Epidemiology

Analyses to evaluate how COVID-19 severity effects the outcomes of melanoma patients on active anti-cancer treatment. Co-PI: Amanda K Arrington, MD MHM FACS FSSO

The overarching goal of this project is to inform parents, pediatricians, and eye care providers if prescribing spectacles for astigmatic toddlers will have a beneficial effect on their global development and will allow clinicians to make evidence-based, rather than consensus-based, recommendations regarding treatment of astigmatism in toddlers. Research area: Vision Science (Ophthalmology)

This research supplement expanded analyses of arsenic and UVR exposures to additional analyses accounting for location and time using spatial epidemiology methods including Geographic Information Systems (GIS). To accomplish this, Marvin Langston was trained in GIS technologies and spatial epidemiologic methods under the mentorship of Dr. Dennis and a co-mentor Dr. Brown (another MEZCOPH faculty with expertise in GIS, not on the parent grant). These methods will then be applied to the arsenic and UVR exposures in relationship to melanoma within this study. Marvin Langston and Charles Lynch are also contributors to this project. 

This environmental epidemiology project is a mentored research award (K99/R00) from the National Institute of Environmental Health Sciences (NIEHS). The project's goals are to 1) create models of atmospheric dispersions of agricultural organophosphorus and pyrethroid pesticide applications over a 20 year period in Arizona, 2) to construct a case control study of ADHD in Arizona by applying a validated algorithm to Medicaid (AHCCCS) claim records, and 3) to examine associations between the modeled ambient pesticide concentrations during fetal/early life and ADHD. The project also employs the use of novel mixture methods, primarily Bayesian Kernel Machine Regression, to assess the potential for mixture effects of different pesticide exposures. Beate Ritz is a Co-Mentor for this project with Paloma Beamer. Avellino Arellano is a collaborator for this project as well. 

We are using genetics to better understand the pathophysiological intersect of type-2 diabetes and cardiovascular disease, and to better understand how and in whom statin use may lead to a higher risk of developing type-2 diabetes. This project is funded by the National Institutes of Health.  Other collaborators on this project include Alexis Frazier-Wood, Craig Stump, and Jose Ordovas. 

This goal of this study was to determine if soil characteristics might determine where Coccidioides sp. grows in the Tucson basin.  The soil type was geo-spatially linked to severe cases of Valley fever to determine whether proximity to specific soil types would result in enhanced disease incidence. This project was supported by ADCRC. 

This project used pesticide application data from Arizona Department of Agriculture to determine children’s exposure to pesticide.  The exposures were then spatially linked to biomarker measurements to determine the efficacy of the model. This project was supported by the Arizona Department of Health Services. 

The goal of the project is to examine the role of women in vector control at three distinct levels of engagement: programmatic, community and household, using case studies in malaria control. This project received support from the Bill and Melinda Gates Foundation. Dr. Ernst's role within this larger project was a Site Principal Investigator. 

By identifying the genes that cause lipedema, we can determine what physiological mechanisms can be therapeutically acted upon, and we can make predictions of an individual’s risk for lipedema. A better understanding of the pathways and mechanisms underlying lipedema can thus lead to improved prevention and treatment.This project is receiving funding from The Lipedema Foundation. 

For over two decades, the Atherosclerosis Risk in Communities (ARIC) study has made many and important contributions to cardiovascular disease epidemiology. That effort will continue during the renewal. Dr. Shahar, a co-investigator on this project for over 20 years, has served on the study’s morbidity and mortality classification committee; designed and implemented ancillary studies; authored or co-authored almost 100 ARIC manuscripts; and internally reviewed ARIC manuscripts for the publication committee. Dr. Shahar has worked closely with investigators and staff at the ARIC coordinating center for many years. He will continue to support blinded endpoint classification in the ARIC cohort through a subcontract with the University of North Carolina. Subaward –University of North Carolina Chapel Hill  

The goal of this project was to develop a community-based participatory surveillance application and educational platform for arboviral diseases in the United States. Financial support from the Skoll Global Threats Fund (STGF) was used to support a University of Arizona developer migrate to a new push notification platform and convene 3-4 meetings of key stakeholders. These funds supplemented the CDC grant funding for the development of Kidenga and previous SGTF funding used for marketing of the tool.

