Child abuse is common and several studies have linked it to health outcomes throughout the lifecourse. Recent information about timing of abuse reported retrospectively is underrepresented in the literature, despite its importance to informing target populations for primary prevention of child abuse and studying effects of child abuse. This study uses data from Wave IV (2008–2009) of The National Longitudinal Study of Adolescent Health to Adult Health  to describe distributions of retrospectively self-reported age of onset of childhood emotional, physical, and sexual abuse perpetrated by parents/adult caregivers and sexual abuse perpetrated by other individuals. Information on childhood abuse history was collected when participants were between 24 and 32 years old.Parental/adult caregiver perpetrated abuse frequently started in early childhood, particularly sexual abuse. Non-parental/adult caregiver sexual abuse motivated by physical force also started early in boys ). Earlier onset of some types of abuse was associated with male sex, not being raised by both biological parents, and low childhood household income.Future studies should further examine timing of childhood abuse onset and include diverse measures of abuse, including those derived from longitudinal studies and validated reports. If these results are replicated, they suggest that abuse, particularly sexual abuse perpetrated by parents/adult caregivers, often starts in early childhood, and preventive interventions should be designed to protect younger children. Adults commonly report having been abused as children, and several studies have linked childhood abuse to various mental and physical outcomes from childhood through late life , when they were queried about history of childhood abuse. Inclusion criteria for the present study  were 1) presence of a Wave IV sampling weight; 2) data for any of the childhood abuse questions in Wave IV. Permission to conduct secondary analyses was approved by the Emory University Institutional Review Board.The National Longitudinal Study of Adolescent to Adult Health  .Abuse history was assessed via five questions through a computer-assisted self interview. Three questions assessed parental/adult caregiver sexual, physical, and emotional abuse, and two questions assessed non-parental/adult caregiver sexual abuse motivated by physical force and non-physical threats , and we dichotomized abuse into present or absent by selecting cut points approximating prevalences in the Adverse Childhood Experiences questionnaire in a multi-state, population based sample (Centers for Disease Control and Prevention (CDC) N = 2,694, 1,321, and 528 for parent/caregiver emotional, physical, and sexual abuse, respectively, and 770 and 565 for non-parent/caregiver sexual abuse motivated by non-physical threats and physical force, respectively), we used multivariate linear regression to model age of onset of each individual abuse type, examining the independent effects of sex, race, childhood household income in 1994 as measured by parent interview , and whether one was raised by both biological parents. All analyses incorporated complex weighting to account for the survey design using SAS callable SUDAAN  following guidelines by Chen and Chantala . For the subset of individuals who experienced abuse and who had information available for all potential determinants of abuse timing  participated in the survey. Table Table In regression models Table , except This study adds to the literature describing age of various types of childhood abuse onset via retrospective-self report, a measure that has been underutilized in recent studies, in a nationally representative sample. In this sample, sexual abuse perpetrated by parents/adult caregivers began particularly early. The median onset of sexual abuse perpetrated by parents/adult caregivers is notably younger than that found in older surveys from the 1980s (median ages between 10 and 11 years) (Finkelhor The effect of interventions for the prevention of child abuse remains unclear, so there is a need for accurate information on characteristics of abuse, such as age of onset, to guide the development of impactful interventions. For example, several interventions shown to increase children’s knowledge of abuse and protective behaviors are based in the school setting (Macmillan et al. An important limitation of our study, as previously mentioned, is that retrospective self-report may be prone to recall error. Research indicates that adults have the ability to recall events from much of their childhood (Tustin and Hayne This study also has noteworthy strengths, particularly as it relates to diversity. Age of onset of child abuse is an important, poorly understood topic across demographic groups. The study design and methods allowed our findings to be representative of the United States school enrolled population, encompassing all regions of country, urbanicity types, school sizes/types, and racial/ethnic groups.These data show that child abuse in the United States is common and starts for many children during early childhood. Additional studies are needed to confirm our preliminary findings, and researchers should utilize various study designs to examine this topic, while remaining cognizant of the biases each method introduces. Such research is an important precursor to studying the effects of abuse on child and adult outcomes and designing effective preventive measures.


Medical countermeasures (MCMs)—drugs, vaccines, diagnostic tests, and other therapies and devices—rank among the most important assets in the nation's arsenal against dangerous pathogens, as well as chemical, radiological, and nuclear threats. Communities with access to vital MCMs are better equipped to detect both accidental and deliberately caused outbreaks quickly, immunize susceptible populations, and treat infected patients, thereby alleviating the consequences associated with infectious diseases: illness and death, economic losses, societal unrest, and strained public health and healthcare delivery systems.BThe United States relies on the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) to develop, approve, purchase, and distribute the MCMs needed to mitigate biological threats and their impacts on health and security. PHEMCE, which is led by the Department of Health and Human Services' (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR), includes several HHS partners, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). Other interagency partners include the Department of Defense (DoD), the Department of Veterans Affairs (VA), the Department of Homeland Security (DHS), and the US Department of Agriculture (USDA). Among these entities, NIH  is a driving force for early-stage biomedical research on infectious disease prevention and treatment. DoD operates a Medical Countermeasure Systems office that leads efforts to develop and field MCMs for military forces. Finally, the Biomedical Advanced Research and Development Authority (BARDA), part of ASPR, plays a key role in developing and procuring MCMs against a range of biological threats.Several policy frameworks and pieces of legislation also govern US efforts in MCM acquisition, regulation, and distribution. Notable among these is the Project BioShield Act of 2004, which was created to fund development and government procurement of novel MCMs against traditional biological weapons threats such as botulism, anthrax, and smallpox. The FY2016 budget for HHS's Public Health and Social Services Emergency Fund included $646 million to support Project BioShield activities. The Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA), enacted in March 2013, authorized further funding for MCM purchasing and advanced MCM research and development efforts through 2018. Additionally, Homeland Security Presidential Directives 10, 18, and 21  underscore the importance of a robust MCM enterprise to national and global health security.With the support of federal policies and legislation, PHEMCE has made many critical contributions to preparedness and response efforts around biological threats. In response to the 2014 Ebola outbreak in West Africa, for example, PHEMCE partners rapidly coordinated efforts to develop and test needed vaccines, therapeutics, and diagnostics. In 2014, PHEMCE partners also procured 4 million additional doses of a next-generation smallpox vaccine, as well as 33,000 doses of a monoclonal antibody against anthrax toxin. Additionally, between 2014 and 2015, FDA approved 2 new influenza products, as well additional MCMs against anthrax, high doses of radiation, and plague.Still, sustaining and furthering national MCM preparedness for biological threats remains a challenge for the nation. Bringing a fully licensed MCM from bench to bedside typically takes up to a decade or longer and close to a billion dollars. An evolving threat landscape further complicates efforts to prioritize MCM investments for different types of biological threats. Recent experiences with Ebola, Zika, Middle East respiratory syndrome coronavirus (MERS-CoV), and pandemic influenza have also highlighted a range of challenges: for example, that pharmaceutical manufacturers have little financial incentive to develop and produce MCMs against rare and emerging—albeit high-consequence—pathogens.Given that most MCMs against high-priority biological threats lack viable commercial markets, there is considerable uncertainty regarding their development. As a result, MCM development for biodefense and emerging infectious diseases remains contingent upon government funding, unique incentive systems, and advance purchase agreements. Federal support for MCM research and development is a prerequisite for national security and preparedness. There are several steps the next administration could take to fortify the United States's MCM enterprise. These efforts, in turn, could enhance national readiness for biological threats, protect the public's health, and strengthen national security.The President should request continued funding for basic research and investments in new technologies that could accelerate MCM development and production.➢ The President's Council of Advisors on Science and Technology (PCAST), in its most recent report on US biosecurity, recommends greater funding for basic and applied research (including regulatory science) at HHS and DoD, which would begin at an initial level of $75 million annually for 4 years and gradually increase to $250 million per year. Such support is an important precondition for successful discovery and development of MCMs for biodefense.PCAST also recommends setting an ambitious national goal: that a vaccine for a novel biological threat should be developed, manufactured, tested, and licensed within 6 months of identifying the threat and deciding to pursue a vaccine. NIH, the biomedical research arm of the federal government, should receive increased funds specifically designated for this foundational work.In addition to supporting basic research for biological threats, the Administration should also increase investments in new technologies  that could accelerate MCM development and help scale-up MCM production during a public health emergency. Funds in support of this aim should be vested in BARDA, which develops technologies for advancing MCM manufacturing, and the Defense Advanced Research Projects Agency's (DARPA) Biological Technologies Office, which executes innovative biotechnology research efforts in support of national security.The Administration should prioritize development and procurement of MCMs to address antimicrobial resistance, including nontraditional MCMs.➢ Federal funding entities and research agencies need to prioritize MCMs needed to combat an evolving array of biological threats. R&D efforts should include a focus on creating point-of-care diagnostic tools, particularly for emerging or novel infections, as well as a strong focus on addressing antimicrobial resistance, given increasing resistance to current anti-infectives. New antibiotics and antivirals are needed, but research and development beyond traditional MCMs is critical. The Administration should continue to support efforts that aim to bring nontraditional MCMs to market. These include, but are not limited to monoclonal antibodies, bacteriophages, lysins, antimicrobial peptides, and microbiome-based products. The Administration should also continue to encourage federal scientists at BARDA and NIAID to identify nontraditional antimicrobials that qualify for fast-track approval, priority review, or accelerated approval pathways under the GAIN Act.To alleviate the regulatory burdens associated with approving new MCMs, the new Administration should also encourage Congress to increase base funding for FDA to strengthen its Medical Countermeasure Initiative. These funds would enable the agency to grow and train its product review workforce; additional supplemental funds could also support FDA's ongoing regulatory scientific research efforts. Such support, in turn, would allow relevant FDA programs and offices to mobilize MCMs through the regulatory pipeline as efficiently as possible.HHS should design and implement new incentive structures to accelerate public- and private-sector MCM research and development efforts.