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PubMed1996

Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America.

PURPOSE: To assess the occupational risk of hepatitis C virus (HCV) infection among dental personnel. METHODS: Three hundred forty-three oral surgeons and 305 general dentists were recruited at national meetings of the American Dental Association and matched by gender, age, years of practice, and location of practice. Each participant completed a detailed questionnaire designated to measure occupational risk of blood-borne infections and supplied a sample of blood. Antibodies to HCV (anti-HCV) were assessed by second-generation enzyme immunoassay and recombinant immunoblot assay. As a marker of occupational exposure to blood-borne viruses, hepatitis B virus (HBV) surface antigen and antibodies to HBV surface and core antigens were measured by enzyme immunoassay. RESULTS: Anti-HCV was found in 2.0% of oral surgeons and 0.7% of general dentists (odds ratio [OR] = 3.2, P = 0.133). Anti-HCV was more prevalent (P < 0.01) in dental personnel who were older, had more years of practice, and had serologic markers of HBV infection. Serologic markers of HBV infection were found in 7.8% of general dentists and 21.2% of oral surgeons (OR 3.1, P < 0.001). CONCLUSIONS: These data confirm high rates of HBV infection among dental personnel, but suggest that the risk of HCV infection is considerably lower.

Adult↗

PubMed2005

Phylogenetic characterization of canine distemper viruses detected in naturally infected dogs in North America.

In 2004, six puppies and one adult dog from a total of four premises were subjected to necropsy evaluation. For five of the seven dogs, disease caused by canine distemper virus (CDV) infection was suspected based on clinical signs. In all of the dogs, a diagnosis of CDV infection was established by the presence of compatible gross and histologic lesions, immunohistochemical labeling for CDV antigen, and detection of CDV RNA by reverse transcription-PCR. To further characterize the CDV strains detected in the four cases, complete gene sequences were determined for the hemagglutinin (H) and fusion (F) protein genes, while partial gene sequencing was performed for the phosphoprotein gene. A total of 4,508 bases were sequenced for the CDV strains detected from each of the four cases. Two cases were found to have identical sequences except for 2 bases in the intergenic region of the F and H genes. Phylogenetic analysis strongly suggested an evolutionary relationship between sequences detected in these two cases and those of phocine distemper virus 2 and two other strains of CDV not previously detected in the continental United States. Clear phylogenetic relationships were not established for viruses detected in the two additional cases; however, one strain showed similarity to CDV strains detected in a panda from China. Importantly, the three CDV strains detected were demonstrated to be genetically distinct from known vaccine strains and strains previously reported in the continental United States.

Amino Acid Sequence↗

PubMed2002

Molecular systematics, hybridization, and phylogeography of the Bufo americanus complex in Eastern North America.

We reconstruct phylogenetic relationships among a well-studied group of toads and find relationships that differ greatly from the current taxonomic understanding. We use mitochondrial sequences encoding ND1, tRNA(Leu(UUR)), and part of 16S to infer relationships among members of the Bufo americanus complex. Focusing on the four taxa that historically have been most problematic due to morphological similarity and hybridization in sympatry, we sample 150 individuals from multiple populations across each species' geographic range. Our evidence conflicts with previous taxonomic hypotheses that were based on ability to hybridize, geographic distribution, and call variation. First, sequences from B. fowleri do not comprise the sister clade to sequences of B. woodhousii; therefore the previous classifications of B. fowleri as sister species to, or eastern subspecies of, B. woodhousii are both called into question. Second, sequences from B. americanus are more closely related to those of B. woodhousii than to those of B. terrestris, indicating that similar advertisement call characteristics evolved independently. Third, sequences of B. fowleri are paraphyletic, with sequences of B. terrestris embedded within. Lastly, sequences from B. fowleri cluster into three distinct mitochondrial clades, with some divergences corresponding to greater than 2mya. These clades are somewhat geographically structured, suggesting divergence in allopatry during the Pleistocene. These mitochondrial divergences are not accompanied by known phenotypic differences, however, suggesting either evolutionary stasis in morphology and behavior, cryptic phenotypic evolution, or that hybridization in secondary contact has homogenized phenotypic differences that may have arisen in allopatry.

Animals↗

PubMed2003

Migratory birds modeled as critical transport agents for West Nile Virus in North America.