Dr. Kacey Ernst (U of AZ, an epidemiologist). The role of Dr. Ernst on the project will be to inform the parameterization of the SEIR models for chikungunya and to refine the model for dengue as new information is generated in the literature. Further she will assist with informing the modifications to the DyMSiM model which includes the parameterization of humidity-related influences on the bionomics of the Ae. aegypti mosquito. She will assist in the validation of said models using multiple data sources. She will be responsible for coordinating access to data from multiple sources including 1) the Sonoran Department of Health for case data on dengue and chikungunya (as available) and 2) adult Ae. aegypti density and longevity information, and 3) ground measurements of humidity and temperature. She will assist in the interpretation of results and its relevance to informing stakeholders about the current risks and dynamics of chikungunya and dengue transmission in the region. She will participate in manuscripts and presentations that arise from the work conducted.

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

The American Lung Association Airways Clinical Research Centers (ACRC) network is a network of asthma and airways experts with access to a nationwide and demographically representative study population, for the purpose of decreasing the prevalence, morbidity and mortality of asthma and COPD. The basic activities of the network and its data coordinating center include:  Developing a collective data base of well characterized patients with asthma and COPD who can serve as potential research participants;  Collecting core data from recruited participants;  Communicating information gained from network activities to local Lung Associations and the populations they serve;  Participating interactively in developing grant and contract proposals. Such proposals may be extensions of initial projects proposed in the applications of individual centers, or may involve emerging new priorities that arise as a consequence of developments within the field.  Participate in development of presentations and publications based on network research.

The goal of this project is to 1) to demonstrate utility and feasibility of detection of LTBI among migrant farmworkers, and to compare outcomes in the US and Mexico and; 2)To assess follow-up of workers detected with LTBI and ability to link individuals to care. Through additional funding, we have been able to expand the work to include further care for participating migrant farmworkers in conjunction with the Migrant clinicians Network.

The goal of this project is to examine the association between stress and asthma morbidity, using our preliminary work from the Children’s Respiratory Study, and within the context of an ongoing school-base randomized clinical trial, to determine to what degree variations in asthma control and morbidity are associated with chronic school stressors. Eyal Oren was a contributor on this project but has since left the University of Arizona. 

The goal of this project is to determine whether texting can serve as a low cost technology for improving low LTBI adherence rates. This work is being completed in partnership with the Pima County Health Department TB Clinic in Tucson, AZ. Specifically, the project will focus on these aims: Aim 1. To determine the effectiveness of text reminders for improving adherence in latent TB patients using a randomized controlled single blinded trial. Aim 2. To establish the costs associated with text messaging. Aim 3. To determine patient experiences with the texting intervention. You can learn more about TXT4MED and its progress at http://txt4med.arl.arizona.edu  

It is estimated that over 48 million people (1 in 6) are affected by a foodborne illness (FBI) every year in the United States. A subset of patients affected by FBIs develop post-infectious sequelae that lead to chronic diseases such as irritable bowel syndrome, Crohn’s disease, reactive arthritis, and Guillain-Barré syndrome. This study focused on Salmonella and Campylobacter; pathogens that cause 2 million illnesses annually and disproportionately affect Hispanics, children, and the elderly, with associated costs for acute outcomes approaching $5 billion. The study followed Campylobacter and Salmonella cases that began at the initial report to the health department surveillance system and ended a year after the onset of acute symptoms. We gathered information on patient risk factors, genetics, and the development of new symptoms, and collected and banked microbial samples linked to patients’ acute infections and performed advanced testing to determine the microbial factors that contributed to specific acute and long-term sequelae. All recruitment, interviews, sample preparation, microbial testing and data analysis were conducted by trained graduate and undergraduate students. Our long-term goal was to develop recommendations for clinicians to more appropriately address the follow-up of FBIs, and to inform the improvement of therapeutics and prevention strategies. To accomplish this, we needed to advance our understanding of the mechanisms and genetics of pathogenesis, including how patient factors (demographics, ethnicity, co-morbidities, genetics, microbiome), mechanisms of disease onset, and microbial factors (subtype, virulence factors, antibiotic resistance) intersected to cause chronic outcomes. This study took advantage of a decade of collaboration between researchers and health departments that maintain robust surveillance systems, while training graduate and undergraduate students in this field.

