indication of which sources may be most useful. We encourage all developing surveillance systems to strive to include these data elements, although some of the elements will be more easily attainable for fatal injury events than nonfatal ones, and no single data source will be able to provide all the desired information about both morbidity and mortality from firearm-related injuries. The RDEs capitalize on the preliminary experiences of the small group of jurisdictions, but they need to be pilot tested and revised as we collect more information about how well these elements capture the desired information and whether the information obtained is useful.

Context: The magnitude of firearm-related deaths is known, but few studies have evaluated the magnitude and epidemiology of nonfatal firearm-related injuries. The circumstances resulting in fatal versus nonfatal injury are likely very different. No single data source provides complete details on nonfatal shootings., Objective: To establish a surveillance system to define the epidemiology of fatal and nonfatal firearm-related injuries., Design: Data were collected on fatal and nonfatal firearm-related injuries that occurred in 1995., Setting: State of Oklahoma., Participants: Medical Examiner, Vital Statistics, hospital emergency and medical records departments, police departments, newspaper clipping service., Main Outcome Measures: Incidence rate of firearm-related injuries; case-fatality rate; demographic, medical, and epidemiologic data; sensitivity of each reporting source; completeness of reporting., Results: The incidence rate of firearm-related injuries was 45.5 per 100,000 population. The case fatality rate was 35%. Injury rates were highest among adolescents, young adults, males, and African Americans. The Medical Examiner and Vital Statistics reported 87% and 98% of fatal cases, respectively. Passive surveillance of hospital emergency departments identified 72% of patients seeking hospital treatment. Among inpatients, 81% were identified by medical records departments. Newspaper clippings were obtained for 31% of cases. Information on the victim-perpetrator relationship and the type of firearm was available for 79% and 80% of cases, respectively., Conclusions: Statewide surveillance of firearm-related injuries using multiple data sources is possible and provides a picture of the overall firearm-related injury problem. Strategies to enhance computer linkages of medical and police data should be pursued to maximize the sensitivity of reporting and minimize the costs of surveillance.

To estimate the frequency of firearm retrieval because of a known or presumed intruder, the authors analyzed data from a 1994 national random digit dialing telephone survey (n = 5,238 interviews). Three mutually exclusive definitions of firearm retrieval were constructed: (1) retrieved a firearm because there might be an intruder, (2) retrieved a firearm and saw an intruder, and (3) retrieved a firearm, saw an intruder, and believed the intruder was frightened away by the gun. Of 1,678 (34%) households with firearms, 105 (6%) retrieved a firearm in the previous 12 months because of an intruder. National projections based on these self-reports reveal an estimated 1,896,842 (95% CI [confidence interval] = 1,480,647-2,313,035) incidents in which a firearm was retrieved, but no intruder was seen; 503,481 (95% CI = 305,093-701,870) incidents occurred in which an intruder was seen, and 497,646 (95% CI = 266,060-729,231) incidents occurred in which the intruder was seen and reportedly scared away by the firearm. Estimates of the protective use of firearms are sensitive to the definitions used. Researchers should carefully consider both how these events are defined and the study methods used.

Objective: Our objective was to review historical trends in U.S. fatal firearm-related injuries for the years 1962-1993., Methods: Using mortality data from the National Center for Health Statistics and population estimates projected from census data, we calculated national age-adjusted mortality rates and examined trends over the 32-year period. Data were also examined by type of firearm-related death (unintentional, suicide, homicide, legal intervention, and undetermined intention), race, gender, and age group., Results: During the 32-year period, the total number of firearm-related deaths increased by 137%, from 16,720 in 1962 to 39,595 in 1993. Suicide and homicide were responsible for most firearm fatalities. Rates for both firearm suicides and firearm homicides increased over time, while rates for unintentional, legal intervention, and undetermined intention decreased. The highest rates and widest variation in total firearm-related mortality occurred among African-American men (35.2/100,000 to 84.5/100,000). Persons 15-19, 20-24, and > or = 75 years of age experienced the largest changes in rates during recent years; total firearm mortality was higher for the younger age groups (15-19, 20-24) during 1990 through 1993 than any other time during the 32-year period., Conclusions: These surveillance data help characterize trends over time and the magnitude of firearm-related mortality and identify groups at risk. However, further efforts to improve our understanding of firearm-related deaths and injuries, such as expansion of current surveillance to include information about morbidity associated with firearms and additional epidemiologic research to identify modifiable individual and societal risk factors, are necessary.

