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High prevalences of HIV and other sexually transmitted infections (STIs) have been reported in the current global monkeypox outbreak, which has affected primarily gay, bisexual, and other men who have sex with men (MSM) (1-5). In previous monkeypox outbreaks in Nigeria, concurrent HIV infection was associated with poor monkeypox clinical outcomes (6,7). Monkeypox, HIV, and STI surveillance data from eight U.S. jurisdictions* were matched and analyzed to examine HIV and STI diagnoses among persons with monkeypox and assess differences in monkeypox clinical features according to HIV infection status. Among 1,969 persons with monkeypox during May 17-July 22, 2022, HIV prevalence was 38%, and 41% had received a diagnosis of one or more other reportable STIs in the preceding year. Among persons with monkeypox and diagnosed HIV infection, 94% had received HIV care in the preceding year, and 82% had an HIV viral load of200 copies/mL, indicating HIV viral suppression. Compared with persons without HIV infection, a higher proportion of persons with HIV infection were hospitalized (8% versus 3%). Persons with HIV infection or STIs are disproportionately represented among persons with monkeypox. It is important that public health officials leverage systems for delivering HIV and STI care and prevention to reduce monkeypox incidence in this population. Consideration should be given to prioritizing persons with HIV infection and STIs for vaccination against monkeypox. HIV and STI screening and other recommended preventive care should be routinely offered to persons evaluated for monkeypox, with linkage to HIV care or HIV preexposure prophylaxis (PrEP) as appropriate.

West Nile virus (WNV) is a mosquito-borne flavivirus that can cause severe neurological disease in humans, for which there is no treatment or vaccine. From 2009 to 2018, California has reported more human disease cases than any other state in the United States. We sought to identify smaller geographic areas within the 10 California counties with the highest number of WNV cases that accounted for disproportionately large numbers of human cases from 2009 to 2018. Eleven areas, consisting of groups of high-burden ZIP codes, were identified in nine counties within southern California and California's Central Valley. Despite containing only 2% of California's area and 17% of the state's population, these high-burden ZIP codes accounted for 44% of WNV cases reported and had a mean annual incidence that was 2.4 times the annual state incidence. Focusing mosquito control and public education efforts in these areas would lower WNV disease burden.

Purpose: Syrian refugees (SRs) in Lebanon are often relegated to informal camps with poor living conditions and substandard access to health care. This study examined the unique condition of urban camp-dwelling SRs in Lebanon. This population is rarely studied as they are marginalized and difficult to access. We sought to assess the prevalence of noncommunicable diseases (NCDs) and health care-seeking behaviors within this population. Methods: A randomized group of urban camp-dwelling SR participants completed a survey on disease burden, health care-seeking patterns, and attitudes toward care. A second group completed interviews regarding health care experiences. We present descriptive population and epidemiologic measures to quantify NCD burden and health care-seeking behaviors. Results: Of 101 participants, 39% reported arthritis, 25% skin infection, 24% high blood pressure, 16% chronic lung conditions, 16% eye disease, and 15% diabetes. Major themes from interviews with SRs included poor living conditions, high cost of health care services, and perceived discrimination by health care workers (HCWs). The major theme from interviews with HCWs was a perception that SRs received health care services similar to members of surrounding communities. Discussion: In this population, we found a higher prevalence of NCDs at younger ages than in the general SR population. We described perceived barriers to accessing health care, including the noteworthy finding of perceived discrimination by HCWs in a linguistically and culturally related host community. We discussed social determinants of health within the camp and refugees' ability to access health care services.

BackgroundInformation on the occupational distribution of COVID-19 mortality is limited.ObjectiveTo characterize COVID-19 fatalities among working Californians.DesignRetrospective study of laboratory-confirmed COVID-19 fatalities with dates of death from January 1 to December 31, 2020.SettingCalifornia.ParticipantsCOVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18-64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as “confirmed working.” The remainder were classified as “likely working” (n=4,121 [51.2%]) or “not working” (n=1,443 [17.9%]) using death certificate and case registry data.MeasurementsWe calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators.ResultsConfirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3-30.8). Workers in nine occupational groups had mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7-88.2); material moving (77.8; 95% CI, 70.2-85.9); construction (62.4; 95% CI, 57.7-67.4); production (60.2; 95% CI, 55.7-65.0); and transportation (57.2; 95% CI, 52.2-62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers.LimitationsThe requirement that fatalities be laboratory-confirmed and the use of 2019 denominator data may underestimate the occupational burden of COVID-19 mortality.ConclusionCalifornians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers.

