Cumulative Number Of Days Research Articles

Clostridium difficile-Associated Disease in Patients in a Small Rural Hospital

To determine the risk factors for Clostridium difficile-associated disease (CDAD) in a 25-bed rural hospital and to compare antimicrobial use ratios at the study hospital with those at a large academic medical center. Case-control study. A 25-bed rural hospital in Iowa during the period from August 2002 through January 2005. A total of 17 case patients with CDAD and 34 control patients matched for age (ie, within 10 years of the case patient's age), sex, and admission date (ie, within 2 weeks of the case patient's admission date). Retrospective medical record review was performed to obtain data on antimicrobial exposures during the 6 weeks before hospital admission for both case and control patients. Exact conditional logistic regression was used for univariable and multivariable analyses. Antimicrobial use ratios were calculated to compare the rates of antimicrobial use for case and control patients at the study hospital with the rates for patients evaluated in a study of CDAD at a nearly 700-bed teaching hospital. Case patients had a larger cumulative number of days of antimicrobial use (P=.004), and they received a larger total number of antimicrobial agents during hospitalization (P=.001). Antimicrobial use ratios were higher for both case and control patients at the smaller hospital, compared with the larger hospital. CDAD at a small rural hospital was not associated with exposure to the antimicrobial classes that are typically associated with CDAD, but was instead related to the total number of antimicrobials used to treat patients. The rate of antimicrobial use for case and control patients was about 40% higher at the small rural hospital, compared with the corresponding rates at a large academic medical center.

High Incidence of Invasive Aspergillosis Associated with Intestinal Graft-versus-Host Disease following Nonmyeloablative Transplantation

Invasive aspergillosis (IA) remains a major complication following allogeneic hematopoietic stem cell transplant (HSCT). In contrast to conventional HSCT, few investigators have examined risk factors of IA associated with nonmyeloablative (NMA) regimens characterized by outpatient administration, immunosuppression rather than cytoreduction, and short duration of neutropenia posttransplant. We report our results on a cohort of 125 patients treated homogenously who received a 6/6 matched sibling NMA HSCT designed to be performed on an outpatient basis. Conditioning regimen included fludarabine (30 mg/m 2 × 5 days) and cyclophosphamide (300 mg/m 2 × 5 days) followed by reinfusion of a minimum of 4 × 10 6 CD34 + cells/kg. Acute graft-versus-host disease (aGVHD) prophylaxis consisted of tacrolimus and mycophenolate mofetil (MMF). Overall, 13 patients developed IA (5 proved, 6 probable, 2 possible) 44-791 days (median 229) after NMA HSCT, with a risk of 7% at 1, 11% at 2, and 15% at 3 years. Patients who suffered from IA had poorer overall survival (crude hazard ratio 2.3; 95% confidence interval [CI] 1.0-5.4; P = .045). Intestinal aGVHD or chronic GVHD (cGVHD) was significantly associated with IA at 1 (27% versus 3%, P = .003), 2 (27% versus 8%, P = .01), and 3 years (37% versus 10%, P = .005). The use of daclizumab was also significantly associated with IA at 3 years (47% versus 12%, P = .02). Age, sex, diagnosis, previous autologous transplant, duration of neutropenia, occurrence of cytomegalovirus viremia, duration of steroids or MMF intake, aGVHD, cGVHD, and cumulative number of days spent in hospital were not associated with IA. After multivariate analysis, intestinal GVHD remained the only statistically significant risk factor for IA at 1 ( P = .003), 2 ( P = .01), and 3 years ( P = .005). We conclude that in NMA HSCT, the risk of IA increases over time and is significantly associated with intestinal GVHD. Because there is currently no surrogate in vitro markers of immunocompetence following NMA HSCT, this clinical finding is of particular importance to identify a population at higher risk who should be targeted for antimold prophylaxis.