➢ Certain incentives could spur innovation around MCMs that target drug-resistant pathogens, agents of bioterrorism, and emerging infectious diseases, while others may pose challenges. With the enactment of the 21st Century Cures Act, FDA will be tasked with overseeing a new priority review voucher program designated for MCMs against high-priority pathogens deemed to be national security threats, as well as other chemical, radiological, and nuclear agents. While such vouchers may offer pharmaceutical developers an added incentive to create needed MCMs for countering biological threats, conducting expedited product reviews over the specified 6-month period  could present FDA with considerable product review burdens. Increased base funding to strengthen FDA's product review workforce, as noted previously, could increase the agency's capacity to conduct expedited reviews of MCMs through this new program.Initiating novel MCM development is only the first hurdle the nation faces in enhancing biothreat preparedness. Advanced or late-stage development is the costliest phase of the MCM pipeline and historically has been a major bottleneck in bringing viable products to market. The Administration could help bridge these late-stage gaps by increasing biodefense-related MCM funding through PAHPRA and Project BioShield—which are intended to cover costs associated with late-stage MCM development and procurement—thereby reducing some of the risks pharmaceutical manufacturers face in bringing MCMs to market.Building public-private biosecurity partnerships could further strengthen research and development efforts at every point in the MCM value chain. The US government should create new opportunities for private-sector pharmaceutical companies to work with DoD and NIAID to translate basic research findings into investigational therapies, diagnostics, and prophylactics. The BARDA-NIH CARB-X accelerator, aimed at developing new MCMs in the face of antimicrobial resistance, is a recent example, as is BARDA's partnership with GlaxoSmithKline to develop novel antibiotics for combating both antibiotic resistance and the threat of bioterrorism. As these MCMs mature, further collaboration between manufacturers and federal entities that specialize in advanced development—such as BARDA's Centers for Innovation in Advanced Development and Manufacturing, or DoD's Medical Countermeasure Systems office—could help ensure that they successfully transition into the appropriate commercial markets.The Administration should strengthen protocols for testing and approving MCMs for use during public health emergencies involving biological agents.➢ The United States faces challenges in verifying the safety and effectiveness of MCMs for biodefense, as many cannot be ethically tested in human subjects. The Animal Efficacy Rule allows for approval of such MCMs based on evidence from animal studies; however, researchers still lack validated animal models for several high-priority diseases. The Administration should therefore fund federal biomedical authorities to continue collaborating with partners in academia and industry to identify additional animal models for basic research on emerging and intentional biological threats.Another challenging problem, exemplified during recent outbreaks of Ebola and Zika, is that of generating enough interpretable clinical trial data to inform regulatory decision making around MCMs during ongoing emergencies. The Administration should encourage Congress to invest additional funds in creating and strengthening the infrastructure—personnel, trial sites, recruitment mechanisms, and the like—needed to conduct clinical trials efficiently both during acute public health emergencies and amid ongoing threats such as the spread of antimicrobial-resistant pathogens.The Administration should strengthen international MCM sharing mechanisms.➢ The United States is an important donor of MCMs during international public health emergencies, but often faces a myriad of legal, logistical, and financial barriers in sharing MCMs with nations affected by biological threats. During the 2009 H1N1 influenza pandemic, for example, the US government provided nearly 1 million doses of antivirals to affected nations through the Pan American Health Organization and pledged up to 25 million additional doses to the World Health Organization. In doing so, however, US health authorities encountered considerable challenges in establishing legal conditions with recipient nations. Assisting other countries in the control and containment of significant infectious disease outbreaks is in the United States's public health and national security interest. In this vein, the Administration should identify strategies for clarifying, codifying, and strengthening international MCM sharing protocols. Given an increasingly globalized world, having stronger national capacities to mitigate biological threats outside the United States lessens the risk of those threats gaining a domestic foothold.The threat of natural and deliberate infectious disease emergencies are ever present and, by their very nature, evolving at a rapid pace. Ensuring that a robust and innovative MCM enterprise is poised to meet these challenges is the chief means of enhancing the national and health security of the nation and its people.


Emerging Non-communicable diseases burden move United Nation to call for 25% reduction by 2025 in premature mortality from non-communicable diseases (NCDs). The World Health Organization (WHO) developed global action plan for prevention and control NCDs, but the countries’ contexts, priorities, and health care system might be different. Therefore, WHO expects from countries to meet national commitments to achieve the 25 by 25 goal through adapted targets and action plan.In this regards, sustainable high-level political statement plays a key role in rules and regulation support, and multi-sectoral collaborations to NCDs’ prevention and control by considering the sustainable development goals and universal health coverage factors.Therefore, Iran established the national authority’s structure as Iranian Non Communicable Diseases Committee (INCDC) and developed NCDs’ national action plan through multi-sectoral approach and collaboration researchers and policy makers. Translation Iran’s expertise could be benefit to mobilizing leadership in other countries for practical action to save the millions of peoples. Alarming increase of premature mortality from non-communicable diseases across the world considered by Global action plan on NCDs and Sustainable Development Goals –3. Also,Evidences indicate that, Iran threatened by NCDs too –10. In IFollowing these progresses in health situation of Iranians, a remarkable revolution occurred in the health status of the country especially in the field of communicable diseases. Nevertheless, non-communicable diseases remained as the great health problem in Iran. In 2013, 236 thousand deaths in Iran occurred due to NCDs and there was 14.5% increase of NCDs’ death during two past decades . At the In 2013, NCDs led to 7 million years lived with disability (YLD) in Iran , 14. It Non-communicable diseases ignored during the framing of the Millennium Development Goals in 2000, but clarification of the reality leads the policymakers to pay attention to it. The United Nations and the World Health Organization (WHO) have called for a 25% reduction by 2025 in mortality from non-communicable diseases among persons between 30 and 70 years of age, in comparison with mortality in 2010, adopting the slogan “25 by 25” .Universal health coverage (UHC) as a critical component of sustainable development reduces poverty and social inequities through financial risk protection. It is important; the Key elements of the right to health are availability, accessibility, acceptability, quality .By considering these rights and responding to significant burden of NCDs, the World Health Organization (WHO) developed the global action plan for the prevention and control of NCDs (2013–2020) which contain 9 targets by considering four main risk factors; including tobacco use, an unhealthy diet, lack of physical activity and harmful alcohol use. These behavioral risk factors are associated with four main disease clusters mentioned above . As manyThe WHO has messaged; the countries could shift from political commitment to effective action by prioritizing affordable interventions. This organization emphasized on the need of all countries to set national NCDs targets and responsible to attain them , 20.The aim of this paper is to present the emerging Iranian architecture for NCDs’ prevention and control and create NCDs’ national action plan to move forward.Mandate with the task of developing a national action plan for NCDs’ prevention and control was the opportunity for Iran to commitment 25 by 25 NCDs goal . In contSuccess in response to NCDs crisis depends on strong and effective leadership in high-level political statement . In thisMinistry of Health and Medical Education (MOHME) of Iran as strong and effective leadership in high-level political statement established Iranian non-communicable diseases committee (INCDC) with the aim of comprehensive policy making, planning, and monitoring of all activities in the area of non-communicable diseases in Iran.As shown in Fig. Iranian non-communicable diseases committee has nine sub-committees according to various aspects of prevention and controls NCDs and their risk factors and national targets Fig. .National Action Plan for Prevention and Control of Non-Communicable Diseases and the related risk factors in Iran, 2015-2025” was developed by considering our country’s priorities, National and Sub-national Burden of Diseases, and WHO global targets [Planning is one of the key steps for responding to NCDs’ dramatic epidemic . “Nation targets –29.The national action plan for NCDs Prevention and Control in Iran including 9 targets based on global action plan for NCDs and 4 special targets regarding trans fatty acid, traffic injuries, drug abuse, and mental diseases.th target of NCDs global action plan set to reduce physical inactivity by 10% by 2025. According to our country situation, we considered 20% reduction of physical inactivity.Among nine global targets on prevention and control NCDs, target 3 and target 8 adapted for our country situation. According to WHO report, Prevalence of insufficient physical activity in Iranian adult was 24.1% among men and 42.9% among women , 31. TheIn addition, the eighth target of global action plan set to receiving drug therapy and counseling to prevent heart attacks and strokes by 50% of eligible people. But we accelerate this desired measure to 70% because of access to medicines plays a vital role in universal health coverage goals achievement and already we stand up good point . It is rIn addition to glossary WHO targets, United Nation proposed Sustainable Development Goals (SDGs). The third sustainable development goal focused on health and considered UHC as a mean of health equity. It is needed to effective attention to non-communicable diseases .By considering burden of diseases in Iran, targets 10 to 13 set for our country  is an appropriate model in supreme level for mega coordination , 40. AccResource mobilization, technical allocation, health workforce development and health care quality improvement are essential for action plan implementation. Poor leadership, change management, financial constraints, poor health infrastructure, inadequate qualified human resources, poor information and communication, poor coordination and resistance of some organizations might be lead to implementation collapse , 43. ButOvercoming possible barriers in action plan implementations, scaling up interventions and health management in various levels of health services leads to reduce years of life lost (YLL) and YLD due to NCDs and finally benefit for health equity and financial protection .President, parliament, supreme council of health members and cabinet ministers’ support and collaboration with other ministries and organizations were unique experience in the region. Access to efficient epidemiological information, explicit views of national policy makers in various domains of public health, treatment, food and medicine, education, and research. Partnership of policy and decision makers, scientist, researchers and health experts in national action plan development, establishment national sub committees guided by national authorities and structuring the provincial committees as the frontline of health services were our strengths.Of course, we faced to some challenges in resource mobilization. Despite our long-term goals, INCDC was not finance by specific and sufficient budget. In addition, lack of private health sector and Nongovernmental organizations’ collaboration was the other limitation could be considered in the way forward. The other important challenge was incompleteness and misclassification reporting of cause of death that addressed by National and Sub-national Burden of Diseases Study (NASBOD) and now, we have comprehensive atlas of death in by cause in various levels .Finally, Similar to other experience, we suggest integration of NCDs’ prevention and control in primary health care, enforce appropriate interventions led by provincial committee, technical use of existing infrastructure and human resources, innovative resource mobilization such as funding through nongovernmental resource, provide progress monitoring system and ensure accountability from the involved sectors, and actions to accelerate progress , 36, 45.