BACKGROUND Despite West Nile virus (WNV) blood donation screening using nucleic acid testing (NAT), donors with low viral loads not detected by mini-pool-NAT have led to transfusion transmitted (TT)-WNV infection. We describe a probable case of fatal TT-WNV infection from an individual donor (ID)-NAT non-reactive apheresis platelet donation. STUDY DESIGN AND METHODS An apheresis platelet donation was WNV ID-NAT reactive and prior donations from the same donor were investigated. A WNV ID-NAT non-reactive apheresis platelet unit collected 26 days earlier was transfused during heart transplantation to a patient who subsequently developed WNV neuroinvasive disease and expired. The source of the recipient's WNV infection was investigated. RESULTS Twenty-six days after collection of the suspect platelet unit, a donation from the same donor was WNV ID-NAT reactive and WNV IgM and IgG positive. In addition to the suspect platelet unit, the heart transplant recipient who developed WNV infection received 17 blood components from 24 donors. Serologic testing performed on 11 of the remaining 24 donors (46%) was WNV IgM negative. Pre-transplant recipient and heart donor samples tested WNV RNA and IgM negative. CONCLUSION A probable case of fatal neuroinvasive TT-WNV was linked to an infectious apheresis platelet unit undetected by WNV ID-NAT. It is hypothesized that the suspect unit was collected early in the viremic period when viral RNA was below the limit-of-detection of the ID-NAT assay. Implementation of ID-NAT screening of blood donors has not entirely eliminated the risk of TT-WNV infections, which may best be addressed by pathogen inactivation technologies.

Temperature is widely known to influence the spatio-temporal dynamics of vector-borne disease transmission, particularly as temperatures vary across critical thermal thresholds. When temperature conditions exhibit such ‘transcritical variation’, abrupt spatial or temporal discontinuities may result, generating sharp geographical or seasonal boundaries in transmission. Here, we develop a spatio-temporal machine learning algorithm to examine the implications of transcritical variation for West Nile virus (WNV) transmission in the Los Angeles metropolitan area (LA). Analysing a large vector and WNV surveillance dataset spanning 2006–2016, we found that mean temperatures in the previous month strongly predicted the probability of WNV presence in pools of Culex quinquefasciatus mosquitoes, forming distinctive inhibitory (10.0–21.0°C) and favourable (22.7–30.2°C) mean temperature ranges that bound a narrow 1.7°C transitional zone (21–22.7°C). Temperatures during the most intense months of WNV transmission (August/September) were more strongly associated with infection probability in Cx. quinquefasciatus pools in coastal LA, where temperature variation more frequently traversed the narrow transitional temperature range compared to warmer inland locations. This contributed to a pronounced expansion in the geographical distribution of human cases near the coast during warmer-than-average periods. Our findings suggest that transcritical variation may influence the sensitivity of transmission to climate warming, and that especially vulnerable locations may occur where present climatic fluctuations traverse critical temperature thresholds.

We assessed the prevalence of antimicrobial resistance and screened for clinically relevant β-lactamase resistance determinants in Gram-negative bacteria from a large urbanized estuary. In contrast to the broad literature documenting potentially hazardous resistance determinants near wastewater treatment discharge points and other local sources of aquatic pollution, we employed a probabilistic survey design to examine ambient, near-shore sediments. We plated environmental samples from 40 intertidal and shallow subtidal areas around San Francisco Bay (California, USA) on drug-supplemented MacConkey agar, and we tested isolates for antimicrobial resistance and presence of clinically relevant β-lactamase resistance determinants. Of the 74 isolates identified, the most frequently recovered taxa were Vibrio spp. (40%), Shewanella spp. (36%), Pseudomonas spp. (11%), and Aeromonas spp. (4%). Of the 55 isolates tested for antimicrobial resistance, the Vibrio spp. showed the most notable resistance profiles. Most (96%) were resistant to ampicillin, and two isolates showed multidrug-resistant phenotypes: V. alginolyticus (cefotaxime, ampicillin, gentamicin, cefoxitin) and V. fluvialis (cefotaxime, ampicillin, cefoxitin). Targeted testing for class 1 integrons and presence of β-lactam-resistance gene variants TEM, SHV, OXA, CTX-M, and Klebsiella pneumonia carbapenemase (KPC) did not reveal any isolates harboring these resistance determinants. Thus, while drug-resistant, Gram-negative bacteria were recovered from ambient sediments, neither clinically relevant strains nor mobile β-lactam resistance determinants were found. This suggests that Gram-negative bacteria in this well-managed, urbanized estuary are unlikely to constitute a major human exposure hazard at this time.