Do staffing levels determine outcome in psychiatric inpatient care? – Factors related to the ratio of period hospitalized in Japan

The aim of this study was to determine the factors related to outcome, as measured by the cumulative number of days hospitalized, of a cohort group of inpatients with a diagnosis of schizophrenia followed up for 6 years. Comprehensive data were obtained from 18 psychiatric hospitals from two surveys conducted in 1993 and 1999. Outcome was evaluated by calculating the cumulative number of days between the two surveys that the cohort group was hospitalized. Tree-based models analysis was used to explore the factors related to outcome. Patient characteristics at the time of the first survey that were related to outcome were the number of days hospitalized, cumulative number of years hospitalized, age, Global Assessment of Functioning score and relationship to the main visitor. The number of beds in each hospital and changes in their number were also related. Increasing staffing levels is not likely to impact on deinstitutionalization since their levels were not related to outcome.

Is there a connection between weather at departure sites, onset of migration and timing of soaring‐bird autumn migration in Israel?

ABSTRACTAims Different aspects of soaring‐bird migration are influenced by weather. However, the relationship between weather and the onset of soaring‐bird migration, particularly in autumn, is not clear. Although long‐term migration counts are often unavailable near the breeding areas of many soaring birds in the western Palaearctic, soaring‐bird migration has been systematically monitored in Israel, a region where populations from large geographical areas converge. This study tests several fundamental hypotheses regarding the onset of migration and explores the connection between weather, migration onset and arrival at a distant site.Location Globally gridded meteorological data from the breeding areas in north‐eastern Europe were used as predictive variables in relation to the arrival of soaring migrants in Israel.Methods Inverse modelling was used to study the temporal and spatial influence of weather on initiation of migration based on autumn soaring‐bird migration counts in Israel. Numerous combinations of migration duration and temporal influence of meteorological variables (temperature, sea‐level pressure and precipitable water) were tested with different models for meteorological sensitivity.Results The day of arrival in Israel of white storks, honey buzzards, Levant sparrowhawks and lesser spotted eagles was significantly and strongly related to meteorological conditions in the breeding area days or even weeks before arrival in Israel. The cumulative number of days or cumulative value above or below a meteorological threshold performed significantly better than other models tested. Models provided reliable estimates of migration duration for each species.Main conclusions The meteorological triggers of migration at the breeding grounds differed between species and were related to deteriorating living conditions and deteriorating migratory flight conditions. Soaring birds are sensitive to meteorological triggers at the same period every year and their temporal response to weather appears to be constrained by their annual routine.

Airway Injuries after One-lung Ventilation: A Comparison between Double-lumen Tube and Endobronchial Blocker

Vocal cord injuries, postoperative hoarseness, and sore throat are common complications after general anesthesia. One-lung ventilation can be achieved via two techniques: double-lumen endotracheal tube or endobronchial blocker such as the Arndt blocker. The current study was designed to assess the impact of these techniques for one-lung ventilation on the incidence and severity of postoperative hoarseness, vocal cord lesions, and sore throat. In this prospective trial, 60 patients were randomly assigned to two groups. One-lung ventilation was achieved with either an endobronchial blocker (blocker group) or a double-lumen-tube (double-lumen group). Postoperative hoarseness and sore throat were assessed at 24, 48, and 72 h after surgery. Bronchial injuries and vocal cord lesions were examined by bronchoscopy immediately after surgery. In 56 included patients, postoperative hoarseness occurred significantly more frequently in the double-lumen group compared with the blocker group: 44% versus 17%, respectively (P = 0.046). Similar findings were observed for vocal cord lesions: 44% versus 17%, respectively (P = 0.046). The incidence of bronchial injuries was comparable between groups (P = 0.540). Cumulative number of days with hoarseness and sore throat were significantly increased in the double-lumen group compared with the blocker group (P < 0.01). No major complications such as bronchial ruptures were observed. Clinicians should be aware of an increased incidence of minor airway injuries that may impair patient satisfaction when using a double-lumen tube instead of an endobronchial blocker for one-lung ventilation.