Numerous bacteria utilize molecular communication systems referred to as quorum sensing (QS) to synchronize the expression of certain genes regulating, among other aspects, the expression of virulence factors and the synthesis of biofilm. To achieve this process, bacteria use signaling molecules, known as autoinducers (AIs), as chemical messengers to share information. Naturally occurring strategies that interfere with bacterial signaling have been extensively studied in recent years, examining their potential to control bacteria. To interfere with QS, bacteria use quorum sensing inhibitors (QSIs) to block the action of AIs and quorum quenching (QQ) enzymes to degrade signaling molecules. Recent studies have shown that these strategies are promising routes to decrease bacterial pathogenicity and decrease biofilms, potentially enhancing bacterial susceptibility to antimicrobial agents including antibiotics and bacteriophages. The efficacy of QSIs and QQ enzymes has been demonstrated in various animal models and are now considered in the development of new medical devices against bacterial infections, including dressings, and catheters for enlarging the therapeutic arsenal against bacteria. Staphylococcus spp., Clostridium spp., or Enterococcus spp., among others, AIPs   act in a network  is a molecular mechanism by which bacteria communicate to collectively adapt their behavior according to cell density and the surrounding environment Figure . This cos Figure . Many GrErwinia carotovora  Figure . QQ was Currently identified QQ enzymes mainly target AHLs and AI-2 mediated QS: phosphotriesterase-like lactonases (PLLs), lactonases, acylases, and oxidoreductases degrade AHL signals Fetzner,  and oxidIn the current context of the rise of antibiotic tolerance and resistance, novel therapeutic approaches are needed  and β-lactam antibiotics  decreased biofilm formation and restored antibiotic susceptibility  and Gram-positive (S. aureus) bacteria and showed synergistic effects in cotreatment with tobramycin and clindamycin or vancomycin respectively both in vitro and in vivo  or a vegetative (trophozoite) form feeding on bacteria among other organisms . In this way, they use phagocytosis coupled with lysosomal digestion which is close to macrophage bacterial elimination pathway  a fast killing assay which leads to worm death in a few hours to assess the presence of toxins, and (ii) a slow killing assay with death occurring after several days to evaluate bacterial colonization  and gives a very deep insight into virulence regulation, modulation by QQ agents and, in general, by anti-infective molecules , and the physiopathology of the roundworm which is very different from the human one. Furthermore, as for amoebae, the influence of assay conditions on the outcome of the assay have been highlighted by several studies  or their cytotoxicity (anti-cancer molecules)  was efficient in reducing infection when incorporated into a Dacron graft (Balaban et al., For Aspergillus melleus was successfully incorporated into polyurethane coatings and silicon catheters reducing biofilm formation of P. aeruginosa ATCC 10145 and PAO1 respectively (Ivanova et al., Bacillus amyloliquefaciens delayed biofilm development of both P. aeruginosa ATCC 10145 and E. coli ATCC 25922 for up to 7 days in an in vivo rabbit model (Ivanova et al., P. aeruginosa PAO1. Topical treatment involving lactonase from Bacillus sp. ZA12 was also investigated in a burn infection model on mice using P. aeruginosa PAO1 (Gupta et al., 6 bacteria burn infection prevented systemic spread, decreased mortality, and showed synergistic effect with ciprofloxacin.Although QS inhibiting materials were obtained after covalent immobilization of QSIs or peptides, QQ enzymes were also thoroughly investigated as these compounds, acting on secreted autoinducers, do not need direct contact with the cells to disrupt communication. Acylase from SsoPox from Sulfolobus solfataricus was found to be a highly attractive way of quenching bacterial virulence (Rémy et al., P. aeruginosa PAO1 (Ng et al., SsoPox-W263I was further shown to significantly reduce the virulence of 51 clinical isolates of P. aeruginosa from diabetic foot ulcerations and kept its efficiency toward PAO1 after immobilization into polyurethane coating via glutaraldehyde crosslinking (Guendouze et al., in vivo use of this variant was also reported through intratracheal administration and drastically enhanced the survival rate in a rat pneumonia model infected by P. aeruginosa PAO1 (Hraiech et al., Because enzyme stability is a major bottleneck in the development of bio-based materials, catalysts from extremophile environments were considered. Particularly, PLL In addition to the studies using AHL-based QS quenchers, a recent report described the use of the AI-2 processing kinase LsrK. This enzyme was attached to a capsule of biological polymers chitosan and alginate supplemented with ATP substrate and reduced AI-2 mediated QS (Rhoads et al., in vivo and in clinical phases. The efficacy of these devices has to be demonstrated not only in model bacterial strains but also on genetically and phenotypically diverse clinical isolates. Although the development of medical devices is less constrained than for drugs, further regulatory concerns have to be considered to confirm the potential of the techniques for therapeutic applications. Nevertheless, the wide spectrum of both QSI and QQE as well as the numerous examples of their medical relevance would pave the way to the emergence of innovative devices.QQ-based devices have raised special attention considering that they could prevent HAIs by limiting bacterial virulence and biofilm formation. However, further efforts have to be dedicated to validate the proof of concepts in vitro and using QS mutants or QSIs, the results obtained so far were not consistent (Griffin et al., Over the past 15 years, many studies have demonstrated that QQ molecules and QQ approaches have great potential as anti-infective agents against a broad range of bacteria. This is evidenced by the numerous studies demonstrating the benefit of these approaches in functionalizing medical devices. To date, little is known about potential resistance mechanisms that bacteria could develop to overcome QQ (Defoirdt et al., The broad effect of QS on the physiology of bacteria shows that QQ would be an appropriate strategy not only to reducing bacterial virulence but also in terms of restoring antibiotic tolerance by decreasing biofilm formation and in terms of decreasing bacterial phage resistance, paving the way for future combination therapies.Aeromonas hydrophila was reduced (Zhou et al., E. coli overproducing AI-2 to counter the impact of streptomycin-induced gut dysbiosis potentially underlining the role of quorum sensing in the context of complex microbiota (Thompson et al., Remarkably, the disruption of bacterial signaling, a communication system central to microbial communities (McFall-Ngai et al., BR, SM, LP, ME, EC, and DD: conceived and designed the work; BR, SM, LP, and DD: performed survey and drafted the paper; BR, SM, LP, ME, EC, and DD: critically revised the manuscript. All authors read and approved the final manuscript.ME and EC have a patent WO2014167140 A1 licensed to Gene&GreenTK. LP, DD, and EC report personal fees from Gene&GreenTK during the conduct of the study. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with the authors ME, EC, and DD.