The threat of introduction of coronavirus disease 2019 (COVID-19) into the United States with the potential for community transmission prompted U.S. federal officials in February 2020 to screen travelers from China, and later Iran, and collect and transmit their demographic and contact information to states for follow-up. During February 5-March 17, 2020, the California Department of Public Health (CDPH) received and transmitted contact information for 11,574 international travelers to 51 of 61 local health jurisdictions at a cost of 1,694 hours of CDPH personnel time. If resources permitted, local health jurisdictions contacted travelers, interviewed them, and oversaw 14 days of quarantine, self-monitoring, or both, based on CDC risk assessment criteria for COVID-19. Challenges encountered during follow-up included errors in the recording of contact information and variation in the availability of resources in local health jurisdictions to address the substantial workload. Among COVID-19 patients reported to CDPH, three matched persons previously reported as travelers to CDPH. Despite intensive effort, the traveler screening system did not effectively prevent introduction of COVID-19 into California. Effectiveness of COVID-19 screening and monitoring in travelers to California was limited by incomplete traveler information received by federal officials and transmitted to states, the number of travelers needing follow-up, and the potential for presymptomatic and asymptomatic transmission. More efficient methods of collecting and transmitting passenger data, including electronic provision of flight manifests by airlines to federal officials and flexible text-messaging tools, would help local health jurisdictions reach out to all at-risk travelers quickly, thereby facilitating timely testing, case identification, and contact investigations. State and local health departments should weigh the resources needed to implement incoming traveler monitoring against community mitigation activities, understanding that the priorities of each might shift during the COVID-19 pandemic.

In 2010, the 10-valent pneumococcal conjugate vaccine (PCV10) was introduced free of charge in Brazil as part of the public immunization program. Here we investigated the carriage prevalence, colonization risk factors, capsular types, and antimicrobial resistance among pneumococcal isolates obtained from children in Brazil four years after routine PCV10 use.Between September and December 2014, we conducted a cross-sectional study among children6years old who attended one public and two private clinics in Niterói, RJ, Brazil to evaluate pneumococcal nasopharyngeal carriage. Antimicrobial susceptibility and capsular types were determined for all isolates.Of 522 children, 118 (22.6%) were pneumococcal carriers. Being≥2years old, attending childcare center, presenting with any symptoms, having acute or chronic respiratory disease, and residing in a slum were associated with pneumococcal carriage. The most prevalent capsular types were 6C (14.5%), 15B/C (11.5%), 11A/D (9.2%), and 6A (7.6%). PCV10 serotypes represented 2.5%. All isolates were susceptible to levofloxacin, rifampicin, and vancomycin. Penicillin non-susceptible pneumococci (PNSP) comprised 39%, with penicillin and ceftriaxone MICs ranging from 0.12-8.0μg/ml and 0.012-1.0μg/ml, respectively. The 33 (28%) erythromycin-resistant isolates (MICs of 1.5 to256μg/ml) displayed the cMLSEffects of universal childhood PCV10 use on carriage were evident, with the near elimination of PCV10 serotypes. The emergence of MDR serotype 6C isolates, however, is a concern. Ongoing surveillance to monitor serotype 6C increase in invasive diseases is warranted.

Background West Nile virus (WNV) is the most commonly reported mosquito-borne disease in the USA. California reports more WNV disease than any other state. Methods We identified WNV-associated hospitalizations from 2004 through 2017 in California and estimated hospitalization incidence using Patient Discharge Data. We described demographic, geographic, and clinical characteristics of WNV hospitalizations; identified risk factors for in-hospital death; and tabulated hospitalization charges. Results From 2004 through 2017, 3109 Californians were hospitalized with WNV (median, 214 patients/year; range, 72–449). The majority were male (1983; 63.8%) and aged ≥60 years (1766; 56.8%). The highest median annual hospitalization rate (0.88 hospitalizations/100 000 persons) was in the Central Valley, followed by southern California (0.59 hospitalizations/100 000 persons). Most patients (2469; 79.4%) had ≥1 underlying condition, including hypertension, cardiovascular disease, diabetes, chronic kidney disease, or immunosuppression due to medications or disease. Median hospitalization length of stay was 12 days (interquartile range, 6–23 days). During hospitalization, 1317 (42%) patients had acute respiratory failure and/or sepsis/septic shock, 772 (24.8%) experienced acute kidney failure, and 470 (15.1%) had paralysis; 272 (8.8%) patients died. Nearly 47% (1444) of patients were discharged for additional care. During these 14 years, $838 680 664 (mean $59.9 million/year) was charged for WNV hospitalizations, 73.9% through government payers at a median charge of $142 321/patient. Conclusions WNV-associated hospitalizations were substantial and costly in California. Hospitalization incidence was higher in males, elderly persons, and patients with underlying conditions. WNV persists as a costly and severe public health threat in California.