The goal of this project is to generate pilot data on the extrinsic incubation period for an important dengue vector. We used this to translate a mathematical model into MATLAB. This model is being used to investigate weather-related vector abundance for dengue, chikungunya, and West Nile virus vectors. Support for this project came from the University of Arizona Center for Insect Science. 

The goal of this project is to evaluate the role of Helicobacter pylori infection and gastric diseases in the southwestern United States to identify interventions to reduce disease. This private foundation-sponsored work has resulted manuscripts and multiple poster presentations, as well as numerous engaged students and faculty. In addition we are using this work as a springboard to apply for additional funding to investigate infectious causes of chronic diseases.

Aedes aegypti mosquitoes are the primary vector for dengue, yellow fever and chikungunya.  The vector is present in most urban communities stretching along the U.S.-Mexico border yet dengue transmission has only been noted in two U.S. border communities in Texas, notably Brownsville and Laredo, TX.  While many argue that this is a result of different social factors across the border, this fails to explain the lack of transmission in some communities in northern Mexico, notably Nogales, Sonora.  Nogales is a large urban area on the Mexican side of the border with large vector populations and a constant influx of people from dengue endemic areas yet no local cases have been recorded.  Vector presence alone is not sufficient to cause disease transmission; vectors must also survive long enough to blood feed and become infected, have the parasite develop and feed again, transmitting the virus.  Climatic influences on the lifespan and behavior of Ae. aegypti may also influence the risk of dengue transmission in this region which lies at the boundary of both virus and vector. Geographic areas such as this, at the edge of the range of disease and vector, are at greatest risk of emergence and reemergence of infectious diseases. We will assess the relative age structure of Ae. aegypti populations in nine cities with varying climates in the southern United States and Sonora, MX by trapping and molecularly determining the ages of adult Ae. aegypti during four mosquito seasons. We expect that cities with extremely dry and hot conditions will have younger Ae. aegypti populations. Cities with reported dengue transmission we expect to have Ae. aegypti that are on average younger when taking their first blood meal than cities without transmission. To determine how the age of Ae. aegypti population vary over a finer spatial scale, we will sample adults in 150 households in Hermosillo, Mexico; a city with a history of dengue outbreaks. Additionally, we will survey the households for potential social and environmental factors that mediate the relationship between climate and longevity.  We expect to find significant variability across households.  Residences with older mosquitoes will have more vegetation, fewer barriers to mosquito access and indoor resting sites, no competing vector species and no control measures. From the information gathered in the first two objectives, we will construct a model to predict the likelihood of the expansion of Ae. Aegypti populations that survive long enough to transmit dengue and thus changes in risk of dengue transmission. We expect that models of risk of dengue under climate change scenarios will decrease in areas that surpass a heat and dryness threshold and will increase in populations with increasing moisture.  Service: During our survey process we went door to door. After the survey was completed we emptied all standing water and taught community members how to identify breeding sources and provided information on dengue and West Nile virus.

Despite dramatic improvements, malaria remains a significant health problem in many regions of the world. As malaria programs move from control to elimination, there is an urgent need to understand barriers to and facilitators of the use of control measures. In this proposal, we focus on the most widely used control measure; bednets in a highland/low transmission and a lowland/high transmission. Our preliminary results indicate that in Kenya roughly 1 in 4 children under 5, the group most vulnerable to malaria, live in households that do not own a bednet. Additionally, even in net owning homes, 1 in 6 children under 5, do not sleep under a net. As Kenya and other programs expand their scope to distribute enough nets to cover all household members, much effort needs to go into understanding the prevalence of and factors related to disuse. The objective of the following proposal is to use qualitative and quantitative methods to determine the prevalence of ownership, misuse and disuse of bednets under field conditions and to identify modifiable risk factors. We will use an ecological approach to assess not only individual level factors that drive bednet ownership and use but the social and environmental context in which these decisions are being made. Following focus group discussions with community members and key informant interviews with health clinic staff, government vector control staff and village and community leaders, we will conduct a cross-sectional survey that examines 1) perceived susceptibility to malaria 2) perceived severity of malaria 3) perceived benefits of ITN use 4) perceived barriers to ITN use 5) cues to action such as health promotion programs and 6) confidence in the subject’s self-efficacy with regard to obtaining an ITN and its proper use. We will use remotely-sensed images and GIS to determine how these perceptions and practices vary geographically and if they correspond with actual risk as determined through parallel parasite prevalence surveys and pyrethrum spray catches of Anopheles. From the cross-sectional participants we will identify positive deviants, community members who own and use bednets regularly despite experiencing at least 75% of the factors associated with not owning or using a bednet. In-depth interviews will be conducted to determine their solutions and personal motivators that may be used to improve community bednet ownership and compliance. Our approach is unique in its combination of rich qualitative data and the rigor and generalizability of established epidemiologic methods. Identifying what is already working in a community is more likely to be successfully implemented as a larger intervention. We expect that we will find that individuals who have personal loss due to malaria, have identified solutions to logistical issues with hanging bednets, have a higher perception of risk and who have greater access to household resources will be more likely to own and use a bednet. This research will help drive the development of targeted community-based interventions that should improve ITN ownership and use and ultimately reduce malaria transmission. Service: Worked with community to identify strategy to disseminate bednets that would provide equitable coverage for the area.