A set of 617 approved anticancer drugs, constituting the active domain, and a set of 2,892 natural products, constituting the inactive domain, were employed to build predictive models and to index natural products for their anticancer bioactivity. Using the iterative stochastic elimination optimization technique, we obtained a highly discriminative and robust model, with an area under the curve of 0.95. Twelve natural products that scored highly as potential anticancer drug candidates are disclosed. Searching the scientific literature revealed that few of those molecules  have already been experimentally screened for their anticancer activity and found active. The other phytochemicals await evaluation for their anticancerous activity in wet lab.Cancer is considered one of the primary diseases that cause morbidity and mortality in millions of people worldwide and due to its prevalence, there is undoubtedly an unmet need to discover novel anticancer drugs. However, the traditional process of drug discovery and development is lengthy and expensive, so the application of  Cancer is one of the primary global diseases that cause morbidity and mortality in millions of people worldwide . Its incThe molecular basis of cancer cell development among differentiated normal cells is well studied and has been attributed to two key components, namely oncogenes and tumor suppressor genes , 4. Respin silico model for indexing natural products for their anticancer bioactivity. The in silico studies and mathematical-/statistical-based modeling presented here provide insights into the physicochemical properties associated with anticancer activity at the molecular level. Structural based , Colchicine[The attained area under the curve (AUC) of the proposed ISE-based model is 0.95, indicating the effectiveness of the model. As well, the ISE-based model and the perfect model overlap somewhere in the range of molecular bioactivity index (MBI) ≥ 4.0; thus, the model is considered highly discriminative and effective for classifying anticancer drug candidates and inactive natural products. 38olchicine, and Pipolchicine) have alin silico model to screen large databases of natural products could undoubtedly save time and costs and aid in detecting novel natural-based anticancer drug candidates. We have disclosed some highly indexed phytochemicals that could serve as potential anticancer drug candidates. A literature search shows that few of those molecules have already been experimentally screened for their anti-cancerous activity and found active. The other phytochemicals await evaluation for their anti-cancerous activity in wet lab. As well, this study provides important insights into discriminative properties of natural products having anti-cancerous activity.A highly efficient and robust model for indexing natural products for their anticancer bioactivity has been built using the ISE algorithm. We believe that the use of such an S1 Table(PDF)Click here for additional data file.


Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability.Function QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training program for caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design.Function QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs.NCT03300336 Registered September 28, 2017, NCT03474380 Registered March 15, 2018.The online version of this article (10.1186/s13012-018-0748-3) contains supplementary material, which is available to authorized users. Clinical improvement efforts require team structure that coordinates the work of individuals who are interdependent in their tasks, manage relationships within one or more social systems , and share responsibility for outcomes. Teams influence relationship patterns that emerge within workgroups , which hTeam factors are especially important in interdisciplinary care settings where expertise and skills vary among clinicians involved in patient care. Moreover, there is limited evidence elucidating the features of teams  that are associated with clinical performance and successful implementation of non-acute services in hospital and specialty care settings. Consistent with an emerging literature indicating that team process and effectiveness are associated with improvements in patient-centered care , the OptGroup PT for knee osteoarthritis, STRIDE, and iHI-FIVES, that fill gaps in current clinical care for Veterans at risk for functional decline and disabilityImplement and evaluate three new clinical programs, CONNECT) for use in a diverse mix of clinical settings and Veterans Affairs Medical Centers (VAMCs)Adapt a novel complexity science-based implementation intervention to promote team readiness . With a lifetime risk of 45% and rising overall prevalence , 9, kneep = 0.007) [Project 2 evaluates the implementation of assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older Veterans focused on maintaining musculoskeletal strength and mobility during hospitalization, a highly vulnerable time for development of disability. A key contributor to hospital-associated disability is immobility during hospitalization . While f= 0.007) . Based o) project by facilitating the rollout of caregiver trainings across eight participating VAMC sites and evaluating the program, with its increased enrollment for definitive retesting on a larger sample (n ≥ 400) in this hybrid type III effectiveness-implementation design. Caregiver Support Program staff and Geriatrics and Extended Care Services staff will be recruited to offer iHI-FIVES.Project 3 examines the implementation of helping invested family members improve veterans experiences study (iHI-FIVES) to promote function and independence through skills training and support for caregivers of Veterans with cognitive and/or functional limitations. The Veterans Health Administration (VHA) has the most extensive system of home and community-based services of any health care system in the USA and yet about two-thirds of the 5.5 million Veterans who receive care in the home receive it exclusively from family and friends. Caregivers allow Veterans to avoid or delay nursing home entry , but carAs described in Table Providing expertise in implementation science, organizational behavior, and quantitative and qualitative analyses, our implementation core serves as an essential bridge across all Function QUERI projects. The implementation facilitation component of the core will develop and facilitate the implementation activities for Group PT, STRIDE, and iHI-FIVES with participating sites. The data and analytic component of the core will develop survey and interview instruments, establish common measurement of team characteristics and outcomes across projects (when possible), and evaluate the impact of teams on implementation and programmatic outcomes. Organizing the projects through this implementation core provides economies of scale and minimizes variation in processes and effort across projects and the participating sites. Implementation core activities are described in more detail below.Our program of work is informed by Grol and Wensing’s Implementation of Change Model (IoC)  and the We use our program’s nested model of team function and performance Fig.  to guideBased on preliminary assessment of barriers to program implementation for each project (noted in Table Replicating Effective Programs (REP) is a package of strategies, originally developed to support dissemination of behavioral and treatment interventions for HIV in community settings . REP hasInformed by social constructivist and learning theories and complexity science, which describe learning as a social process drawn from engaged interactions and information flow, CONNECT is a bundle of interaction-oriented activities designed to supplement implementation efforts by promoting team function and readiness for change , 56–61. Function QUERI will adapt the CONNECT intervention for application in Function QUERI clinical contexts, where new clinical programs are composed of team members from multiple service units within a VA hospital. For example, participants targeted for CONNECT training vary across the three clinical program’s delivery teams and their referring providers. CONNECT for the two larger, longer term projects will be informed by initial work of the single-site Group PT project, which will identify relevant components of CONNECT for improving team communication. Furthermore, CONNECT activities and didactic content will be modified to fit each clinical program. Role play will include scenarios related to issues surrounding each project’s clinical problem, and the emphasis on CONNECT activities may differ. To illustrate, activities known as group and individual mapping are the likely focus of CONNECT team building for Group PT and iHI-FIVES because team members of these clinical programs work in different locations  with limited opportunities for frequent interaction and thus require support for improving communications about appropriate referrals, administrative logistics, and communicating patients’ clinical status. CONNECT training for STRIDE and iHI-FIVES will be conducted prior to launch of clinical programs across multiple sites.clinicaltrials.gov (STRIDE no. NCT03300336 and iHI-FIVES no. NCT03474380).The Function QUERI’s program goals are to assess (1) the effectiveness of the clinical programs and (2) the impact of CONNECT and team characteristics on clinical program implementation. The remainder of this paper focuses on the design of our evaluation of teams and CONNECT. Details on evaluations of clinical program effectiveness  are available at As a 1-year quality improvement project at a single site, the study design for Group PT is different than that of our multi-site implementation projects. Because the Durham VA Health Care System’s Physical Medicine and Rehabilitation Service had already initiated implementation of Group PT for Veterans with knee OA, Function QUERI’s role is to evaluate the program’s successes, challenges, and outcomes to inform programmatic adaptations in a rapid timeframe, akin to a Plan-Do-Study-Act cycle –66. FuncClinical program implementation and testing of the CONNECT intervention for the STRIDE and iHI-FIVES implementation projects use a hybrid type III effectiveness-implementation design because the implementation intervention (CONNECT) and clinical programs (STRIDE and iHI-FIVES) have solid evidence bases but could yield weaker outcomes in new or less controlled environments , 67, 68.STRIDE and iHI-FIVES will each recruit eight unique participating sites for implementation and evaluation. Each project’s implementation will occur in two stratified blocks (four VAMCs per block) with two waves per block (two VAMCs per wave) Fig. . We willWith assistance from our VA operation partners and marketing clinical programs through VAMC clinical conferences and national meetings, we will recruit sites on a volunteer basis. We will assess eligibility of sites to determine if they meet project-specific criteria that includes adequate sample size for evaluation. Specifically, STRIDE sites must have a minimum inpatient average daily census of 20 general medicine patients per day and iHI-FIVES sites must commit to conducting two rounds of iHI-FIVES training sessions every 6 months.Evaluation of team and CONNECT impacts on implementation will employ a mixed methods design. Guided by our nested model of team function and performance in implementation, the implementation core will develop and collect common measures from primary and secondary data sources to evaluate team processes and characteristics, program characteristics, environmental context, and implementation outcomes. The data used to evaluate team and CONNECT impacts on clinical program implementation will be obtained from