This chapter describes the growth and impact on public health of urban informal settlements or “slums” in metropolitan Rio de Janeiro, colloquially known as favelas in Brazil. We outline the specific physical, legal, and social characteristics of life in favelas in this region in addition to describing several of the public health systems’ responses to support Brazilians who live in such communities, such as the Sistema Unico de Saude, introduced in the 1988 Constitution as a single-payer health system. We then highlight some of these characteristics by examining select diseases through a series of case studies from our work in these communities.

The California Arbovirus Surveillance Program was initiated over 50 years ago to track endemic encephalitides and was enhanced in 2000 to include West Nile virus (WNV) infections in humans, mosquitoes, sentinel chickens, dead birds and horses. This comprehensive statewide program is a function of strong partnerships among the California Department of Public Health (CDPH), the University of California, and local vector control and public health agencies. This manuscript summarizes WNV surveillance data in California since WNV was first detected in 2003 in southern California. From 2003 through 2018, 6,909 human cases of WNV disease, inclusive of 326 deaths, were reported to CDPH, as well as 730 asymptomatic WNV infections identified during screening of blood and organ donors. Of these, 4,073 (59.0%) were reported as West Nile neuroinvasive disease. California’s WNV disease burden comprised 15% of all cases that were reported to the U.S. Centers for Disease Control and Prevention during this time, more than any other state. Additionally, 1,299 equine WNV cases were identified, along with detections of WNV in 23,322 dead birds, 31,695 mosquito pools, and 7,340 sentinel chickens. Annual enzootic detection of WNV typically preceded detection in humans and prompted enhanced intervention to reduce the risk of WNV transmission. Peak WNV activity occurred from July through October in the Central Valley and southern California. Less than five percent of WNV activity occurred in other regions of the state or outside of this time. WNV continues to be a major threat to public and wild avian health in California, particularly in southern California and the Central Valley during summer and early fall months. Local and state public health partners must continue statewide human and mosquito surveillance and facilitate effective mosquito control and bite prevention measures., Author summary West Nile virus (WNV) was first detected in the United States in 1999, and subsequently spread throughout the country. It is now the most commonly reported disease that is transmitted by mosquitoes in the United States. California has reported approximately 15% of all human WNV infections since the virus was first reported in the state in 2003. The California Department of Public Health works with partners throughout the state to conduct robust surveillance of WNV infections in mosquitoes, dead birds, and sentinel chickens, using these data to direct vector control activity and reduce the risk of WNV transmission to people. This article summarizes sixteen years of human, mosquito, chicken, equine, and dead wild bird surveillance for WNV in California, the most comprehensive description of WNV surveillance data to date. We found that WNV enzootic and human activity varied geographically and in intensity from year-to-year. Almost 95% of all WNV activity in California occurred in the Central Valley and southern California between April and November.

Staphylococcus aureus nasal colonization is a major risk factor for infection. Studies have suggested an epidemiologic shift in the methicillin-resistant S. aureus (MRSA) strains that circulate in Brazil. We conducted cross-sectional studies of MRSA carriage among 1) children and adolescents in community daycare centers, 2) an outpatient clinic, and 3) hospitals in a large Brazilian metropolitan setting. There were 1.500 study subjects, 500 from each locale: 768 (51.2%) carried S. aureus whereas 150 (10%) of these were colonized with MRSA. The most common lineages were the Southwest Pacific (SWP) and the Pediatric clones in all three groups. Roughly 50% of SWP carried Panton-Valentine leukocidin (PVL) (p 0.01) genes while 63.3% of the Pediatric clones were resistant or intermediately resistant to erythromycin (p 0.01). This study describes a clonal change of the Brazilian epidemic clone (BEC) to the Pediatric and SWP lineages in Brazil. This finding has implications for clinical management of MRSA infections.