The New York State Perinatal Hepatitis B Prevention Program was implemented in New York State (excluding New York City) as a surveillance and control program in 1988. This report describes and evaluates the program and provides data from 1991 regarding hepatitis B surface antigen (HBsAg)-positive mothers and their infants' subsequent hepatitis B vaccination. The program was created using multiple existing surveillance and data collection systems. Completeness of case-ascertainment was estimated by means of the Chandra Sekar-Deming method (J Am Stat Assoc 1949; 44:101-15). An audit of hospital medical records and follow-up by local health departments were used to validate reporting accuracy. Of 158,273 live births in 1991, 363 (0.2%) were born to confirmed HBsAg-positive mothers. Estimated completeness of case-ascertainment was 96%. Thirty-five percent of HBsAg-positive mothers did not report risk factors for hepatitis B, confirming the need for universal testing. Of the infants, 83% received hepatitis B immune globulin and three doses of vaccine within one year of birth. By using existing data collection systems, the program was established quickly, and start-up funding and training requirements were simplified. Multiple reporting increased case-ascertainment to almost 100%. The program effectively identifies and ensures prompt vaccination of infants born to HBsAg-positive mothers.

Objective: To evaluate nosocomial transmission of multidrug-resistant (MDR) tuberculosis (TB)., Design: Outbreak investigation: review of infection control practices and skin test results of healthcare workers (HCWs); medical records of hospitalized TB patients and mycobacteriology reports; submission of specimens for restriction fragment length polymorphism (RFLP) typing; and an assessment of the air-handling system., Setting: A teaching hospital in upstate New York., Results: Skin-test conversions occurred among 46 (6.6%) of 696 HCWs tested from August through October 1991. Rates were highest on two units (29% and 20%); HCWs primarily assigned to these units had a higher risk for conversion compared with HCWs tested following previous incidents of exposure to TB (relative risk [RR] = 53.4, 95% confidence interval [CI95] = 6.9 to 411.1; and RR = 37.4, CI95 = 5.0 to 277.3, respectively). The likely source patient was the only TB patient hospitalized on both units during the probable exposure period. This patient appeared clinically infectious, was associated with a higher risk of conversion among HCWs providing direct care (RR = 2.37; CI95 = 1.05 to 5.34), and was a prison inmate with TB resistant to seven antituberculosis agents. The MDR-TB strain isolated from this patient also was isolated from other inmate and noninmate patients, and a prison correctional officer exposed in the hospital. Mycobacterium tuberculosis isolates from all of these patients had matching RFLP patterns. Infection control practices closely followed established guidelines; however, several rooms housing TB patients had marginal negative pressure with variable numbers of air changes per hour, and directional airflow was disrupted easily., Conclusions: These data strongly suggest nosocomial transmission of MDR-TB to HCWs, patients, and a prison correctional officer working in the hospital. Factors contributing to transmission apparently included prolonged infectiousness of the likely source patient and inadequate environmental controls. Continued urgent attention to TB infection control is needed.

An increase in measles occurred in New York City (NYC) during 1989-1990, affecting primarily unvaccinated preschool-aged children. Many of these children were also enrolled in Aid to Families with Dependent Children (AFDC) programs. To determine the immunization status of children receiving AFDC, immunization records were reviewed at three NYC income support centers. Records were assessed for vaccination eligibility on the day of the visit and at various ages. Seventy-six percent of the children were found eligible for vaccination on the day of their visit. Vaccination levels at two years of age were among the lowest measured in New York. Future immunization efforts should be directed toward this population.

This article examines the effectiveness of the rehabilitation of anesthesiologists who are addicted to alcohol or other drugs. There has been some concern and discussion about allowing anesthesiologists who are addicted to alcohol or other drugs to continue practicing in their specialty. This article analyzes success rates, relapse rates, and failure rates among the anesthesiologists and residents of anesthesiology in the California Physicians Diversion Program for chemically dependent doctors. Of the 255 physicians who have successfully completed the program during the ten years prior to March 1990, 35 were practicing anesthesiologists, including six resident anesthesiologists. Although doctors in this specialty are more at risk for manifesting addiction to alcohol and other drugs, California's experience demonstrates that they have an equal chance of recovery and contradicts the pessimism about recovery in anesthesiologists.

