12 results
Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) outbreaks in nursing homes involving residents who had completed a primary coronavirus disease 2019 (COVID-19) vaccine series—13 US jurisdictions, July–November 2021
- W. Wyatt Wilson, Amelia A. Keaton, Lucas G. Ochoa, Kelly M. Hatfield, Paige Gable, Kelly A. Walblay, Richard A. Teran, Meghan Shea, Urooj Khan, Ginger Stringer, Joanne G. Colletti, Erin M. Grogan, Carly Calabrese, Andrew Hennenfent, Rebecca Perlmutter, Katherine A. Janiszewski, Ishrat Kamal-Ahmed, Kyle Strand, Emily Berns, Jennifer MacFarquhar, Meghan Linder, Dat J. Tran, Patricia Kopp, Rebecca M. Walker, Rebekah Ess, Jennifer S. Read, Chelsey Yingst, James Baggs, John A. Jernigan, Alex Kallen, Jennifer C. Hunter, the MOVIN Surveillance Team
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 6 / June 2023
- Published online by Cambridge University Press:
- 16 January 2023, pp. 1005-1009
- Print publication:
- June 2023
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Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.
Outbreak response activities conducted by public health programs in healthcare facilities nationwide, August 2019–July 2020
- Nijika Shrivastwa, Lucas Ochoa, Maroya Walters, Kiran Perkins, Joseph Perz, Jennifer C. Hunter
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s15
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Background: Rapid response is critical to control healthcare-associated infection (HAI) and antibiotic resistance threats within healthcare facilities to prevent illness among patients, residents, and healthcare personnel. Through this analysis, we aimed to quantify public health response activities, by healthcare setting type, for (1) novel and targeted multidrug-resistant organisms or mechanisms (MDROs), (2) SARS-CoV-2, and (3) other possible outbreaks. Method: We reviewed response activity data submitted by US state, territorial, and local health department HAI/AR programs to the CDC as part of funding requirements. We performed descriptive analyses of response activities conducted during the funding reporting period (August 2019–July 2020). SARS-CoV-2 response activities were reported from January through July 2020. Data were analyzed by response category (novel or targeted MDRO, SARS-CoV-2, other HAI/AR responses), and healthcare setting type. Results: During August 2019–July 2020, 57 HAI/AR Programs (50 state, 1 territorial, 5 local health departments, and District of Columbia) reported 18,306 public health responses involving healthcare facilities. These data included 3,860 responses to 1 or more cases of novel or targeted MDROs, 13,992 responses to SARS-CoV-2 outbreaks (beginning in January 2020), and 454 responses to other possible outbreaks. Novel and targeted MDRO responses most frequently occurred in acute-care hospitals (ACHs, 64.5%), skilled nursing facilities (SNFs, 24.5%), and long-term acute-care hospitals (LTACHs, 5.8%). SARS-CoV-2 responses most frequently occurred in SNFs (55%), and assisted living facilities (24%). Other HAI/AR responses most frequently occurred in ACH (50%), SNF (28.4%), and outpatient settings (19.6%). Of the “other” HAI/AR responses, 76% were responses to cases, clusters, or outbreaks, and 23.8% were responses to serious infection control breaches including device and instrument reprocessing, injection safety, and other deficient practices. Conclusions: During the study period, public health programs performed a high volume of HAI/AR response activities largely focused on SARS-CoV-2 in nursing homes and assisted living facilities. Other important response activities occurred across a range of other healthcare settings, including responses to novel and targeted MDROs, HAI outbreaks, and serious infection control breaches. Whereas SARS-CoV-2 response activities largely centered in long-term care settings, MDRO and other HAI/AR responses occurred mostly in acute-care settings. These data demonstrate the importance of building and sustaining public health response capacity for a broad array of healthcare settings, pathogens, and patient populations to meet the range of current and emerging HAI/AR threats.
