HPV vaccine coverage in Texas counties: An application of multilevel, small area estimation

Health departments, research institutions, policy-makers, and healthcare providers are often interested in knowing the health status of their clients/constituents. Without the resources, financially or administratively, to go out into the community and conduct health assessments directly, these entities frequently rely on data from population-based surveys to supply the information they need. Unfortunately, these surveys are ill-equipped for the job due to sample size and privacy concerns. Small area estimation (SAE) techniques have excellent potential in such circumstances, but have been underutilized in public health due to lack of awareness and confidence in applying its methods. The goal of this research is to make model-based SAE accessible to a broad readership using clear, example-based learning. Specifically, we applied the principles of multilevel, unit-level SAE to describe the geographic distribution of HPV vaccine coverage among females aged 11-26 in Texas.^ Multilevel (3 level: individual, county, public health region) random-intercept logit models of HPV vaccination (receipt of ≥ 1 dose Gardasil® ) were fit to data from the 2008 Behavioral Risk Factor Surveillance System (outcome and level 1 covariates) and a number of secondary sources (group-level covariates). Sampling weights were scaled (level 1) or constructed (levels 2 & 3), and incorporated at every level. Using the regression coefficients (and standard errors) from the final models, I simulated 10,000 datasets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county and respective demographic subgroup. For simplicity, I only provide coverage estimates (and 95% confidence intervals) for counties.^ County-level coverage among females aged 11-17 varied from 6.8-29.0%. For females aged 18-26, coverage varied from 1.9%-23.8%. Aggregated to the state level, these values translate to indirect state estimates of 15.5% and 11.4%, respectively; both of which fall within the confidence intervals for the direct estimates of HPV vaccine coverage in Texas (Females 11-17: 17.7%, 95% CI: 13.6, 21.9; Females 18-26: 12.0%, 95% CI: 6.2, 17.7).^ Small area estimation has great potential for informing policy, program development and evaluation, and the provision of health services. Harnessing the flexibility of multilevel, unit-level SAE to estimate HPV vaccine coverage among females aged 11-26 in Texas counties, I have provided (1) practical guidance on how to conceptualize and conduct modelbased SAE, (2) a robust framework that can be applied to other health outcomes or geographic levels of aggregation, and (3) HPV vaccine coverage data that may inform the development of health education programs, the provision of health services, the planning of additional research studies, and the creation of local health policies.^

BENZENE TOXICITY AND THE OCCURRENCE OF BENZENE IN THE AMBIENT AIR OF THE HOUSTON AREA

This study was conducted by either literature review or actual field survey. Results are summarized as follows: (1) Long-term occupational exposure of workers to benzene vapor at levels of 3-7 ppm, 2-3 ppm and 1.6 ppm may result in a decreased level of leucocyte alkaline phosphates, an increased incidence of chromosome aberrations and an increased level of ALA in erythrocytes, respectively; (2) Benzene is capable of causing fetotoxic effects in animals at levels as low as 10 ppm by volume; (3) Exposure of animals to or less than 1 ppm benzene vapor may result in leucopenia, an inverse ratio of muscle antagonist chronaxy and a decreased level of ascorbic acid in fetus's and mother's liver as well as whole embryo; (4) Benzene is causally associated with the increased incidence of pancytopenia, including unicytopenia, bicytopenia and aplastic anemia, and chromosome aberrations in occupational exposure population, and at best benzene must also be considered as a leukemogen; (5) Since it can be emitted into the atmosphere from both man-made and natural sources, benzene in some concentrations is present everywhere in the various compartments of the environment; (6) The findings of the emission of benzene from certain natural sources indicate that reducing benzene to a zero-level of exposure is theoretically impossible; (7) The annual average of benzene concentration detected in the Houston ambient air is 2.50 ppb, which is about 2.4 times higher than the nation-wide annual average exposure level and may have been some health implications to the general public; (8) In the Houston area, stationary sources are more important than mobile sources in contributing to benzene in the ambient air. ^