Early suppression of disease activity is essential for maintenance of work capacity in patients with recent‐onset rheumatoid arthritis: Five‐year experience from the FIN‐RACo trial

To explore the impact of an early treatment response on maintenance of work capacity in patients with early, active rheumatoid arthritis (RA). In the Finnish Rheumatoid Arthritis Combination Therapy trial, 195 patients with recent-onset RA were randomized to receive either a combination of disease-modifying antirheumatic drugs (DMARDs) with prednisolone or a single DMARD with or without prednisolone for 2 years. Treatment responses were evaluated according to the American College of Rheumatology (ACR) criteria. After a 5-year followup, the cumulative number of days of sick leave and RA-related permanent work disability was calculated for each of the 162 patients who were available for the active work force at baseline. Of the 159 patients assessed at 6 months, 29 were in clinical remission, 66 achieved an ACR50 response but not remission, 29 achieved an ACR20 response but not an ACR50 response, and 35 failed to achieve an ACR20 response. In these 4 groups, the median numbers of work disability days per patient-year from 6 months through 60 months of followup were 0 (interquartile range [IQR] 0-3), 4 (IQR 0-131), 16 (IQR 0-170), and 352 (16-365), respectively (P < 0.001). Pairwise multiple comparisons showed a statistically significant difference between all groups except the ACR50 and ACR20 groups. At 12 months, 30 patients were in remission. None of the 44 patients in remission at 6 or 12 months became permanently work disabled over the 5-year followup, as compared with 15 patients in the ACR50 group (23%), 6 in the ACR20 group (21%), and 19 without an ACR20 response at 6 months (56%). Prompt induction of remission translates into maintenance of work capacity. At 6 months, an ACR50 response is no better than an ACR20 response with regard to future productivity, while failure to achieve an ACR20 response carries a high risk for work disability.

Emergency medical services for children assessment of all-terrain vehicle–related injuries in Illinois

Study objectives: This study seeks to describe injuries in children related to all-terrain vehicle (ATV) use during a 4-year period in Illinois before development of an injury prevention program. Methods: Patients were identified using a state Trauma Registry Database that is composed of data from 67 hospitals within Illinois designated as either a Level I or Level II trauma center. Patients entered into the state database met the following criteria: sustained an injury that required treatment at a trauma center and admission to a trauma center, transferred to a trauma center, died on arrival to the hospital, or died in the emergency department. The Trauma Registry identified ATV-related injuries using E-codes. Four age groups (0 to 4, 5 to 9, 10 to 14, and 15 to 16 years) were retrospectively reviewed between 1998 and 2001. Patients were categorized into nonhelmeted, helmeted, or unknown helmet use rider status. Results: Two hundred seventy-five (80 nonhelmeted, 56 helmeted, and 139 unknown helmet use) children aged 16 years or younger in Illinois sustained ATV-related injuries during the study period. One hundred forty-three (52%) of the patients were between 10 and 14 years old. Extremities were the most frequently injured body region in nonhelmeted (61), helmeted (47), and unknown helmet use (113) groups (76%, 84%, and 82%, respectively). Head and neck injuries were the second most common category of injury in the nonhelmeted (44), the helmeted (29), and in the unknown helmet use group (62; 55%, 52%, and 45%, respectively). The nonhelmeted group had a cumulative length of stay in the hospital of 228 days compared with the helmeted and unknown helmet use group length of stay of 137 days and 400 days, respectively. The nonhelmeted group and helmet use unknown group had a similar number of cumulative days in the ICU of 58 days and 52 days, respectively, compared with the helmeted group of 20 cumulative days in the ICU. The cumulative hospital charges for the nonhelmeted, helmeted, and unknown helmet use rider groups were $754,096, $457,409, and $1,269,314, respectively, for a total of $2,480,819. The 10- to 14-year-old age group comprised the highest percentage of total hospital charges of $1,330,585 (54%). Conclusion: The majority of pediatric ATV-related injuries in Illinois occurred in the 10- to 14-year-old age group. Upper and lower extremity injuries were the most common type of injury. The cost of injuries increased throughout the study period, similar to national trends. As the incidence of ATV injuries in children continues to increase, injury prevention programs should target methods to reduce injuries of extremities and head and neck, especially in the 10- to 14-year-old age group.