Abstract not available. 

I will obtain publically available data from several studies in different ethnic/racial groups, and use data mining procedures to develop prediction models of type-2 diabetes risk from genetic markers. Career Development - This K01 grant also has a major career development component for which I am taking courses, going to workshops and conferences, and attending research seminars.

Abstract not available. 

This research project was part of my dissertation.  Students who were enrolled in SAFER in the fall semester of 2010 helped by participating in the data collection.

Atherosclerosis Risk in Communities (ARIC) is a  study to investigate the etiology of atherosclerosis and its clinical sequelae and variation in cardiovascular risk factors, medical care, and disease by race, sex, place, and time. In each of four US communities--Forsyth County, North Carolina, Jackson, Mississippi, suburbs of Minneapolis, Minnesota, and Washington County, Maryland--4,000 adults aged 45-64 years will be examined twice, three years apart. ARIC has coordinating, ultrasound, pulmonary, and electrocardiographic centers and three central laboratories. Three cohorts represent the ethnic mix of their communities; the Jackson cohort, its black population. Examinations include ultrasound scanning of carotid and popliteal arteries; lipids, lipoproteins, and apolipoproteins assayed in the Lipid Laboratory; and coagulation, inhibition, and platelet and fibrinolytic activity assayed in the Hemostasis Laboratory. Surveillance for coronary heart disease will involve review of hospitalizations and deaths among community residents aged 35-74 years. ARIC aims to study atherosclerosis by direct observation of the disease and by use of modern biochemistry. This study received support through a subcontract to the University of Minnesota.

This project is a contract, specifically contract 1202, with the Arizona Biomedical Research Commission. Project work will be done in conjunction with Hopi Pilot Survey funded under NACP (AzCC).

Melanoma is a public health concern since the incidence is increasing faster than any other cancer in the United States. While ultraviolet radiation is a widely accepted risk factor for this disease, understanding the possible role arsenic exposure may play in the development of melanoma will allow for a more developed base of knowledge regarding the etiology of melanoma.We will conduct a population-based case-control study of incident cutaneous melanoma (CM) cases and arsenic content detected in toenail samples. To eliminate biases, we will a) use newly diagnosed cases rather than prevalent cases, b) use toenails collected within 1-9 months of diagnosis, c) use a non-cancer control group, and d) use neutron activation analysis (NAA), considered the gold standard in trace element analyses. CM cases in Iowa residents will be semi-rapid reported through the Iowa Cancer Registry. Population-based controls will be identified using the Iowa Voter Registration file, which is comparable to the Iowa Census data. We will mail subjects an introductory letter, instructions for the toenail sample collection and small baggie. We will then conduct the survey using computer-assisted telephone interviewing (CATI) software in order to collect complex data related to residential histories (water source, sun exposure, and occupations). This format will allow interviewers to collect a residential history and probe for additional information about potential exposures at each residence. We will focus on arsenic detected by NAA in toenail samples from cases and controls. Additionally, we will assess known risk factors for CM in this population, including natural and artificial UV exposure, residential and occupational histories, sun sensitivity factors, family history of skin cancer, and sunscreen use. We will also correlate available data on arsenic levels in current drinking water to arsenic in subjects' toenails. Recording residential histories and relating them to current and historical water sources will allow us to examine the length of the potential arsenic exposure, since drinking water is believed to be the main source of arsenic exposure and may provide evidence of long-term exposure. Collecting biomarkers of arsenic exposure along with surveying subjects about known UV factors and their sun sensitivity will allow for the examination of important interactions and potential confounding of the association between arsenic and CM. This knowledge will in turn help identify a group of high-risk individuals for public health messages to target. Funding for this project comes from the National Institutes of Health. 

