This book is a summary of the presentations and discussions at the Workshop on Methods of Pesticide Exposure Assessment held in Ottawa, Canada, on October 5-8, 1993. The event was a joint effort of Health Canada and the North Atlantic Treaty Organisation and was officially supported by the United States Environmental Agency and the Organisation for Economic Co-operation and Development (OECD). The goal of the workshop was to examine current issues in the field of pesticide exposure assessment with the aim of reaching an internationally harmonized approach to methods of exposure assessment. With regulatory agencies of OECD Member countries moving towards the harmonization of data requirements, it was timely and beneficial to bring together international experts in the field of pesticide exposure assessment to discuss current issues. Approximately 60 delegates and 20 observers participated, including individuals from 15 different countries representing academia, government, industry and international organizations. A guidance document on methods of pesticide exposure assessment was presented as a means to achieving the goal of international for critique and discussion harmonization. After extensive discussion, the workshop delegates agreed in principle to procedures for revising the guidance document. Following revision and further review by a designated peer review group, the revised document will be submitted to the OECD for consideration as a draft OECD Guidance Document on pesticide exposure assessment methods. Both the revised and original documents are included in these proceedings.

Reproductive tract infections (RTis) have become a silent epidemic that is devastating women's lives. Each year, thousands of women die needlessly from the consequences of these infections, including cervical cancer, ectopic pregnancy, acute and chronic infections of the uterus and the fallopian tubes, and puerperal infections. For many women, this happens because they receive medical attention too late, if at all. The terrible irony of this tragedy is that early diagnosis of and treatment for many RTis do not require high-technology health care. For the hundreds of millions of women with chronic RTis acquired from their sexual partners, life can become a living hell. Infection is a major cause of infertility, and it leads to scorn and rejection in many countries. These women may experience constant pain, have festering lesions of the genital tract, be at enhanced risk of second ary diseases, and endure social ostracism. The problems associated with RT s have grown even greater in the past decade with the emergence of human immunodeficiency virus (HIV) and AIDS. Preexisting sexually transmitted disease, particularly when associated with genital tract ulcers, raises women's vulnerability to the transmission of HIV 3-5 fold."

Research on cholera has contributed both to knowledge of the epidemic in particular, and to a broader understanding of the fundamental ways in which cells communicate with each other. This volume presents current knowledge in historical perspective to enable the practitioner to treat cholera in a more effective manner, and to provide a comprehensive review for the researcher.

This volume of the series Advances in Risk Analysis consists of papers presented at the 1988 Annual Meeting of the Society for Risk Analysis, which was held October 30 through November 2 at the Mayflower Hotel in Washington, DC. The papers span the gamut of the increasing number of risk assessment topics addressed by the Society since it held its fIrst annual meeting in June 1981, also in Washington DC. Organized to promote interdisciplinary analyses, the Society approaches risks from three broad perspectives: (1) the impact of various risks on the health of the world's populations and on the environment; (2) the social and political implications of specifIc risks, and (3) the management and reduction of risks through the development of a risk analysis methodology and corresponding data bases. The papers included in this volume typify these three approaches and illustrate their interdependence. For example, both cancer and noncancer health risks are examined for a variety of situations that exist within society. The public's perception of risks and the correlation between that perception and the acceptance or nonacceptance of certain risks is also addressed. In addition, the progress to date on predicting and quantifying specifIc risks, including the risks associated with the construction and use of large engineered systems, is reported. Included among the papers are several dealing with recent current issues, such as the impact of California's Proposition 65, hazardous waste disposal, and chemical accidents.

'Each topic is covered in sufficient depth, currency, and clarity to be of value to the neophyte and the seasoned researcher/clinician.' --- American Journal of Psychiatry, from a review of a previous volume The current volume addresses a range of issues across this diverse field, including the effects on society, physiology and biochemistry, clinical pathology, and trends in treatment.

Throughout the world, scientists and the general with environmental illness. Part II presents an over public are concerned about the adverse effects of view of chemical and physical agents commonly toxic agents found in contaminated air, water, food, found in contaminated air, water, food, and soil. and soil. In the past, attention has focused on haz The problem of hazardous wastes is also discussed. ards originating in the workplace. As a consequence, Part III characterizes the body's defense against occupational medicine has become a well-recognized such exposure. Defenses at the portals of entry are and established clinical discipline. Much less atten discussed, with emphasis placed on the role of tion has been paid to nonoccupational hazards. There nutrition. Detoxication and immunologic defense is a growing awareness, however, of the dangers of mechanisms are described. Part IV indicates the exposure to toxic chemical and physical agents in importance of and provides instruction on the the homes, community, and general environment, method of including occupational and environmen especially for the fetus, the infant, the very young, tal factors in the routine medical history. The role of the elderly, and the chronically ill, those most sus enhanced susceptibility as a factor in an individual's ceptible. Environmental medicine, fOCUSing on the response to toxic exposure is discussed."

