Transport of Neisseria meningitidis cultures: growth-supporting media and freezing as an alternative.

The abilities of Transgrow (TG), Thayer-Martin (TM), and New York City (NYC) solid media to maintain the viability of 12 strains of Neisseria meningitidis under various controlled conditions were assessed. The effects of charcoal impregnation of swabs, temperature, and an enriched CO2 atmosphere were examined with holding for up to 21 days. Recovery from samples held at 35 degrees C was, in almost all instances, greater than at 22 or 4 degrees C. A strong requirement for added CO2 was demonstrated, especially at lower temperatures. No positive effect could be attributed to the use of charcoal-impregnated swabs. NYC and TM media were the best overall, with the former permitting recovery from more than 75% of all samples held on slants for 20 days at 4 degrees C in an atmosphere of 5% CO2 in air. Freezing, with holding on dry ice, was a useful alternative to the use of growth-supporting media. This latter method eliminated the requirement for an enriched CO2 atmosphere.     

Drinking Water Turbidity and Emergency Department Visits for Gastrointestinal Illness in New York City, 2002-2009

Background

Studies have examined whether there is a relationship between drinking water turbidity and gastrointestinal (GI) illness indicators, and results have varied possibly due to differences in methods and study settings.

Objectives

As part of a water security improvement project we conducted a retrospective analysis of the relationship between drinking water turbidity and GI illness in New York City (NYC) based on emergency department chief complaint syndromic data that are available in near-real-time.

Methods

We used a Poisson time-series model to estimate the relationship of turbidity measured at distribution system and source water sites to diarrhea emergency department (ED) visits in NYC during 2002-2009. The analysis assessed age groups and was stratified by season and adjusted for sub-seasonal temporal trends, year-to-year variation, ambient temperature, day-of-week, and holidays.

Results

Seasonal variation unrelated to turbidity dominated (~90% deviance) the variation of daily diarrhea ED visits, with an additional 0.4% deviance explained with turbidity. Small yet significant multi-day lagged associations were found between NYC turbidity and diarrhea ED visits in the spring only, with approximately 5% excess risk per inter-quartile-range of NYC turbidity peaking at a 6 day lag. This association was strongest among those aged 0-4 years and was explained by the variation in source water turbidity.

Conclusions

Integrated analysis of turbidity and syndromic surveillance data, as part of overall drinking water surveillance, may be useful for enhanced situational awareness of possible risk factors that can contribute to GI illness. Elucidating the causes of turbidity-GI illness associations including seasonal and regional variations would be necessary to further inform surveillance needs.     

Winter circulation weather types and hospital admissions for respiratory diseases in Galicia,Spain

The link between various pathologies and atmospheric conditions has been a constant topic of study over recent decades in many places across the world; knowing more about it enables us to pre-empt the worsening of certain diseases, thereby optimizing medical resources. This study looked specifically at the connections in winter between respiratory diseases and types of atmospheric weather conditions (Circulation Weather Types, CWT) in Galicia, a region in the north-western corner of the Iberian Peninsula. To do this, the study used hospital admission data associated with these pathologies as well as an automatic classification of weather types. The main result obtained was that weather types giving rise to an increase in admissions due to these diseases are those associated with cold, dry weather, such as those in the east and south-east, or anticyclonic types. A second peak was associated with humid, hotter weather, generally linked to south-west weather types. In the future, this result may help to forecast the increase in respiratory pathologies in the region some days in advance.     

Adverse Trends in Ischemic Heart Disease Mortality among Young New Yorkers,Particularly Young Black Women

Background

Ischemic heart disease (IHD) mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals.

Hypothesis

Trends in IHD vary by age, sex, and race in New York City (NYC). Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD.

Methods

IHD mortality trends were assessed in NYC 1980–2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity.

Results

The decline in IHD mortality rates slowed in 1999 among individuals aged 35–54 years but not ≥55. IHD mortality rates were higher among young men than women age 35–54, but annual declines in IHD mortality were slower for women. Black women age 35–54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35–54.

Conclusions

The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality.     