Dipyridamole and headache—a pilot study of initial dose titration

Headache is reported by about one third of patients using dipyridamole (DP) after stroke or TIA. No study has systematically examined if initial dipyridamole titration may affect this headache. We therefore randomised patients to (1) standard aspirin and dipyridamole treatment b.i.d. for 2 weeks or (2) titration with aspirin only in the morning and aspirin and dipyridamole in the evening for 5 days, followed by 9 days of standard aspirin and dipyridamole treatment. Among 57 patients included for analysis, moderate to severe headache was reported by 28% in the standard treatment group and 25% in the titration group (n.s.). Headache for more than two consecutive days occurred in 24% and 11%, respectively. Rescue medication because of headache for more than 2 days was used by 14% and 0% in the respective groups. The cumulative number of days with headache was more than twice as high in the standard treatment group. The total numbers of other side effects were 25 and 11 in the two groups. The observed differences in this pilot study were not statistically significant, but nevertheless suggest that titration with an initially lower dose of dipyridamole may be considered to reduce headache and thereby increase compliance. A larger study is needed to clarify this with sufficient statistical power.

Least limiting water range indicators of soil quality and corn production, eastern Ontario, Canada

The least limiting water range (LLWR) attempts to incorporate crop-limiting values of soil strength, aeration, and water supply to plant roots into one effective parameter (on the basis of soil water content). The LLWR can be a useful indicator of soil quality and soil physical constraints on crop production. This study focused on assessing dynamic cultivation zone LLWR parameters between different cropping/tillage/trafficked clay loam plots at Winchester, Ont., to identify potential management impact on surficial soil physical conditions for contrasting growing seasons. This study also evaluated dynamic cultivation layer LLWR variables as indicators of corn ( Zea mays L.) plant establishment and corn yield. The results suggest that no-till soils had lower average air-filled porosities (AFP) and O 2 concentrations than respectively managed tilled plots for both years of study. Potential trafficking effects on aeration properties were most evident in no-till relative to till; preferentially trafficked no-tilled plots had lower AFP and O 2 concentrations than respective non-preferentially trafficked no-till plots for both years of study. Corn establishment and yield variability were principally explained by cumulative differences between daily AFP and aeration threshold values, and the cumulative number of days daily AFP was below an AFP aeration threshold for specific corn growth stage periods. Lower AFP was linked to lower yields and plant establishments. Soil strength, as measured by cone penetration resistance, was important over certain sites, but not as important globally as AFP in predicting crop properties. Overall, conventional tilled soils that were not preferentially trafficked had most favorable aeration properties, and subsequently, greatest corn populations and yields. No-till soils were at greater risk of aeration limiting conditions, especially those in continuous corn and preferentially trafficked.

Modeling the Population Dynamics of &lt;I&gt;Culex quinquefasciatus&lt;/I&gt; (Diptera: Culicidae), along an Elevational Gradient in Hawaii

We present a population model to understand the effects of temperature and rainfall on the population dynamics of the southern house mosquito, Culex quinquefasciatus Say, along an elevational gradient in Hawaii. We use a novel approach to model the effects of temperature on population growth by dynamically incorporating developmental rate into the transition matrix, by using physiological ages of immatures instead of chronological age or stages. We also model the effects of rainfall on survival of immatures as the cumulative number of days below a certain rain threshold. Finally, we incorporate density dependence into the model as competition between immatures within breeding sites. Our model predicts the upper altitudinal distributions of Cx. quinquefasciatus on the Big Island of Hawaii for self-sustaining mosquito and migrating summer sink populations at 1,475 and 1,715 m above sea level, respectively. Our model predicts that mosquitoes at lower elevations can grow under a broader range of rainfall parameters than middle and high elevation populations. Density dependence in conjunction with the seasonal forcing imposed by temperature and rain creates cycles in the dynamics of the population that peak in the summer and early fall. The model provides a reasonable fit to the available data on mosquito abundance for the east side of Mauna Loa, Hawaii. The predictions of our model indicate the importance of abiotic conditions on mosquito dynamics and have important implications for the management of diseases transmitted by Cx. quinquefasciatus in Hawaii and elsewhere.

