Search

Population-based case-control studies are a time- and labor-intensive component of foodborne outbreak investigations. One alternative is a binomial trial that asks the question "if the likelihood of each case's having eaten a given food is no different from that of the average person in the population, how often would we find, by chance alone, that x of n (or more) cases would have eaten this food?" Calculating a binomial trial requires background exposure data. We conducted case-control studies and binomial trials in two foodborne outbreaks and compared results. In both outbreaks, using binomial trials we found much less than a 5% probability that the number of cases eating the suspected food vehicle would have occurred by chance. These results were comparable with results of the case-control studies, but with considerably less effort. When background exposure data are available, binomial trials are an efficient way to explore hypotheses that can be further tested by traceback efforts to identify a common source.

Introduction: Resistance to second-line tuberculosis drugs is common, but slow to diagnose with phenotypic drug sensitivity testing. Rapid molecular tests speed up diagnosis, but can only detect limited mutations. Whole genome sequencing (WGS) of culture isolates can generate a complete genetic drug resistance profile, but is delayed by the initial culture step. In the case presented here, successful WGS directly from sputum was achieved using targeted enrichment., Case Report: A 29-year-old Nigerian woman was diagnosed with tuberculosis. Xpert MTB/RIF and Hain line probe assays identified rpoB and inhA mutations consistent with rifampicin and intermediate isoniazid resistance, and a further possible mutation conferring fluoroquinolone resistance. WGS directly from sputum identified a further inhA mutation consistent with high-level isoniazid resistance and confirmed the absence of fluoroquinolone resistance. Isoniazid was stopped, and the patient has completed 18 months of a fluoroquinolone-based regimen without relapse., Discussion: Compared to rapid molecular tests (which can only examine a limited number of mutations) and WGS of culture isolates (which requires a culture step), WGS directly from sputum can quickly generate a complete genetic drug resistance profile. In this case, WGS altered the clinical management of drug-resistant tuberculosis and demonstrated potential for guiding individualized drug treatment where second-line drug resistance is common., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category., Methods: A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY., Results: In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time., Conclusions: Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals., (Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Background and Overview: Knowing how to search for evidence that can inform clinical decisions is a fundamental skill for the practice of evidence-based dentistry. There are many available types of evidence-based resources, characterized by their degrees of coverage of preappraised or summarized evidence at varying levels of processing, from primary studies to systematic reviews and clinical guidelines. The practice of evidence-based dentistry requires familiarity with these resources. In this article, the authors describe the process of searching for evidence: defining the question, identifying the question's nature and main components, and selecting the study design that best addresses the question.

Background: Limited scientific evidence is available regarding D/deaf women's breast cancer knowledge and early detection practices, as well as about how to increase D/deaf women's breast cancer control practices., Objective/hypothesis: To assess baseline breast cancer knowledge and practices among a sample of D/deaf women recruited into a randomized controlled trial of a breast cancer education program developed for this population., Methods: A written and signed (American Sign Language) survey was administered to a racially/ethnically diverse sample of 209 D/deaf women, 40+ years old, with lower levels of education, recruited in California between October 2008 and May 2009., Results: There were misconceptions about breast cancer risk factors, screening, and treatment; only 64.2% of respondents correctly identified the purpose of mammography. Mammography in the prior 2 years was reported by 57.3% of the sample, by 69.8% of White women, and by 43.5% of women from other racial/ethnic groups. Rates also varied by education, having seen a physician in the prior year, and type of insurance., Conclusions: This study underscores significant gaps in breast cancer screening knowledge and practices, communication issues in health care settings, and unmet needs for tailored health information and materials in this population. Challenges faced in conducting the research needed to develop and test such programs are noted., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Evidence-based policy depends on the availability of high-quality research that is relevant to the population. This study aimed to identify the available data on the health of older Indigenous Australians in population-based longitudinal studies of ageing., Approach: Evaluation of the Dynamic Analyses to Optimise Ageing Project (DYNOPTA) dataset that has pooled nine Australian longitudinal ageing studies, six of which were analysed here., Main Outcome Measures: Proportions of the DYNOPTA sample identified as Indigenous., Results: Indigenous participants made up 0.7% of males and 0.5% of females in the weighted sample, compared with 0.8% of both sexes in the Australian population. Indigenous under-representation is greater at ages 45-54 than at older ages, despite overall greater participation in this age range., Conclusions and Implications: Within the existing Australian longitudinal ageing studies, Indigenous Australians are under-represented. This means there is a significant gap in the evidence base relating to the health of older Indigenous Australians. Research approaches specifically designed to address the health and wellbeing of older Indigenous Australians are urgently required., (© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.)