Funding: None
Disclosures: None
CDC COVID-19 healthcare infection prevention and control assistance to health departments, January 2020–December 2021
- Ayana Hart, Caroline A. Schrodt, Jennifer C. Hunter, David Ham, Elizabeth Soda, Joseph Perz, Kiran Perkins
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s36
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Background: Throughout the COVID-19 pandemic, CDC Division of Healthcare Quality Promotion (DHQP) has provided technical assistance in support of state, tribal, local, and territorial health departments for COVID-19 healthcare outbreak management and infection prevention and control (IPC). We characterized the volume and trends of technical assistance provided during the pandemic to inform the future needs of health departments for COVID-19 healthcare IPC and DHQP resources required to meet these needs. Methods: In January 2020, DHQP began receiving COVID-19 IPC TA requests directly from health departments for remote assistance or from CDC staff on field deployments providing onsite support. DHQP subject-matter experts provided responses via e-mail or, for more complex inquiries, outbreaks, or field deployments, via phone consultations. Records of e-mail communications and phone consultations were entered into an inquiry database for tracking. We calculated the number, mean, and range of technical-assistance responses by jurisdiction and by month from January 2020 through December 2021. We designated months as high-volume periods for technical assistance if inquiries surpassed the 75th percentile. Results: In total, 1,869 IPC technical-assistance responses were provided. Of all technical-assistance responses, 1,725 (92%) were to state or local health departments, 115 (6%) were tribal nations, and 28 (2%) were US territories. IPC technical assistance was provided to all 50 states and the District of Columbia, 16 tribal nations, and 5 US territories. The average total number of technical assistance responses per site during the 24-month period was 34 to state and local HDs (range, 2–111), 6 to tribal nations (when tribal nation was specified; range, 1–17), and 6 to US territories (range, 1–15). E-mail communications comprised 1,164 responses (62%); phone consultations made up the remaining 705 responses (38%). Of phone consultations, 350 (50%) were with CDC field deployers providing onsite support to health departments. The average number of technical-assistance responses provided each month across all jurisdictions was 78 (range, 0–334); months with high volumes included April–August 2020 and January 2021. Conclusions: These findings highlight the high-level collaboration between federal and state, tribal, local, and territorial health department partners in remote and onsite support of COVID-19 prevention and response efforts in healthcare settings. Variations in monthly volumes of health-department COVID-19 healthcare IPC technical assistance requests may reflect factors such as fluctuations in community infection rates and changes in CDC IPC guidance. The ability to provide effective technical assistance during pandemic response depends on the CDC maintaining sufficient healthcare IPC staffing and expertise.
Funding: None
Disclosures: None
Evolution of Healthcare-Associated Infections and Antibiotic Resistance Programs in US Health Departments, 2009–2018
- Michael Ashley, Stephanie Gumbis, Jennifer C. Hunter, Joseph Perz
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s232
- Print publication:
- October 2020
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Background: Domestically, the integration of public health into healthcare-associated infection (HAI) and antibiotic resistance (AR) prevention activities represents a major development. We describe CDC Funding: of public health HAI/AR programs through the Epidemiology and Laboratory Capacity (ELC) cooperative agreement to improve local capacity to prevent HAIs and detect and contain the spread of AR threats. Methods: We reviewed ELC budget reports and program documents to summarize the evolution of funded activities and programs from 2009 to 2018. Results: In 2009, 51 programs (49 states, 2 cities and territories) received US$35.8 million through the American Recovery and Reinvestment Act for an initial 28-month period. These funds supported each jurisdiction to establish an HAI coordinator and a multidisciplinary HAI advisory group, coordinate and report HAI prevention efforts, conduct surveillance and report HAI data, and maintain an HAI plan; ~27 programs were also funded to coordinate multicenter HAI prevention collaboratives among acute-care hospitals. Through 2011, 188 state or local HAI/AR program positions were at least partially funded by the CDC. From 2011 to 2015, investments from the Affordable Care Act (~US$10–11 million annually) were used to maintain the HAI/AR programs, with some expansion of program goals related to non–acute-care settings and antibiotic stewardship. In 2015, following the Ebola outbreak in West Africa, supplemental ELC funds were awarded to 61 programs (50 states, 11 cities and territories) totaling US$85 million over 36 months. These awards marked an expansion of HAI/AR program activities to develop healthcare provider inventories, to conduct data-driven education and training, and to perform onsite infection control assessments in healthcare facilities. In 2016, through its AR Solutions Initiative, CDC invested US$57.3 million in Funding: to 57 programs (50 states, 7 cities and territories), expanding laboratory capacities for AR threat detection (via the AR Laboratory Network) and epidemiologic activities to rapidly contain novel and targeted multidrug-resistant organisms. As of 2018, >500 state or local HAI/AR program positions were at least partially funded by the CDC. Conclusions: State and local HAI/AR programs have grown substantially over the 10 years of their existence, as reflected in major increases in funding, staffing, scope, and partnerships. CDC investments and guidance have supported the development of HAI/AR epidemiology prevention and response capacity.