several sources, including provider/staff surveys and interviews, patient surveys and interviews, patient electronic medical record abstraction, and VA administrative data for patient encounters and VAMC performance measures. Since all projects’ clinical programs utilize staff from existing care teams, inpatient wards, and service lines, Function QUERI will assess team characteristics and function before and after CONNECT training and program implementation. Sample measures and associated data sources are displayed in Table Team characteristics and processes will be primarily assessed using the Team Development Measure (TDM©), a 31-item questionnaire, which characterizes teams’ stage of development and the degree to which groups have the characteristics of highly effective teamwork in place [in place , 71. Thein place . This wiThe implementation core will supplement the TDM© with additional survey and interview questions identified from the literature on healthcare teams . These aClinical program characteristics include the components and processes that each site chooses for program delivery. Each site for STRIDE and iHI-FIVES will be provided with clinical program implementation packages that outline both the core and optional elements of each program. We will track how each site decides to structure their program and also assess other important elements associated with delivering the program such as task complexity and uncertainty, and dependence on other teams or clinical units within the organization.Environmental context is an important consideration in our evaluation. Clinical programs and their teams operate within the broader context of local VAMCs that vary by facility complexity, organizational climate, presence of policies and practices to support innovative practices, and historical performance. These factors may work individually or in combination to support or challenge a team’s ability to accomplish intended goals.Implementation outcomes are the intermediate result of deliberate action in implementing new practices/services [services . They seservices . Given tqual) in which quantitative data constitute the core component and are collected in parallel with qualitative data [Function QUERI’s evaluation of implementation will focus on examining the impact of teams and the CONNECT implementation strategy, within and across projects. We will use a quantitatively driven simultaneous design  than sites receiving REP alone. To evaluate the impact of CONNECT on clinical program implementation, penetration, fidelity, and cost outcomes will be assessed only in the post-implementation period and primary analyses will be conducted on implementation outcomes observed in the first post-implementation period to avoid potential confounding with time since implementation. We will use appropriate logistic or linear mixed regression models –81, wherOrganization-specific context and processes are likely to affect both implementation and program outcomes. Our quantitative findings will be complemented by additional analyses of context sensitivity and qualitative data from semi-structured interviews with key informants at participating sites. Responses will be coded and analyzed at individual and team levels, using both a priori labels of facility context, team processes and implementation outcomes, and data-derived labels to develop site-level case memo summaries of contextual factors and team processes. From this coded data, we will identify and visually display emergent themes in a matrix, with columns reflecting implementation outcomes  arranged from high to low, to illustrate patterns in contextual factors and team processes according to implementation outcomes. For example, we will develop a matrix to compare reports of implementation processes and outcomes between REP alone and REP + CONNECT sites. The rows of the matrix will reflect a priori implementation measures, and the columns will reflect whether responses are from REP or REP + CONNECT sites.Utilizing a similar approach across projects, we will perform budget impact analysis for STRIDE and iHI-FIVES multi-site projects to frame affordability to the VHA . DependiThe Function QUERI set an ambitious and important agenda to explore ways to effectively disseminate and implement innovative evidence-based clinical programs across the VA health system. There is a significant amount of work that presents challenges and opportunities. First, conducting the implementation and evaluation, with an a prior stepped-wedge design in ever changing real-world settings, forces Function QUERI to delicately balance considerations of study design and voluntary participation in implementing clinical programs. To this end, our use of REP to work with sites in a systematic and standardized way is a great strength in facilitating local adaptations to optimize implementation. Second, our selection of volunteer sites may limit heterogeneity in our sample. However, there is a great deal to learn about implementation processes and adaptations in real-world settings to inform continuous improvement and to the likelihood of effective uptake and sustainability of valuable clinical intervention. Third, our measurement approach involves significant effort in primary data collection of patient and provider surveys, interviews, and extraction of secondary administrative/clinical data with attention to common measures across three contextually disparate clinical contexts. The challenges of data collection and management may be outweighed by the opportunity to generate a broader, nuanced understanding of implementation in hospital settings and to facilitating effective interdisciplinary team function across VA settings.Function QUERI will achieve an immediate impact on the VHA by providing access to evidence-based clinical services for a large group of vulnerable Veterans at risk for functional decline and loss of independence. A long-term impact will be to enhance VA’s capacity for clinical innovation through development and testing of an implementation intervention (CONNECT) to enhance uptake of evidence-based programs in interdisciplinary teams. To this end, the Function QUERI program will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs. Synthesizing findings within and across projects, we will translate implementation findings to identify the contextual factors and components from CONNECT that improve team processes and function to optimize future wide-scale implementation of VA clinical programs.Additional file 1:Function QUERI implementation activities, by phase of REP (indicated by green arrows) and highlighting application of CONNECT (red arrows) for each project. (DOCX 222 kb)


This article extends environmental risk perception research by exploring how potential health risk from exposure to industrial and vehicular air pollutants, as well as other contextual and socio-demographic factors, influence racial/ethnic differences in air pollution health risk perception. Our study site is the Greater Houston metropolitan area, Texas, USA—a racially/ethnically diverse area facing high levels of exposure to pollutants from both industrial and transportation sources. We integrate primary household-level survey data with estimates of excess cancer risk from ambient exposure to industrial and on-road mobile source emissions of air toxics obtained from the U.S. Environmental Protection Agency. Statistical analysis is based on multivariate generalized estimation equation models which account for geographic clustering of surveyed households. Our results reveal significantly higher risk perceptions for non-Hispanic Black residents and those exposed to greater cancer risk from industrial pollutants, and also indicate that gender influences the relationship between race/ethnicity and air pollution risk perception. These findings highlight the need to incorporate measures of environmental health risk exposure in future analysis of social disparities in risk perception. Under the rubric of environmental justice (EJ) research, a wide range of quantitative case studies have found neighborhoods with higher proportions of racial/ethnic minority and socioeconomically disadvantaged residents to be disproportionately exposed to various environmental risks in the U.S. ,2,3,4. EA number of prior studies suggest that racial/ethnic minorities demonstrate higher levels of environmental concern than Whites, especially when such concerns are framed in terms of environmental health risk ,10,11,12Empirical research on racial/ethnic differences in environmental risk perception is characterized by several additional limitations. A recent review of this literature  identifiThis article seeks to address the aforementioned limitations of previous work and extend environmental risk perception research by exploring how the spatial pattern of exposure to industrial and vehicular air pollutants and other contextual factors influence racial/ethnic differences in perceptions of air pollution health risks. The study site for this research is the Greater Houston metropolitan area, Texas, USA—a racially/ethnically diverse urban area with numerous neighborhoods facing high levels of exposure to toxic air emissions from industrial and transportation sources. Our specific objectives are to examine: (a) the relationship between race/ethnicity and air pollution health risk perception at the individual/household level; and (b) how this relationship changes when we consider exposure to both industrial and vehicular air pollution, as well as other contextual and socio-demographic variables such as gender, age, home ownership, socioeconomic status, and previous experience with air pollution that have been found to influence perceived environmental risks in previous research; and (c) if the relationship between race/ethnicity and air pollution risk perception is conditional on gender, after controlling for other contextual and socio-demographic characteristics. Our study integrates primary household-level survey data with modeled estimates of potential cancer risk from exposure to industrial toxic releases and on-road mobile source emissions of hazardous air pollutants that were obtained from the U.S. Environmental Protection Agency (USEPA). In order to analyze racial/ethnic differences in environmental risk perception, we use generalized estimation equation (GEE) models, which account for geographic clustering of surveyed households in our study area and provide more statistically valid inferences regarding the environmental and social determinants of air pollution health risk perception.The Greater Houston Metropolitan Statistical Area (MSA) comprises ten counties in southeastern Texas, as depicted in Mayor’s Task Force on the Health Effects of Air Pollution concluded that air pollution levels in this metropolitan area are considered to be unacceptable by knowledgeable experts and the general public, and are likely to cause air pollution-related health effects for residents [The Greater Houston MSA is a suitable study area for this research because of its racial/ethnic diversity and ambient air pollution problems. Airborne emissions from numerous point and on-road sources have contributed to elevated levels of chronic exposure to various types of air pollutants in this MSA. A report compiled by the esidents .Both industrial and transportation-related air pollution have emerged as significant health threats for residents of Greater Houston. Chronic exposure to industrial air pollutants is of particular concern in this MSA, based on the nature and quantity of toxic chemical releases resulting from petrochemical industrial activities. This MSA is one of the world’s largest manufacturing centers for petrochemicals and home to the largest petrochemical