Here is the first comprehensive cross-disciplinary work to examine the current health situation of our immigrants, successfully integrating the vast literature of diverse fields -- epidemiology, health services research, anthropology, law, medicine, social work, health promotion, and bioethics -- to explore the richness and diversity of the immigrant population from a culturally-sensitive perspective. This unequalled resource examines methodological issues, issues in clinical care and research, health and disease in specific immigrant populations, patterns of specific diseases in immigrant groups in the US, and conclusive insight towards the future. Complete with 73 illustrations, this singular book is the blueprint for where we must go in the future.

Proceedings of the FEMS Symposium on Genes and Proteins Underlying Microbial Urinary Tract Virulence: Basic Aspects and Applications, held September 16-19, 1999, in Pecs, Hungary. Urinary tract infections are among the most frequent diseases caused by microbial pathogens. In this volume, researchers, clinical microbiologists and clinicians exchange the latest ideas covering four major aspects of this important topic: * Genetic information, synthesis and assembly of virulence factors in urinary pathogens; * Regulation of genes involved in the phenotypic appearance of virulence; * Host-parasite interactions determining the process and outcome of the infection; * Possible applications of the above aspects in diagnosis, therapy and prevention.

The intestinal protozoan Giardia was first described over 300 years ago in 1681 by Leeuwenhoek, from his own stools. In his description of Giardia, he noted the size, movement, and morphology of the organism, and associated its presence with the diarrheic nature of his stools and his dietary habits. This truly remarkable account contains the first description of Giardia in morphologic, pathogenic, and epidemiologic terms. Our knowledge of the organisms in the genus Giardia has advanced tremendously in the past two decades. With the advent of new tech nologies, including techniques in electron microscopy, biochemistry, immunochemistry, tissue culture, and physiology, a tidal wave of information has appeared on the organization and function of this parasitic protozoan and its interaction with its host. The purpose of this book is to celebrate the tricentennial discovery of Giardia by Leeuwenhoek by presenting the above-mentioned advances in our knowledge of Giardia and giardiasis. In the first section of this book, the dominant theme is the biology of the organism and the correlation of structure-function relationships."

This volume contains the proceedings of the 1986 annual meeting and conference of the Society for Risk Analysis. It provides a detailed view of both mature disciplines and emerging areas within the fields of health, safety, and environmental risk analysis as they existed in 1986. In selecting and organizing topics for this conference, we sought both (i) to identify and include new ideas and application areas that would be of lasting interest to risk analysts and to users of risk analysis results, and (ii) to include innovative methods and applications in established areas of risk analysis. In the three years since the conference, many of the topics presented there for the first time to a broad risk analysis audience have become well developed-and sometimes hotly debated-areas of applied risk research. Several, such as the public health hazards from indoor air pollutants, radon in the home, high-voltage electric fields, and the AIDS epidemic, have been the subjects of headlines since 1986. Older areas, such as hazardous waste site ranking and remediation, air emissions dispersion modeling and exposure assessment, transportation safety, seismic and nuclear risk assessment, and occupational safety in the chemical industry, have continued to receive new treatments and to benefit from advances in quantitative risk assessment methods, as documented in the theoretical and methodological papers in this volume. A theme of the meeting was the importance of new technologies and the new and uncertain risks that they create.

As we enter the last decade of the twentieth century, the AIDS epidemic looms ever larger and threatening. The specter of upwards of a million deaths in the United States and perhaps many millions worldwide from a sexually transmitted virus shakes our belief in modem medical science, while challenging the foundations of democratic society. Almost ten years into the epidemic, and with an enormous body of basic science research on the Human Immunodeficiency Virus (HIV), we still do not know why AIDS emerged when it did or how to stop its spread. A very humbling experience for scientists, clinicians, public health experts, politicians, and the general public. Yet there are signs that a well coordinated multidisciplinary research program can conquer the epidemic and, perhaps, provide the basis for preventing future epidemics. The HIV family of viruses is now better understood, both in terms of structure and function, than any other virus. Genetically engineered peptides and nucleic acids are being tested as specific treatments or vaccines against HIV infection/disease. Most prom ising are the strides which have been made in understanding those aspects of human behavior which have contributed to the spread of HIV infection and which must be substantially modified if AIDS is to be controlled and eventually eradicated. The basis of that understanding has roots in a diverse set of disciplines which have converged in the work presented in this book."