West Nile Virus has spread more rapidly than expected in the Western Hemisphere. We tested Culex mosquitoes and long-distance migratory birds as potential agents of spread for the virus, using a series of techniques, as follows. (1) Mosquito vector distributions were modeled using an ecological niche modeling approach (GARP) to produce a map of suitability of the landscape for mosquito transmission of the virus. (2) Simulations of spread were developed with an algorithm originally developed for modeling the spread of wildfires (EMBYR), seeding an initial presence of the virus in the New York City area. (3) Alternative spread scenarios were developed as (a) just mosquitoes as movement agents (spread simulation seeded once at New York City and allowed to spread across the mosquito suitability surface), versus (b) spread via mosquitoes on local scales in tandem with long-distance colonization with migratory birds as movement agents (spread simulation seeded once at New York City, and again at sites sampled from the winter destinations of birds breeding in southeastern New York State). The first scenario (mosquitoes only) did not coincide with observed patterns of spread, whereas the second (mosquitoes and migratory birds) coincided closely, suggesting that observed patterns of spread are best explained with migratory birds as critical long-distance transport agents; the virus, in regions to which it is transported by migratory birds, then is transmitted enzootically via mosquitoes. Similar simulations of spread were used to predict extensions of the virus in the Western Hemisphere in coming years.

Animal Migration↗

PubMed2000

Overdiagnosis and consequent mismanagement of head louse infestations in North America.

BACKGROUND: Lay personnel and many health care workers in the United States believe that head louse infestations caused by Pediculus capitis are exceedingly transmissible and that infested children readily infest others. Schoolchildren therefore frequently become ostracized and remain so until no signs of their presumed infestations are evident. Repeated applications of pediculicidal product and chronic school absenteeism frequently result. METHODS: To determine how frequently louse-related exclusions from schools and applications of pediculicidal therapeutic regimens might be inappropriate, we invited health care providers as well as nonspecialized personnel to submit specimens to us that were associated with a diagnosis of pediculiasis. Each submission was then characterized microscopically. RESULTS: Health care professionals as well as nonspecialists frequently overdiagnose pediculiasis capitis and generally fail to distinguish active from extinct infestations. Noninfested children thereby become quarantined at least as often as infested children. Traditional anti-louse formulations are overapplied as frequently as are "alternative" formulations. Pediculicidal treatments are more frequently applied to non-infested children than to children who bear active infestations. CONCLUSIONS: Pediculicidal treatments should be applied solely after living nymphal or adult lice or apparently viable eggs have been observed. Because health care providers as well as lay personnel generally misdiagnose pediculiasis, and because few symptoms and no direct infectious processes are known to result, we suggest that the practice of excluding presumably infested children from school may be more burdensome than the infestations themselves.

Administration, Topical↗

PubMed2002

The epidemiology of primary hyperparathyroidism in North America.

The impact of primary hyperparathyroidism (HPT) on the population has not been well documented, particularly with respect to asymptomatic HPT. Only 83 deaths were attributed to hyperparathyroidism in the United States in 1999, for a reported death rate of just 0.3 per million per year. Many more patients are affected, of course, and the national hospitalization rate for HPT was 8.0 per 100,000 in 1999, counting 22,000 "all-listed" diagnoses, and 1.8 per 100,000 counting only the 5000 admissions where HPT was the first-listed discharge diagnosis. Surgery was performed on approximately 12,000 hospitalized patients in the United States in 1999, for a parathyroidectomy rate of about 4.4 per 100,000 per year. Overall, the annual incidence of HPT was 20.8 per 100,000 in Rochester, MN, during 1983-1992, although this represented a substantial decline from incidence rates reported a decade earlier. There are no estimates of HPT prevalence from this country, but the figure was 4.3 per 1000 in one Swedish survey. By any of these measures, HPT is more common in women than men and increases with aging in both sexes. Other risk factors are obscure. The cost of parathyroidectomies for HPT has been estimated at $282 million annually in the United States, but no reliable estimate of overall expenditures for HPT has been made, and no formal assessment of the cost-effectiveness of any treatment approach has been carried out. Better data on the disability and costs related to HPT and its treatment will be needed to devise the most efficient approaches to patient management.

Hospitalization↗

PubMed1988

The epidemiology of bovine ostertagiasis in the north temperate regions of North America.

