Department of Population Health Sciences

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Addressing opioid misuse through community-engaged strategy development: study protocol of a randomized controlled trial
Zimmerman, Emily B.; Rafie, Carlin; Wenzel, Sophie G.; Hosig, Kathryn; Villani, Domenique; Dance, Jon; Lee, Samantha S. (2024-07-19)
Background: Involving stakeholders in the research process facilitates collaboration, increasing understanding of factors influencing their wellbeing and motivating community action. Currently, there is a need for randomized controlled trials to evaluate the effectiveness of community-engaged research approaches for health, well-being, and engagement outcomes. In this study, we evaluate the effectiveness of both the SEED Method and a modified Delphi method in a participatory project to develop local strategies to address the opioid epidemic in three rural communities. The purpose of this study is to increase the level of evidence for community-engaged research methods through a randomized controlled trial. Methods: Two communities will use the SEED Method and one will use a modified Delphi method. We aim to recruit a total of 144 participants (48 per community). The evaluation team will randomize participants to an intervention group or a control group. In addition, we will collect outcome data from the participatory research team members leading the projects in each county (n = 18) and from additional community members who participate in focus groups (n = 32). The primary outcome for all participants will be the change in self-reported civic engagement as measured by the total score on the Individual Mobilization Scale. Discussion: In the context of participatory action to address opioid misuse in rural counties, this study will provide an understanding of the effectiveness of two community engagement methods for increasing civic engagement, as well as the extent to which participants successfully create locally tailored action strategies. The study will also explore how the observed effects differ depending on the participant’s role in the project (stakeholder participant, community research team member, or focus group participant), which is an important consideration for participatory research.
Adverse Health Outcomes Following Hurricane Harvey: A Comparison of Remotely-Sensed and Self-Reported Flood Exposure Estimates
Ramesh, Balaji; Callender, Rashida; Zaitchik, Benjamin F.; Jagger, Meredith; Swarup, Samarth; Gohlke, Julia M. (American Geophysical Union, 2023-04)
Remotely sensed inundation may help to rapidly identify areas in need of aid during and following floods. Here we evaluate the utility of daily remotely sensed flood inundation measures and estimate their congruence with self-reported home flooding and health outcomes collected via the Texas Flood Registry (TFR) following Hurricane Harvey. Daily flood inundation for 14 days following the landfall of Hurricane Harvey was acquired from FloodScan. Flood exposure, including number of days flooded and flood depth was assigned to geocoded home addresses of TFR respondents (N = 18,920 from 47 counties). Discordance between remotely-sensed flooding and self-reported home flooding was measured. Modified Poisson regression models were implemented to estimate risk ratios (RRs) for adverse health outcomes following flood exposure, controlling for potential individual level confounders. Respondents whose home was in a flooded area based on remotely-sensed data were more likely to report injury (RR = 1.5, 95% CI: 1.27-1.77), concentration problems (1.36, 95% CI: 1.25-1.49), skin rash (1.31, 95% CI: 1.15-1.48), illness (1.29, 95% CI: 1.17-1.43), headaches (1.09, 95% CI: 1.03-1.16), and runny nose (1.07, 95% CI: 1.03-1.11) compared to respondents whose home was not flooded. Effect sizes were larger when exposure was estimated using respondent-reported home flooding. Near-real time remote sensing-based flood products may help to prioritize areas in need of assistance when on the ground measures are not accessible.