Here, Wm. Alex McIntosh analyzes the relationship between food and nutrition and social factors, using a wide array of sociological theories. The author applies theories of social organization, culture, social stratification, social change, rural sociology, the sociology of the body, and social problems to empirical problems in food and nutrition. By doing so, he sheds light on issues such as the rise of the state; population growth; famine; obesity; eating disorders; the maldistribution of food across class, gender, and ethnic boundaries; and the changing nature of the food industry.

A Primer of Population Dynamics introduces to the basics of population studies. Author Krishnan Namboodiri utilizes a question-and-answer format that explores topics such as population theories and conceptual schemes, demographic data, mortality, fertility, migration, family and household, food production, and the environment and much more. Questions are accompanied by detailed explanations as well as references for additional information. An extensive index and glossary allow for easy retrieval of information. This introductory textbook is written for students studying demography, population, sociology, and public health.

This book provides a theoretical foundation for the analysis of discrete data such as count and binary data in the longitudinal setup. Unlike the existing books, this book uses a class of auto-correlation structures to model the longitudinal correlations for the repeated discrete data that accommodates all possible Gaussian type auto-correlation models as special cases including the equi-correlation models. This new dynamic modelling approach is utilized to develop theoretically sound inference techniques such as the generalized quasi-likelihood (GQL) technique for consistent and efficient estimation of the underlying regression effects involved in the model, whereas the existing 'working' correlations based GEE (generalized estimating equations) approach has serious theoretical limitations both for consistent and efficient estimation, and the existing random effects based correlations approach is not suitable to model the longitudinal correlations. The book has exploited the random effects carefully only to model the correlations of the familial data. Subsequently, this book has modelled the correlations of the longitudinal data collected from the members of a large number of independent families by using the class of auto-correlation structures conditional on the random effects. The book also provides models and inferences for discrete longitudinal data in the adaptive clinical trial set up. The book is mathematically rigorous and provides details for the development of estimation approaches under selected familial and longitudinal models. Further, while the book provides special cares for mathematics behind the correlation models, it also presents the illustrations of the statistical analysis of various real life data. This book will be of interest to the researchers including graduate students in biostatistics and econometrics, among other applied statistics research areas. Brajendra Sutradhar is a University Research Professor at Memorial University in St. John's, Canada. He is an elected member of the International Statistical Institute and a fellow of the American Statistical Association. He has published about 110 papers in statistics journals in the area of multivariate analysis, time series analysis including forecasting, sampling, survival analysis for correlated failure times, robust inferences in generalized linear mixed models with outliers, and generalized linear longitudinal mixed models with bio-statistical and econometric applications. He has served as an associate editor for six years for Canadian Journal of Statistics and for four years for the Journal of Environmental and Ecological Statistics. He has served for 3 years as a member of the advisory committee on statistical methods in Statistics Canada. Professor Sutradhar was awarded 2007 distinguished service award of Statistics Society of Canada for his many years of services to the society including his special services for society's annual meetings.

This volume is a summary of material presented in the course given in the International School of Phannacology on "Drug Epidemiology and Post-Marketing Surveillance" between September 27 and October 8, 1990, at the "Ettore Majorana Center for Scientific Culture" in Erice, Sicily. The course, which was a NATO Advanced Study Institute, included lectures and workshops presented by experts in the new field of phannacoepidemiology. The material covered includes various approaches to spontaneous reporting of adverse drug reactions, including aggregate approaches, such as those used in France, and detailed analyses of individual reports, such as that done in The Netherlands and in Sweden. Also, included are studies using traditional epidemiology methods. In addition, modern pharmacoepidemiology makes considerable use of automated databases. As such, information is presented on their use as well. Phannacoepidemiology started in hospitals and some of the newest work in the field is returning to the hospital as a site for studies. Material on these topics was presented as well. Finally, selected new methodologic developments were outlined in specific examples presented that were of regulatory and commercial importance. This new field of phannacoepidemiology is exploding in interest internationally. Evidence of this is the increasing development of pharmacoepidemiology programs in industry, medical schools, pharmacy schools, and schools of public health. Also, there is a new International Society ofPhannacoepidemiology. Practitioners in this field tend to specialize in either analyses of spontaneous reporting or the use of formal epidemiologic techniques.