Mycophenolate Mofetil Dose Reduction and the Risk of Acute Rejection after Renal Transplantation

Mycophenolate mofetil (MMF) significantly decreases acute rejection rates after renal transplantation, but intolerance often occurs, leading to dose reduction. The clinical effect of MMF dose reduction has not been clearly established. This study determined whether MMF dose reduction after renal transplantation was associated with subsequent risk of acute rejection. This retrospective cohort study assessed 213 renal transplant recipients. Cox regression was used to model MMF dose as a time-dependent variable, with time to first acute rejection as the primary outcome. One hundred twenty-six patients (59%) had a total of 176 MMF dose reductions during the study. MMF dose was reduced because of leukopenia (55.1%), gastrointestinal symptoms (22.2%), infection (7.4%), malignancy (1.1%), and unknown reasons (14.2%). The cumulative number of days with the MMF dose reduced below full dose was an independent predictor of acute rejection. The relative risk of rejection increased by 4% for every week that the MMF dose was reduced below full dose. No significant association was observed between the number of days with MMF dropped below full dose and allograft failure. The cumulative number of days with the MMF dose dropped below full dose is a significant predictor of acute rejection after renal transplantation. Clinicians need to be aware of the rejection risk when the MMF dose is reduced and maintain close surveillance on such patients.

Seasonal patterns of activity among species of black fire ant parasitoid flies (Pseudacteon: Phoridae) in Argentina explained by analysis of climatic variables

Abstract We monitored weekly relative abundances of adult female Pseudacteon (Diptera: Phoridae) species between February 1998 and May 2000 in Argentina. Fire ant-phorids were active around mounds of Solenopsis richteri Forel throughout the year. Phorid species richness ranged from six species during the summer-fall, to a single, large species during the winter. Species were classified as winter, summer, or fall-spring species, depending on times of peak mean abundance. We used descriptive multivariate techniques to analyze phorid phenological data (correspondence analysis), climatic data (principal component analysis), and their relationships (canonical correspondence analysis=CCA) at three temporal scales. The long-term mean temperatures, the mean and minimum sampling-time temperature, and the cumulative number of days without rain from the two months preceding each sampling day explained >90% of the variance when the data for sampling dates were averaged across the same months over the two years. Pseudacteon borgmeieri Schmitz, the winter dominant, was associated with lower temperatures and rainfall, whereas Pseudacteon curvatus Borgmeier, the summer dominant, showed the opposite pattern. Among the fall-spring species, Pseudacteon comatus Borgmeier was associated with months of higher maximum temperatures, longer photoperiods, and lower relative humidity. Pseudacteon nudicornis Borgmeier, in contrast, showed the opposite pattern. Pseudacteon tricuspis Borgmeier, was associated with months, typically in fall, having greater rainfall and fewer days with frosts. Implications of these patterns for the process of selecting particular species of S. richteri-attacking Pseudacteon for use in biological control introductions against imported fire ants are discussed in relation to climates of source and release areas.

Prevalence of IgG antibodies to human parvovirus B19 in haemophilia children treated with recombinant factor (F)VIII only or with at least one plasma‐derived FVIII or FIX concentrate: results from the French haemophilia cohort

Human parvovirus B19 (B19) has been transmitted by some brands of virally attenuated plasma-derived factor VIII (FVIII) or IX (FIX) concentrates. To quantify the differences of human parvovirus B19 risk transmission between albumin-stabilized recombinant factor and plasma-derived factor, we studied the prevalence of IgG antibodies to B19 (anti-B19) in 193 haemophiliac children between 1 and 6-years of age who had previously been treated with albumin-stabilized recombinant FVIII only (n = 104), and in children previously treated with solvent/detergent high-purity non-immunopurified and non-nanofiltered FVIII or IX concentrates (n = 89). Association between the prevalence of anti-B19 and the treatment group was analysed using multivariate logistic regression. Age, severity and type of haemophilia, number of cumulative days of exposure to factor VIII or IX, previous history of red blood cells or plasma transfusion were considered as potential confounding variables. A higher prevalence of anti-B19 was found in children previously treated with solvent/detergent high-purity non-immunopurified and non-nanofiltered FVIII or IX concentrates than in children treated with albumin- stabilized recombinant FVIII only (OR: 22.3; CI: 7.9-62.8), independently of the other factors studied.