Catheterization of the aorta via the umbilical artery provides a convenient route for monitoring arterial blood pressure, for obtaining blood specimens for measurement of blood gas tensions and chemistries, and for the infusion of fluids and pharmacologic preparations in sick newborn infants. Use of this technique may be accompanied by a number of complications of which thrombotic phenomena are the most common. Twenty-three of 98 (24%) newborn infants undergoing umbilical artery catheterization were found to have thrombotic complication determined by aortography. No correlation was present between the duration of time that the umbilical artery catheters were in place and the occurrence of thrombotic complications. From paired aortographic or aortographic and autopsy studies in 24 patients, it was concluded that if a thrombotic complication did not occur early, none was likely to occur subsequently. One patient was considered to have died as a direct result of a thrombotic complication. Aortography is a safe, simple, and reliable technique for the early detection of thrombotic complications of umbilical artery catheters. Umbilical artery catheterization is not without risk and careful selection of patients for this procedure is indicated.

1. A densitometric method has been developed for the quantification of azodipyrroles derived from dog bile pigments treated with diazotized ethyl anthranilate. 2. This method was used to estimate the bilirubins in bile and meconium from foetuses of 14-36 weeks gestation. 3. The proportion of the bilirubins in foetal bile changed during gestation. (a) No bile pigments were found until 14 weeks. (b) Between 14 and 15 weeks bilirubin-IX beta was the only bile pigment detected. (c) At 16-17 weeks some unconjugated bilirubin-IX alpha was found in the bile, but up to 20 weeks bilirubin-IX beta was the predominant bilirubin in the bile. (d) At about 20 weeks glucose, xylose, and an unidentified bilirubin-IX alpha monoconjugate were found in the bile. (e) Between 20 and 23 weeks bilirubin-IX alpha glucuronide appeared in the bile. (f) At 30 weeks monoconjugates of bilirubin-IX alpha were the predominant bilirubins in the bile. (g) Only in full-term foetuses was bilirubin-IX alpha monoglucuronide the major bilirubin derivative.

Laser energy delivered through optical fibers can produce potent controlled thermal dissolution of human coronary obstructive disease, thus widening the stenotic vascular lumen. The ease of vaporization and penetration depends not only on the physical properties of the laser beam but also on the physical characteristics of the atherosclerotic plaque. Lipid-laden plaques are more easily vaporized compared with plaques that are heavily calcified. In atherosclerotic animal models studied in vivo, laser radiation produced a charred lining around the evacuated area and rapid regeneration of a new endothelial lining. After several weeks, the laser-induced crater was still evident, and thrombogenesis was not a significant complication. Focal aneurysmal dilatation may develop when there is thermal injury of the medial layer, and acute perforation can occur if severe laser burn is extended beyond the adventitial layer. Further technical advances and achievements are needed before laser recanalization becomes a clinical reality.

To further our understanding of the role of host immunity in the development of lymphoid neoplasia, groups of germfree BALB/c nude and nu/+ mice were either followed unmanipulated or were treated, beginning at birth, with anti-mu, normal goat IgG or with lipopolysaccharide (LPS). The survival and development of neoplasia of all groups of animals were monitored up to 2 yr. Nude mice, under germfree and specific pathogen-free (spf) conditions, had a higher incidence of lymphoid neoplasia and reduced survival when compared to nu/+ littermates. The incidence of lymphoid tumors in nude mice under spf or germfree conditions was 7.2 and 8.7%, respectively, in comparison to 0% in nu/+ animals. Treatment of germfree nude mice with anti-mu, but not with goat IgG, increased the incidence of lymphoid tumors to 39%. Anti-mu did not significantly change the incidence of lymphoid neoplasia in nu/+ animals. Treatment of nu/nu and nu/+ mice with LPS, however, led to a several-fold increase in the appearance of neoplasia, to values of 25.4% in nude and 10% in nu/+ mice. Lymphoid neoplasia found in either unmanipulated, anti-mu, or IgG-treated germfree or spf mice included Thy-1.2+, surface IgM+, and IgG+ tumors. In contrast, all the lymphomas found in LPS-treated mice were surface IgM+. Thus, whereas LPS may have generated a relatively homogeneous group of tumors, anti-mu may have randomly increased the normal incidence of spontaneous tumors. Moreover, although there was significant variation in the histologic appearance of tumors, both within treatment groups as well as in different areas of the same animal, only LPS-treated mice were regularly noted to have distant nonlymphoid involvement, with lesions found in liver, lung, and kidney. In contrast, the incidence of nonlymphoid neoplasia was similar and was less than 2.5% in all groups.