Ostertagia ostertagi is widely distributed and is the most pathogenic of the parasitic nematodes affecting cattle in this region. Clinical ostertagiasis is seen mainly in calves and yearlings but outbreaks tend to be sporadic; the subclinical disease is of greater importance. Studies on the population dynamics of the free-living stages have shown that infective larvae can survive on pasture over the relatively severe winter conditions encountered in this region but that such pasture contamination declines during the succeeding grazing season and is lost by midsummer. In the host there is gradual acquisition of worms from pasture over the summer period, with relatively high burdens accumulating in the autumn. A dramatic shift in the proportion of adult to immature worms occurs during the autumn (October). By the time calves are housed, the proportion of larvae (mainly L4) is greater than 80%. This relative distribution of adults to larvae continues through the winter months until early spring when there appears to be a shift to a higher proportion of adults, presumably due to resumption of development of the L4. These persistent L4 stages are considered to be undergoing hypobiosis. Spring infections of calves appear to be mainly acquired from larvae that have successfully overwintered on pasture, and availability of these larvae is drastically reduced by midsummer. There appears to be negligible development of the eggs that result from the spring infections until late summer and early autumn. At this time because of favorable climatic conditions there is rapid larval development which can result in heavy infections in susceptible calves in the autumn.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Molecular determinants of virulence of West Nile virus in North America.

West Nile virus (WNV) is a mosquito-borne flavivirus that until very recently had not been found in the Americas. In 1999, there was an outbreak of West Nile encephalitis in New York and surrounding areas, involving 62 human cases, including 7 fatalities. The virus has subsequently become established in the United States of America (U.S.) with 4156 human cases, including 284 deaths, in 2002. The WNV strains found in the U.S. are members of "lineage I", a genetic grouping that includes viruses from Europe, Asia and Africa. Molecular epidemiologic studies indicate that two genetic variants of WNV emerged in 2002. The major genetic variant is found in most parts of the U.S., while the minor genetic variant has been identified only on the southeast coast of Texas. Investigation of WNV in mouse and hamster models demonstrated that strains from the U.S. are highly neurovirulent and neuroinvasive in these laboratory rodents. Other strains, such as Ethiopia 76a from lineage I, are not neuroinvasive and represent important viruses which can be used to elucidate the molecular basis of virulence and attenuation of WNV. To identify putative molecular determinants of virulence and attenuation, we have undertaken comparative nucleotide sequencing of Ethiopia 76a and strains from the U.S. The results show that the two viruses differ by 5 amino acids in the envelope (E) protein, including loss of the glycosylation site. Comparison of our panel of 27 WNV strains suggests that E protein glycosylation is a major determinant of the mouse neuroinvasive phenotype.

Disease Outbreaks↗

PubMed2000

Detection of chelonid herpesvirus DNA by nonradioactive in situ hybridization in tissues from tortoises suffering from stomatitis-rhinitis complex in Europe and North America.

Chelonid herpesvirus (ChHV) infection in tortoises associated with stomatitis-rhinitis complex is a severe, mostly epizootic disease characterized by proliferative and diphtheroid-necrotizing glossitis, pharyngitis, rhinitis, and tracheitis, often occurring with pneumonia and encephalitis. The UL5 gene from a German ChHV isolate was used to generate a digoxigenin-labeled 307-base-pair DNA probe by polymerase chain reaction (PCR). ChHV DNA was detected in paraffin-embedded tissues of five naturally infected tortoises (two Afghan tortoises [Testudo horsfieldii], USA; two Hermann's tortoises [Testudo hermanni], Switzerland; one T. hermanni, Germany) by means of in situ hybridization (ISH) and PCR. Distribution of ChHV DNA exhibits many characteristics of alphaherpesvirus but also some characteristics of betaherpesvirus infections. The amino acid sequence of a portion of the ChHV UL5 homolog exhibited more than 50% similarity to alphaherpesvirus UL5 proteins. Nuclear hybridization signals were detected in epithelial cells of the lingual mucosa and glands. Furthermore, ChHV DNA was observed in tracheal epithelium, pneumocytes, hepatocytes, the renal tubular epithelium, cerebral glia cells and neurons, and intramural intestinal ganglia. ChHV DNA in endothelial cells of many organs underlines the systemic character of the disease. Importantly, ChHV DNA was detected by ISH in multiple tissues of tortoises originating from different geographic provenances. This indicates a high degree of conservation of the UL5 gene fragment among viruses prevalent in tortoises on different continents. With the described ISH, a molecular biological tool is available for rapid and specific diagnosis of ChHV infections and, more importantly, comparative pathogenetic studies of ChHV isolates from geographically unrelated regions.