complex in the U.S., in addition to hosting two of the four largest refineries in the nation . The petAlthough recent EJ studies have reported racial/ethnic and socioeconomic inequities in the distribution of exposure to toxic air pollutants in Greater Houston ,35 previThe data used to construct the dependent and a majority of independent variables for this study was derived from an Institutional Review Board (IRB)-approved cross-sectional telephone survey of randomly selected adults in the Greater Houston MSA that was conducted from 28 June to 1 August 2012. The human subjects research protocol  was approved by the University of Texas at El Paso IRB on 18 May 2012. The telephone interviews were conducted by trained, English-Spanish bilingual interviewers employed by a firm with expertise in survey research in this metropolitan area. Each survey lasted approximately 30 min and incentives of $10 in cash were provided to all participants who completed the survey. Additional information regarding the structured survey instrument and related details are available in Collins et al. .A multi-stage sampling approach was utilized to ensure that our sample was drawn randomly using probability methods, as well as being spatially and socially representative of the Greater Houston MSA. The approach involved stratifying and randomly selecting a subset of census tracts across four geographic quadrants of our study area (stage 1), and then completing telephone surveys with randomly selected residents in each selected tract (stage 2). To select the census tracts for stage 1, tracts with each quadrant were stratified into quintiles based on an index created from two census variables representing race/ethnicity and socioeconomic status: percentage of non-Hispanic whites, and median household income. Within each quintile for each quadrant, we randomly chose six tracts, with a total of 30 selected tracts per quadrant. For sampling at the household level, we utilized listed residential landline telephone numbers because of the detailed geographic resolution necessary for our analysis and to connect each survey respondent to a home address within our selected census tracts. Although landline-only surveys might disproportionately exclude people known to have high rates of cell-only usage  from sampling frames, research indicates that this does not necessarily produce more biased estimates for those groups ,38. The Air pollution health risk perception (APHRP) was measured at the individual level by combining responses to two specific survey questions that relied on Likert-scale items to evaluate respondents’ perceptions: (1) How much of a problem do you think air pollution is in this urban area ; and (2) How concerned are you about the possibility of air pollution causing health problems to you or members of your household . Responses to these two questions were combined to construct a two-item factor  using principal components analysis that represented the dependent variable for our statistical analysis. The use of these two survey variables allowed us to assess respondents’ perceptions regarding the seriousness of air pollution problems in the Greater Houston MSA, as well as their levels of concerns regarding potential health impacts in their own homes, thus incorporating both the local and household dimensions of the issue .We first used secondary data sources to construct two explanatory variables that examine potential health risks associated with ambient exposure to industrial and vehicular air pollutants, respectively. To measure risk from industrial pollution sources, we used the USEPA’s Risk Screening Environmental Indicators (RSEI) model for 2011. Nationally, the RSEI model includes over 400 chemicals from more than 25,000 facilities in the manufacturing, mining, power generation, waste-management and chemical-management sectors that are required to report their chemical releases to the Toxics Release Inventory (TRI), established under the Emergency Planning and Community Right-to-Know Act in 1986. The RSEI includes a fate-and-transport model that uses information on stack heights, exit gas velocities, wind patterns, and chemical decay rates to estimate ambient concentrations of the toxic releases for 11,289 grid cells, each 810 m by 810 m, around each TRI facility. Chemicals are weighted in the RSEI by toxicity, defined in the case of air releases as chronic human health effects from inhalation exposure . CombiniFor this study, our industrial air pollution risk variable is based on estimates of excess cancer risk extracted from the RSEI-GM database for 2011. Since our analysis is not chemical specific, we used the aggregated sum of excess cancer risk across all chemicals at the grid cell-level that results in a total excess cancer risk estimate for each 810 m by 810 m grid cell. The cancer risk scores obtained for the RSEI-GM grid cells in the Greater Houston MSA were spatially allocated to our sample of 586 surveyed households. Each geocoded survey respondent’s cancer risk from industrial air pollutants thus equals the total excess cancer score of the RSEI-GM grid cell in which their home address is located. To measure health risks from ambient exposure to vehicular sources of air pollutants, we used the U.S. EPA’s National-Scale Air Toxics Assessment (NATA), which has emerged as an important database for estimating health risks associated with the inhalation of hazardous air pollutants (HAPs), as well as the most reliable data source for spatially explicit characterization of HAP risk exposure in U.S. urban areas ,45,46,47To represent our independent variable for vehicular air pollution risk, we use values of estimated lifetime cancer risk from inhalation exposure to on-road mobile sources of HAPs associated with each participating household, based on the census block within which the household resided at the time the telephone survey was conducted. The on-road mobile source category includes motorized vehicles that typically operate on public roadways and comprises passenger cars, motorcycles, minivans, sport-utility vehicles, trucks, and buses . LifetimThe second set of explanatory factors comprise socio-demographic variables from the structured survey that have been found to have a significant relationship with environmental risk perception in previous studies. A description of the survey variables used for this analysis is provided in In terms of control variables relevant to environmental risk perception, we included the gender (sex) and age (in years) of each survey respondent. The amplification of risk perception among females compared to males is well-documented ,52,53,54To evaluate socioeconomic status (SES), another important dimension of risk perception, we used a continuous and standardized variable that combines 2011 annual household income levels with the level of education for the individual in the household with the highest attainment , using principal components analysis. The evidence on how SES influences environmental risk perception is somewhat mixed ,56. AnotDescriptive statistics for the entire set of variables used in our analysis are provided in We used generalized estimating equations (GEEs), a multivariate analysis technique appropriate for clustered data, to analyze determinants of air pollution health risk perception. Prior to running the GEEs, multiple imputation (MI) was employed to account for non-response bias associated with missing values for the control variables derived from our household survey. MI is considered to be the best practice for addressing missing data in statistical analysis ,65,66 anOur multivariate analysis utilized GEEs with robust covariance estimates that extend the generalized linear model of Nelder and Wedderburn  to accomn = 8), which yielded a total of 48 different clusters. This cluster definition approach was selected over other alternatives such as census tract of residence, since GEE techniques assume dependence of observations within clusters and independence between clusters. These assumptions would be less reliable if only census tracts were utilized to define clusters, because data for households living in separate tracts, but within the same urban developmental context with similar socio-demographic characteristics, would be treated as independent [To fit a GEE model, clusters of observations must be defined based on the assumption that observations from within a cluster are correlated, while observations from different clusters are independent. Our cluster definition was based on median year of housing construction, obtained from the 2010–2014 American Community Survey, by county of location, for census tracts in which surveyed households reside. Specifically, we defined clusters of census tracts based on median decade of housing construction  by county  was calculated for the combination of variables included in the multiple regression model. For all models, the MCI was found to be smaller than 30, indicating the absence of serious collinearity problems among the explanatory variables.In order to explore the statistical effects of our explanatory variables on APHRP, three multivariate models based on the GEE approach are utilized. We used two different GEEs to examine the role of: (1) race/ethnicity; and (2) other independent variables/controls; separately and collectively. While the first model (model 1) only includes non-Hispanic Black and Hispanic status, the second model (model 2) includes these two racial/ethnic variables, cancer risks from exposure to industrial and vehicular air pollution, as well as the set of control variables representing socio-demographic characteristics. Model 3 encompasses all variables included in model 2, in conjunction with additional terms that represent two-way interactions between racial/ethnic and gender variables. Non-Hispanic White status was treated as the reference group in all models and thus excluded from the GEEs. The pooled GEE results, based on our multiply imputed dataset, are summarized in In Model 1, the positive coefficients for both non-Hispanic Black and Hispanic status indicate significantly higher levels of APHRP for respondents in these racial/ethnic groups compared to non-Hispanic Whites. After the inclusion of cancer risk and other control variables in model 2, non-Hispanic Black status continues to indicate statistically higher APHRP than non-Hispanic White status, but the coefficient for Hispanics becomes non-significant. While excess cancer risk from industrial air pollution shows a significantly positive association with APHRP, vehicular air pollution risk has a non-significant effect. In terms of our control variables, APHRP is found to be significantly higher among respondents who are female and those who have previously suffered from air pollution-related health problems. When gender-based interaction terms were added in model 3, variables that were significantly related to APHRP in model 2  retain their statistically significant associations. The interactions between non-Hispanic Black and female status, as well as Hispanic and female status are significant, which suggest that the relationship between air pollution risk perception and race/ethnicity is conditional on the gender of the survey respondent. When other explanatory variables are held constant or at zero, APHRP scores are found to be the highest for non-Hispanic Black males (0.246) and females (0.113), followed by Hispanic males (−0.109), White females (−0.128), and Hispanic females (−0.145). White male respondents indicate the lowest APHRP scores (−0.497), compared to the other combinations of race/ethnicity and gender. This article sought to improve the current state of knowledge regarding the major factors shaping local perceptions of air pollution