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Describes the first reported cases of blastomycosis acquired occupationally in Colorado in 1998. Medical conditions of the patients; Complaints from the patients; Factors that contributed to blastomycosis; Risk factors of blastomycosis.

We explore how hallucinations might be studied within the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) framework, which asks investigators to step back from diagnoses based on symptoms and focus on basic dimensions of functioning. We start with a description of the objectives of the RDoC project and its domains and constructs. Because the RDoC initiative asks investigators to study phenomena across the wellness spectrum and different diagnoses, we address whether hallucinations experienced in nonclinical populations are the same as those experienced by people with psychotic diagnoses, and whether hallucinations studied in one clinical group can inform our understanding of the same phenomenon in another. We then discuss the phenomenology of hallucinations and how different RDoC domains might be relevant to their study. We end with a discussion of various challenges and potential next steps to advance the application of the RDoC approach to this area of research., (© The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)

The capacity of state and territorial health departments to investigate foodborne diseases was assessed by the Council of State and Territorial Epidemiologists from 2001 to 2002 with a self-administered, Web-based survey. Forty-eight health departments responded (47 states and 1 territory). The primary reason for not conducting more active case surveillance of enteric disease is lack of staff, while the primary reasons for not investigating foodborne disease outbreaks are limited staff and delayed notification of the outbreak. Sixty-four percent of respondents have the capacity to conduct analytic epidemiologic investigations. States receiving Emerging Infections Program (EIP) funding from the Centers for Disease Control and Prevention more often reported having a dedicated foodborne disease epidemiologist and the capability to perform analytic studies than non-EIP states. We conclude that by addressing shortages in the number of dedicated personnel and reducing delays in reporting, the capacity of state health departments to respond to foodborne disease can be improved.

Background: In a one month period, 10 Serratia liquefaciens bloodstream infections and 6 pyrogenic reactions occurred in outpatients at a hemodialysis center., Methods: We performed a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections or pyrogenic reactions. We reviewed procedures and cultured samples of water, medications, soaps, and hand lotions and swabs from the hands of personnel., Results: We analyzed 208 sessions involving 48 patients. In 12 sessions, patients had S. liquefaciens bloodstream infections, and in 8, patients had pyrogenic reactions without bloodstream infection. Sessions with infections or reactions were associated with higher median doses of epoetin alfa than the 188 other sessions (6500 vs. 4000 U, P=0.03) and were more common during afternoon or evening shifts than morning shifts (P=0.03). Sessions with infections or reactions were associated with doses of epoetin alfa of more than 4000 U (multivariate odds ratio, 4.0; 95 percent confidence interval, 1.3 to 12.3). A review of procedures revealed that preservative-free, single-use vials of epoetin alfa were punctured multiple times, and residual epoetin alfa from multiple vials was pooled and administered to patients. S. liquefaciens was isolated from pooled epoetin alfa, empty vials of epoetin alfa that had been pooled, antibacterial soap, and hand lotion. All the isolates were identical by pulsed-field gel electrophoresis. After the practice of pooling epoetin alfa was discontinued and the contaminated soap and lotion were replaced, no further S. liquefaciens bloodstream infections or pyrogenic reactions occurred at this hemodialysis facility., Conclusions: Puncturing single-use vials multiple times and pooling preservative-free epoetin alfa caused this outbreak of bloodstream infections in a hemodialysis unit. To prevent similar outbreaks, medical personnel should follow the manufacturer's guidelines for the use of preservative-free medications.

A laboratory-based blood lead surveillance system in Colorado identified radiator repair workers as having the highest blood lead levels of all worker groups reported. A survey of 42 radiator repair shops in ten locales throughout Colorado was undertaken to estimate the prevalence of workers with elevated blood lead levels > 25 micrograms/dL. The survey was designed to test the sensitivity of the surveillance system and to assess working conditions and practices in the radiator repair industry in Colorado. Of 63 workers, 39 (62%) had blood lead levels > 25 micrograms/dL. The sensitivity of the surveillance system for detecting radiator repair workers with elevated blood lead levels was estimated at 11%. None of the radiator repair shops had adequate local exhaust ventilation. Work practice and engineering modifications are needed to reduce lead exposure in this industry.

The Health Promotion and Disease Prevention Survey, a component of the 1985 National Health Interview Survey (NHIS), contained a set of questions on injury control and child safety and health. The data collected from the responses were used to evaluate progress toward achieving three of the 1990 objectives for the nation related to injury prevention. Those three objectives concerned the proportions of households with a properly placed and functioning smoke detector (63.2 percent, as shown by the survey), parents who can identify appropriate measures to address the risks to their children of motor vehicle injuries, burns, and poisonings (39.1 percent), and primary health providers who advise their patients about the importance of using safety belts and child restraint devices in cars (47.0 percent). Further, information was gathered on the proportion of adults using seatbelts all or most of the time (35.5 percent) and the proportion of those who knew the range of hot water temperatures (120 degrees to 130 degrees F.) above which scald injuries can occur (21.3 percent). In general, the data demonstrated a direct relationship of injury prevention awareness to education and income. In the future it will be important to demonstrate that increasing injury awareness has a measurable, beneficial impact on injury mortality and morbidity rates.

It is difficult to make generalizations concerning the type of epidemiologic data currently preferred in the courts because trial judges' decisions are infrequently published, appellate judges' decisions are not always accompanied by an opinion, and there is often disparity between the opinions and standards of different courts. In this paper I have chosen cases either for their legal significance or their illustrative nature. The cases essentially represent numerator data, and therefore, I cannot determine definite trends in the courtroom use of epidemiologic data. When trying to determine if a causal relationship exists between an exposure and illness, epidemiologists attempt to examine the statistical strength, consistency, specificity, temporal sequence, dose-response characteristics, and biologic plausibility of the association. In contrast, a widely used legal standard of proof of association is "reasonable probability." However, the interpretation of "reasonable probability" is evolving. And just as epidemiologists may be pushed to the limit of their methods in trying to determine if and at what level a health risk exists, so the courts have had to forge new legal paths in considering whether epidemiologic evidence is sufficient to establish a causal relation between exposure to a substance and ill health. Furthermore, it is not certain what standard of significance the courts will require in the future. In 1975 in Reserve Mining Company vs. EPA, and Ethyl Corporation vs. EPA, the theoretical existence of risk was adequate to move the Appeals Courts to take precautionary action. But when considering a standard for safe levels of an occupational toxin, the Supreme Court has rejected a theoretical risk as significant (in Industrial Union vs. American Petroleum Institute) and instead, has required factual evidence of a dose-response relationship (as in American Textile Manufacturer's Institute vs. Donovan) because it did not want to extrapolate the risk of low levels of exposure from data based on high levels of exposure. Since demonstration of a dose-response relationship, although rarely obtained easily, is one of the criteria used by epidemiologists to infer a causal relationship, there can be no doubt that such evidence will strengthen any attempt to prove future damages from low level exposure to toxins. In addition, I predict evidence of attributable risk or attributable fraction will be useful in determining the extent of potential losses and, therefore, the value of future damages.(ABSTRACT TRUNCATED AT 400 WORDS)