To determine the population structure and change in drug resistance of pneumococci colonizing children before and after the introduction of the 10-valent and 13-valent pneumococcal conjugate vaccines (PCV10/13) in Brazil.We used MLST to analyse 256 pneumococcal isolates obtained from children aged6 years before (2009-10; n = 125) and after (2014; n = 131) the introduction of the PCV10 and PCV13. Antimicrobial susceptibility and capsular types were previously determined.We identified 97 different STs. Ninety (35.2%) isolates were related to international clones. The most frequent lineages were serogroup 6-CC724 (where CC stands for clonal complex) and the MDR serotype 6C-CC386 in the pre- and post-PCV10/13 periods, respectively. Penicillin-non-susceptible pneumococci (PNSP) formed 24% and 38.9% of the pre- and post-PCV10/13 isolates, respectively (P = 0.01). In the pre-PCV10/13 period, serotype 14-ST156 was the predominant penicillin-non-susceptible lineage, but it was not detected in the post-PCV10/13 period. Serotype 14-ST156 and serotype 19A-ST320 complex isolates had the highest penicillin and ceftriaxone MICs in the pre- and post-PCV10/13 periods, respectively. In turn, serotype 6C-CC386 comprised almost 30% of the PNSP and over 40% of the erythromycin-resistant isolates (MIC256 mg/L) in the post-PCV10/13 period.Although PNSP strains were polyclonal, most resistant isolates belonged to a single genotype from each period. Higher erythromycin resistance prevalence (42%) in the post-PCV10/13 period was mainly attributed to MDR serotype 6C-CC386. Ongoing surveillance of pneumococcal clonal composition is important to evaluate PCV use outcomes and to identify factors other than PCVs that drive pneumococcal drug resistance evolution.

Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9⁻26.4) and 22.9% (21.2⁻24.6), respectively) and for dyslipidemia (22.7% (19.8⁻25.5) and 21.5% (19.7⁻23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9⁻12.3)) and of overweight/obesity (46.5% (43.1⁻49.9)), compared to 5.2% (4.2⁻6.1) and 40.6% (38.5⁻42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1⁻17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1⁻9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities.

Author(s): Snyder, Robert E; Boone, Claire E; Cardoso, Claudete A Araujo; Aguiar-Alves, Fabio; Neves, Felipe PG; Riley, Lee W

Summary For the past six years in which overwintering mortality of honey bee colonies has been surveyed in the USA, estimates of colony loss have fluctuated around one-third of the national population. Here we report on the losses for the 2012-2013 seasons. We collected data from 6,482 US beekeepers (6,114 backyard, 233 sideline, and 135 commercial beekeepers) to document overwintering mortality rates of honey bee colonies for the USA. Responding beekeepers reported a total 30.6% (95% CI: 30.16-31.13%) loss of US colonies over the winter, with each beekeeper losing on average 44.8% (95% CI: 43.88-45.66%) of their colonies. Total winter losses varied across states (range: 11.0% to 54.7%). The self-reported level of acceptable winter loss was 14.6%, and 73.2% of the respondents had mortality rates greater than this level. The leading self-identified causes of overwintering mortality were different according to the operation type; backyard beekeepers generally self-identified “manageable” factors (e.g., starvation, weak colony in the fall), while commercial beekeepers generally identified nonmanageable factors (e.g., queen failure, pesticides) as the main cause of losses. For the first time in this series of surveys, we estimated mortality during the summer (total loss = 25.3% (95% CI: 24.80-25.74%), average loss = 12.5% (95% CI: 11.92-13.06%)). The entire 12months period between April 2012 and April 2013 yielded a total loss of 45.2% (95% CI: 44.58-45.75%), and an average loss of 49.4% (95% CI: 48.46-50.43%). While we found that commercial beekeepers lost fewer colonies than backyard beekeepers in the winter (30.2% (95% CI: 26.54-33.93% vs 45.4% (44.46-46.32%) respectively), the situation was reversed in the summer where commercial beekeepers reported higher average losses than backyard beekeepers (21.6% (95% CI: 18.4-24.79%) vs 12.1% (11.46-12.65%)). These findings demonstrate the ongoing difficulties of US beekeepers in maintaining overall colony heath and survival.

