Systematic Surveillance Program Research Articles

Listeria contamination in chevon and mutton from retail meat shops and slaughter house environment of Punjab, India.

Listeria monocytogenes is recognized as an emerging pathogen, with limited information or statistics on this pathogen. Moreover, poor hygienic practices in the unorganized meat sector favor its growth and survival. Therefore, the present study was carried out in Punjab, India to assess the prevalence of Listeria spp. in chevon and mutton samples, followed by its characterization. The prevalence of Listeria in chevon, mutton and swab samples collected from butchers' shops and slaughter houses was 1.82%, 3.21% and 6.66%, respectively. The 18 (2.67%) L. monocytogenes strains isolated from 786 samples carried one or more virulence-associated gene. Based on virulence genes, 6/18 isolates were potentially pathogenic. Serovar 4b (44.4%) was predominant, followed by serovars 1/2a (22.2%), 1/2b (22.2%) and 1/2c (11.1%). Detection of L. monocytogenes in meat and environment samples indicated poor hygiene, potential cross-contamination and risk of listeriosis to consumers and occupational workers. The findings of the study were also relevant to the fact that most of the slaughtering in Punjab, India is carried out in unorganized way, and this meat is not stored propery. Moreover, in the absence of a systematic foodborne disease surveillance and monitoring program, a database on foodborne diseases is absent, and needs to be established.

Determination of fasiglifam-induced liver toxicity: Insights from the data monitoring committee of the fasiglifam clinical trials program.

Different approaches to safety event collection influence the determination of liver toxicity within drug development programs. Herein, a description of how fasiglifam-induced liver injury was detected is provided. This eight-trial drug development program was intended to evaluate fasiglifam (25 mg, 50 mg) against placebo or active comparators (glimepiride, sitagliptin) in approximately 11,000 suboptimally controlled patients with type 2 diabetes (terminated Dec 2013 due to liver toxicity). Liver safety had been pre-identified as a concern, and within the phase 3 trials, was measured through (1) adverse event reporting, (2) central predefined liver monitoring schedule with various thresholds for potential drug-induced liver injury, and (3) blinded adjudication of serious liver toxicity by a panel of experts in drug-induced liver injury. A single data monitoring committee provided safety oversight across all trials within the program. Prior to program termination, 7595 of 7602 (99.9%) randomized participants across the eight trials received at least one dose of the study drug (fasiglifam, placebo, or active control). No concerning trends were noted in adverse or serious adverse event frequency, suspected unexpected serious adverse reaction, alanine or aspartate transaminase elevations, or hepatobiliary or gastrointestinal adverse events as reported by local site investigators. However, the predefined central liver safety measurements revealed a greater frequency of possible Hy's Law cases (5 vs 2) and a 3- to 7-fold greater relative risk in alanine or aspartate transaminase elevation (with respect to upper limit of normal) within fasiglifam recipients compared with placebo/active control: alanine or aspartate transaminase > 3×: relative risk 3.34 (95% confidence interval 2.29-4.90), alanine or aspartate transaminase > 5×: relative risk 6.60 (95% confidence interval 3.03-14.38), alanine or aspartate transaminase > 8×: relative risk 6.14 (95% confidence interval 2.18-17.27), and alanine or aspartate transaminase > 10×: relative risk 6.74 (95% confidence interval 2.05, 22.14). All elevations resolved on study drug discontinuation. Drug-induced liver injury was adjudicated as highly likely or probably related in 0.64% of fasiglifam-treated versus 0.06% placebo or active control-treated patients. In spite of clear liver toxicity detected with a systematic surveillance program, liver safety signals were not identified from investigator adverse event reporting alone. By integrating key safety monitoring processes within the randomized design of adequately sized clinical trials, the rare but serious liver toxicity signal became clear, leading to timely program termination.

Epidemiology and mechanism of drug resistance of Mycoplasma pneumoniae in Beijing, China: A multicenter study.