Funding: None
Disclosures: None
Health Department Authorities to Assist Healthcare Facilities with Outbreaks or High HAI Rates—Preliminary Assessment, 2018
- Nijika Shrivastwa, Joseph Perz, Jennifer C. Hunter
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s244
- Print publication:
- October 2020
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Background: Health departments have been increasingly called upon to monitor healthcare associated-infections (HAIs) at the hospital- or facility-level and provide targeted assistance when high rates are identified. Health department capacity to effectively respond to these types of signals depends not only on technical expertise but also the legal and regulatory authority to intervene. Methods: We reviewed annual reports describing HAI and antibiotic resistance (HAI/AR) activities from CDC-funded HAI/AR programs for August 2017 through July 2018. We performed a qualitative data analysis on all 50 state health department responses to a question about their regulatory and legal authority to intervene or assist facilities without invitation when outbreaks are suspected (as determined by the health department) or high HAI rates have been identified (eg, based on NHSN data). Results: When an outbreak is identified, 31 health departments (62%) indicated that they have the authority to intervene without invitation from a facility and 8 (16%) did not specify. Among the 11 health departments (22%) that indicated that they do not have this authority, 5 (45%) states noted that they operate under decentralized systems in which the local health department can intervene in outbreak situations and the state health department is available to assist. When a health department identifies high HAI rates, 14 health departments (28%) indicated that they have the authority to intervene without invitation, 22 (44%) indicated that they do not, and 14 (28%) did not specify. Among those in the latter categories, 3 stated they can work through their local health departments, which do have this authority and 8 described working through partners (eg, State Hospital Association, n = 3 or State Healthcare Licensing Agency, n = 5). Discussion: Assistance from state health departments (eg, HAI/AR programs) in the context of outbreaks and high HAI rates has value that is usually well recognized and welcomed by healthcare facilities. Nonetheless, there are occasions when a health department might need to exert its authority to intervene. The preliminary analysis described here indicated that this authority was more commonly self-reported in the context of outbreaks than when high HAI rates are identified. These 2 situations are connected, as high rates might be indicative of unrecognized or unreported outbreak activity, and these issues may benefit from further analysis.
Funding: None
Disclosures: None
Contributor affiliations
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael Selzer, Stephanie Clarke, Leonardo Cohen, Gert Kwakkel, Robert Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 May 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, Case Western Reserve University, Ohio
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- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Controlled Fabrication of Nanostructure Material Based Chemical Sensors
- Laura J Evans, Gary W. Hunter, Jennifer C. Xu, Gordon M. Berger, Randall L. Vander Wal
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1253 / 2010
- Published online by Cambridge University Press:
- 01 February 2011, 1253-K08-04
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- 2010
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The use of nanotechnology based materials for chemical sensing has been of great interest since nanocrystalline materials have been shown to offer improved sensor sensitivity, stability, and response time. Several groups are successfully integrating nanostructures such as nanowires into operational sensors. The typical procedure may include random placement (e.g., dispersion, with fine-line patterning techniques used to create functional sensors) or time consuming precise fabrication (e.g., mechanical placement using an atomic force microscope or laser tweezer techniques). Dielectrophoresis has also been utilized, however it can be challenging to achieve good electrical contact of the nanostructures to the underlying electrodes. In this paper we report on a sensor platform that incorporates nanorods in a controlled, efficient, and effective manner. Semiconducting SnO2 nanorods are used as the sensing element for detection of hydrogen (H2) and propylene (C3H6) up to 600oC. Using a novel approach of combining dielectrophoresis with standard microfabrication processing techniques, we have achieved