health risk by examining racial/ethnic differences in perceived risks, the spatial pattern of cancer risk from exposure to industrial and vehicular pollutants, and the role of specific socio-demographic characteristics in forming these perceptions. Our statistical results provide strong evidence of racial/ethnic disparities in air pollution risk perceptions in the Greater Houston MSA. Our multivariate analysis indicated that personal perceptions of air pollution health risk are significantly higher for both non-Hispanic Black and Hispanic residents, compared to non-Hispanic Whites and other non-Hispanic minorities when exposure to industrial and vehicular air pollutants and other socio-demographic factors are not considered. Although the differences in perceived health risk between non-Hispanic White and Hispanic respondents became non-significant, the White–Black disparity remained highly significant even after considering the effects of exposure to industrial/vehicular air pollution risks and other socio-demographic factors that shape risk perception. Dumping in Dixie [Since the 1980s, EJ researchers have documented how Black communities in this MSA and the city of Houston, in particular, are disproportionately exposed to industrial pollutants, hazardous waste, and other forms of environmental contamination ,35,75,76Risk perception levels were found to be significantly higher for those exposed to greater risk from industrial sources but not for those exposed to transportation sources of risk, after racial/ethnic status and other control variables were included in the multivariate model. Recent research on perceptions of air quality near busy highways also indicate that local residents often have a beneficial relationship with vehicles and roadways, which translates to lower health risk perception for traffic pollution, compared to industrial pollution . For theIt is also important to consider that several previous studies reported a disconnect between personal risk perceptions and scientifically-measured air pollution levels in Houston  and otheIn terms of other characteristics, female respondents and those who have suffered health problems related to air pollution in the past indicated significantly higher levels of environmental risk perception, after controlling for other explanatory factors and interaction effects. These results do not differ from the findings of previous perception studies that report similar statistical relationships with perceived risk for gender  and prevAdditional data and further research are needed to develop a more comprehensive understanding on how race/ethnicity and local exposure to air pollution shape public perceptions of environmental health risk. Firstly, our dependent variable provides a general assessment of air pollution health risk perception for local residents, but does not incorporate emission sources or categories. Future research could focus on formulating and utilizing variables that examine personal risk perceptions associated with specific air pollution sources such as oil refineries, petrochemical plants, automobile exhaust, construction, and/or agricultural dust in the local area. Secondly, our measurement of household-level air pollution risk focuses only on cancer risk and does not include non-cancer health effects such as respiratory or neurological risks that are also associated with ambient exposure to industrial and vehicular air pollutants. It is important to explore the use of additional data sources that provide geographically detailed information on other air pollution-related health risks and adverse health outcomes that can be linked to the surveyed households. Thirdly, the racial/ethnic categories used in our analysis  are somewhat broad and imply a degree of homogeneity that may not exist with minority populations in this metropolitan area. While our study contributes to the growing trend of looking beyond White/non-White dichotomies in the literature on race/ethnicity and perceived environmental risks by including Hispanics ,85, receIn summary, our study demonstrates significantly higher concerns regarding air pollution health risk for non-Hispanic Black residents of Greater Houston, even after accounting for their exposure to industrial and vehicular air pollutants, other socio-demographic factors, and the effects of spatial clustering in our survey data. The fact that our statistical controls were insufficient in explaining risk perception differences between White and Black respondents confirms themes that environmental justice advocates and scholars have repeatedly asserted—environmental health risks in U.S. urban areas are unequally distributed and this form of inequality is particularly palpable for residents who live near industrial pollution sources, as well as highways and roadways . This re


CCT spatial variation was primarily affected by the ratio of planting area to regional area (RPR) via its effect on the magnitude of carbon transfer (MCT), which depended mainly on fertilizer usage per area (FUA). From 1992 to 2014, CCT exhibited a significantly increasing trend with a rate of 0.48 TgC yr−1. The inter-annual variation of CCT was dominated by carbon transfer per planting area (CTP) through its effect on MCT, which significantly correlated with FUA but showed no significant correlation with climatic factors. Therefore, the factors affecting the spatial variation of CCT differed from those that affected its inter-annual variation, indicating that the spatial and temporal variations of ecological phenomena were affected by divergent factors.Spatial and temporal variations are important points of focus in ecological research. Analysing their differences improves our understanding on the variations of ecological phenomena. Using data from the Liaoning Statistical Yearbook, we investigated the spatial and temporal variations of cropland carbon transfer (CCT), an important ecological phenomenon in quantifying the regional carbon budget, in particular, the influencing factors and difference. The results showed that, from 1992 to 2014, the average CCT in Liaoning province was 18.56 TgC yr Many studies have assumed that the drivers of spatial and temporal variations in ecology are similar and have investigated the temporal variation of ecological phenomena using spatial sampling4. However, recent studies have showed that the spatial variation of annual gross primary productivity (GPP) is strongly affected by annual mean air temperature (MAT) and annual mean precipitation (MAP)6, while MAT and MAP contribute little to the inter-annual variation of annual GPP in most ecosystems8. This highlights the need to illustrate whether drivers of spatial variation differ from those of temporal variation.Spatial and temporal variations have been a vital focus of ecological research and have attracted much attention9 and is composed of the quantity of organic matter harvested from croplands11 including grains and straws but excluding residues. Investigating the spatiotemporal variations of CCT helps to accurately assess the cropland carbon budget, which is vital in regional carbon budget assessments aiming to mitigate climate change9. This is because cropland plays a key role in maintaining the global carbon budget13. In addition, CCT serves as a vital process of global carbon cycle, which is a key topic of ecological research. Analysing the spatiotemporal variations of CCT can also reveal whether there are differences in the drivers of spatial and temporal variations of ecological phenomena.Cropland carbon transfer (CCT) is an important component of cropland carbon budgetY), harvest index (HI), carbon content (C), and water content (W), where Y can be obtained from statistical yearbook and the remaining values are empirical parameters. In addition, CCT can be deemed as the product of the magnitude of carbon transfer per area  and regional area , where RA can be obtained from available data. MCT, an important item in quantifying the regional carbon budget14, is thus calculated as the ratio of CCT to RA. Additionally, MCT is regarded as the product of carbon transfer per planting area  and the ratio of planting area to regional area , where the planting area is obtained from statistical yearbook. Furthermore, CTP, the quantity of carbon contained in grains and straws but excluding residues, can also be deemed as gross primary productivity (GPP) minus autotrophic respiration (AR). Therefore, CCT can be separated into many components  How CCT spatially and temporally varied in Liaoning province? (2) Which components dominated the spatial and temporal variations of CCT? (3) Were there differences in the drivers of spatial and temporal variations? Our results provide a data foundation to assess the regional carbon budget in Liaoning province and a reference for calculating CCT in other regions. They also provide evidence for understanding the difference between spatial and temporal variations.−1 and spatially varied, exhibiting a decreasing trend from northwest to southeast  varied little among years, and MCT dominated the pattern of CCT, exhibiting an increasing trend Fig.  at a rat−2 yr−1 from 1992 to 2014 , harvest index , water content , and carbon content , since the statistical yearbook only reported the yield. Then, the CCT of Liaoning province was summed as CCT from all prefectural-level cities and all crops  or any region (CCTi) can be expressed as:i) as:RA) and MCT (∆CCTMCT) can thus be expressed as:RA/∆CCT and ∆CCTMCT/∆CCT, respectively. For simplicity, we selected the largest CCTi for all prefectural-level cities as the benchmark value (CCT0).In this study, we employed the factor decomposition modelThe roles of CTP and RPR in the spatial and inter-annual variations of MCT were also investigated in the same way.44, including sunshine duration (SD), annual mean air temperature (MAT), and annual mean precipitation (MAP). In addition, we calculated the climatic data of Liaoning province based on climatic data for each prefectural-level city to illustrate the inter-annual variation of CCT.In this study, we selected the climatic data of each prefectural-level city Table  from theFurthermore, given that fertilization promoted crop yield and thus CCT, we selected fertilizer usage per area (FUA) as a societal factor affecting the spatiotemporal variations of CCT. FUA was calculated using the regional area and the quantity of fertilizer used in each prefectural-level city, as reported in the Liaoning Statistical Yearbook.In this study, we created the spatial distributions of CCT, MCT, RPR, and CTP with ArcGIS 10.0. The trends of CCT, MCT, RPR and CTP were determined by Mann-Kendall trend analysis using MATLAB 2014 . The correlation between CCT, including its components, and various factors, including climatic and societal variables, were investigated with correlation analysis using MATLAB 2014 at the significance level of 0.05.www.cnki.net. All datasets generated during the current study are available from the corresponding author on reasonable request.The datasets analysed during the current study are calculated based on the methods described in this study and the original data of the statistical yearbook, which can be found at