The influence of weather on asthma in Nairobi

The frequency of bronchial asthma in Nairobi is related to meteorological parameters such as relative humidity, rainfall, dew point temperature, hours of sunshine and dry bulb temperature. Two seasons were taken for study: one cold season (May–August 1975) and one relatively warm season (December 1975–March 1976). It was found that significant correlations occurred at a lag of 2 or 3 days, but not at a lag of 4 or 5 days. Cold and wet weather during the cold season and heat of the day and dryness of the atmosphere during the warm season aggravate asthma in Nairobi.. The frequency of asthmatic attacks is about the same during the two seasons, but the intensity of suffering of a greater majority of patients is more in cold and wet weather than in warm and dry weather. 20–25% of the patients do not feel any relationship between weather and their asthmatic troubles. Nearly twice as many patients suffer from cough with the production of sputum in the cold season than in the warm season. About three times as many patients suffer from bronchospasm in the cold season than in the warm season. Severe asthmatic attacks occur almost equally in both the seasons.     

Promoting collective recovery through organizational mobilization: the post-9/11 disaster relief work of NYC RECOVERS

NYC RECOVERS, an alliance of organizations concerned with New York City's social and emotional recovery post-9/11, was formed to meet the need to rebuild social bonds strained or ruptured by the trauma to the regional system caused by the destruction of the Twin Towers. NYC RECOVERS, with minimal funding, was able to create a network of 1000 organizations spanning the five boroughs, carrying out recovery events throughout the 'Year of Recovery', September 2001 to December 2002. This paper describes the concepts, techniques and accomplishments of NYC RECOVERS, and discusses potentials of the model, as well as obstacles to its implementation.     

Effects of Meteorological Factors on Daily Hospital Admissions for Asthma in Adults: A Time-Series Analysis

Background

There is limited evidence for the impacts of meteorological changes on asthma hospital admissions in adults in Shanghai, China.

Objectives

To quantitatively evaluate the short-term effects of daily mean temperature on asthma hospital admissions.

Methods

Daily hospital admissions for asthma and daily mean temperatures between January 2005 and December 2012 were analyzed. After controlling for secular and seasonal trends, weather, air pollution and other confounding factors, a Poisson generalized additive model (GAM) combined with a distributed lag non-linear model were used to explore the associations between temperature and hospital admissions for asthma.

Results

During the study periods, there were 15,678 hospital admissions for asthma by residents of Shanghai, an average 5.6 per day. Pearson correlation analysis found a significant negative correlation (r = −0.174, P<0.001) between asthma hospitalizations and daily mean temperature (DMT). The DMT effect on asthma increased below the median DMT, with lower temperatures associated with a higher risk of hospital admission for asthma. Generally, the cold effect appeared to be relatively acute, with duration lasting several weeks, while the hot effect was short-term. The relative risk of asthma hospital admissions associated with cold temperature (the 25^th percentile of temperature relative to the median temperature) was 1.20 (95% confidence interval [CI], 1.01∼1.41) at lag0-14. However, warmer temperatures were not associated with asthma hospital admissions.

Conclusions

Cold temperatures may trigger asthmatic attacks. Effective strategies are needed to protect populations at risk from the effects of cold.     

Association between weather conditions and the number of patients at the emergency room in an Argentine hospital

The aim of this paper is to study the relationships between hospital emergencies and weather conditions by analysing summer and winter cases of patients requiring attention at the emergency room of a hospital in the city of Buenos Aires, Argentina. Hospital data have been sorted into seven different diagnostic groups as follows: (1) respiratory, cardiovascular and chest-pain complaints; (2) digestive, genitourinary and abdominal complaints; (3) neurological and psychopathological disorders; (4) infections; (5) contusion and crushing, bone and muscle complaints; (6) skin and allergies and (7) miscellaneous complaints. In general, there is an increase of 16.7% in winter while, for group 2 and group 6, there are more patients in summer, 54% and 75% respectively. In summer, the total number of patients for group 6 shows a significant positive correlation with temperature and dew-point temperature, and a negative correlation with the sea-level pressure for the same day. In winter, the same relationship exists, however its correlation is not as strong. The lags observed between these three variables: maximum dew-point temperature, maximum temperature, minimum air pressure and the peaks in admissions are 1, 2 and 4 days respectively. In winter, increases in temperature and dew point and decreases in pressure are followed by a peak in admissions for group 2. In winter, there are significantly more cases in group 5 on warm, dry days and on warm, wet days in the summer.     