Aligning evidence generation and use across health, development, and environment
Tallis, Heather; Kreis, Katharine; Olander, Lydia P.; Ringler, Claudia; Ameyaw, David; Borsuk, Mark E.; Fletschner, Diana; Game, Edward; Gilligan, Daniel O.; Jeuland, Marc; Kennedy, Gina; Masuda, Yuta J.; Mehta, Sumi; Miller, Nicholas; Parker, Megan; Pollino, Carmel; Rajaratnam, Julie; Wilkie, David; Zhang, Wei; Ahmed, Selena; Ajayi, Oluyede C.; Alderman, Harold; Arhonditsis, George; Azevedo, Ines; Badola, Ruchi; Bailis, Rob; Balvanera, Patricia; Barbour, Emily; Bardini, Mark; Barton, David N.; Baumgartner, Jill; Benton, Tim G.; Bobrow, Emily; Bossio, Deborah; Bostrom, Ann; Braimoh, Ademola; Brondizio, Eduardo; Brown, Joe; Bryant, Benjamin P.; Calder, Ryan S. D.; Chaplin-Kramer, Becky; Cullen, Alison; DeMello, Nicole; Dickinson, Katherine L.; Ebi, Kristie L.; Eves, Heather E.; Fanzo, Jessica; Ferraro, Paul J.; Fisher, Brendan; Frongillo, Edward A.; Galford, Gillian; Garrity, Dennis; Gatere, Lydiah; Grieshop, Andrew P.; Grigg, Nicola J.; Groves, Craig; Gugerty, Mary Kay; Hamm, Michael; Hou, Xiaoyue; Huang, Cindy; Imhoff, Marc; Jack, Darby; Jones, Andrew D.; Kelsey, Rodd; Kothari, Monica; Kumar, Ritesh; Lachat, Carl; Larsen, Ashley E.; Lawrence, Mark; DeClerck, Fabrice; Levin, Phillip S.; Mabaya, Edward; Gibson, Jacqueline MacDonald; McDonald, Robert; Mace, Georgina; Maertens, Ricardo; Mangale, Dorothy; Martino, Robin; Mason, Sara A.; Mehta, Lyla; Meinzen-Dick, Ruth; Merz, Barbara; Msangi, Siwa; Murray, Grant; Murray, Kris A.; Naude, Celeste E.; Newlands, Nathaniel K.; Nkonya, Ephraim; Peterman, Amber; Petruney, Tricia; Possingham, Hugh; Puri, Jyotsna; Remans, Roseline; Remlinger, Lisa; Ricketts, Taylor H.; Reta, Bedilu; Robinson, Brian E.; Roe, Dilys; Rosenthal, Joshua; Shen, Guofeng; Shindell, Drew; Stewart-Koster, Ben; Sunderland, Terry; Sutherland, William J.; Tewksbury, Joshua; Wasser, Heather; Wear, Stephanie; Webb, Chris; Whittington, Dale; Wilkerson, Marit; Wittmer, Heidi; Wood, Benjamin DK K.; Wood, Stephen; Wu, Joyce; Yadama, Gautam; Zobrist, Stephanie (Elsevier, 2019-08-01)
Although health, development, and environment challenges are interconnected, evidence remains fractured across sectors due to methodological and conceptual differences in research and practice. Aligned methods are needed to support Sustainable Development Goal advances and similar agendas. The Bridge Collaborative, an emergent research-practice collaboration, presents principles and recommendations that help harmonize methods for evidence generation and use. Recommendations were generated in the context of designing and evaluating evidence of impact for interventions related to five global challenges (stabilizing the global climate, making food production sustainable, decreasing air pollution and respiratory disease, improving sanitation and water security, and solving hunger and malnutrition) and serve as a starting point for further iteration and testing in a broader set of contexts and disciplines. We adopted six principles and emphasize three methodological recommendations: (1) creation of compatible results chains, (2) consideration of all relevant types of evidence, and (3) evaluation of strength of evidence using a unified rubric. We provide detailed suggestions for how these recommendations can be applied in practice, streamlining efforts to apply multi-objective approaches and/or synthesize evidence in multidisciplinary or transdisciplinary teams. These recommendations advance the necessary process of reconciling existing evidence standards in health, development, and environment, and initiate a common basis for integrated evidence generation and use in research, practice, and policy design.
