On May 22, 2013, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the shelter manager at a large homeless shelter in Dallas, Texas, linked to an ongoing tuberculosis outbreak. The request asked NIOSH to assess the heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at the shelter. During an on-site evaluation of the homeless shelter in June 2013, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where shelter guests typically congregate or spend significant amounts of time. We recorded the make and model number of all air-handling units (AHUs) providing air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The AHUs in place were state-of-the-art and were controlled by a modern building automation system. The ventilation systems were well maintained and functional during our visit, and all AHUs were equipped with proper filter configurations. Despite their excellent condition and maintenance, certain aspects of the ventilation systems' operation could potentially contribute to airborne disease transmission among shelter guests. During our visit, it appeared the AHUs were not providing adequate outdoor air to the occupied spaces under certain occupancy and environmental conditions, as is required by the Dallas Mechanical Code and ASHRAE standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, the shelter has taken numerous steps to improve administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend additional improvements to the administrative and environmental controls at the shelter. From a ventilation standpoint, we suggest that all occupied spaces at the shelter complex be supplied adequate amounts of outdoor air, as prescribed by the Dallas Mechanical Code and ASHRAE standards.

关键词：气溶胶；空气质量；细菌；疾病暴发；环境暴露

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The efficacy of attractive toxic sugar baits (ATSB) with the active ingredient eugenol, an EnvironmentalProtection Agency exempt compound, was evaluated against vector and nuisance mosquitoes in bothlaboratory and field studies. In the laboratory, eugenol combined in attractive sugar bait (ASB) solutionprovided high levels of mortality for Aedes aegypti, Culex quinquefasciatus, and Anopheles quadrimaculatus. Field studies demonstrated significant control: >70% reduction for Aedes atlanticus, Aedes. infirmatus, andCulex nigripalpus and >50% reduction for Anopheles crucians, Uranotaenia sapphirina, Culiseta melanura, andCulex erraticus three weeks post ATSB application. Furthermore, non-target feeding of six insect orders,Hymenoptera, Lepidoptera, Coleoptera, Diptera, Hemiptera, and Orthoptera, was evaluated in the fieldafter application of a dyed-ASB to flowering and non-flowering vegetation. ASB feeding (staining) wasdetermined by dissecting the guts and searching for food dye with a dissecting microscope. The potentialimpact of ATSB on non-targets, applied on green non-flowering vegetation was low for all non-targetgroups (0.9%). However, application of the ASB to flowering vegetation resulted in significant stainingof the non-target insect orders. This highlights the need for application guidelines to reduce non- targeteffects. No mortality was observed in laboratory studies with predatory non-targets, spiders, prayingmantis, or ground beetles, after feeding for three days on mosquitoes engorged on ATSB.

关键词：按蚊鲫鱼；诱饵；鞘翅目；库蚊；蚊科；疾病传播媒介

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The Health Hazard Evaluation Program received a request from employees at a medical office building. They were concerned about indoor environmental quality and exposure to sewer gas, specifically hydrogen sulfide. The medical office building was a four-story, concrete masonry office building constructed in the 1960s that had been renovated twice; the three main floors were converted into offices and exam rooms. The building was surrounded by manholes that had been identified as sources of odors. The building was within 30 feet of a 24-inch trunk line that carried sewage from approximately 60% of the surrounding area toward the wastewater treatment facility. Most of the building's current plumbing was the original cast iron waste and vent piping, which can become brittle and crack with age. We visited the facility in April 2013 and measured hydrogen sulfide, carbon dioxide, temperature, and humidity levels throughout the building. We also inspected the building's heating, ventilation, and air-conditioning system. We did not detect hydrogen sulfide in the building. We found that carbon dioxide concentrations generally increased when moving further away from the supply air discharge point on each floor; outdoor air supplied to each floor was not uniformly distributed. Temperature and humidity were within ANSI/ASHRAE recommended levels. We found problems with duct dampers, heat pumps, and the computerized control system, and determined that air flowed from the restrooms into the hallways. We found odor sources within and near the building such as dry drain traps and manholes.

关键词：空气流动；空气质量；环境暴露；环境因素；气体；对健康的危害

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The study has made substantial progress over the past year. The emerging data on cognition, emotion, and subjective sleep suggest that six weeks of morning Blue Light Therapy versus comparable Amber Light Placebo supports our initial hypotheses that the treatment would improve sleep and cognition. Emerging data from functional magnetic resonance imaging tasks also suggest that the Blue Light condition was effective in altering brain responses during two demanding attention and working memory tasks, whereas such changes were not evident in the Amber Light Placebo condition. Overall, these findings suggest that the Blue Light treatment improved hippocampal functioning during working memory and was associated with prefrontal cortex activation during an attention-based conflict monitoring task. The initial findings point toward some beneficial effects of the active treatment in reducing daytime sleepiness and sleep-related functional impairments, improving subjective sleep, showing clinically significant improvements in attention, and affecting functional brain responses. The current data set is still small and we are exploring avenues to increase sample size to obtain sufficient power to detect reliable effects.