Animals↗

PubMed1987

Potential arthropod vectors of African swine fever virus in North America and the Caribbean basin.

In an effort to identify arthropods that might serve as vectors and perhaps reservoirs of African swine fever virus (ASFV) if it were to enter the U.S.A., the blood-sucking insect Triatoma gerstaeckeri and four species of ticks of the genus Ornithodoros were established in colonies capable of reproducing in numbers sufficient to enable thorough studies to be made of their ASFV vector potentials. A nymphal stage of T. gerstaeckeri carried the virus for 41 days and retained it through one molt, but was unable to transmit it to susceptible pigs. Studies on O. coriaceus revealed that the species is able to harbor and transmit the virus for greater than 440 days, passing it trans-stadially from the first nymphal stage to the adult, sustaining it through at least four molts. Trans-ovarial passage was not demonstrated and nearly 40% of the ticks died, apparently, of the ASFV infection. O. turicata collected in Florida was also found to be capable of becoming infected with ASFV and transmitting it by bite to susceptible pigs. O. puertoricensis collected during the ASF eradication programs in the Dominican Republic and Haiti was not only readily infected experimentally, but it was also able to transmit the virus trans-stadially and trans-ovarially. However, ASFV was not isolated from any of the 350 O. puertoricensis collected in the Dominican Republic and Haiti. O. parkeri from a long-established laboratory colony were able to carry the virus through at least one molt, but they were unable to transmit it to susceptible pigs.

African Swine Fever↗

PubMed2003

Propionic acidemia: identification of twenty-four novel mutations in Europe and North America.

Propionic acidemia is an inherited metabolic disease caused by the deficiency of the mitochondrial protein propionyl-CoA carboxylase (PCC), one of the four biotin-dependent enzymes. PCC is a multimeric protein composed of two different alpha- and beta-PCC subunits, nuclearly encoded by the PCCA and PCCB genes, respectively. Mutations in either gene cause the clinically heterogeneous disease propionic acidemia. In this work we describe the mutational analysis of PCCA and PCCB deficient patients from different European countries (Spain, Italy, Belgium, Croatia, and Austria) and from America (mainly USA). We report 24 novel PA mutations, nine affecting the PCCA gene and 15 affecting the PCCB gene. They include six missense mutations, one nonsense mutation, one point exonic mutation affecting splicing, seven splicing mutations affecting splice sequences, and nine short insertions or deletions, only two in-frame. We have found a highly heterogenous spectrum of PCCA mutations, most of the PCCA deficient patients are homozygous carrying a unique genotype. The PCCA mutational spectrum includes a high proportion of short insertions or deletions affecting one nucleotide. In the PCCA mutant alleles analyzed we have also found one single nucleotide change, a novel nonsynonymous SNP. On the other hand, the PCCB deficient patients carry a more reduced spectrum of mutations, 50% of them are missense. This work represents an extensive update of the mutational study of propionic acidemia providing important information about the worldwide distribution of PA mutations and representing another essential part in the study of the phenotype-genotype correlations for the prediction of the metabolic outcome and for the implementation of treatments tailored to each PA patient.

Alternative Splicing↗

PubMed2003

Genomic sequence of a ranavirus (family Iridoviridae) associated with salamander mortalities in North America.

Disease is among the suspected causes of amphibian population declines, and an iridovirus and a chytrid fungus are the primary pathogens associated with amphibian mortalities. Ambystoma tigrinum virus (ATV) and a closely related strain, Regina ranavirus (RRV), are implicated in salamander die-offs in Arizona and Canada, respectively. We report the complete sequence of the ATV genome and partial sequence of the RRV genome. Sequence analysis of the ATV/RRV genomes showed marked similarity to other ranaviruses, including tiger frog virus (TFV) and frog virus 3 (FV3), the type virus of the genus Ranavirus (family Iridoviridae), as well as more distant relationships to lymphocystis disease virus, Chilo iridescent virus, and infectious spleen and kidney necrosis virus. Putative open reading frames (ORFs) in the ATV sequence identified 24 genes that appear to control virus replication and block antiviral responses. In addition, >50 other putative genes, homologous to ORFs in other iridoviral genomes but of unknown function, were also identified. Sequence comparison performed by dot plot analysis between ATV and itself revealed a conserved 14-bp palindromic repeat within most intragenic regions. Dot plot analysis of ATV vs RRV sequences identified several polymorphisms between the two isolates. Finally, a comparison of ATV and TFV genomic sequences identified genomic rearrangements consistent with the high recombination frequency of iridoviruses. Given the adverse effects that ranavirus infections have on amphibian and fish populations, ATV/RRV sequence information will allow the design of better diagnostic probes for identifying ranavirus infections and extend our understanding of molecular events in ranavirus-infected cells.