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired respiratory tract infections (RTIs). We aimed to investigate the prevalence of M. pneumoniae infection, antibiotic resistance and genetic diversity of M. pneumoniae isolates across multiple centers in Beijing, China. P1 protein was detected by Nested PCR to analyze the occurrence of M. pneumoniae in pediatric patients with RTI. M. pneumoniae isolates were cultured and analyzed by Nested-PCR to determine their genotypes. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of antibiotics. Out of 822 children with RTI admitted to 11 hospitals in Beijing, 341 (41.48%) were positive for M. pneumoniae by Nested PCR and 236 (69.21%) samples had mutations in 23S rRNA domain V. The highest proportion of M. pneumoniae positive samples was observed in school-age children (118/190; 62.11%) and in pediatric patients with pneumonia (220/389; 56.56%). Out of 341 M. pneumoniae positive samples, 99 (12.04%) isolates were successfully cultured and the MIC values were determined for 65 M. pneumoniae strains. Out of these, 57 (87.69%) strains were resistant to macrolides, and all 65 strains were sensitive to tetracyclines or quinolones. M. pneumoniae P1 type I and P1 type II strains were found in 57/65 (87.69%) and 8/65 (12.31%) of cultured isolates, respectively. Overall, we demonstrated a high prevalence of M. pneumoniae infection and high macrolide resistance of M. pneumoniae strains in Beijing. School-age children were more susceptible to M. pneumoniae, particularly the children with pneumonia. Thus, establishment of a systematic surveillance program to fully understand the epidemiology of M. pneumoniae is critical for the standardized use of antibiotics in China.

Evidence From a Long-Term, Systematic Post-Market Surveillance Program: Clinical Performance of a Hematocrit-Insensitive Blood Glucose Test Strip.

Described is a manufacturer's systematic post-market evaluation of the long-term clinical accuracy of a commercially available blood glucose monitoring (BGM) test strip product. Production batches of test strips were routinely and regularly sampled and evaluated in a clinical setting to assess product accuracy. Evaluations were performed on capillary blood samples from a minimum of 100 subjects with diabetes, by clinical staff according to instructions for use. Readings were compared against capillary blood samples collected at the same time and measured by a standard laboratory reference method. Clinical accuracy was calculated according to EN ISO 15197:2015. A total of 21 115 paired results were obtained, equating to 209 production batches over the >3-year period since test strip launch. Of the results, 97.6% met the accuracy criterion (range: 97.1-98.1% by year), with 98.1% of values presenting zero risk as defined by the surveillance error grid. At the <5th (21.0-33.8%) and >95th (48.3-59.4%) percentile extremes of hematocrit distribution, 97.9% and 96.4% of values were clinically accurate. The product also demonstrated clinical accuracy across all seven glucose ranges ("bins") as defined by the standard. Under conditions of combined hematocrit and glucose (<80 mg/dL and ≥300 mg/dL) extremes, 97.7% of values were clinically accurate. Methodologies and results from a manufacturer's self-imposed clinical accuracy surveillance program of a BGM product is presented. Given the publication of sometimes-conflicting data presented within ad hoc BGM clinical accuracy evaluations, usually of limited size, it is advocated that BGM manufacturers adopt similarly robust and systematic surveillance programs to safeguard patients.

Austropuccinia psidii on the move: survey based insights to its geographical distribution, host species, impacts and management in Australia

Austropuccinia psidii is a plant fungus native to South and Central America which causes myrtle rust disease, affecting the growth and reproduction of species in the Myrtaceae family. Austropuccinia psidii was first detected in Australia 8 years ago in New South Wales. Since then it has spread rapidly along the east coast, and to date is known to infect more than 375 native Myrtaceae species in Australia. Despite this, its rapid spread is not well documented and the potential threat to additional Myrtaceae species remains unknown, with no systematic surveillance or monitoring program in Australia. In order to better understand the extent of A. psidii geographic distribution and impacts on Australian landscapes, a survey was sent to national park, botanical garden, local council, nursery and forestry agency employees in all states and territories where the disease is known to be present. More than 500 surveys were sent, and 254 responses were received. The survey confirms that A. psidii is widespread in New South Wales and Queensland urban environments as well as in native vegetation communities. Four new host species were confirmed, as well as four new local government areas in two different states reporting A. psidii infection. The disease severity was classified as medium to high for most host species, with especially negative impacts for Rhodamnia rubescens and Rhodomyrtus psidioides. These survey results provide up-to-date information on the geographical distribution, host species and impacts of A. psidii, which will assist in making management decisions relating to this pathogen across Australia.