Brazil’s National Tuberculosis Control Program seeks to improve tuberculosis (TB) treatment in vulnerable populations. Slum residents are more vulnerable to TB due to a variety of factors, including their overcrowded living conditions, substandard infrastructure, and limited access to healthcare compared to their non-slum dwelling counterparts. Directly observed treatment (DOT) has been suggested to improve TB treatment outcomes among vulnerable populations, but the program’s differential effectiveness among urban slum and non-slum residents is not known. Methods: We retrospectively compared the impact of DOT on TB treatment outcome in residents of slum and non-slum census tracts in Rio de Janeiro reported to the Brazilian Notifiable Disease Database in 2010. Patient residential addresses were geocoded to census tracts from the 2010 Brazilian Census, which were identified as slum (aglomerados subnormais -AGSN) and non-slum (non-AGSN) by the Census Bureau. Homeless and incarcerated cases as well as those geocoded outside the city’s limits were excluded from analysis. Results: In 2010, 6,601 TB cases were geocoded within Rio de Janeiro; 1,874 (27.4 %) were residents of AGSN, and 4,794 (72.6 %) did not reside in an AGSN area. DOT coverage among AGSN cases was 35.2 % (n = 638), while the coverage in non-AGSN cases was 26.2 % (n = 1,234). Clinical characteristics, treatment, follow-up, cure, death and abandonment were similar in both AGSN and non-AGSN TB patients. After adjusting for covariates, AGSN TB cases on DOT had 1.67 (95 % CI: 1.17, 2.4) times the risk of cure, 0.61 (95 % CI: 0.41, 0.90) times the risk of abandonment, and 0.1 (95 % CI: 0.01, 0.77) times the risk of death from TB compared to non-AGSN TB cases not on DOT. Conclusion: While DOT coverage was low among TB cases in both AGSN and non-AGSN communities, it had a greater impact on TB cure rate in AGSN than in non-AGSN populations in the city of Rio de Janeiro.

Low- and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21 % (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95 % confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (p

To quantitatively assess disease burden due to tuberculosis between populations residing in and outside of urban informal settlements in Rio de Janeiro, Brazil, we compared disability-adjusted life years (DALYs), or “DALY-gap.” Using the 2010 Brazilian census definition of informal settlements as aglomerados subnormais (AGSN), we allocated tuberculosis (TB) DALYs to AGSN vs non-AGSN census tracts based on geocoded addresses of TB cases reported to the Brazilian Information System for Notifiable Diseases in 2005 and 2010. DALYs were calculated based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted DALYs/100,000 population between AGSN and non-AGSN. Total TB DALY in Rio in 2010 was 16,731 (266 DALYs/100,000). DALYs were higher in AGSN census tracts (306 vs 236 DALYs/100,000), yielding a DALY-gap of 70 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4 %. DALY-gap was highest for males 40–59 years of age (501 DALYs/100,000) and in census tracts with

Background In the past decade methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly prevalent in community settings. Attending a daycare center (DCC) is a known risk factor for colonization with MRSA. Brazil operates free, public DCCs for low-income families, some of which are located in census tracts defined by the Brazilian Census Bureau as informal settlements (aglomerados subnormais, AGSN). Physical and demographic characteristics of AGSNs suggest that S. aureus colonization prevalence would be higher, but little is known about the prevalence of MRSA in these settings. Methods We conducted a cross-sectional study to assess risk factors for S. aureus and MRSA colonization among children attending DCCs located in AGSN vs non-AGSN. Nasal swabs were collected from children aged three months to six years in 23 public DCCs in Niterói, Brazil between August 2011 and October 2012. Results Of 500 children enrolled in the study, 240 (48%) were colonized with S. aureus and 31 (6.2%) were colonized with MRSA. Children attending DCCs in AGSNs were 2.32 times more likely to be colonized with S. aureus (95% CI: 1.32, 4.08), and 3.27 times more likely to be colonized with MRSA than children attending non-AGSN DCCs (95% CI: 1.52, 7.01), adjusted for confounding variables. Conclusion S. aureus and MRSA colonization prevalence among children attending DCCs in informal settlement census tracts was higher than previously reported in healthy pre-school children in Latin America. Our data suggest that transmission may occur more frequently in DCCs rather than at home, highlighting the importance of DCCs in AGSNs as potential MRSA reservoirs. This finding underscores the importance of local epidemiologic surveillance in vulnerable AGSN communities. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-538) contains supplementary material, which is available to authorized users.