reproducible, time-efficient fabrication of gas sensors with reliable contacts to the SnO2 nanorods used for the detection of gases. The sensor layout is designed to assist in the alignment of the nanorods by selectively enhancing the electric field strength and allowing for the quick production of sensor arrays. The SnO2 nanorods are produced using a thermal evaporation-condensation approach. After growth, nanorods are separated from the resulting material using gravimetric separation. The rods vary in length from 3μm to greater than 10μm, with diameters ranging from 50 to 300nm. Dielectrophoresis is used to align multiple nanorods between electrodes. A second layer of metal is incorporated using standard microfabrication methods immediately after alignment to bury the ends of the rods making contact with the underlying electrodes within another layer of metal. Electrical contact was verified during testing by the response to H2 and C3H6 gases at a range of temperatures. Testing was performed on a stage with temperature control and probes were used for electrical contact. Gas flows into the testing chamber at a flow rate of 4000sccm. Sensor response of normalized current shift, |Igas-Iair|/Iair, was measured at a constant voltage bias. Sensors showed response to both H2 and C3H6. Detection of H2 was achieved at 100oC and response levels improved approximately 12000-fold at 600oC. Detection of C3H6 started at 100oC and improved approximately 10000-fold at 600oC. Detection of at least 200ppm for both gases was achieved at 600oC. Using this novel microfabrication approach, semiconducting SnO2 nanorods integrated into a microsensor platform have been demonstrated and sensing response showed dramatic increases at higher temperatures.
Contributors
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- By Nicholas B. Allen, Joan Rosenbaum Asarnow, Jeanne Brooks-Gunn, Ronald E. Dahl, Joanne Davila, Laura M. DeRose, Lea R. Dougherty, Nancy Eisenberg, Erika E. Forbes, Wyndol Furman, Paul Gilbert, Julia A. Graber, Danielle M. Hessler, Erin C. Hunter, Chris Irons, Lynn Fainsilber Katz, Amanda Kesek, Daniel N. Klein, Annette M. La Greca, Rebecca S. Laptook, Reed W. Larson, Primrose Letcher, Peter M. Lewinsohn, Marc D. Lewis, Christine McDunn, James W. McKowen, Christopher S. Monk, Amanda Sheffield Morris, Thomas M. Olino, Tomáš Paus, Daniel S. Pine, Ann V. Sanson, John R. Seeley, Lisa B. Sheeber, Rebecca Siegel, Jennifer S. Silk, Diana Smart, Martha C. Tompson, Julie Vaughan, Brennan J. Young, Philip David Zelazo
- Edited by Nicholas B. Allen, University of Melbourne, Lisa B. Sheeber
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- Book:
- Adolescent Emotional Development and the Emergence of Depressive Disorders
- Published online:
- 14 September 2009
- Print publication:
- 20 November 2008, pp ix-xiv
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68 - Tularemia
- from Part IV - Current Topics
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- By David M. Stier, Medical Epidemiologist, Medical Director, Adult Immunization and Travel Clinic, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Jennifer C. Hunter, Research Assistant, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Olivia Bruch, Health Program Coordinator, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Karen A. Holbrook, Medical Epidemiologist, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
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- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 451-458
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Summary
INTRODUCTION
Tularemia is a zoonotic disease caused by Francisella tularensis, a nonsporulating, nonmotile, aerobic, gram-negative coccobacillus. There are several subspecies of F. tularensis, with the biovars tularensis (type A) and holarctica (type B) occurring most commonly in the United States. The clinical syndromes caused by tularemia depend on the route of infection and subspecies of the infecting organism. Tularemia is highly infectious, requiring inhalation or inoculation of as few as 10 organisms to cause disease. Although its virulence factors are not well characterized, type A is generally thought to be the more virulent subspecies. However, the virulence of type A subspecies may vary between geographic regions within the United States, with the midwestern and eastern states having more severe infections.
The Working Group for Civilian Biodefense considers tularemia to be a dangerous potential biological weapon because of its “extreme infectivity, ease of dissemination, and its capacity to cause illness and death.” Of the potential ways that F. tularensis could be used as a biological weapon, an aerosol release is expected to have the most severe medical and public health outcomes.