The French haemophilia cohort: rationale and organization of a long‐term national pharmacosurveillance system

Medicinal products of biological origin still carry a specific iatrogenic risk, mainly because of their starting material, mode of preparation and variability. Careful postmarketing surveillance systems are therefore necessary. To assess the long‐term safety of haemophilia treatment with plasma‐derived and recombinant clotting factor products, a cohort study was set up in France in 1994. Participants were patients with haemophilia A and B, with or without previous clotting factor therapy. Clinical events, treatments, biological data and adverse events were recorded on standard forms. Blood samples were separated into serum, plasma and peripheral blood mononuclear cells, frozen, and banked in a central laboratory. The same data and samples were collected at yearly follow‐up visits. As of December 1999, 1234 haemophiliacs were enrolled in 39 haemophilia centres. At enrolment, 50.2% of patients were under 15 years of age, and the cumulative number of days of exposure to the product was below 50 in 35.1% of cases. The median duration of follow‐up was 26.9 months, with a total of 2729 patient‐years (135 947 days of exposure and 211 million units of factor VIII or IX). To date, only 17 patients were lost to follow‐up. The initial results show good compliance with this health‐watch policy among patients and clinicians specializing in haemophilia. The regular follow‐up data and centralized sample bank will serve to investigate rapidly any suspected outbreaks as soon as reliable biological tests become available in the future.

The French haemophilia cohort: rationale and organization of a long-term national pharmacosurveillance system.

Medicinal products of biological origin still carry a specific iatrogenic risk, mainly because of their starting material, mode of preparation and variability. Careful postmarketing surveillance systems are therefore necessary. To assess the long-term safety of haemophilia treatment with plasma-derived and recombinant clotting factor products, a cohort study was set up in France in 1994. Participants were patients with haemophilia A and B, with or without previous clotting factor therapy. Clinical events, treatments, biological data and adverse events were recorded on standard forms. Blood samples were separated into serum, plasma and peripheral blood mononuclear cells, frozen, and banked in a central laboratory. The same data and samples were collected at yearly follow-up visits. As of December 1999, 1234 haemophiliacs were enrolled in 39 haemophilia centres. At enrollment, 50.2% of patients were under 15 years of age, and the cumulative number of days of exposure to the product was below 50 in 35.1% of cases. The median duration of follow-up was 26.9 months, with a total of 2729 patient-years (135,947 days of exposure and 211 million units of factor VIII or IX). To date, only 17 patients were lost to follow-up. The initial results show good compliance with this health-watch policy among patients and clinicians specializing in haemophilia. The regular follow-up data and centralized sample bank will serve to investigate rapidly any suspected outbreaks as soon as reliable biological tests become available in the future.

A Model for Predicting the Frequency of High Pesticide Exposure Events in the Agricultural Health Study

The frequency of self-reported high pesticide exposure events (HPEE) has been recorded in the NCI/EPA/NIEHS Agricultural Health Study (AHS). Fourteen percent (14%) of the enrolled applicators responding reported “an incident or experience while using any pesticide which caused an unusually high exposure.” These data show, as expected, that the probability of a report of an HPEE increases with the cumulative number of days of pesticide application reported by the applicator. We have developed a three-parameter model that predicts the risk odds ratio (OR) of an HPEE as a function of the number of days that pesticides are applied. These events are costly in terms of resulting health-care visits, lost time from work, and potential risk for cancer and other chronic diseases. We propose that failure to carefully follow all the pesticide manufacturer's label requirements, inexperience, and random events (i.e., breaking hose) are the three factors responsible for the events observed. Special precautions for new or infrequent users of pesticides are indicated.

Does time spent in hospital in the final 15 years of life increase with age at death? A population based study

The use of health services rises substantially with increasing age.1 Although this is commonly assumed to be a consequence of longevity, the chief determinants of lifetime use of health services,...

Age-0 Yellow Perch Growth and Its Relationship to Temperature

Temperature is known to be an important determinant of growth, but its influence on the growth of juvenile yellow perch Perca flavescens has not been unambiguously quantified. In this study, temperature data loggers were deployed in several northern Alberta lakes, and the data collected were used to compute the cumulative number of days for which water temperature exceeded the 13.5°C minimum temperature required for yellow perch growth. Tow-net and seine samples of young of the year (age-0 fish) were obtained to describe growth in fork length throughout the summer. Length and degree-day data were used to test the importance of temperature as a determinant of growth. A significant relationship was obtained and validated with data from previous studies of age-0 yellow perch in Manitoba. The importance of temperature was further assessed over a broader geographic range with the use of latitude as a surrogate for temperature and published data on end-of-season lengths. Though not the sole determinant of among-population variability, latitude was found to have a significant effect on growth. Collectively the results suggest that temperature has both a micro- and a macro-scale effect on determining age-0 yellow perch growth.