Weather changes associated with hospitalizations for cardiovascular diseases and stroke in California, 1983–1998

Poisson regression models were used to evaluate associations between temperature, precipitation, days of extreme heat, and other weather changes (lagged 7 days), as well as El Niño events, with hospitalizations for acute myocardial infarction, angina pectoris, congestive heart failure, and stroke in three California regions. Temperature changes were defined as a 3 °C decrease in maximum temperature or a 3 °C increase in minimum temperature. Temperature and precipitation were analyzed separately for normal weather periods and El Niño events, and for both weather periods combined. Associations varied by region, age, and gender. In Los Angeles, temperature changes resulted in small changes in hospitalizations. Among San Francisco residents 70+ years of age, temperature changes increased hospitalizations for nearly all outcomes from 6% to 13%. Associations among Sacramento residents were similar to those in San Francisco: among men 70+ years of age, temperature changes increased hospitalizations by 6%–11% for acute myocardial infarction and congestive heart failure, and 10%–18% for stroke. El Niño events were consistently and significantly associated with hospitalizations only in San Francisco and Sacramento, and then only for angina pectoris (increasing hospitalizations during El Niño events). These exploratory analyses merit further confirmation to improve our understanding of how admissions to hospitals for cardiovascular disease and stroke change with changing weather. Such an understanding is useful for developing current public health responses, for evaluating population vulnerability, and for designing future adaptation measures.     

Drugs, sex and HIV: a mathematical model for New York City.

A data-based mathematical model was formulated to assess the epidemiological consequences of heterosexual, intravenous drug use (IVDU) and perinatal transmission in New York City (NYC). The model was analysed to clarify the relationship between heterosexual and IVDU transmission and to provide qualitative and quantitative insights into the HIV epidemic in NYC. The results demonstrated the significance of the dynamic interaction of heterosexual and IVDU transmission. Scenario analysis of the model was used to suggest a new explanation for the stabilization of the seroprevalence level that has been observed in the NYC IVDU community; the proposed explanation does not rely upon any IVDU or sexual behavioural changes. Gender-specific risks of heterosexual transmission in IVDUs were also explored by scenario analysis. The results showed that the effect of the heterosexual transmission risk factor on increasing the risk of HIV infection depends upon the level of IVDU. The model was used to predict future numbers of adult and pediatric AIDS cases; a sensitivity analysis of the model showed that the confidence intervals on these prediction estimates were extremely wide. This prediction variability was due to the uncertainty in estimating the values of the models' thirty variables (twenty biological-behavioural transmission parameters and the initial sizes of ten subgroups). However, the sensitivity analysis revealed that only a few key variables were significant in contributing to the AIDS case prediction variability; partial rank correlation coefficients were calculated and used to identify and to rank the importance of these key variables. The results suggest that long-term precise estimates of the future number of AIDS cases will only be possible once the values of these key variables have been evaluated accurately.     

Using Syndromic Surveillance to Investigate Tattoo-Related Skin Infections in New York City

In response to two isolated cases of Mycobacterium chelonae infections in tattoo recipients where tap water was used to dilute ink, the New York City (NYC) Department of Health and Mental Hygiene conducted an investigation using Emergency Department (ED) syndromic surveillance to assess whether an outbreak was occuring. ED visits with chief complaints containing the key word “tattoo” from November 1, 2012 to March 18, 2013 were selected for study. NYC laboratories were also contacted and asked to report skin or soft tissue cultures in tattoo recipients that were positive for non-tuberculosis mycobacterial infection (NTM). Thirty-one TREDV were identified and 14 (45%) were interviewed to determine if a NTM was the cause for the visit. One ED visit met the case definition and was referred to a dermatologist. This individual was negative for NTM. No tattoo-associated NTM cases were reported by NYC laboratories. ED syndromic surveillance was utilized to investigate a non-reportable condition for which no other data source existed. The results were reassuring that an outbreak of NTM in tattoo recipients was not occurring. In response to concerns about potential NTM infections, the department sent a letter to all licensed tattoo artists advising them not to dilute tattoo ink with tap water.     

Seasonal variation of microhabitat distribution of the polymorphic land snail Cepaea nemoralis

We studied the seasonal variation of microhabitat distribution of the land snail Cepaea nemoralis over a 3-year period in a population at Dansville, New York. Stratified random quadrat sampling was used to determine snail densities and environmental variables in each month. The plant cover of each quadrat was estimated by a modified Daubenmire measure. Canonical correlation analysis was used to investigate the relationship between the morph density and the environmental variables. Significant relations existed between snail morphs and environmental variables in 8 of the 13 months analyzed. Temperature and rainfall are two important factors affecting such relations. In hot and dry summer months, morphs had a stronger canonical correlation with the environmental variables than in cool and wet months. Food and shelter were important in determining distribution over habitats of the snail. Food was primarily responsible for snail distribution over habitats in the early summer. As the weather became hot and dry, the importance of shelter became more evident. Both banded and unbanded morphs tended to be associated strongly with sheltered microhabitats in hot dry seasons.     