Alternative approaches for creating a wealth index: the case of Mozambique
Xie, Kexin; Marathe, Achla; Deng, Xinwei; Ruiz-Castillo, Paula; Imputiua, Saimado; Elobolobo, Eldo; Mutepa, Victor; Sale, Mussa; Nicolas, Patricia; Montana, Julia; Jamisse, Edgar; Munguambe, Humberto; Materrula, Felisbela; Casellas, Aina; Rabinovich, Regina; Saute, Francisco; Chaccour, Carlos J.; Sacoor, Charfudin; Rist, Cassidy (BMJ, 2023-08)
Introduction: The wealth index is widely used as a proxy for a household's socioeconomic position (SEP) and living standard. This work constructs a wealth index for the Mopeia district in Mozambique using data collected in year 2021 under the BOHEMIA (Broad One Health Endectocide-based Malaria Intervention in Africa) project. Methods: We evaluate the performance of three alternative approaches against the Demographic and Health Survey (DHS) method based wealth index: feature selection principal components analysis (PCA), sparse PCA and robust PCA. The internal coherence between four wealth indices is investigated through statistical testing. Validation and an evaluation of the stability of the wealth index are performed with additional household income data from the BOHEMIA Health Economics Survey and the 2018 Malaria Indicator Survey data in Mozambique. Results: The Spearman's rank correlation between wealth index ventiles from four methods is over 0.98, indicating a high consistency in results across methods. Wealth rankings and households' income show a strong concordance with the area under the curve value of ∼0.7 in the receiver operating characteristic analysis. The agreement between the alternative wealth indices and the DHS wealth index demonstrates the stability in rankings from the alternative methods. Conclusions: This study creates a wealth index for Mopeia, Mozambique, and shows that DHS method based wealth index is an appropriate proxy for the SEP in low-income regions. However, this research recommends feature selection PCA over the DHS method since it uses fewer asset indicators and constructs a high-quality wealth index.
AMS Community Synthesis on Geohealth
Seitter, Keith E.; Tipton, Emma; Higgins, Paul; White, Lauren; Miller, Andy (American Meteorological Society, 2022-04-20)
The Earth system and human health are inextricably linked. In this period of widespread and rapid global change, understanding the challenges and opportunities at the intersection of health, geoscience, and the Earth system (broadly termed “geohealth”) has taken on a new level of importance. Scientific discovery and innovation can play a key role in helping humanity understand and respond to environmental, technological, and societal drivers of global changes so as to enable security, prosperity, and positive health outcomes for all. This American Meteorological Society Policy Program study synthesizes input from the AMS community on the various connections, gaps, and opportunities that currently exist at the geohealth interface. It was carried out in an accelerated time frame in response to a request from the National Science Foundation for rapid community input. Through these community discussions this study identifies: 1) a set of critical throughlines for effective convergence in geohealth research, 2) overarching challenges that currently impede progress, and 3) potential solution areas where significant progress might be made quickly.
Analysis of environmental and economic impacts of hydropower imports for New York City through 2050
Calder, Ryan S. D.; Borsuk, Mark E.; Robinson, Celine (Duke University Nicholas Institute for Environmental Policy Solutions, 2020-10-13)
Indian Point Energy Center (IPEC), a nuclear generating facility that has provided roughly 15 TW·h per year of low-emissions power to the New York City area, will close by 2021. There has been debate over the potential responses to the closure of IPEC which include the development of new generation and transmission infrastructure. This derives in part from difficulties in comparing direct and indirect costs and benefits and environmental and social impacts, which vary substantially across energy alternatives. In particular, the potential role of increased imports of hydropower from Canada to the New York City area has been controversial because of large upfront capital costs and uncertain benefits relative to alternatives such as increased build-out of Downstate New York offshore wind and solar.
Antibiotic Use on Goat Farms: An Investigation of Knowledge, Attitudes, and Behaviors of Missouri Goat Farmers
Landfried, Lauren K.; Barnidge, Ellen K.; Pithua, Patrick; Lewis, Roger D.; Jacoby, Jonathan A.; King, Christopher C.; Baskin, Carole R. (MDPI, 2018-11-01)
Use of low dose, prophylactic antibiotics contributes to the emergence of antibiotic resistant bacteria. In one study, goat meat in Missouri was found to have a higher percentage of antibiotic residues at slaughter than the national average, so we attempted to identify factors related to goat production that may contribute to this issue. Using the knowledge, attitude, and behavior (KAB) model, we interviewed 11 Missouri goat farmers about factors affecting antibiotic use. Most of the farmers did not have specific protocols for managing illnesses and only relied on veterinarians for major health issues. Many felt veterinarians lacked knowledge about goat medicine so instead relied on other farmers’ or their own experiences for treatment modalities. While most agreed that antibiotic resistance was a concern, only 4 of the 11 indicated that they only used antibiotics when prescribed by the veterinarian. Veterinarians should be relied on and valued for their medical expertise, but they are not always being utilized in this manner. Therefore, veterinary education should emphasize goat health management to a greater extent than it currently does, and soft skills to build collaborative relationships with farmers should be taught to promote preventative health measures and more judicious use of antibiotics.