'Solid, plausible, accurate and loaded with pertinent and highly referenced information regarding clinical and basic research in alcholism among women and ethnic groups...an essential text in the libraries of academicians, teachers, clinicians, researchers, and policy makers. The quality and scope of the work are groundbreaking, and it is convenient to have it all in one source.' -American Journal of Psychiatry Volume 12 highlights the remarkable evolution of alcoholism research during the last few years, focusing on gender in alcohol actions and consequences.

The papers assembled in this collection comprise a majority of the oral presentations as well as several poster presentations given at the 22nd Annual Symposium arranged by the Bastern Pennsylvania Branch of the American Society for MicrobioloS)'. The symposium would not be possible without the generous support of the many sponsors (see sponsor list) or without the concerted effort of a11 the Committee members. This Symposium series has evolved into an annual Bastern Pennsylvania Branch ASM event that attracts participants from a wide geographie area. It should be noted that one of the hallmarks of these symposia involves interaction between the presenters and those in attendance. Several authors have altered their by the participants. Therefore, the manuscript that manuscripts based on comments fo11ows should be viewed as a group effort of both the participants and presenters. J ames Poupard Lori Walsh Bruee Kleger ix CONTENTS 1 Introduction 1: CURRENT METHODS The Evolution of Antimicrobial Susceptibility Testing Methods . . . . . . . . . . . . . . . 3 James A. Poupard, Stephen F. Rittenhouse, and Lori R. Walsh Antimicrobial Susceptibility Tests: Testing Methods and Interpretive Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Patrick R. Murray Clinician Utilization of Rapid Antibiotic Susceptibility Data: A Prospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Franklin P. Koontz SESSION 2: CONTEMPORARY ISSUES IN SUSCEPTIBILITY TESTING When We Should Be Testing, How Often and What to Report . . . . . . . . . . . . . . . 35 Raymond C. Bartlett Areas of Recent Emphasis of the National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing . . . . . . . . . . . . . . . . . . . . . . . 61 James H. Jorgensen Non-Traditional Approaches for Quality Control of Antimicrobial Susceptibility Tests . . . . . . . . . . . . . . . . . . . . . . . . .

The motivation and inspiration for this book come directly from expe- ences with clients during the years that I practiced HIV-related law at the Legal Aid Society of San Diego, Inc. The issues discussed in this work reflect issues that arose on a recurring basis with clients participating in HIV research studies, with investigators calling for guidance on the legal implications of particular aspects of their proposed studies, and with research institutions and health care facilities struggling to make sense of legal maneuvers aimed at obtaining the records of their HIV-infected patients. It is impossible to thank each of these persons individually for their provocative questions and their insights. The discussion of ethical and legal issues relating to the design of clinical trials reflects questions raised during discussions with Donald J. Slymen, Ph.D. Don was one of the first researchers, in my realm of experience, to pay close attention to ethical concerns, and I am greatly appreciative of his contribution to both my professional growth and the development of various scenarios discussed in this text. The portions of this text dealing with confidentiality are the result of many hours of thoughtful discussion and analysis with Penn Lerblance, J.D., now deceased and still missed. Penn and I often participated together as presenters of in-service training programs for health prof- sionals. Penn addressed discrimination, and I focused on confidentiality.

This textbook provides a brief history of human experimentation and reviews various theories of ethics from which the principles and rules that govern this research are derived. All relevant international documents and national regulations, policies and memoranda are referred to extensively to assist in addressing issues that regularly arise during the course of research involving human subjects. It includes case examples and exercises and is of interest to students and experienced researchers.

Methodological problems have hampered researchers' efforts to understand and control AIDS since the beginning of the epidemic. This practical book addresses these problems by using actual health research case studies to develop strategies regarding design and sampling, measurement, and analysis and modeling issues. Researchers working on both biological and behavioral aspects of the disease will find this work a singularly effective tool to improve their study designs.