Prostaglandin E(2) (PGE(2)) inhibits fibroblast proliferation and collagen production. Its synthesis by fibroblasts is induced by profibrotic mediators including transforming growth factor (TGF)-beta(1). However, in patients with pulmonary fibrosis, PGE(2) levels are decreased. In this study we examined the effect of TGF-beta(1) on PGE(2) synthesis, proliferation, collagen production, and cyclooxygenase (COX) mRNA levels in fibroblasts derived from fibrotic and nonfibrotic human lung. In addition, we examined the effect of bleomycin-induced pulmonary fibrosis in COX-2-deficient mice. We demonstrate that basal and TGF-beta(1)-induced PGE(2) synthesis is limited in fibroblasts from fibrotic lung. Functionally, this correlates with a loss of the anti-proliferative response to TGF-beta(1). This failure to induce PGE(2) synthesis is because of an inability to up-regulate COX-2 mRNA levels in these fibroblasts. Furthermore, mice deficient in COX-2 exhibit an enhanced response to bleomycin. We conclude that a decreased capacity to up-regulate COX-2 expression and COX-2-derived PGE(2) synthesis in the presence of increasing levels of profibrotic mediators such as TGF-beta(1) may lead to unopposed fibroblast proliferation and collagen synthesis and contribute to the pathogenesis of pulmonary fibrosis.

The diffusion coefficient for cyclohexane confined within pores of diameter 40 to 500 A has been measured as a function of temperature between 296 and 180 K, and is compared to values obtained for the bulk material. A substantial liquid-like signal is observed in the region of the depressed freezing points and a diffusion coefficient is measurable in all samples to well below these temperatures. The diffusion data appear to be continuous over the freezing region. These observations suggest persisting molten layers at interfaces which exchange with crystals forming within the silica pores. The diffusion coefficient of the molecules in the surface layer is three orders of magnitude larger than in the plastic phase of bulk cyclohexane.

The effects of confinement on various organic molecules have been studied by nuclear magnetic resonance (NMR) relaxation techniques (T2 and T1 rho) between room temperature and 77 K. Cyclohexane, pentadecane, squalane, and squalene have been constrained within 60 A porous silica, and the behaviour of the resulting nanocrystals has been compared to that of the bulk material. In all cases the molecular dynamics of the confined material were found to be significantly different from the bulk, and there is evidence to suggest that the behaviour is largely dependent on the size and shape of the molecules and the resultant structural disorder present when constrained within the pores.

Study Objective: A disposable barrier filter (Pall Biomedical, United Kingdom) was developed to prevent the contamination of lung function equipment in clinical use. The aims of this study were to examine its resistance characteristics and to determine the effect of the filter on clinical measurements of lung function., Measurements: Twenty-one randomly selected patients and four normal subjects had lung function measured with and without the filter between the mouth and measuring equipment. Measurements of ventilatory function were made with a pneumotachograph (Lilly; Hoechberg, Germany), total lung capacity and airway resistance by constant volume plethysmography, and diffusing capacity for carbon monoxide by the single breath method. Resistance was determined in five unused filters over the flow range 1 to 12 L/s and at a single flow rate (12 L/s) just after a normal subject expired 20 forced vital capacity (FVC) breaths through each of them., Results: The resistance (mean +/- SD) of unused filters was 0.19 +/- 0.02 cm H2O/L/s at 1 L/s and increased linearly to 0.56 +/- 0.02 cm H2O/L/s at 12 L/s. There was no significant increase in resistance after use. The addition of the filter to the breathing circuit caused statistically significant decreases in forced expiratory volume in 1 s (FEV1) (0.044 +/- 0.08 L, p = 0.014) and peak expiratory flow rate (PEFR) (0.47 +/- 0.073 L/s, p = 0.004). The filter did not affect other indices of lung function., Conclusion: The filter caused a statistically significant reduction in FEV1 and PEFR; however, this difference was believed not to affect the clinical utility of routine lung function testing.