Anticipating and adapting to the future impacts of climate change on the health, security and welfare of low elevation coastal zone (LECZ) communities in Southeastern USA
Allen, Thomas; Behr, Joshua; Bukvic, Anamaria; Calder, Ryan S. D.; Caruson, Kiki; Connor, Charles; D'Elia, Christopher; Dismukes, David; Ersing, Robin; Franklin, Rima; Goldstein, Jesse; Goodall, Jonathon; Hemmerling, Scott; Irish, Jennifer L.; Lazarus, Steven; Loftis, Derek; Luther, Mark; McCallister, Leigh; McGlathery, Karen; Mitchell, Molly; Moore, William B.; Nichols, C. Reid; Nunez, Karinna; Reidenbach, Matthew; Shortridge, Julie; Weisberg, Robert; Weiss, Robert; Donelson Wright, Lynn; Xia, Meng; Xu, Kehui; Young, Donald; Zarillo, Gary; Zinnert, Julie C. (MDPI, 2021-10-29)
Low elevation coastal zones (LECZ) are extensive throughout the southeastern United States. LECZ communities are threatened by inundation from sea level rise, storm surge, wetland degradation, land subsidence, and hydrological flooding. Communication among scientists, stakeholders, policy makers and minority and poor residents must improve. We must predict processes spanning the ecological, physical, social, and health sciences. Communities need to address linkages of (1) human and socioeconomic vulnerabilities; (2) public health and safety; (3) economic concerns; (4) land loss; (5) wetland threats; and (6) coastal inundation. Essential capabilities must include a network to assemble and distribute data and model code to assess risk and its causes, support adaptive management, and improve the resiliency of communities. Better communication of information and understanding among residents and officials is essential. Here we review recent background literature on these matters and offer recommendations for integrating natural and social sciences. We advocate for a cyber-network of scientists, modelers, engineers, educators, and stakeholders from academia, federal state and local agencies, non-governmental organizations, residents, and the private sector. Our vision is to enhance future resilience of LECZ communities by offering approaches to mitigate hazards to human health, safety and welfare and reduce impacts to coastal residents and industries.
Antimicrobial susceptibility and risk factors for resistance among Escherichia coli isolated from canine specimens submitted to a diagnostic laboratory in Indiana, 2010-2019
Ekakoro, John E.; Hendrix, G. Kenitra; Guptill, Lynn F.; Ruple, Audrey (Public Library of Science, 2022-08)
Escherichia coli (E. coli) is the most common Gram-negative pathogen isolated in human infections. Antimicrobial resistant (AMR) E. coli originating from dogs may directly or indirectly cause disease in humans. The objective of this study was to calculate the proportion of antimicrobial susceptible E. coli isolated from canine specimens submitted to the Indiana Animal Disease Diagnostic Laboratory and to identify temporal patterns of susceptibility among these isolates. Susceptibility data of 2,738 E. coli isolates from dogs from 2010 through 2019 were used in this study. Proportions of isolates susceptible to the various antimicrobials were calculated using SAS statistical software and the Cochran-Armitage trend test was used to investigate the temporal trends in susceptibility. A multivariable binary logistic regression model was built to investigate the association between host factors and AMR. Overall, 553/2,738 (20.2%) of the isolates were susceptible to 17 of the 27 antimicrobials examined. Of the 2,638 isolates examined for amikacin susceptibility, 2,706 (97.5%) were susceptible, 2,657/2,673 (99.4%) isolates were susceptible to imipenem, and 2,099/2,670 (78.6%) were susceptible to marbofloxacin. A significant decreasing trend in susceptibility was observed for amoxicillin-clavulanic acid (P<0.0001), ampicillin (P<0.0001), Cefazolin (P<0.0001), ceftazidime (P = 0.0067), chloramphenicol (P<0.0001), and orbifloxacin (P = 0.008). The overall percentage of AMR isolates (isolates not susceptible to at least one antimicrobial) was 61.7% (1,690/2,738) and 29.3% (801/2,738) of isolates were multidrug resistant. Multivariable regression analyses showed significant associations between AMR and age (P = 0.0091), breed (P = 0.0008), and sample isolation site/source (P<0.0001). The decreasing trend in the proportion of isolates susceptible to several beta-lactam antimicrobials suggests that resistance of Escherichia coli in dogs to these antimicrobials could be increasing in Indiana. The decreasing trend in susceptibility to these drugs could be due to selection pressure from antimicrobial use.