EPIDEMIOLOGY
Tularemia as a Biological Weapon
Weaponized F. tularensis was developed and stockpiled by the U.S. military, though the supply was destroyed in the 1970s. The Soviet Union is reported to have developed antibiotic- and vaccine-resistant strains of weaponized F. tularensis.
Experts believe that an aerosolized release is the most likely intentional use of F. tularensis organisms.
69 - Viral Hemorrhagic Fever
- from Part IV - Current Topics
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- By David M. Stier, Medical Epidemiologist, Medical Director, Adult Immunization and Travel Clinic, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Jennifer C. Hunter, Research Assistant, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Olivia Bruch, Health Program Coordinator, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Karen A. Holbrook, Medical Epidemiologist, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
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- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 459-468
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Summary
INTRODUCTION
Viral hemorrhagic fevers (VHFs) refer to a group of illnesses caused by several families of viruses, including:
Filoviridae (Ebola and Marburg viruses)
Arenaviridae (Lassa fever and New World hemorrhagic fever)
Bunyaviridae (Rift Valley fever, Crimean-Congo fever, and agents of “hemorrhagic fever with renal syndrome” [HFRS])
Flaviviridae (yellow fever, Omsk hemorrhagic fever, Kyasanur Forest disease, and dengue)
Many VHF viruses are virulent, and some are highly infectious (e.g., filoviruses and arenaviruses) with person-to-person transmission from direct contact with infected blood and bodily secretions. Effective therapies and prophylaxis are extremely limited for VHF; therefore, early detection and strict adherence to infection control measures are essential.
The Working Group for Civilian Biodefense considers some hemorrhagic fever (HF) viruses to pose a serious threat as potential biological weapons based on their risk of morbidity and mortality, feasibility of production, and their ability to cause infection through aerosol dissemination. These include Ebola, Marburg, Lassa fever, New World arenaviruses, Rift Valley fever, yellow fever, Omsk hemorrhagic fever, and Kyasanur Forest disease. This chapter will focus only on these VHF viruses and will not include a discussion of dengue fever (see Chapter 54, Fever in the Returning Traveler), hemorrhagic fever with renal syndrome (see Chapter 70, Hantavirus), and Crimean-Congo hemorrhagic fevers.
64 - Anthrax
- from Part IV - Current Topics
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- By David M. Stier, Medical Epidemiologist, Medical Director, Adult Immunization and Travel Clinic, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Jennifer C. Hunter, Research Assistant, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Olivia Bruch, Health Program Coordinator, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA, Karen A. Holbrook, Medical Epidemiologist, Communicable Disease Control and Prevention Section, San Francisco Department of Public Health, San Francisco, CA
- Edited by Rachel L. Chin, University of California, San Francisco
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- Book:
- Emergency Management of Infectious Diseases
- Published online:
- 15 December 2009
- Print publication:
- 30 June 2008, pp 421-428
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Summary
INTRODUCTION
Anthrax is an acute infection caused by Bacillus anthracis, a large, gram-positive, spore-forming, aerobic, encapsulated, rod-shaped bacterium. Spores germinate and form bacteria in nutrient-rich environments, whereas bacteria form spores in nutrient-poor environments. The anthrax bacillus produces high levels of two toxins: Edema toxin causes massive edema at the site of germination, and lethal toxin leads to sepsis. Severity of anthrax disease depends on the route of infection and the presence of complications, with case fatality ranging from 5% to 95% if untreated.
The Working Group for Civilian Biodefense considers B. anthracis to be one of the most serious biological threats. Anthrax has been weaponized and used. It can be fairly easily disseminated and causes illness and death. Of the ways that B. anthracis could potentially be used as a biological weapon, an aerosol release would be expected to have the most severe medical and public health outcomes.
EPIDEMIOLOGY
Anthrax as a Biological Weapon
Anthrax was successfully used as a biological weapon in the United States in October 2001. Cases resulted from direct or indirect exposure to mail that was deliberately contaminated with anthrax spores. In total, 22 cases were identified, 11 with inhalational (five fatal) and 11 with cutaneous anthrax (seven confirmed, four suspected).
Several countries, including the United States, have had anthrax weaponization programs in the past.