Effectiveness of the International Phytosanitary Standard ISPM No. 15 on reducing wood borer infestation rates in wood packaging material entering the United States

Numerous bark- and wood-infesting insects have been introduced to new countries by international trade where some have caused severe environmental and economic damage. Wood packaging material (WPM), such as pallets, is one of the high risk pathways for the introduction of wood pests. International recognition of this risk resulted in adoption of International Standards for Phytosanitary Measures No. 15 (ISPM15) in 2002, which provides treatment standards for WPM used in international trade. ISPM15 was originally developed by members of the International Plant Protection Convention to “practically eliminate” the risk of international transport of most bark and wood pests via WPM. The United States (US) implemented ISPM15 in three phases during 2005–2006. We compared pest interception rates of WPM inspected at US ports before and after US implementation of ISPM15 using the US Department of Agriculture AQIM (Agriculture Quarantine Inspection Monitoring) database. Analyses of records from 2003–2009 indicated that WPM infestation rates declined 36–52% following ISPM15 implementation, with results varying in statistical significance depending on the selected starting parameters. Power analyses of the AQIM data indicated there was at least a 95% chance of detecting a statistically significant reduction in infestation rates if they dropped by 90% post-ISPM15, but the probability fell as the impact of ISPM15 lessened. We discuss several factors that could have reduced the apparent impact of ISPM15 on lowering WPM infestation levels, and suggest ways that ISPM15 could be improved. The paucity of international interception data impeded our ability to conduct more thorough analyses of the impact of ISPM15, and demonstrates the need for well-planned sampling programs before and after implementation of major phytosanitary policies so that their effectiveness can be assessed. We also present summary data for bark- and wood-boring insects intercepted on WPM at US ports during 1984–2008.

Survival in 1001 patients with carcinoma of the pancreas

Among 1001 patients with carcinoma of the pancreas, 23 of 912 patients with exocrine carcinomas, 10 of 46 with ampullary carcinomas, and 21 of 43 with malignant islet cell tumors survived 3 years. Of the survivors with exocrine cancers, there were nine of 97 patients who had curative operation, two had had palliative resections only, and one was an incidental microfocal carcinoma; in the remaining 11 patients a histologic origin in the pancreas was not established. Preoperatively suspected and histologically proven 3-year survivors included six patients with ductal adenocarcinomas, three patients with mucinous cystadenocarcinomas, one patient with acinic cell carcinoma, and one patient with microadenocarcinoma. Only two patients can be considered cured. Tumor size and lymph node status did not correlate with survival. Cystadenocarcinomas comprised 1% of cases but one third of 3-year survivors. Long-term survival in histologically confirmed pancreatic carcinoma is a rare event that cannot be predicted in the individual case.

The physician/population ratio as a proxy measure of the adequacy of health care

In the absence of service use and health status data at the individual level in most developing countries of the world, the utility of the physician/population ratio as a proxy measure of health service availability and use in health needs assessment is tested. Data from 60 predominantly developing countries show that the physician/population ratio is curvilinearly related to an indicator of population health status, namely infant mortality. When this relation is linearized by logarithmic transformations, the physician/population ratio accounts for 53% of the variance in infant mortality. There is no significant functional relationship between the physician/population ratio and infant mortality when state-level data in the US are analysed. Implications of these findings are discussed with respect to needs assessment in developing regions of the world.

Masticatory handicap, socioeconomic status, and chronic conditions among adults

Analysis of data from some 8,300 adults, ages 25-74, shows an inverse relationship between the probability of having a masticatory handicap and socioeconomic status: lower socioeconomic status is associated with higher probability of having a masticatory handicap. Further, adults with a masticatory handicap among the low socioeconomic group have significantly lower intakes, adjusted for age, gender, and body mass, of calories and some nutrients than the non-handicapped. In the former, there is also a higher probability of three dietary-related chronic conditions developing: hypertension, heart attack, and diabetes mellitus. A masticatory handicap appears to have little effect on nutrient intake or the development of the chronic conditions among the high socioeconomic group. The evidence suggests that masticatory handicap is an added risk factor among the low socioeconomic group for these chronic conditions.

Lymphoma cutis of apparent B cell origin

A nodular, poorly differentiated lymphocytic lymphoma involving lymph nodes, spleen, and skin is reported in a 60-year-old man. The clinical course of this disorder strongly implied cutaneous involvement as the initial site of disease. Immunologic studies indicated that the neoplastic cells carried surface immunoglobulin (IgMgamma), thus suggesting a B lymphocyte origin for the lymphatic neoplasia.