Antimicrobial Susceptibility of Bacteria Isolated from Freshwater Mussels in the Wildcat Creek Watershed, Indiana, United States
Ekakoro, John E.; Guptill, Lynn F.; Hendrix, G. Kenitra; Dorsey, Lauren; Ruple, Audrey (MDPI, 2023-04-08)
Antimicrobial resistance (AMR) is a global health crisis that threatens the health of humans and animals. The spread of resistance among species may occur through our shared environment. Prevention of AMR requires integrated monitoring systems, and these systems must account for the presence of AMR in the environment in order to be effective. The purpose of this study was to establish and pilot a set of procedures for utilizing freshwater mussels as a means of surveillance for microbes with AMR in Indiana waterways. One hundred and eighty freshwater mussels were sampled from three sites along the Wildcat Creek watershed in north-central Indiana. Specimens were evaluated for the presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species), Escherichia coli, Campylobacter, and Salmonella species, and the isolates were tested for antimicrobial resistance. A total of 24 bacterial isolates were obtained from tissue homogenates of freshwater mussels collected at a site directly downstream from Kokomo, Indiana. Of these, 17 were Enterobacter spp., five were Escherichia coli, one was Pseudomonas aeruginosa, and one was Klebsiella pneumoniae. All isolates were resistant to three or more antimicrobial drug classes. Further work is necessary to determine the source of the bacterial species found in the mussels.
Approaches Used to Construct Antibiograms for Dogs in a Veterinary Teaching Hospital in the United States
Ekakoro, John E.; Guptill, Lynn; Hendrix, Kenitra; Anderson, Melinda; Ruple, Audrey (MDPI, 2023-06-09)
Non-judicious antimicrobial use (AMU) is a major driver of antimicrobial resistance (AMR). In human hospitals, cumulative antibiograms are often used by clinicians to evaluate local susceptibility rates and to select the most appropriate empiric therapy with the aim of minimizing inappropriate AMU. However, the use of cumulative antibiograms to guide empiric antimicrobial therapy in veterinary hospitals in the United States is limited, and there are no specific guidelines or standardized methods available for the construction of antibiograms in veterinary clinical settings. The objective of this methods article is to describe the approaches that were used to construct antibiograms from clinical samples collected from dogs seen at a veterinary teaching hospital. Laboratory data for 563 dogs for the period from 1 January 2015 to 31 December 2015 was utilized. We used the Clinical and Laboratory Standards Institute (CLSI) guidelines for use in the construction of the antibiograms in human healthcare settings as the basis for the veterinary antibiograms. One general antibiogram and antibiograms stratified by hospital section, the anatomic region of sample collection/by sample type, were created and the challenges encountered in preparing these antibiograms were highlighted. The approaches described could be useful in guiding veterinary antibiogram development for empiric therapy.
Assessing Ecosystem Service Benefits from Military Installations
Kagan, James; Borsuk, Mark E.; Calder, Ryan S. D.; Creutzburg, Megan; Mason, Sara A.; Olander, Lydia P.; Plantinga, Andrew; Robinson, Celine (2019-07-26)
Military bases provide substantial ecosystem services to local communities and other members of the public. This project conceptualizes and quantifies ecosystem services provided by U.S. military bases developing an integrated modeling platform called MoTIVES (Model-based Tracking and Integrated Valuation of Ecosystem Services). MoTIVES manages probabilistic simulations of biophysical and economic models for relevant ecosystem services provided by alternative base management scenarios, and then assigns values where valuation is possible. The project demonstrated a proof of concept at Eglin Air Force Base, showing that current management provides approximately $110 million in ecosystem services per year, $40 million more than a scenario where no base was present, and $90 million more than a scenario where no base management was occurring.