Hepatocellular carcinoma surveillance: Eastern and Western perspectives.

Eastern and Western guidelines for the management of hepatocellular carcinoma (HCC) are known to significantly differ on many points, because they reflect different diagnostic and therapeutic approaches to this cancer. Importantly, these guidelines are primarily consensus-driven when it comes to surveillance, both in term of the tests used and surveillance program design. The main difference between East and West lies in clinical practice, as several Eastern countries implement coordinated and systematic surveillance programs, while most Western countries rely on individual adherence to surveillance recommendations. This review article presents an overview of the evidence supporting surveillance programs for HCC, with a particular focus on the efficacy, cost-effectiveness, and consequences of this approach for patient survival. Western and Eastern guideline recommendations are discussed.

Timing, diagnosis, and treatment of surgical site infections after colonic surgery: prospective surveillance of 1263 patients

Surgical site infections (SSIs) are the most frequent complication after colorectal surgery and have a major impact on length of stay and costs. To analyse the incidence, timing, and treatment of SSIs within 30 days after colonic surgery. This was a quality improvement project through retrospective analysis of consecutive colonic surgeries between February 2012 and October 2017 at Lausanne University Hospital (CHUV). SSIs were prospectively assessed by an independent national surveillance programme (www.swissnoso.ch) up to 30 postoperative days. Treatment strategies including drainage of infection (direct wound opening or percutaneous) and surgical management were reviewed. The study cohort included 1263 patients with 532 procedures (42%) performed as emergencies. SSIs were observed in 271 patients (21%), occurring at median postoperative day (POD) 9 (interquartile range (IQR): 4-16). Specifically, 53 (4%) were superficial incisional, 65 (5%) deep incisional, and 153 (12%) organ space infections (anastomotic insufficiency included). Superficial incisional SSI occurred at a median of POD 10.5 (IQR: 7-15), deep incisional at a median of POD 10 (8-15) and organ space at a median of POD 8 (5-11). Diagnosis was performed post discharge in 64 cases (24%). Whereas 47% of organ space infections were detected by POD 7, this rate was only 26% for superficial and deep incisional infections (P= 0.003). Surgical management was necessary in 133 cases (49%), and the remaining cases were managed by drainage without general anaesthesia (138 cases, 51%). Organ space infections occurred early in the postoperative course, whereas incisional infections were mostly detected post discharge over the entire 30-day observation period, emphasizing the importance of proper follow-up using a systematic, complete and independent surveillance programme.

Evaluation of the leprosy control programme surveillance system in Kwara State, Nigeria, 2010 - 2014

Objective: Leprosy is a chronic, infectious disease complicated with blindness and loss of fingers/toes in some cases. Though the disease is targeted for eradication in Nigeria, the country had the 6th highest prevalence globally in 2013. This study was conducted to evaluate the leprosy surveillance system in Kwara State, assessing its operations, attributes and determining its usefulness. Method: The 2001 updated guidelines for evaluating public health systems of Centers for Disease Control and Prevention was used. Key informant interviews were done with the State Tuberculosis and Leprosy (TBL) Control Officer, and the State Epidemiologists to assess the importance of the public health, purpose and operation of the surveillance system, resources used to operate it as well as the attributes of the system. Questionnaires were administered to Local Government Area TBL supervisors to assess the attributes of the surveillance system. Surveillance data from 2010 to 2014 was analyzed and data quality determined. Results: Incidence of leprosy over the five year period 2010 – 2014 was 62.0%, 59.0%, 54.0%, 67.0%, and 42.0% respectively, with occurrence of the multi-bacillary type in 83.1% to 90.7% newly detected cases. The system was found to be 51.0% sensitive(most hospitals do not have treatment forms for health workers use, community awareness programmes was done in 53.0% of local government areas in last 3 months, contact tracing was however always done), 90.0% simple, 93.0% acceptable and 95.0% timely. Data system was both paper and electronics, based on collection, collation, analysis and reporting done quarterly in a year. The surveillance system is donor-driven and fully integrated with that of tuberculosis and buruli ulcer. Annual surveillance expenditure was about $2 500. Conclusion: Kwara State Leprosy Surveillance System has a low sensitivity with delayed case detection. Training of health workers on early case detection, provision of treatment forms and more community awareness will improve the surveillance system’s sensitivity.