Shepherd of the Hills Country: Tourism Transforms the Ozarks, 1880s-1930s Lynn Morrow and Linda Myers-Phinney. Fayetteville: University of Arkansas Press, 1999. Tourism is projected to become the number one industry in Missouri in the twenty-first century, bringing in more than $17 billion annually. Lynn Morrow and Linda Myers-Phinney draw on their experience as preservationists and archivists to examine the evolution and impact of tourism in the Ozarks, a mountain and river chain in Missouri and Arkansas. In the nineteenth century, immigrants came by wagon roads and keelboats, and established a stockman's agriculture centering on furs, pelts, cattle, hogs, cotton, grain, flour, and lumber. In the 1870s, railroads broke down the isolation of the frontier, expanded the population, and diversified the economy. As the United States industrialized and urbanized in the mid-nineteenth century, people sought escape from the stresses and strains of cities. The countryside offered opportunities of rest, relaxation, and regeneration from regimented lives. People of means from Kansas City, St. Louis, and other Midwestern points sought out the Ozarks for physical and spiritual regeneration. Harold Bell Wright romanticized the natural and primitive locale in The Shepherd of the Hills (1907). More and more people wanted to experience the romanticized ideal of simplicity and wholesomeness. Travelogues provided a popular way of explaining and inventing the mythical Ozarks. Tourists were attracted to the karst formations: valleys, caves, springs, and sinkholes carved by water running over limestone. In a state that had over 4,000 caves, Marble Cave, Missouri, for example, had multiple lives: a repository of minerals, relics of earlier civilizations, and natural fertilizer (bat dung); a sublime place to hold social and political events; and a natural storage site for food and moonshine. Hunting and fishing also proved popular, not simply for food and clothing but also for sport and recreation. Float trips became a popular wilderness adventure. In the 1890s, wealthy businessmen purchased thousands of acres for private game parks and made longterm investments. Over the decades, commercialization also set in. As the railroad added a spur to Marble Cave, management in turn accommodated visitors by erecting ladders down into the cavern, a stage for performances in the Great Room, and cabins and souvenir stands around the attraction. Local arts and crafts-handmade chairs, rugs, quilts, and baskets - became cottage industries. …

After sending off a portfolio of his pictures to the headquarters of the Farm Security Administration (FSA) in Washington, DC, John Collier, Jr, became so preoccupied with just trying to survive in photography that he forgot about his submission. As weeks turned into months, he bounced from one photography job to another. Collier felt that he had hit rock bottom in 1941 working as a printer for Gabriel Milan's, ‘a very cut-throat photography company in San Francisco’. Then one day his labour in the laboratory was interrupted by a telephone call from Washington. ‘I was called out of my little dungeon where I was tinting goldtoned baby portraits and picked up the phone and couldn't hear what the man said, having a life-long hearing difficulty’. Collier handed the receiver over to the nearest person, who happened to be his boss, to relay the message. ‘There's a crazy guy in Washington, DC, who wants to pay you $2,300 a year. You'd better take it because I'm going to fire you’. A shocked and elated C...

The American South has been defined and described in terms ranging all the way from physiographic factors like climate, soil types, and staple crops, through demographical statistics on race, health, and education, to psychological considerations of defeat, guilt, and deprivation.1 In his celebrated study The Mind of the South, Wilbur J. Cash observed that the American South was ‘the closest thing to a nation within a nation’.2 Indeed, the principles and practices of white supremacy, one-party politics, and Jim Crow persisted in those states that had once formed the Confederacy well into the twentieth century. Since Cash made his observations immigration, industrialization, and metropolitanization among other powerful crosscurrents have dramatically transformed the physical and mental landscapes of the region.

capital of the state of Bahia. This NIAID-supported longitudinal project was established to primarily study the natural history of leptospirosis and determining the effectiveness of community-based interventions, such as improved sanitation. This research has also led to the collection of basic demographic and health data on blood pressures and cardiovascular disease outcomes relevant to leptospirosis, and has given a unique picture of the burden of hypertension and other noncommunicable diseaeses in this unique population. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): We work closely with the Fiocruz, the research branch of the Brazilian Ministry of Health. Our team also has a longstanding relationship with teh Urban Health Council of the Residents’ Association of Pau da Lima. Summary/Conclusion: The worldwide growth of slums presents a significant challenge to global public health. Limited data suggest that all health outcomes, both communicable and noncommunicable, are worse in slums that are by their nature illegal, comprised of overcrowded and poorly built communities that have limited access to safe water, sanitation, and other services. Yet, accurate health statistics in these communities are difficult to obtain and interventions are limited by their informal relationship to the state. Large investments in the study of disease in these communities may have multiple returns. For instance, the study of rheumatic disease may provide important information on cardiovascular disease outcomes in these communities. The implications of this kind of “double-dipping” challenges certain aspects of research design, but if done responsibly, may also provide a wealth of information where information is sparse, and further draw closer those who study communicable and noncommunicable diseases.