Assessing the Effect of Global Travel and Contact Restrictions on Mitigating the COVID-19 Pandemic
Lai, Shengjie; Ruktanonchai, Nick W.; Carioli, Alessandra; Ruktanonchai, Corrine W.; Floyd, Jessica R.; Prosper, Olivia; Zhang, Chi; Du, Xiangjun; Yang, Weizhong; Tatem, Andrew J. (2021-07)
Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019 (COVID-19) pandemic, but studies are needed to understand their effectiveness across regions and time. Based on the population mobility metrics derived from mobile phone geolocation data across 135 countries or territories during the first wave of the pandemic in 2020, we built a metapopulation epidemiological model to measure the effect of travel and contact restrictions on containing COVID-19 outbreaks across regions. We found that if these interventions had not been deployed, the cumulative number of cases could have shown a 97-fold (interquartile range 79-116) increase, as of May 31, 2020. However, their effectiveness depended upon the timing, duration, and intensity of the interventions, with variations in case severity seen across populations, regions, and seasons. Additionally, before effective vaccines are widely available and herd immunity is achieved, our results emphasize that a certain degree of physical distancing at the relaxation of the intervention stage will likely be needed to avoid rapid resurgences and subsequent lockdowns. (C) 2021 THE AUTHORS. Published by Elsevier LTD on behalf of Chinese Academy of Engineering and Higher Education Press Limited Company.
Assessing the impact of coordinated COVID-19 exit strategies across Europe
Ruktanonchai, Nick W.; Floyd, J. R.; Lai, S.; Ruktanonchai, Corrine W.; Sadilek, Adam; Rente-Lourenco, P.; Ben, X.; Carioli, A.; Gwinn, J.; Steele, J. E.; Prosper, Olivia F.; Schneider, A.; Oplinger, A.; Eastham, Paul; Tatem, A. J. (2020-09-18)
As rates of new coronavirus disease 2019 (COVID-19) cases decline across Europe owing to nonpharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. We use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we find that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe means that half as many lockdown periods would be required to end continent-wide community transmission.
Assessment of Two Novel Live-Attenuated Vaccine Candidates for Herpes Simplex Virus 2 (HSV-2) in Guinea Pigs
Joyce, Jonathan D.; Patel, Anant K.; Murphy, Brandie; Carr, Daniel J.J.; Gershburg, Edward; Bertke, Andrea S. (MDPI, 2021-03-13)
Treatment to ameliorate the symptoms of infection with herpes simplex virus 2 (HSV-2) and to suppress reactivation has been available for decades. However, a safe and effective preventative or therapeutic vaccine has eluded development. Two novel live-attenuated HSV-2 vaccine candidates (RVx201 and RVx202) have been tested preclinically for safety. Hartley guinea pigs were inoculated vaginally (n = 3) or intradermally (n = 16) with either vaccine candidate (2 × 10⁷ PFU) and observed for disease for 28 days. All animals survived to study end without developing HSV-2-associated disease. Neither vaccine candidate established latency in dorsal root or sacral sympathetic ganglia, as determined by viral DNA quantification, LAT expression, or explant reactivation. Infectious virus was shed in vaginal secretions for three days following vaginal inoculation with RVx202, but not RVx201, although active or latent HSV-2 was not detected at study end. In contrast, guinea pigs inoculated with wild-type HSV-2 MS (2 × 10⁵ PFU) vaginally (n = 5) or intradermally (n = 16) developed acute disease, neurological signs, shed virus in vaginal secretions, experienced periodic recurrences throughout the study period, and had latent HSV-2 in their dorsal root and sacral sympathetic ganglia at study end. Both vaccine candidates generated neutralizing antibody. Taken together, these findings suggest that these novel vaccine candidates are safe in guinea pigs and should be tested for efficacy as preventative and/or therapeutic anti-HSV-2 vaccines.