Population-level risks of physical activity: Saving bones and screening hearts

Documented risks of physical activity include reduced bone mineral density at high activity volume, and sudden cardiac death among adults and adolescents. Further illumination of these risks is needed to inform future public health guidelines. The present research seeks to 1) quantify the association between physical activity and bone mineral density (BMD) across a broad range of activity volume, 2) assess the utility of an existing pre-screening questionnaire among US adults, and 3) determine if pre-screening risk stratification by questionnaire predicts referral to physician among Texas adolescents. ^ Among 9,468 adults 20 years of age or older in the National Health and Nutrition Examination Survey (NHANES) 2007-2010, linear regression analyses revealed generally higher BMD at the lumbar spine and proximal femur with greater reported activity volume. Only lumbar BMD in women was unassociated with activity volume. Among men, BMD was similar at activity beyond four times the minimum volume recommended in the Physical Activity Guidelines. These results suggest that the range of activity reported by US adults is not associated with low BMD at either site. ^ The American Heart Association / American College of Sports Medicine Preparticipation Questionnaire (AAPQ) was applied to 6,661 adults 40 years of age or older from NHANES 2001-2004 by using NHANES responses to complete AAPQ items. Following AAPQ referral criteria, 95.5% of women and 93.5% of men would be referred to a physician before exercise initiation, suggesting little utility for the AAPQ among adults aged 40 years or older. Unnecessary referral before exercise initiation may present a barrier to exercise adoption and may strain an already stressed healthcare infrastructure. ^ Among 3181 athletes in the Texas Adolescent Athlete Heart Screening Registry, 55.2% of boys and 62.2% of girls were classified as high-risk based on questionnaire answers. Using sex-stratified contingency table analyses, risk categories were not significantly associated with referral to physician based on electrocardiogram or echocardiogram, nor were they associated with confirmed diagnoses on follow-up. Additional research is needed to identify which symptoms are most closely related to sudden cardiac death, and determine the best methods for rapid and reliable assessment. ^ In conclusion, this research suggests that the volume of activity reported by US adults is not associated with low BMD at two clinically relevant sites, casts doubts on the utility of two existing cardiac screening tools, and raises concern about barriers to activity erected through ineffective screening. These findings augment existing research in this area that may inform revisions to the Physical Activity Guidelines regarding risk mitigation.^

Evaluation of the attack rates and level of damages by the fall armyworm, Spodoptera frugiperda (Lepidoptera: Noctuidae), affecting corn-crops in the northeast of Argentina

The fall armyworm (FAW) is the most important threat to corn crops in Argentina, and there exists very little up-to-date information on its actual pest status because the available literature was published more than 20 years ago. Therefore, field surveys were carried out in the northeast of Argentina, in order to establish the attack rates and injury levels of the pest in relation to the crop phenology. The study was carried out at two localities: Colonia Benítez, an agricultural region, and Tapenagá, a cattle-raising area. At each site two 1-ha plots were sown either with a Bt-corn expressing Cry 1F protein or with an untransformed corn germplasm. Optimal and late sowing was assayed and FAW larval abundance, relative age composition, attack rates and level of damage to corn were recorded. At the moment of the field experiments, Bt-corn was not affected by FAW larvae. However, untransformed germplasms were severely affected by FAW larvae, with an average of attacked plants of 18% or more. In contrast to data obtained 30 years ago, higher values of FAW density were registered. Levels of damage to corn plants were higher after the V4 stage. It was found that the sowing date affected the infestation levels and early seeding avoided high armyworm densities that develop later in the season; in northern Argentina, this was only relevant in agricultural areas.