1. On the Cusp of Classical Hollywood Cinema Patrolling the Diegesis Pre-Code Contexts 2. Breadlines and Box Office Lines: Hollywood in the Nadir of the Great Depression The Lost Millions A Synchronized Industry "Mike Fright" 3. Preachment Yarns: The Politics of Mere Entertainment Telegraphing Ideology Class Distinctions Professional Malfeasance 4. Dictators and Democrats: The Rage for Order Hankering for Supermen "The Barrymore of the Capital": The Newsreel Presidency of Franklin Delano Roosevelt A New Deal in the Last Reel The Mad Dog of Europe 5. Vice Rewarded: The Wages of Cinematic Sin Packaging Vice Models of Immorality Figurative Literalness Queer Flashes "Women Love Dirt" Working Girls 6. Criminal Codes: Gangsters Unbound, Felons in Custody Rushing Toward Death: The Gangster Film Men Behind Bars: The Prison Film 7. Comic Timing: Cracking Wise and Wising Up Commentators on the Action Story, Screenplay, and All Dialogue by Mae West Newspaper Patter The Blue Eagle and Duck Soup (1933) 8. News on Screen: The Vividness of Mechanical Immortality Library Stock The Newsreel Ethos Covering Up the Great Depression 9. Remote Kinships: The Geography of the Expeditionary Film Points on the Compass Faking It: Phoney Expeditions and Real Deaths The Dark Continent 10. Primitive Mating Rituals: The Color Wheel of the Racial Adventure Film "He's White": Tarzan, the Ape Man (1932) and Tarzan and His Mate (1934) Red Skin, Red Lips: Massacre (1934) East Mates West "The Ethiopian Trade" Nerve and Brains: Paul Robeson and The Emperor Jones (1933) Beauty and the Beast: King Kong (1933) 11. Nightmare Pictures: The Quality of Gruesomeness Rugged Individualism: Dracula (1931), Frankenstein (1931), and Their Progeny The Lower Orders Rise Up: Island of Lost Souls (1933) and Freaks (1932) 12. Classical Hollywood Cinema: The World According to Joseph I. Breen "The Storm of '34" Hollywood Under the Code Post-Code Hollywood Cinema

Margaret Bourke-White (1904–1971) has been called “the most famous woman photographer” and “the finest woman photographer of our times.” Indeed, in a photographic career that spanned nearly five decades, Bourke-White demonstrated great professional versatility, registered many photographic firsts, and in a male-dominated field set standards by which others were measured. During the 1920s, Bourke-White carved out her first reputation in architectural and industrial photography. Her pictures of steel mills, shipyards, packing houses, logging camps, quarries, auto plants, skyscrapers, banks, and terminals captured the atmosphere of the industry and the dynamics of the capitalist system. Her industrial photography was of such outstanding quality that, as one critic observed, it “transformed the American factory into a Gothic cathedral.”Henry Luce was so impressed by her early work that he hired her as the first photographer for his business magazine Fortune. Under a unique arrangement she was allowed six months out of the year to pursue her own private studio practice for advertising agencies and corporations. When Henry Luce added the pictorial magazine Life to his growing publishing empire in the 1930s, he selected Margaret Bourke-White to become one of the four original staff photographers. At Life she established the tradition of negatives printed full frame and proved by black borders, and pioneered the synchronized multiple flash picture. Bourke-White revealed the range of her photographic talents in photo essays, murals, and documentary travelogues. “As a result of her twelve- and fourteen-page essays,” Carl Mydans noted, “her monumental work became known throughout the world — beyond that of any other photographer.”

A Project Manager must be able to assess the status of his program to maintain control of it. Numerous methods have been used by the Naval Sea Systems Command (NAVSEA). The latest is the concept of Pre-Sea Trial Audit (PSTA). This paper describes the first application of this audit process to a major, new construction combatant ship, the USS Nimitz (CVN-68), a nuclear aircraft carrier; outlines the major problems encountered in its implementation; and offers the Author's conclusions on the usefulness of the concept.

In 1937, Erskine Caldwell, the noted Southern author ofTobacco RoadandGod's Little Acre, and Margaret Bourke-White, the famous photographer forFortuneandLifemagazines, publishedYou Have Seen Their Faces. The documentary was a devastating broadside on Southern delinquencies. Right from the opening paragraph, Caldwell began painting an image of the South as a benighted region.