Rapid,pervasive genetic differentiation of urban white‐footed mouse (Peromyscus leucopus) populations in New York City

We investigated genetic diversity and structure of urban white‐footed mouse, Peromyscus leucopus, populations in New York City (NYC) using variation at 18 microsatellite loci. White‐footed mice are ‘urban adapters’ that occur at higher population densities as habitat fragments are reduced in area but have a limited ability to disperse through urbanized areas. We hypothesized that this combination of traits has produced substantial genetic structure but minimal loss of genetic variation over the last century in NYC. Allelic diversity and heterozygosity in 14 NYC populations were high, and nearly all of our NYC study sites contained genetically distinct populations of white‐footed mice as measured by pairwise F_ST, assignment tests, and Bayesian clustering analyses performed by Structure and baps . Analysis of molecular variance revealed that genetic differences between populations separated by a few kilometres are more significant than differences between prehistorically isolated landmasses (i.e. Bronx, Queens, and Manhattan). Allele size permutation tests and lack of isolation by distance indicated that mutation and migration are less important than drift as explanations for structure in urban, fragmented P. leucopus populations. Peromyscus often exhibit little genetic structure over even regional scales, prompting us to conclude that urbanization is a particularly potent driver of genetic differentiation compared to natural fragmentation.     

Weather patterns and asthma epidemics in New York City and New Orleans,U.S.A.

Twenty-five years of data on asthmatic attacks in New Orleans (covering approximately 170,000 asthma attacks) have been analyzed to identify asthma epidemic days, defined as days on which an unusually high number of asthmatic individuals had attacks. Similar data covering three years was obtained for New York City. A preliminary examination of detailed meteoroligical data revealed a consistent meteorological pattern preceding and associated with such asthma epidemic days which consisted of a cold front preceding an asthma epidemic by one to three days followed by a high pressure system. The significance of these meteorological findings and their relationship to other environmental agents such as natural or man-made atmospheric pollutants that are likely to be associated with asthma attacks will be discussed.Presented at the Eighth International Congress of Biometeorology, 9–14 September 1979, Shefayim, Israel.     

Integrated population models reveal local weather conditions are the key drivers of population dynamics in an aerial insectivore

Changes to weather patterns under a warming climate are complex: while warmer temperatures are expected virtually worldwide, decreased mean precipitation is expected at mid-latitudes. Migratory birds depend on broad-scale weather patterns to inform timing of movements, but may be more susceptible to local weather patterns during sedentary periods. We constructed Bayesian integrated population models (IPMs) to assess whether continental or local weather effects best explained population dynamics in an environmentally sensitive aerial insectivorous bird, the tree swallow (Tachycineta bicolor), along a transcontinental gradient from British Columbia to Saskatchewan to New York, and tested whether population dynamics were synchronous among sites. Little consistency existed among sites in the demographic rates most affecting population growth rate or in correlations among rates. Juvenile apparent survival at all sites was stable over time and greatest in New York, whereas adult apparent survival was more variable among years and sites, and greatest in British Columbia and Saskatchewan. Fledging success was greatest in Saskatchewan. Local weather conditions explained significant variation in adult survival in Saskatchewan and fledging success in New York, corroborating the hypothesis that local more than continental weather drives the population dynamics of this species and, therefore, demographic synchrony measured at three sites was limited. Nonetheless, multi-population IPMs can be a powerful tool for identifying correlated population trajectories caused by synchronous demographic rates, and can pinpoint the scale at which environmental drivers are responsible for changes. We caution against applying uniform conservation actions for populations where synchrony does not occur or is not fully understood.     