Probability inundation map for a scenario combining storm surge and sea-level rise

Coastal managers require reliable spatial data on the extent and timing of potential coastal inundation, particularly in a changing climate. Most sea level rise (SLR) vulnerability assessments are undertaken using the easily implemented bathtub approach, where areas adjacent to the sea and below a given elevation are mapped using a deterministic line dividing potentially inundated from dry areas. This method only requires elevation data usually in the form of a digital elevation model (DEM). However, inherent errors in the DEM and spatial analysis of the bathtub model propagate into the inundation mapping. The aim of this study was to assess the impacts of spatially variable and spatially correlated elevation errors in high-spatial resolution DEMs for mapping coastal inundation. Elevation errors were best modelled using regression-kriging. This geostatistical model takes the spatial correlation in elevation errors into account, which has a significant impact on analyses that include spatial interactions, such as inundation modelling. The spatial variability of elevation errors was partially explained by land cover and terrain variables. Elevation errors were simulated using sequential Gaussian simulation, a Monte Carlo probabilistic approach. 1,000 error simulations were added to the original DEM and reclassified using a hydrologically correct bathtub method. The probability of inundation to a scenario combining a 1 in 100 year storm event over a 1 m SLR was calculated by counting the proportion of times from the 1,000 simulations that a location was inundated. This probabilistic approach can be used in a risk-aversive decision making process by planning for scenarios with different probabilities of occurrence. For example, results showed that when considering a 1% probability exceedance, the inundated area was approximately 11% larger than mapped using the deterministic bathtub approach. The probabilistic approach provides visually intuitive maps that convey uncertainties inherent to spatial data and analysis.

Discharge data derived from five water level gauges and discharge measurements in the Aguima and Niaou catchment, Benin, West Africa

This paper analyzes the hydrological processes and the impact of soil properties and land use on these processes in tropical headwater catchment in the sub-humid part of Benin (West-Africa), the Aguima catchment. The presented study is integrated in the GLOWA IMPETUS project, which investigates the effects of global change on the water cycle and water availability on a regional scale in Morocco and Benin. The lack of field investigations concerning soil and surface hydrology in the Benin research area necessitates detailed field measurements including measurements of discharge, soil water dynamics, soil physical properties etc. on the local scale in order to understand the dominant runoff generation processes and its influencing factors. This is a pre-requisite to be able to forecast the effects which global change has on hydrological processes and water availability in the region. The paper gives an overview over the hydrologic measuring concept of the IMPETUS-Benin project focusing on measurements concerning the soil saturated conductivity ksat and discharge behaviour of two different sub-catchment of the Aguima catchment. The results of ksat measurements revealed that interflow is the dominant runoff process on the hillslopes of the investigated catchment. Concerning the impact of land use on the hydrological processes infiltration experiments showed that infiltration rates were reduced on cultivated land compared to natural land cover. This results in significant differences in runoff behaviour and runoff ratios while comparing natural and agricultural used catchments.

(Table 1) Luminescence age determination of sediments from the Arkhangelsk area

The Arkhangelsk area lies in the region that was reached by the northeastern flank of the Scandinavian ice sheet during the last glaciation. Investigations of Late Pleistocene sediments show interglacial terrestrial and marine conditions with sea level up to 52 m above the present level. An unconformity in the stratigraphy suggests a hiatus representing the Early Valdaian (Weichselian) and the beginning of the Middle Valdaian. This unconformity could be related to a low base level and isostatic depression of the area north of Arkhangelsk, either caused by ice masses advancing from the Kara and Barents ice sheets and/or to Scandinavian ice over the Kola Peninsula. During Middle Valdaian, from c. 66 ka BP, until the advance of the Late Valdaian glacier, c. 17-16 ka BP, peat formation, and northward fluvial sedimentation occurred coexisting with permafrost conditions in a later phase. Before the glacier advance, the base level rose and thick vertical accumulations of fluvial sediments were formed. Associated with this glacier advance from the north-northwest, ice damming occurred. Fluvial drainage was opposite to the present drainage pattern and deposition appeared in glaciolacustrine ponds in the area outside the limit of the glaciation. After the deglaciation that started c. 15 ka BP, permafrost conditions and downwasting of buried stagnant glacier ice prevailed until at least 10.7 ka BP.