In 2013, one in five reported nonfatal occupational injuries occurred among workers in the health care and social assistance industry, the highest number of such injuries reported for all private industries . New data submissions are available to OHSN participants within a week, and they can analyze new and historical injury data and produce outputs in the form of graphs and tables at any time. The NIOSH OHSN topic page provides information on 1) data terminology, transmission, and security; 2) examples of output graphs and tables; and 3) intervention resources  were OSHA-recordable injuries. Overall incidence rates of OSHA-recordable injuries  per 10,000 worker-months for patient handling; slips, trips and falls; and workplace violence were 11.3, 9.6, and 4.9, respectively . Most inNurse assistants were more likely to sustain injuries than workers in other job categories; this occupation had more than twice the injury rate of nurses for patient handling and workplace violence injuries . Injury Of all patient handling injury reports, 62% included data on the use of lifting equipment; 82% of the injuries occurred when lifting equipment was not used . Of all This report examines patient handling; slips, trips, and falls; and workplace violence injuries, which make up a substantial portion of all occupational injuries in the health care sector, as reported by the national Bureau of Labor Statistics findings for workers in all sectors . OverallOther studies found that musculoskeletal disorders are increasing among health care personnel . NursingIn 2013, Bureau of Labor Statistics found rates of injuries and illnesses resulting from workplace violence increased for the second year in a row to 16.2 cases per 10,000 full-time workers in the health care and social assistance sector . Data reThe findings in this report are subject to at least four limitations. First, in 2012–2014, only 112 U.S. health care facilities from 19 states participated, and the data in this report might not be very representative of the thousands of health care facilities in the United States. Second, a considerable proportion of OHSN injury data regarding risk factors are categorized as unspecified, which could limit OHSN’s ability to identify causality and prevention needs. Third, possible participation, reporting, and recording biases might exist. Voluntary participation might skew participation to best-practice facilities and some facilities might not report all injury data, leading to underestimation of injury rates. Not all facilities collect detailed data requested by OHSN, such as specific activities which lead to patient-handling injuries or why a patient or coworker commits violence against health care personnel. Thus, missing data might bias the results. As participating facilities submit more complete information on worker injuries, the large amount of unspecified data might likely diminish. NIOSH personnel can assist facilities with improving data completeness and quality.OHSN offers a variety of tools for NIOSH and health care institutions to work toward a common goal of employee safety and health by reducing all types of injuries among health care personnel. OHSN enables health care facilities to track injuries; collect and analyze detailed standard injury data to direct resources toward employees, departments, and situations most at risk; compare their own injury rates with groups of their choosing; access prevention resources; facilitate implementation of timely prevention measures; and monitor intervention impact. Emphasizing worker safety promotes and strengthens patient safety , which cWhat is already known on this topic?The health care and social assistance sector accounts for the greatest proportion (20.7%) of private industry nonfatal occupational injuries among all sectors. The most common injuries are due to patient handling; slips, trips, and falls; and workplace violence.What is added by this report?The Occupational Health Safety Network (OHSN) collects and reports near real-time, specific, standard benchmarking information on injuries to help target prevention measures toward workers, departments, and activities at highest risk. From January 1, 2012 to September 30, 2014, the highest incidence rates of the three categories of occupational injuries were among nurse assistants and nurses. Workplace violence injury incidence rates increased from 2012 to 2014; most of these injuries were physical in nature and caused by patients. In over half of patient handling injuries, lifting equipment was not used (51%).What are the implications for public health practice?Injury prevention interventions mitigating high-risk aspects of nurse and nurse assistant duties are needed. Safety cultures that emphasize continuous improvement and support resources such as routine use of lifting equipment, as well as safe patient-handling training and lifting teams, might prevent many of the musculoskeletal disorders from patient handling and the associated costs of diagnosis, treatment, and disability.


Floodplain lake qualitative evaluations yielded similar results; floodplain lake fish communities were likely altered  by Silver Carp. Furthermore, laboratory experiments corroborated field evidence; Silver Carp negatively influence native planktivores through competition for prey . To this end, this study provides evidence that Silver Carp are likely adversely influencing native fishes; however, mere presence of Silver Carp in the system does not induce deleterious effects on native fishes. To the best of our knowledge, this evaluation is the first to describe the effects of Asian Carp throughout the Mississippi River Basin and could be used to reduce the effects of Asian Carp on native biota through an integrated pest management program as suggested by congressional policy. Despite the simplicity of the data analyzed and approach used, this study provides a framework for beginning to identify the interactions of invasive fish pests on native fishes . However, knowledge gaps remain. We suggest future efforts should conduct more in depth analyses  that investigate the influence on all native species.Numerous studies throughout North America allege deleterious associations among invasive Asian Carp and native fishes; however, no empirical evidence on a system-wide scale exists. We used Mississippi River Basin fish community data collected by the Long Term Resource Monitoring program and the Missouri Department of Conservation to evaluate possible interaction between Asian Carp and native fishes. Results from two decades of long-term monitoring throughout much of the Mississippi River suggest that Silver Carp relative abundance has increased while relative abundance (Bigmouth Buffalo [F  Intentional and accidental introduction of species outside of their native range occur without full comprehension of their effects on native fauna –3. IntroAs it relates to fishes, integrated pest management has been used to combat the increased successful introductions of non-native fishes –14. BarrHypophthalmichthys nobilis, Black carp Mylopharyngodon piceus, Grass Carp Ctenopharyngodon idella, and Silver Carp Hypophthalmichthys molitrix) on inland North American waters have dramatically increased. Asian Carps were introduced into the United States for human consumption and supposed biological control –23Hypoph control , [21], ).).HypophtBecause of these attributes Asian Carp often attain high densities, can have injurious effects  on aquatic environments , 21], , , and areOne of the most detrimental and ubiquitous invasive Asiatic fish species is Silver Carp. Silver Carp are a large planktivorous species , 27] na na27] naThese perceived harmful interactions are likely driven by the exceedingly high abundance or biomass, migrate long distances, jumping ability (danger to boaters) and their effective filter-feeding ability , 29]. B. B29]. BThe objective of this study was to determine population level interactions of Silver Carp with native fishes. We used data collected by the Long Term Resource Monitoring program (LTRM) and the Missouri Department of Conservation in the Mississippi River basin from 1993–2012. We also sampled four Mississippi River floodplain lakes having varying abundances of Silver Carp to evaluate the response in fish community composition after Silver Carp invaded during and after the flood of 2011. Controlled experiments were conducted to determine if competition was structuring the relationship between Silver Carp and native fishes. This study aims to provide evidence that would help facilitate the development of integrated pest management program on Asian carp in North America. Furthermore, our study provides a framework for identifying the interactions of invasive fish pests on native fishes , regardless of location.oN, 92.2667oW), Pool 8 , Pool 13 , Pool 26 , La Grange Pool, Illinois River , and the Open River . All collected fish were held in stock tanks and worked up as quickly as possible to reduce stress and mortality per Long Term Resource Monitoring element and Missouri Department of Conservation veterinary protocols. Once measured and weighed fish were returned alive to the river from which they were collected. All collections were approved by Long-Term Resource Monitoring Program and corresponding state agency authorities.The Illinois and Mississippi River are public waterways, requiring no specific permission to access them. Fish were collected by state agencies located in each of the pools listed below. Fish were collected throughout Pool 4  to the southern lowermost reach  longitudinal variation in environmental attributes exists. Vegetation density and physical complexity are greater in the upper reaches species relative to the lower reaches , 39]. F. F39]. Fdianum , . Total lThe three uppermost reaches, Pool 4, Pool 8, and Pool 13, have not been fully invaded by Silver Carp and serve as a control reach while the three lower reaches, Pool 26, La Grange, and Open River, have well established Silver Carp populations and serve as an impact reach. Although environmental variability exists longitudinally, electrofishing is performed during the same time period among all reaches and is accounted for given the statistical analyses performed. We used a ‘Beyond BACI’ (Before-After-Control-Impact) study design  to evaluAn asymmetrical analysis of variance (AANOVA) is used for this BACI design to determine the significance of possible effects of Silver Carp establishment –45. In tCondition indices, relative weight or Fulton’s condition factor, were computed using weights from Bigmouth Buffalo , Gizzard Shad , and Silver Carp  in the Open River reach to evaluate the potential influence of Silver Carp on Bigmouth Buffalo and Gizzard Shad. Slope tests within linear regression analyses were conducted to determine whether the relationship between the condition indices for each species and the sampling year were different from zero.oN, 89.3856oW) adjacent to the Mississippi River. The floodway has an area of approximately 536 square km and begins just south of Cairo, IL and extends southward to New Madrid, MO. The Floodway is approximately 53 kilometers long, with a maximum width of 16 kilometers, all of which was inundated during the flood of 2011 after the levee was breached by the United States Army Corps of Engineers to relieve flooding pressure. The New Madrid floodway had not been inundated since 1937. Since 1937, none of the floodplain lakes sampled had ever been inundated by the Mississippi River. After the 2011 flood, four floodplain lakes similar in size (>2.5 ha) and water quality characteristics (temperature and dissolved oxygen) were sampled using standardized LTRM electrofishing protocols . T. T24]. TTo further evaluate the influence of Silver Carp on native fishes and because of the synergistic relationship between the floodplain and the main river, investigating and evaluating the native and non-native fish species interactions in the floodplain lakes was necessary. We have shown that in newly created floodplain lakes following a major flood event, high Silver Carp abundance can drastically alter native fish communities. Gause  determinPolyodon spathula), Bigmouth Buffalo, and Gizzard Shad in the Mississippi, Missouri, and Illinois rivers may be at risk of competition with Silver Carp –5755–57]