A systematic surveillance programme for infectious salmon anaemia virus supports its absence in the Pacific Northwest of the United States.

In response to reported findings of infectious salmon anaemia virus (ISAV) in British Columbia (BC), Canada, in 2011, U.S. national, state and tribal fisheries managers and fish health specialists developed and implemented a collaborative ISAV surveillance plan for the Pacific Northwest region of the United States. Accordingly, over a 3-1/2-year period, 4,962 salmonids were sampled and successfully tested by real-time reverse-transcription PCR. The sample set included multiple tissues from free-ranging Pacific salmonids from coastal regions of Alaska and Washington and farmed Atlantic salmon (Salmo salar L.) from Washington, all representing fish exposed to marine environments. The survey design targeted physiologically compromised or moribund animals more vulnerable to infection as well as species considered susceptible to ISAV. Samples were handled with a documented chain of custody and testing protocols, and criteria for interpretation of test results were defined in advance. All 4,962 completed tests were negative for ISAV RNA. Results of this surveillance effort provide sound evidence to support the absence of ISAV in represented populations of free-ranging and marine-farmed salmonids on the northwest coast of the United States.

The role of a surveillance programme for intro-ducing peripherally inserted central catheters: a 2-year observational study in an academic hospital.

In our hospital, a previous attempt to introduce peripherally inserted central catheters (PICC) was aborted after a nonsystematic approach, seemingly accompanied by high rates of complications. The goal of this new interdisciplinary project was to introduce PICCs in an academic hospital, with an embedded interdisciplinary surveillance programme for both infectious and noninfectious outcomes. We prospectively collected data for this surveillance study from all patients who underwent PICC insertion from 1 January 2014 and had the catheter removed by 31 December 2015 in our 950-bed academic hospital (Bern University Hospital, Switzerland). Infectious complications were defined according to Centers for Disease Control and Prevention / National Healthcare Safety Network criteria. PICCs were restricted to cancer and infectious disease patients, and were followed up irrespective of the management setting (inpatient, outpatient or intermittently hospitalised after insertion). An interdisciplinary team reviewed the outcomes on a routine basis and discussed changes to the process to improve outcomes, if necessary. One hundred and thirty-five PICCs were inserted in 124 patients, the majority of whom were patients from the medical oncology department (n = 107, 86.3%). Indications for PICC insertion included: chemotherapy (n = 97, 71.9%), antibiotic therapy (n = 24, 17.8%), total parenteral nutrition (n = 8, 5.9%), blood product transfusion (n = 4, 3.0%) and palliative care (n = 2, 1.5%). During a total of 10 402 catheter-days (median dwell time 62 days), there were five central line-associated bloodstream infections, including one mucosal barrier injury laboratory-confirmed bloodstream infection and two exit-site infections, yielding incidence rates of 0.48 and 0.19 infections per 1000 catheter-days, respectively. Incidence rates were 0.67 per 1000 catheter-days (n = 7) for radiologically documented deep venous thrombosis, 0.96 (n = 10) for tip dislocation and 0.67 (n = 7) for catheter occlusion. The overall rate of complications was 4.5 per 1000 catheter-days. Seventeen catheters (12.6%) were removed because of any complication. We successfully introduced PICCs in an academic hospital by implementing a systematic surveillance programme for complications. Both infectious and noninfectious complications were rare. Infection prevention specialists should be actively involved during the introduction of new intravascular devices in order to provide quality indicators and assure patient safety.