Animals↗

PubMed1998

Genetic analysis of the diversity and origin of hantaviruses in Peromyscus leucopus mice in North America.

Nucleotide sequences were determined for the complete M genome segments of two distinct hantavirus genetic lineages which were detected in hantavirus antibody- and PCR-positive white-footed mice (Peromyscus leucopus) from Indiana and Oklahoma. Phylogenetic analyses indicated that although divergent from each other, the virus lineages in Indiana and Oklahoma were monophyletic and formed a newly identified unique ancestral branch within the clade of Sin Nombre-like viruses found in Peromyscus mice. Interestingly, P. leucopus-borne New York virus was found to be most closely related to the P. maniculatus-borne viruses, Sin Nombre and Monongahela, and monophyletic with Monongahela virus. In parallel, intraspecific phylogenetic relationships of P. leucopus were also determined, based on the amplification, sequencing, and analysis of the DNA fragment representing the replication control region of the rodent mitochondrial genome. P. leucopus mitochondrial DNA haplotypes were found to form four separate genetic clades, referred to here as Eastern, Central, Northwestern, and Southwestern groups. The distinct Indiana and Oklahoma virus lineages were detected in P. leucopus of the Eastern and Southwestern mitochondrial DNA haplotypes, respectively. Taken together, our current data suggests that both cospeciation of Peromyscus-borne hantaviruses with their specific rodent hosts and biogeographic factors (such as allopatric migrations, geographic separation, and isolation) have played important roles in establishment of the current genetic diversity and geographic distribution of Sin Nombre-like hantaviruses. In particular, the unusual position of New York virus on the virus phylogenetic tree is most consistent with an historically recent host-switching event.

Animals↗

PubMed1993

Isolation and characterization of encephalitic bovine herpesvirus type 1 isolates from cattle in North America.

Nine CNS bovine herpesvirus type 1 (BHV-1) isolates, recovered from bovine brain samples submitted to the Texas Veterinary Medical Diagnostic Laboratories from 1974-1989, were compared by analyzing their DNA restriction endonuclease (RE) fragment migration pattern. Seven had pattern similar to that of the respiratory BHV-1 Cooper strain. The remaining 2 isolates, however, had variant patterns, similar to that of each other, but completely different from patients for the other 7. The RE patterns of these 2 variants were similar to published RE patterns for 2 encephalitic or neuropathogenic BHV-1 strains--the Australian N-569 strain and the Argentine A-663 strain. One of the Texas encephalitic variants (No. 30326) was isolated from the CNS of a calf that died during an epizootic of encephalitis in 1974. The other, designated TX-89, was isolated in 1989 from the CNS of a 7-month-old feedlot steer with acute fatal encephalitis. Microscopic lesions of encephalitis with neuronal degeneration and intranuclear inclusions were observed for 3 of the 9 isolates, the 2 variant isolates (No. 30326 and TX-89), and a respiratory isolate. The remaining 6 CNS isolates, all respiratory subtypes, were recovered from cattle that did not have clinical CNS disease or gross or microscopic CNS lesions; in 5 of these cattle, virus was recovered from at least 1 other organ (lungs) besides the CNS. We conclude that the CNS of calves can be naturally infected with 2 distinct BHV-1 subtypes, the respiratory and the encephalitic, and that the encephalitic subtype (subtype 3 or BHV-1.3) has been present in Texas cattle since at least 1974.

Animals↗

PubMed1999

Germ cell tumor clinical trials in North America.