Bead size has a greater effect on in vitro elution from antimicrobial-impregnated calcium sulfate beads than drug concentration
Olsen, Ronald S.; Sawyere, Dominique M.; Davis, Jennifer L.; Lanz, Otto I.; Werre, Stephen R. (American Veterinary Medical Association, 2023-05)
OBJECTIVE To compare the elution characteristics of amikacin-impregnated calcium sulfate (CaSO4) beads based on different drug concentrations and bead size configurations. SAMPLE Six groups of amikacin-impregnated CaSO4 beads and one negative control group. PROCEDURES Amikacin-impregnated CaSO4 beads were formed with either 500 mg (low-concentration) or 1 g (high-concentration) of amikacin per 15 g CaSO4 hemihydrate powder. The number of beads necessary to approximate 150 mg of amikacin for each of the 3 bead sizes (3 mm, 5 mm, and 7 mm) at both low and high concentrations were placed in 6 mL of phosphate-buffered saline. The saline was sampled at 14 time points over 28 days. Amikacin concentrations were determined using liquid chromatography-mass spectrometry. RESULTS Smaller beads reached higher mean peak concentrations than larger beads (P < .0006). Peak concentrations for the low-and high-concentration groups were 20.5 mg/mL and 27.4 mg/mL, 13.1 mg/mL and 14.0 mg/mL, and 8.85 mg/mL and 6.75 mg/mL for the 3 mm, 5 mm, and 7 mm beads, respectively. Bead size also affected the length of therapeutic duration, lasting 6 days for the 3 mm and 5 mm beads and 9 days for the 7 mm beads. However, this was only statistically evident among the high-concentration beads (P < .044). Antimicrobial concentration within the same bead sizes did not affect elution. CLINICAL RELEVANCE Amikacin-impregnated CaSO4 beads achieved extreme supratherapeutic eluent concentrations. While additional studies are needed, bead size significantly affected elution with smaller beads reaching higher peak concentrations and 7 mm, high-concentration beads demonstrating a longer therapeutic duration than smaller beads.
Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing
Dearfield, Craig T.; Horn, Kimberly; Crandell, Ian; Bernat, Debra H. (Bmj Publishing Group, 2022-07)
Objectives Local, national and international policies are being proposed to ban the sale of menthol-flavoured tobacco products. With more bans being implemented, it is increasingly important to understand reactions to these bans among smokers of low socioeconomic status. This study examined public housing residents' behavioural intentions if menthol-flavoured cigarettes were no longer sold. Setting 15 District of Columbia Housing Authority properties between March 2019 and March 2021. Participants 221 District of Columbia Housing Authority residents ages 18-80 years who reported smoking menthol cigarettes (83.3% African-American/black). Primary and secondary outcomes Cigarette quitting and switching intentions due to a hypothetical menthol-flavoured cigarette sales ban. Results Nearly one-half (48.0%) of residents said they intended to quit cigarette use if menthol-flavoured products were no longer sold, while 27.2% were unsure if they would quit, and 24.9% reported they would not quit. Older residents (OR 0.94 per year, 95% CI 0.91 to 0.97), senior/disabled building versus family building residents (OR 0.50, 95% CI 0.25 to 0.97), those who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) had lower odds of reporting quit intentions associated with a menthol ban. Of those not intending to quit, 40.7% reported they would switch to non-menthol cigarettes, 20.4% to another non-menthol product, 13.0% to menthol e-cigarettes and 20.4% to another menthol product. Conclusions Results suggest banning the sale of menthol-flavoured products has the potential to impact cigarette smoking cessation. Nearly three-quarters of smokers in public housing indicated a possibility of quitting smoking because of a menthol cigarette ban. Bans that include all flavours in all tobacco products may be most effective for facilitating overall tobacco cessation.
Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China
Cohen, Alasdair; Pillarisetti, Ajay; Luo, Qing; Ling, Hongxing; Zhong, Gemei; Colford, John M., Jr.; Smith, Kirk R.; Ray, Isha; Tao, Yong (National Institute of Environmental Health Sciences, 2020-12-04)
Background: Inadequate access to safe drinking water remains a global health problem, particularly in rural areas. Boiling is the most commonly used form of point-of-use household water treatment (HWT) globally, although the use of bottled water in low- and middle-income countries (LMICs) is increasing rapidly. Objectives: We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling. Methods: We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter ≤2.5μm in aerodynamic diameter (PM2.5) concentrations. Results: Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) (−0.66 log10 TTC most probable number/100mL), followed by boiling with pots (−0.58), and bottled water use (−0.39); all were statistically significant (p<0.001). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio (RR)=0.25, p<0.001] and reported diarrhea (RR=0.80, p=0.672). TTCs were detected in 51% (n=136) of bottled water samples. For households boiling with biomass, modeled PM2.5 concentrations averaged 79 μg/m3 (standard deviation=21). Discussion: Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access.