Incidence of aflatoxins contamination in dry fruits and edible nuts collected from Pakistan

During 2012–2015, a total of 624 samples of 13 different types of dry fruits and edible nuts were collected from retail shops and local markets of Pakistan. The collected samples were then studied for the occurrence of total aflatoxins (AFs) after immunoaffinity cleanup followed by HPLC coupled with fluorescence detector and post-column derivatization unit (Kobra Cell™). The seasonal variation of AFs was studied with respect to average temperature and relative humidity in Pakistan. LOD (S/N; 3:1) and LOQ (S/N; 10:1) of the utilized method were in the range of 0.09–0.12 and 0.30–42 μg/kg, respectively. About 165 (26%) samples were found contaminated, ranging from 0.22 to 30.11 μg/kg with a mean equivalent to 0.85 ± 0.26 μg/kg. In 459 (74%) samples, the AFs contamination was found lower than detectable limit corresponding to0.12 μg/kg. In 99 (15%) samples, the contamination range of AFs was 1–4 μg/kg. However, 28 (4%) samples exceeded the maximum tolerated limit (MTL) of 4 μg/kg as imposed by EU. However, 6 (1%) samples were found beyond the MTL of20 μg/kg as regulated by USA. Highly contaminated samples were found during the months of July, August and September. Achieved data highlighted the requirement of continuous monitoring and further investigation of AFs contamination in dry fruits/edible nuts under the authority of a definite systematic surveillance program adapted as a food safety measure.

Healthcare Associated Infections in a Resource Limited Setting.

Health Care associated Infections (HAI) are the most common complications affecting the hospitalized patients. HAI are more common in developing and under developed countries. However, there are no systematic surveillance programs in these countries. To find out the burden, predisposing factors and multidrug resistant organisms causing HAI in a resource limited setting. This prospective observational study was done at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Patients aged 13 years or more with stay of more than 48 hours in a 16 bedded Medical Intensive Care Unit (MICU) between November 2011 and April 2013 were included in the study. Patients were prospectively followed up till discharge or death for the development of HAI. Device associated HAI like Ventilator Associated Pneumonia (VAP), Catheter Related-Blood Stream Infection (CR-BSI) and Catheter Associated-Urinary Tract Infections (CA-UTI) were studied. Standard laboratory methods were used for identification of microorganisms causing HAI and to test their antibiotic sensitivity. A total of 346 patients were included in the study with median age of 38 years. Common indications for admission to Medical Intensive Care Unit (MICU) were poisoning (31.5%); neurological illness (23.4%) like Guillian-Barre syndrome, tetanus, meningitis, encephalitis; respiratory illness (14.5%) like pneumonia, acute respiratory distress syndrome and tropical infections (7.2%) like malaria, scrub typhus, leptospirosis. Fifty percent (174/346) patients developed one or more HAI with VAP being the most common. The rates of HAI per 1000 device days for VAP, CR-BSI, CA-UTI were 72.56, 3.98 and 12.4, respectively. Acinetobacter baumannii was the most common organism associated with HAI. Multidrug resistance was seen in 74% of the isolates. The burden of HAI, especially with MDR organisms, in resource constrained setting like ours is alarming. There is urgent need for infection control and monitoring system to reduce HAI.

Age-specific genetic and antigenic variations of influenza A viruses in Hong Kong, 2013-2014.

Age-specific genetic and antigenic variations of influenza viruses have not been documented in tropical and subtropical regions. We implemented a systematic surveillance program in two tertiary hospitals in Hong Kong Island, to collect 112 A(H1N1)pdm09 and 254 A(H3N2) positive specimens from 2013 to 2014. Of these, 56 and 72 were identified as genetic variants of the WHO recommended vaccine composition strains, respectively. A subset of these genetic variants was selected for hemagglutination-inhibition (HI) tests, but none appeared to be antigenic variants of the vaccine composition strains. We also found that genetic and antigenicity variations were similar across sex and age groups of ≤18 yrs, 18 to 65 yrs, and ≥65 yrs. Our findings suggest that none of the age groups led other age groups in genetic evolution of influenza virus A strains. Future studies from different regions and longer study periods are needed to further investigate the age and sex heterogeneity of influenza viruses.