Mild illness at or after measles vaccination does not reduce seroresponse in young children

We analyzed data from a randomized trial of AIK-C, high-titre (EZ-H) or medium-titre EZ (EZ-M) vaccines in 3.5 and 6 month old infants in Kinshasa, Zaire, in which the occurrence of rhinorrhoea, cough, diarrhoea, fever, conjunctivitis or rash was monitored for 15 days post-vaccination (including the day of vaccination, day 0). We compared sero-response at 6 weeks and 6 months post-vaccination among children with and without mild illness at or after vaccination. Seroresponse tended to be higher in children with mild illness after vaccination than those without, whether days 0–7 or 8–15 were examined. For most symptoms, these differences did not reach statistical significance after adjusting for prevaccination maternal antibody level. However, in the EZ-M group, the proportion of children attaining at least the median post-vaccination antibody level was significantly higher in children with rhinorrhoea in days 0–7 post-vaccination than those without (adjusted odds ratio 2.6, 95% CI 1.08–6.27), as was that among children with at least one symptom in days 0–7 compared with children with no symptoms (adjusted OR 4.55, 95% CI 1.18–17.57). There were no significant differences in post-vaccination antibody levels among children with symptoms compared either to those without the specific symptom or those with no symptoms. Fever on the day of vaccination or at home visits on 7,10 or 14 days post-vaccination, did not affect seroconversion or GMTs. Regression models showed no relation between the cumulative number of days with symptoms and antibody increase after vaccination. Analysis of antibody levels at 6 months post-vaccination showed no consistent differences according to presence or absence of symptoms. These findings provide further strong support to recommendations that mild illness is not a reason to delay measles vaccination.

Long-term nitrogen use and nitrogen-removal index in continuous crops and rotations

Cropping systems, nitrogen (N) fertilizer levels, and climate largely dictate patterns of N use and influence problems arising from N fertilization. Nitrogen use was assessed in cropping systems with a nitrogen removal-index (NRI), defined as the ratio of N removed in the grain to total N supply including that from N fixation by legumes grown in rotation. Results are reported from analyses of NRIs of cropping systems that comprised a 12-yr continuous and sequential growing of maize [ Zea mays L.], soybean [ Glycine max. (L.) Merr.], sorghum [ Sorghum bicolor (L.) Moench], and oat/clover [ Avena sativa (L.)/80% Melilotus officinalis (L.) Lam., 20% Trifolium pratense] in eastern Nebraska. Rotations involving maize or sorghum had higher NRIs than continuous cereals at 0 N application levels. Increasing N rates reduced NRI and resulted in an increase of residual nitrate in all but the continuous soybean system. Also, NRI was highest in continuous soybean, lower in continuous maize, and lowest in continuous sorghum. Rotations and lower N rates both contributed to higher NRI and lower soil residual nitrate. Biological windows that comprised the cumulative number of days in the entire year when soil is moist and temperature above a specific threshold correlated positively and significantly with NRI, whereas NRI and August temperature were negatively related. Between 43 and 87% of variability of NRI in maize and soybean systems was attributed to August temperature plus August precipitation index. Biological window (moist soil, temperature above 5°C ) plus May temperature explained up to 76% of variability of NRI of maize and soybean. Nitrogen removal index for sorghum was unrelated to weather variables. Estimated additions to the soil organic N reserve from the return of crop residues averaged between 16 and 80 kg ha −1 yr −1 with higher levels from sorghum and from all treatments with high levels of N fertilizer. Crop rotations generally increased the N-removal index, reduced the year-to-year variability in N-removal-index, and at 0 N-application rate, increased the return of N in residue to the soil N pool, compared to continuous cropping of single species.