The management of germ cell tumors (GCT) in men has been the focus of intense clinical investigation over the past 25 years. Following clinical trials which demonstrated that GCTs are curable, considerable effort has been directed at refinement of the multidisciplinary treatment plan. During the past decade, there has been a major emphasis on identifying those clinical prognostic features most closely associated with a high likelihood of a complete response (good risk) and a low likelihood of complete response (poor risk). Randomized good- and poor-risk clinical trials have been conducted which clarify the role of bleomycin and the number of cycles of therapy in good-risk patients and the role of high-dose cisplatin (200 mg/m(2)/cycle) and ifosfamide in poor-risk patients. The efficacy of high-dose chemotherapy with stem cell rescue has led to a randomized trial of its use following standard induction therapy as compared to standard induction therapy in previously untreated poor-risk patients. Salvage chemotherapy for patients in first or second relapse, or those who have not achieved an initial complete response, initially tested the role of ifosfamide; efforts are now focused on the role of paclitaxel and high-dose therapy in specific patient subgroups. High-dose chemotherapy with stem cell rescue is the treatment of choice for patients in second relapse with gonadal primary tumors who have responsive disease and factors which predict a reasonable likelihood of achieving a disease-free status. A general understanding of tumor biology and specific knowledge regarding GCTs will be very important in the next decade of discovery as the pathways of malignant transformation, progression, and drug resistance become better known and serve as targets for new therapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Patients using chiropractors in North America: who are they, and why are they in chiropractic care?

SUMMARY OF BACKGROUND DATA AND OBJECTIVES: Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. METHODS: The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. RESULTS: More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. CONCLUSION: These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.

Adult↗

PubMed2003

Intratumoral cisplatin/epinephrine gel in advanced head and neck cancer: a multicenter, randomized, double-blind, phase III study in North America.

BACKGROUND: The objective was to evaluate the efficacy and safety of a novel intratumoral cisplatin/epinephrine injectable gel (CDDP/epi gel) for local control and palliation of tumor-related symptoms in patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Eighty-seven patients were randomly assigned to either CDDP/epi or placebo gel in this phase III, double-blind study. Tumors were < or =20 cm(3); most recurrences (88%) were in a previously irradiated field. The most symptomatic or threatening tumor was designated as the target tumor. DOSE: 0.25 mL CDDP/epi gel/cm(3) tumor volume. TREATMENTS: < or =6 weekly intratumoral injections in an 8-week period. PRIMARY OUTCOMES: target tumor response and symptom relief. RESULTS: During the blinded phase, 34% (21 of 62) of patients achieved an objective response (CR or PR) in the target tumor treated with CDDP/epi gel vs 0% (0 of 24) treated with placebo gel (p <.001). Responses occurred within a median of four treatments (range, 2-6) and were durable (median, 95 days; range, 34-168+ days). More patients treated with CDDP/epi gel achieved palliative benefit than did those treated with placebo gel (37% vs 12%, p =.036). Most frequent side effects were local pain and local cutaneous reactions, which resolved over 3-12 weeks. Renal and hematologic toxicities were rare. CONCLUSIONS: This phase III trial showed that CDDP/epi gel significantly reduces tumor burden, palliates tumor-related symptoms, and is an effective local treatment for recurrent tumors.

Adrenergic Agonists↗

PubMed2003

Organisation of truck-driver training for the transportation of dangerous goods in Europe and North America.

In Canada, as in several other countries, truck drivers involved in the transportation of dangerous goods must be trained. However, given the many differences in vehicles, substances transported and driving conditions, international guidelines are very open-ended. This article outlines the domestic training requirements in Canada, the United States, The Netherlands and Sweden, and examines the manner in which the training is provided. In both Canada and the United States, the responsibility for assuring a driver is adequately trained rests with the employer. It is the employer who determines the duration and content of any training program. In addition, the assessment of a driver is also an employer responsibility. In practice, possibility in light of liability issues, many employers use commercial training firms. However, generally speaking there is no national or regional accreditation program for such commercial firms. In Europe, where training is conducted in response to the European Agreement concerning the International Carriage of Dangerous Goods by Road, training and testing must receive national accreditation, although the specific details of such accreditation are not spelled out. Sweden places its emphasis on careful accreditation of those providing training, while in The Netherlands more importance is placed on examinations to be used to test the results of the training. The intent of this article is to show that the same goal in four different countries has resulted in four different schemes, each of which appears to be accepted in the country of use. A comparison of safety achieved in the transportation of dangerous goods in each country is beyond the scope of this article. International evaluation studies would be necessary to draw scientifically-based conclusions on the effectiveness of truck-driver training systems for the safe transportation of dangerous goods.

Accident Prevention↗