Performance evaluation and mechanisms study of near-miscible CO2 flooding in a tight oil reservoir of Jilin Oilfield China

Jilin Oilfield has been conducting a large-scale demonstration project on CO2 EOR and storage in China. CO2 separated from a nearby natural gas reservoir (15–30 vol% CO2) has been injected into the northern part of H-59 oil block with the permeability of 3.0 mD and porosity of 12.7%. After six years of operation, nearly 0.26 million ton of CO2 (0.32 Hydrocarbon Pore Volume) has been injected under a miscible or near-miscible flooding mode with CO2 utilization efficiency of 6.3 MScf/bbl, and an expected enhanced oil recovery of over 10% would be achieved. A systematic and thorough reservoir surveillance program has been conducted to facilitate efficient operation and evaluation. Casing annulus gas composition was analyzed to monitor gas breakthrough in production wells as well as the gas tracer to detect CO2 flow across the reservoir. Bottom hole pressure (BHP) survey of producers and fluid sampling were combined to evaluate the miscibility effect in conjunction with the injection-production data analysis. It is revealed that the designed miscible flooding is best described as near-miscible due to the large pressure difference between injector and producer, and the gas channeling and fractures/heterogeneities cause the miscibility instability. Gravity-stabilized displacement may develop in the downdip part of the reservoir during the flooding process. The vaporization and condensation effects have been observed and confirmed through laboratory core flooding and field produced oil compositions analysis. A key insight from the evaluation study is that CO2 near-miscible flooding is more flexible and easily realizable relative to miscible, particularly in the tight oil reservoir. Further study would be necessary to optimize the reservoir development program under the near-miscible flooding design.

Development of the Diabetes Technology Society Blood Glucose Monitor System Surveillance Protocol

Background:Inaccurate blood glucsoe monitoring systems (BGMSs) can lead to adverse health effects. The Diabetes Technology Society (DTS) Surveillance Program for cleared BGMSs is intended to protect people with diabetes from inaccurate, unreliable BGMS products that are currently on the market in the United States. The Surveillance Program will provide an independent assessment of the analytical performance of cleared BGMSs.Methods:The DTS BGMS Surveillance Program Steering Committee included experts in glucose monitoring, surveillance testing, and regulatory science. Over one year, the committee engaged in meetings and teleconferences aiming to describe how to conduct BGMS surveillance studies in a scientifically sound manner that is in compliance with good clinical practice and all relevant regulations.Results:A clinical surveillance protocol was created that contains performance targets and analytical accuracy-testing studies with marketed BGMS products conducted by qualified clinical and laboratory sites. This protocol entitled “Protocol for the Diabetes Technology Society Blood Glucose Monitor System Surveillance Program” is attached as supplementary material.Conclusion:This program is needed because currently once a BGMS product has been cleared for use by the FDA, no systematic postmarket Surveillance Program exists that can monitor analytical performance and detect potential problems. This protocol will allow identification of inaccurate and unreliable BGMSs currently available on the US market. The DTS Surveillance Program will provide BGMS manufacturers a benchmark to understand the postmarket analytical performance of their products. Furthermore, patients, health care professionals, payers, and regulatory agencies will be able to use the results of the study to make informed decisions to, respectively, select, prescribe, finance, and regulate BGMSs on the market.

Survey on European studies of the chemical characterisation of tattoo ink products and the measurement of potentially harmful ingredients.

The results of the detection of carcinogenic aromatic amines in about 300 ink samples are discussed. All analysed inks contained at least one or more azo compound pigments, and the presence of aromatic amines could only have originated from these compounds through a chemical process named 'reductive cleavage'. Sometimes, aromatic amines were also present as impurities derived from the processing of the pigments. A systematic surveillance programme in Italy, promoted by the Italian Ministry of Health with the involvement of Italian regions, local public health authorities and Agenzia Regionale per la Protezione Ambiente del Piemonte (Environmental Protection Agency), has shown that about 40% of the monitored inks are not regular according to European Resolution ResAP(2008):1. The method utilised for the detection of aromatic amines has allowed the identification of other substances that are not carcinogenic but are toxic or have sensitisation properties that are derived from reductive cleavage or that are present as impurities.

Investigations of Mycoplasma pneumoniae infections in the United States: trends in molecular typing and macrolide resistance from 2006 to 2013.

Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently, pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve with empirical antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae infections that were supported by the Centers for Disease Control and Prevention (CDC) between 2006 and 2013. We examined 199 M. pneumoniae-positive specimens collected during this time period in order to identify trends in antimicrobial resistance and circulating types. Overall, macrolide resistance was identified in approximately 10% of M. pneumoniae infections occurring during this time period. Typing of strains revealed cocirculation of multiple multilocus variable-number tandem-repeat analysis (MLVA) and P1 types throughout this period, including diversity in types detected within individual outbreaks. Three MLVA types (4572, 3562, and 3662) accounted for 97% of the infections during the study period. A systematic surveillance program is necessary to understand the burden of M. pneumoniae disease in the United States, facilitate case and outbreak identification, and inform appropriate therapeutic and infection control strategies.