A steerable, fiberoptic catheter coupled to a laser light guide tipped with a metal cap was used. Four monkeys fed an atherogenic diet for 7-8 years were angiographed and were found to have extensive mural plaque in the iliac arteries. Plaque sites in these monkeys were vaporized using the laser-heated metal cap. Energies of 1.5-9 Joules were employed. Application of the energy was tangential of perpendicular to the plaque. Lased sites were examined histologically at 24 hr or at 3 months after treatment. No effect was seen at 1.5 Joules. Three to six Joules tangentially produced a superficial lesion that extended into the tunica intima. Six Joules perpendicularly produced a burn into the tunica adventitia, with damage to the vasavasorum. Nine Joules tangentially produced a burn into the tunica media. Three months after treatment, this lased site showed no stenosis or aneurysm formation.

Patients with histologically proven carcinoma of the prostate (n = 186) were initially assessed and followed up according to the standardized protocol of the British Prostate Study Group, urologists from which contributed patients to this investigation. These patients were given either endocrine therapy or orchidectomy as first line treatment; the ratio of the number of patients receiving these two treatments was similar in each group of subjects compared for survival. Prognostic indices were derived for all patients and for those classified according to the presence (M1) or absence (M0) of metastases. The prognostic indices were derived from clinical and hormone data obtained at initial presentation. Whereas the degree of tumor differentiation and plasma testosterone concentrations were significant prognostic factors in both M0 and M1 disease, growth hormone was only significant in M1 patients, where age was also of borderline significance; elevated growth hormone, higher Gleason grade, younger age, and lower testosterone indicated a poorer prognosis in M1 patients. These findings indicated the feasibility of selecting a poor prognostic group of patients that may derive benefit from a more aggressive therapy.

University of California, Davis (UCD) line 200 White Leghorn Chickens spontaneously develop a syndrome that has many analogous features to human progressive systemic sclerosis. This syndrome is characterized by progressive involution of comb, dermal fibrosis, and distal polyarthritis. These three features occur within 6 wk after hatching, and are accompanied by a 40% mortality as a result of vaso-occlusive disease, with development of secondary infection of peripheral gangrenous lesions. Birds that survive greater than 2 mo after hatching progressively develop fibrosis of the esophagous and mononuclear infiltration of heart and kidney, with prominent occlusion of small and medium sized blood vessels. In addition, line 200 chickens develop rheumatoid factors, antinuclear antibodies, and antibodies to collagen, but do not have antibodies to thymocytes, DNA, or extractable nuclear antigens. Moreover, antinuclear antibodies when studied using HEp-2 cells as substrate demonstrate predominantly a speckled pattern. This syndrome of line 200 chickens is not detectable in F1 crosses to several UCD inbred lines. F1 X parental line BC1 backcrosses have an approximately 50% incidence of disease, suggesting that this syndrome is inherited as autosomal recessive. However, only 4% of F2 generation birds show abnormal symptoms, suggesting the presence of modifying genes. There is no appearance of IgG deposition, as determined by immunofluorescence, in either skin, blood vessels, esophagus, or heart. However, approximately 20% of chickens have a glomerulonephritis; this feature appears to be a terminal event and does not appear clinically significant. Although this syndrome of line 200 chickens has several features that are in sharp distinction to human scleroderma, the presence of common immunologic and pathologic denominators suggest that this spontaneous disease may be an appropriate model to develop a better understanding of autoimmune connective tissue diseases.

Because vascular thrombosis often accompanies arteriosclerotic disease in occluding blood vessels, the dissolution properties of laser irradiation were investigated and the energies needed to penetrate different lengths of thrombus were quantitated. Spectrophotometric studies show that the blood clot due to the presence of hemoglobin is well absorbed by argon laser energies, which emit blue-green wavelengths between 454 and 514 nm. Thus, laser energies transmitted directly from an argon-ion source produced vaporization and penetration of human thrombus in a linear dose-response fashion; the longer the thrombus, the greater the power intensity or time exposure necessary to penetrate the clot.