关键词：脑；明亮的光线；认知；数据库；功能性磁共振成像

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Renal ischemia that occurs intraoperatively during procedures requiring clamping of the renal artery (such as renal procurement for transplantation and partial nephrectomy for renal cancer) is known to have a significant impact on the viability of that kidney. To better understand the dynamics of intraoperative renal ischemia and recovery of renal oxygenation during reperfusion, a visible reflectance imaging system (VRIS) was developed to measure renal oxygenation during renal artery clamping in both cooled and warm porcine kidneys. For all kidneys normothermic and hypothermic, visible reflectance imaging demonstrated a spatially distinct decrease in the relative oxy-hemoglobin concentration (%HbO2) of the superior pole of the kidney compared to the middle or inferior pole. Mean relative oxy-hemoglobin concentrations decrease more significantly during ischemia for normothermic kidneys compared to hypothermic kidneys. VRIS may be broadly applicable to provide an indicator of organ ischemia during open and laparoscopic procedures.

关键词：缺血；肾；脱氧；组织（生物学）；VRIS

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This technical report is the third of three reports from the U.S. Army Edgewood Chemical Biological Center (ECBC) In-House Laboratory Independent Research (ILIR) funded project Molecular Toxicology of TICs in Human Embryonic Stem Cells . One of the goals of the study was to identify metabolites from the secretome of human embryonic stem cells (hESC) exposed to the toxic industrial chemicals (TICs) methyl parathion (MP) and methyl paraoxon (MPO). The non- targeted liquid chromatography followed by mass spectrometry (LC-MS) approach used in the Phase I work (Sekowski et al., ECBC-TR-1177) revealed hundreds of human metabolites and multiple metabolic pathways altered as a result of exposure to both chemicals. This was followed by Phase II work (Madren-Whalley et al., ECBC-TR-1178) in which twenty metabolites were down-selected for further structural confirmation. The purpose of this Phase III study was to confirm the identity of the down-selected subset of putative metabolites by comparing them with commercially available standards using liquid chromatography followed by tandem mass spectrometry (LC-MS-MS). Commercially available standards were available for nine metabolites. Of these nine, the identity of five metabolites was confirmed in this work.

关键词：胚胎；代谢物；甲基自由基；对硫磷；干细胞

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Trauma is known to induce hemostatic disorders such as trauma- induced coagulopathy (TIC), which evolves rapidly during the first few hours following injury. Commercially available devices for measuring blood-clotting status have many limitations that render them generally unsuitable for use in forward military treatment facilities and particularly during patient transport. These devices (Haemonetics thrombelastography (TEG) and ROTEM thromboelastometry (TEM)) require clean, stable and vibration-free environments to properly validate their measurements. Coagulation assessment can take up to an hour using these instruments. Entegrion has developed an alternative to these devices that will perform the necessary testing in a portable environment suitable for far forward and patient transport arenas. Use of this device will allow surgeons in level 1, 2, or 3 hospitals to make medical decisions based on the accepted state of a patient's coagulation profile.

关键词：血液凝固；手持式；军事设施；便携式设备

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In 2009, pandemic H1N1 influenza virus (2009 H1N1) emerged worldwide, causing morbidity and mortality that disproportionately affected young adults. Upper respiratory infection (URI), largely due to adenovirus, is an endemic cause of morbidity in military training. Whether clinical presentations differ or excess morbidity results from coinfection is unclear.

关键词：腺病毒；临床医学；流行病学；甲型H1N1流感病毒

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On January 4, 2011, President Barack Obama signed into law the National Alzheimers Project Act (NAPA) (Public Law 111-375), requiring the Secretary of the U.S. Department of Health and Human Services (HHS) to establish the National Alzheimers Project to: Create and maintain an integrated national plan to overcome Alzheimers disease; Coordinate Alzheimers disease research and services across all federal agencies; Accelerate the development of treatments that would prevent, halt, or reverse the course of Alzheimers disease; Improve early diagnosis and coordination of care and treatment of Alzheimers disease; Decrease disparities in Alzheimer's for ethnic and racial minority populations that are at higher risk for Alzheimers disease; and Coordinate with international bodies to fight Alzheimers globally.

关键词：阿尔茨海默氏病；诊断；差异

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As requested by the United States Senate Committee on Veterans Affairs, the VA Office of Inspector General conducted a study to assess the provision of VA outpatient (take-home) opioids and monitoring of patients on opioid therapy (hereinafter referred to as opioid patients). Specifically, we described both the prevalence of VA patients who filled any take-home opioid prescriptions at VA in fiscal year (FY) 2012 and their baseline characteristics; evaluated VA dispensing patterns of take-home opioids, including concurrent (filled) benzodiazepines, filled dose of acetaminophen, and early refills of opioids; and assessed the extent to which VA screens and monitors opioid patients in alignment with measures adapted from selected recommendations in the VA/Department of Defense Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain (hereinafter referred to as the Clinical Practice Guideline). We also defined VA patterns of providing psychosocial treatment for pain, Pain Clinic service, and medication management/pharmacy reconciliation for take-home opioid patients and determined the prevalence of six selected serious clinical adverse effects among VA take-home opioid patients that may be reasonably expected to be related to opioid therapy.

关键词：保健；检查；阿片生物碱；门诊；疼痛管理

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