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Epidemics of novel or re-emerging infectious diseases have quickly spread globally via air travel, as highlighted by pandemic H1N1 influenza in 2009 (pH1N1). Federal, state, and local public health responders must be able to plan for and respond to these events at aviation points of entry. The emergence of a novel influenza virus and its spread to the United States were simulated for February 2009 from 55 international metropolitan areas using three basic reproduction numbers (R0): 1.53, 1.70, and 1.90. Empirical data from the pH1N1 virus were used to validate our SEIR model. Time to entry to the U.S. during the early stages of a prototypical novel communicable disease was predicted based on the aviation network patterns and the epidemiology of the disease. For example, approximately 96% of origins (R0 of 1.53) propagated a disease into the U.S. in under 75 days, 90% of these origins propagated a disease in under 50 days. An R0 of 1.53 reproduced the pH1NI observations. The ability to anticipate the rate and location of disease introduction into the U.S. provides greater opportunity to plan responses based on the scenario as it is unfolding. This simulation tool can aid public health officials to assess risk and leverage resources efficiently.

Young rifts are shaped by combined tectonic and surface processes and climate, yet few records exist to evaluate the interplay of these processes over an extended period of early rift-basin development. Here, we present the longest and highest resolution record of sediment flux and paleoenvironmental changes when a young rift connects to the global oceans. New results from International Ocean Discovery Program (IODP) Expedition 381 in the Corinth Rift show 10s–100s of kyr cyclic variations in basin paleoenvironment as eustatic sea level fluctuated with respect to sills bounding this semi-isolated basin, and reveal substantial corresponding changes in the volume and character of sediment delivered into the rift. During interglacials, when the basin was marine, sedimentation rates were lower (excepting the Holocene), and bioturbation and organic carbon concentration higher. During glacials, the basin was isolated from the ocean, and sedimentation rates were higher (~2–7 times those in interglacials). We infer that reduced vegetation cover during glacials drove higher sediment flux from the rift flanks. These orbital-timescale changes in rate and type of basin infill will likely influence early rift sedimentary and faulting processes, potentially including syn-rift stratigraphy, sediment burial rates, and organic carbon flux and preservation on deep continental margins worldwide.

Background The offer of free nicotine replacement therapy (NRT) can be a cost-effective marketing strategy to induce smokers to call a telephone quitline for quitting assistance. However, the most cost-effective supply of free NRT to provide to smokers who call a quitline remains unknown. This study tests the hypothesis that smokers who call a telephone quitline and are given more free nicotine patches would report higher quit rates upon follow-up 12 months later. Methods A quasi-experimental design was used to assess nicotine patch usage patterns and quit rates among five groups of smokers who called the New York State Smokers' Quitline (NYSSQL) between April 2003 and May 2006 and were mailed 2-, 4-, 6- or 8-week supplies of free nicotine patches. The study population included 2,442 adult (aged 18 years or older) current daily smokers of 10 or more cigarettes per day, who were willing to make a quit attempt, and reported no contraindications for using the nicotine patch. Outcome variables assessed included the percentage of smokers who reported that they had not smoked for at least 7-days at the time of a 12 months telephone follow-up survey, sustained quitting, delayed quitting and nicotine patch use. Results Quit rates measured at 12 months were higher for smokers in the groups who received either 2, 6, or 8 weeks of free patches. The lowest quit rate was observed among the group of Medicaid/uninsured smokers who were eligible to receive up to six weeks of free patches. The quit rate for the 4-week supply group did not differ significantly from the 6-week or 8-week groups. These patterns remained similar in an intent-to-treat analysis of 12-month quit rates and in an analysis of sustained quitting. Conclusion No clear cut dose response relationship was observed between the number of free nicotine patches sent to smokers and smoking outcomes. Baseline diferences in the characteristics of the groups compared could account for the null findings, and a more definitive randomized trial is warranted.