Small invisible particles in the urban air, especially those produced by human activities, have recently stimulated intense scrutiny, debate, regulation, and legal proceedings. The stakes are high, both with respect to health impacts and economic costs, and the methods used previously to resolve similar issues are no longer adequate. Everyone on earth inhales thousands to millions of particles in each breath, so if urban particulate air pollution-particulate matter (PM)-is significantly hazardous, the negative impact on health could be staggering. Yet the activities that generate PM, such as farming, manufacturing, mining, transportation, and generating electricity, are themselves essential to human health and welfare. Scientists, regulators, legislators, activists, judges, lawyers, journalists, and representatives of the business community are actively involved in addressing the question of what should be done. This complex issue presents opportunities for critically assessing the relevant knowledge and for adopting more rigorous approaches to this and similar problems. What is the PM controversy, and why is it a good case study for how science and public policy might better interface? The PM controversy is the sum of the frequently heated debates related to the potential health risks from urban PM.

Globally, action to prevent HIV spread is inadequate. Over 16,000 new infections occur every day. Yet we are not helpless in the face of disaster, as shown by the rich prevention experience analyzed in this valuable new compendium. "Best pr- tice" exists-a set of tried and tested ways of slowing the spread of HIV, of persuading and enabling people to protect themselves and others from the virus. Individually, features of best practice can be found almost everywhere. The tragedy, on a world scale, is that prevention is spotty, not comprehensive; the measures are not being applied on anywhere near the scale needed, or with the right focus or synergy. The national response may concentrate solely on sex workers, for example. Elsewhere, efforts may go into school education for the young, but ignore the risks and vulnerability of men who have sex with men. Action may be patchy geographically. AIDS prevention may not benefit from adequate commitment from all parts and sectors of society, compromising the sustainability of the response. In some countries matters are still worse-there is still hardly any action at all against AIDS and scarcely any effort to make HIV visible. It is no wonder that the epidemic is still emerging and in some places is altogether out of control.

This book reflects cutting-edge science that has only recently become available. It is a comprehensive assortment of new approaches to HIV prevention. It describes a set of prevention strategies that do not solely rely on male condoms, including: the use of HIV antibody testing and 'negotiated safety', abstinence, control of sexually transmitted diseases, treatment advances as prevention, and psychopharmacology to assist with behavior change. It is of interest to HIV prevention scientists, health psychologists, health educators, and public health workers in the communities at risk.

This book has been well received in many places and in many countries. It was awarded a ranking in the top ten publications on behavioral medicine in the year that it first appeared. When, in 1977, we began to fit the components of Cancer, Stress, and Death together, the established medical view was that each subject repre sented a different discipline, and that to integrate fields so diverse in information content was to seek to achieve a synthesis beyond reasonable limits. Had we been required to concern ourselves with the knowledge of each component in its entirety, this might have been so, but our concern, of course, was to integrate only those items of knowledge in any one field that could bear upon the field of interest of another. Moreover, we were concerned that physi cians and scientists take account of the inner forces that shape motivation and individual behavior, as well as the cultural identity of individuals, and we hoped that the biopsychosocial way in which we believed would gain ground and win support. Now, with need for a second edition, one can hardly conceive of not bringing together diverse contributions in one volume. Such syntheses as we have made clearly confirm that one can arrive at several levels of understanding of human situations through wise integration of biological paradigms within various social, cultural, and psychological parameters-which essentially is a simple way of defining the biopsychosocial way."

This is a collection of papers presented at the 1985 annual meeting of the Society for Risk Analysis. As always seems to occur at these meetings, the discussion was lively, the sessions were filled, and people complained about not being able to hear all the papers they wanted to because of concurrent sessions. If ever someone is in charge of a meeting, I wish them the good luck to have it be one for the Society for Risk Analysis. While I was responsible for the meeting, it could not have taken place without the efforts of the general chairman, Alan Moshissi. The program committee was chaired by Janice Longstreth, and included Lee Abramson and Vincent Covello. Together we assembled disparate papers into reasonably coherent sessions, prodded authors into getting us manuscrLpts on time, and dealt with all the last minute changes that are required for a major meeting. The Washington chapter of the Society for Risk Analysis hosted the meeting. Dr. Longstreth was president of the chapter during this fateful year and deserves a great deal of thanks for her organizational skills and efforts. Rick Cothern, Jerry Chandler, Kathleen Knox, Sue Perlin, and Paul Price played major roles in organ1z1ng the meeting and making it run smoothly. Special thanks go to Richard J. Burk, Jr. , Executive Secretary of the Society, and his staff for handling the logistics.