Evaluation of School Health Surveillance System in Baghdad Governorate

Objective(s): A descriptive evaluation study is conducted on primary health care centers, primary health sectors, health directorates in Baghdad Governorate and General Health Directorate/ Ministry of Health of November 27th 2011 to June30th 2012. Methodology: A probability multistage sample of (54) subjects which is selected of school health units. Data are collected throughout the utilization of the developed questionnaire and interview technique and keeping records of all available contacts. Interviews are conducted with the chief of school health unit in each stage level. Questionnaire has been divided into three main parts consist, in (A) especially for health directorate, in (B) for health sectors, and in (C) for primary health care centers each form contains the basic components; consists of manpower and health facilities; consists objectives, system components, resources, feedback and attributes. Results: consists prevention and behavioral indicators and disease prevalence indicators, total items of questionnaire was (217) items. Reliability of the questionnaire was determined through pilot study and validity determined through a panel of experts consists of (13) experts. Data were analyzed by using of descriptive data analysis (frequencies and percentages). The study results indicate that the system is average adequacy, simple, moderate flexible, highly acceptance, representative, low utility, unstable system. The study recommended computerizing as addition to manual documentation. Statisticians may coordinate the monthly surveillance forms. Engage the nurse in school units in primary health care centers. Involving all health institutions and centers related to school health in the surveillance system program. Conclusions: Lack of cooperation between the public and private. In the absence of mechanisms to provide feedback or disseminate data to the decision makers, the usefulness of school health surveillance system was very limited. The system adequate in primary health care centers more than health sectors and health directorates. The system has low utility in primary health centers and high ones in both health sectors and health directorate. System attributes are simple, moderate flexible, high acceptance, Representative and unstable system, moderate data quality. Recommendation: Provision of laboratory and radiological facilities and integration of their data in school surveillance. Review the surveillance forms to ensure reporting useful data. Besides enhancing representativeness of school health, there is need to have a regular feedback and information dissemination mechanism. Available data may be computerized as addition to manual documentation. Statisticians may coordinate the monthly surveillance forms. Engagement of the nurse at school units in primary health care centers. Involving all health institutions and centers related to school health in the surveillance system program. Customizing special financial of school health isolation of the general budget.

Tu1522 Implementing Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Dysplasia Detection Compared to Conventional Colonoscopy With Random Biopsies: a Retrospective Study

Tu1522 Implementing Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Dysplasia Detection Compared to Conventional Colonoscopy With Random Biopsies: a Retrospective Study

Hierarchical cluster analysis of carbonyl compounds emission profiles from building and furniture materials

Emission profiles of carbonyl compounds from twenty-three indoor materials were assessed by chamber tests and compared by means of a hierarchical cluster analysis. This multivariate method provides a partition into six clusters of materials having statistically similar chemical profiles. Formaldehyde is the most dominant component of emissions mainly related to two types of wood composite products (chipboards and medium-density fibreboards (MDF)) and one finishing plaster. The analysis of clusters reveals that the emission profiles of materials belonging to a same category can have various degrees of variability. Some common pressed-wood products as chipboards and medium-density fibreboards have relatively uniform profiles characterized by its unique emission of formaldehyde. On the contrary, the profiles of Oriented Strand Boards (OSB) and finishing plasters appear very heterogeneous and unspecific in terms of relative dominance between different carbonyl compounds. The finishing plasters are identified as sources of carbonyl compounds (formaldehyde and acetaldehyde, especially). These finishing products have not yet been listed as potential formaldehyde and acetaldehyde emitters. According to these results, the wood composite products can also be ranked in the decreasing order of formaldehyde emission as follows: Chipboards > MDFs > Plywoods > OSBs. In light of these results, more systematic surveillance program on the emissions from materials should be set up by Public Health services to require or request product changes for building and furnishing applications.