The impact of heat,cold, and heat waves on hospital admissions in eight cities in Korea

Although the impact of temperature on mortality is well documented, relatively fewer studies have evaluated the associations of temperature with morbidity outcomes such as hospital admissions, and most studies were conducted in North America or Europe. We evaluated weather and hospital admissions including specific causes (allergic disease, asthma, selected respiratory disease, and cardiovascular disease) in eight major cities in Korea from 2003 to 2008. We also explored potential effect modification by individual characteristics such as sex and age. We used hierarchical modeling to first estimate city-specific associations between heat, cold, or heat waves and hospitalizations, and then estimated overall effects. Stratified analyses were performed by cause of hospitalization, sex, and age (0–14, 15–64, 65–74, and ≥75 years). Cardiovascular hospitalizations were significantly associated with high temperature, whereas hospitalizations for allergic disease, asthma, and selected respiratory disease were significantly associated with low temperature. The overall heat effect for cardiovascular hospitalization was a 4.5 % (95 % confidence interval 0.7, 8.5 %) increase in risk comparing hospitalizations at 25 to 15 °C. For cold effect, the overall increase in risk of hospitalizations comparing 2 with 15 °C was 50.5 (13.7, 99.2 %), 43.6 (8.9, 89.5 %), and 53.6 % (9.8, 114.9 %) for allergic disease, asthma, and selected respiratory disease, respectively. We did not find statistically significant effects of heat waves compared with nonheat wave days. Our results suggest susceptible populations such as women and younger persons. Our findings provide suggestive evidence that both high and low ambient temperatures are associated with the risk of hospital admissions, particularly in women or younger person, in Korea.     

Globalization and loss of plant knowledge: challenging the paradigm

The erosion of cultural knowledge and traditions as a result of globalization and migration is a commonly reported phenomenon. We compared one type of cultural knowledge about medicinal plants (number of plants reported to treat thirty common health conditions) among Dominican laypersons who self-medicate with plants and live in rural or urban areas of the Dominican Republic (DR), and those who have moved to New York City (NYC). Many plants used as medicines were popular Dominican food plants. These plants were reported significantly more often by Dominicans living in NYC as compared to the DR, and this knowledge was not age-dependent. These results contradict the popular paradigm about loss of cultural plant knowledge and is the first study to report a statistically measurable increase in this type of knowledge associated with migration.     

The impact of weather on influenza and pneumonia mortality in New York City, 1975-2002: a retrospective study

The substantial winter influenza peak in temperate climates has lead to the hypothesis that cold and/or dry air is a causal factor in influenza variability. We examined the relationship between cold and/or dry air and daily influenza and pneumonia mortality in the cold season in the New York metropolitan area from 1975–2002. We conducted a retrospective study relating daily pneumonia and influenza mortality for New York City and surroundings from 1975–2002 to daily air temperature, dew point temperature (a measure of atmospheric humidity), and daily air mass type. We identified high mortality days and periods and employed temporal smoothers and lags to account for the latency period and the time between infection and death. Unpaired t-tests were used to compare high mortality events to non-events and nonparametric bootstrapped regression analysis was used to examine the characteristics of longer mortality episodes. We found a statistically significant (p = 0.003) association between periods of low dew point temperature and above normal pneumonia and influenza mortality 17 days later. The duration (r = −0.61) and severity (r = −0.56) of high mortality episodes was inversely correlated with morning dew point temperature prior to and during the episodes. Weeks in which moist polar air masses were common (air masses characterized by low dew point temperatures) were likewise followed by above normal mortality 17 days later (p = 0.019). This research supports the contention that cold, dry air may be related to influenza mortality and suggests that warning systems could provide enough lead time to be effective in mitigating the effects.     

A respiratory alert model for the Shenandoah Valley, Virginia, USA

Respiratory morbidity (particularly COPD and asthma) can be influenced by short-term weather fluctuations that affect air quality and lung function. We developed a model to evaluate meteorological conditions associated with respiratory hospital admissions in the Shenandoah Valley of Virginia, USA. We generated ensembles of classification trees based on six years of respiratory-related hospital admissions (64,620 cases) and a suite of 83 potential environmental predictor variables. As our goal was to identify short-term weather linkages to high admission periods, the dependent variable was formulated as a binary classification of five-day moving average respiratory admission departures from the seasonal mean value. Accounting for seasonality removed the long-term apparent inverse relationship between temperature and admissions. We generated eight total models specific to the northern and southern portions of the valley for each season. All eight models demonstrate predictive skill (mean odds ratio = 3.635) when evaluated using a randomization procedure. The predictor variables selected by the ensembling algorithm vary across models, and both meteorological and air quality variables are included. In general, the models indicate complex linkages between respiratory health and environmental conditions that may be difficult to identify using more traditional approaches.