Bottled and Well Water Quality in a Small Central Appalachian Community: Household-Level Analysis of Enteric Pathogens, Inorganic Chemicals, and Health Outcomes in Rural Southwest Virginia
Cohen, Alasdair; Rasheduzzaman, Md; Darling, Amanda; Krometis, Leigh-Anne H.; Edwards, Marc A.; Brown, Teresa; Ahmed, Tahmina; Wettstone, Erin; Pholwat, Suporn; Taniuchi, Mami; Rogawski McQuade, Elizabeth T. (MDPI, 2022-07-15)
Consumption of unsafe drinking water is associated with a substantial burden of disease globally. In the US, ~1.8 million people in rural areas lack reliable access to safe drinking water. Our objective was to characterize and assess household-level water sources, water quality, and associated health outcomes in Central Appalachia. We collected survey data and water samples (tap, source, and bottled water) from consenting households in a small rural community without utility-supplied water in southwest Virginia. Water samples were analyzed for physicochemical parameters, total coliforms, E. coli, nitrate, sulfate, metals (e.g., arsenic, cadmium, lead), and 30+ enteric pathogens. Among the 69% (n = 9) of households that participated, all had piped well water, though 67% (n = 6) used bottled water as their primary drinking water source. Total coliforms were detected in water samples from 44.4% (n = 4) of homes, E. coli in one home, and enteric pathogens (Aeromonas, Campylobacter, Enterobacter) in 33% (n = 3) of homes. Tap water samples from 11% (n = 1) of homes exceeded the EPA MCL for nitrate, and 33% (n = 3) exceeded the EPA SMCL for iron. Among the 19 individuals residing in study households, reported diarrhea was 25% more likely in homes with measured E. coli and/or specific pathogens (risk ratio = 1.25, cluster-robust standard error = 1.64, p = 0.865). Although our sample size was small, our findings suggest that a considerable number of lower-income residents without utility-supplied water in rural areas of southwest Virginia may be exposed to microbiological and/or chemical contaminants in their water, and many, if not most, rely on bottled water as their primary source of drinking water.
Bottled water quality and associated health outcomes: a systematic review and meta-analysis of 20 years of published data from China
Cohen, Alasdair; Cui, Jingyi; Song, Qingyang; Xia, Qiwen; Huan, Jiexuan; Guo, Yalu; Sun, Yixin; Colford, John M., Jr.; Ray, Isha (IOP Publishing, 2022-01-20)
Bottled water is a rapidly growing yet relatively understudied source of drinking water globally. In addition to concerns about the safety of bottled water, the adverse environmental health and social impacts associated with bottled water production, distribution, consumption, and reliance are considerable. Our objective was to comprehensively review, analyze, and synthesize ∼20 years of publicly available data on bottled water quality and associated health outcomes in China. We conducted a systematic review and meta-analysis of publicly available studies of bottled water quality and associated health outcomes in China published between 1995 and early 2016 (in Chinese and English). We pre-specified and registered our study protocol, independently replicated key analyses, and followed standardized reporting guidelines. Our search identified 7059 potentially eligible records. Following screening, after full-text review of 476 publications, 216 (reporting results from 625 studies) met our eligibility criteria. Among many findings, 93.7% (SD = 10.1) of 24 585 samples tested for total coliforms (n = 241 studies), and 92.6% (SD = 12.7) of 7261 samples tested for nitrites (n = 85 studies), were in compliance with China’s relevant bottled water standards. Of the studies reporting concentration data for lead (n = 8), arsenic (n = 5), cadmium (n = 3), and mercury (n = 3), median concentrations were within China’s standards for all but one study of cadmium. Only nine publications reported health outcome data, eight of which were outbreak investigations. Overall, we observed evidence of stable or increasing trends in the proportions of samples in compliance over the ∼20 year period; after controlling for other variables via meta-regression, the association was significant for microbiological but not chemical outcomes (p = 0.017 and p = 0.115, respectively). Bottled water is typically marketed as being safe, yet in most countries it is less well-regulated than utility-supplied drinking water. Given the trend of increasing bottled water use in China and globally—and the associated environmental health impacts—we hope this work will help to inform policies and regulations for improving bottled water safety, while further highlighting the need for substantially expanding the provision of safe and affordable utility-supplied drinking water globally.

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