Introduction: Telephone quitlines are an easily accessible and effective means for delivering cessation services including nicotine replacement therapy (NRT). Varenicline (VAR) may show superior quit rates to NRT, but has not been routinely evaluated in the context of quitlines. Aims: To assess the feasibility of distributing VAR through a quitline, and preliminarily compare cessation rates between participants receiving VAR and NRT. Methods: Participants were recruited through the New York State Smokers’ Quitline. Those randomised to VAR (n = 200) were instructed to obtain a prescription from their primary care physician (PCP) to be filled by mail through the research pharmacy. Those randomised to NRT (n = 100) were mailed NRT using an existing protocol. Outcome measures were number of submitted prescriptions and dispensed medication kits, and self-reported 7-day point prevalence abstinence at follow-up. Results: The research pharmacy filled 100% of prescriptions through the quitline. However, only 27% of the VAR Arm submitted a prescription. An intent-to-treat analysis revealed that those receiving NRT were more likely to be abstinent at follow-up than the VAR Arm (OR, 2.42; 95% CI, 1.27–4.60; p < 0.01). The per-protocol analysis, which only included those in the VAR Arm who submitted a prescription, showed no difference in quit rates. Conclusions: The present protocol resulted in successful delivery of VAR through the quitline, but a sizable proportion of the VAR Arm did not submit a prescription. Self-reported barriers included being unable to obtain a prescription from a PCP. Future studies should explore alternative methods for delivering VAR through quitlines.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Previous studies have found that offering additional callback counseling support to smokers calling a telephone quit line increases quit rates. However, what is less certain is the most cost-efficient protocol for offering such a service. This study compares the efficacy of offering 2 versus 4 counseling callbacks after an initial call from Medicaid/uninsured adult smokers contacting the New York State Smokers' Quit Line (NYSSQL). Outcomes compared are the 7- and 30-day nonsmoker prevalence rates measured at 3-month follow-up and the cost per quit. A 2-group randomized trial was conducted. The study population included 1923 adult (18+ years) Medicaid/uninsured current smokers (10+ cigarettes per day) who called the NYSSQL between February and March 2009 seeking help to stop smoking. At the time of the study, the NYSSQL provided Medicaid/uninsured callers with up to 6 weeks of free nicotine medications and up to 4 counseling callbacks. Half the subjects were randomized to standard care with up to 4 counseling callbacks with the remaining subjects offered only 2 counseling callbacks. All participants were sent a minimum of a 2-week supply of nicotine replacement therapy, with some receiving up to 6 weeks. Participants were recontacted 3 months after enrollment in the study to assess smoking status. Quit rates, total counseling callbacks completed, reductions in cigarette consumption, and cost per quit measures. There was not a significant difference between study groups in the number of callbacks completed. There was also no difference in 7- or 30-day nonsmoker prevalence rates measured after 3 months' follow-up or reported use of the free nicotine replacement therapy between those assigned to either the 2- or 4-callback protocols. The cost per quit was essentially the same in both groups (2 callbacks--$442 per quit vs 4 callbacks--$445 per quit). There was no advantage in terms of quit success or cost to offering up to 4 callbacks instead of 2 callbacks.

Up to 10% of all cancers are thought to have a familial basis through complex interactions between genes and environment. A community-wide education campaign was conducted that included several elements: a five part television news series; an educational newsletter; web site pages and links to educational materials; a Continuing Medical Education (CME) program for professionals; and an evaluation survey. Survey estimates revealed that 39000 households recalled seeing the series; 14800 households changed their views about the risks of hereditary cancers; and about 9900 households were made more aware/informed about cancer and hereditary risk. This awareness campaign broadened public knowledge about the myths and realities associated with genetic factors and cancer risk. It reinforced the importance of early screening for persons at high risk of cancer due to hereditary factors.

We report the safety and antigenicity of influenza A vaccines in seronegative children one to seven years of age. A natural HINI challenge that occurred shortly after completion of the vaccination program permitted an evaluation of efficacy. Twenty-eight subjects were inoculated with live cold-adapted (ca) influenza A/Washington/897/80 (H3N2), 29 with ca influenza A/California/10/78 (H1N1), 24 with inactivated whole-virus influenza A/Bangkok/79 (H3N2), and 30 with a placebo. The ca vaccines were well tolerated, whereas the inactivated vaccine caused adverse reactions in about one-third of the children. Fifty-seven percent of the ca HINI recipients showed serological responses, contrasted with 84% and 100% of subjects receiving the ca or inactivated H3N2 vaccines, respectively. None of the 16 children with induced H1N1 antibody developed clinically apparent influenza-like illness, compared with eleven of the 51 initially seronegative children who did not receive the ca H1N1 vaccine and with four of the 12 who failed to respond. Results of the efficacy field trial suggest protection against infection and symptomatic illness in children inoculated with ca HINl, despite its failure to stimulate high levels of hemagglutinin-inhibiting antibody.