The Arizona Cancer Center in collaboration with other institutions has been awarded an NCI-Avon grant which will assess whether changing social and cultural factors influence clinical, histological, and molecular patterns of breast cancer in women of Mexican descent.  Maria Elena Martinez was a contributor on this project but has since left the University of Arizona.

This program is a continuation of the ongoing surveillance of autism ​​spectrum​ disorders and intellectual disability among children age​​s​ 4 and​​​​ 8​ in Maricopa​ County.​

A subcontract to the U of MN.

The Jackson Heart Study, JHS, uses community-driven research strategies that promise impact in the near and the long term as a response to American health disparities. This research includes scientific investigations in the tradition of Framingham and other large-scale epidemiologic studies to confirm or revise our understanding of key factors in the current epidemic. The future health of the nation compels us to produce future cohorts of scientists that are prepared to sustain any gains made and to press on toward the long-term goal of eliminating CVD from all segments of American society. The dearth of scientists from the population most afflicted by CVD means that we must make the inclusion of such scientists in the scientific workforce a priority. Through programs described in this issue, the JHS is taking steps toward these goals. Ultimately, the science and the scientists produced by JHS will produce health benefits that transcend geography, ethnicity, and the current era of population research. This study was supported through a subcontract to the University of Mississippi. 

Anemia is a common health problem in US older populations. It increases the risk for disability, a decline in physical performance, low muscle strength, and premature death in the elderly. A recent study reported the prevalence of anemia being larger than 10% in the US population over age 65, and the prevalence of anemia varied by ethnicity, suggesting significant health disparities in minorities, especially in the African American population. In this study, a large (N >160,000) multiethnic (non-Hispanic white, Hispanic, African American, Native American, Asian/Pacific Islander) cohort from the nationwide Women's Health Initiative (WHI) study will be used to investigate the relationships of aging with anemia epidemiology, pathology and prognosis. Specifically, we will: Evaluate the frequency of and risk factors for anemia overall and according to race-ethnicity and co-morbidity Determine the association between anemia and risk of death over 10 years of follow-up in the WHI overall and by race-ethnicity Determine associations between anemia and changes in physical function over 9 years of follow-up in the WHI cohort overall and by race-ethnicity Examine associations of anemia with muscle loss (sarcopenia) among those with baseline and prospective measurements of body composition from dual-energy x-ray absorptiometry, and  Study the association of anemia with bone loss and risk for osteoporotic fractures in older women. In addition, the frequency of anemia subtypes by morphologic categories and optimal cutoff points of hemoglobin concentrations for anemia in older women will be evaluated. This study will use archived observational and clinical trial data from 40 WHI clinical centers. Additional data entering for blood analysis from existing reports, and data merging (body composition measurements) will be conducted in the WHI DXA cohort from Arizona, Birmingham and Pittsburgh. Multivariate data analyses will be conducted for the specific aims. The WHI provides a unique and invaluable resource for answering the research questions proposed above, as the WHI is the only study in the nation that has prospective co-morbidities and body composition data as well as hemoglobin values in multiethnic groups of older women. This study has a great potential to provide new and critical evidence that is needed for preventing and managing anemia in older women from different health, age, and ethnic backgrounds.  This study was funded by the National Institutes of Health. 

Abstract not available. 

In close partnership with the Great West Division of the American Cancer Society (ACS), we propose to develop a program focused on increasing CRC screening rates in the state of Arizona, with an overall goal of increasing  to 75% by the year 2010 the proportion of the Arizona population aged 50 years and older who undergoes CRC screening.  Maria Martinez was the Principal Investigator on this project but has since left the University of Arizona. 

Subcontract of ARRA Prime Award with Vanderbilt University.  Bonnie LaFleur was a contributor on this project but has since left the University of Arizona.

The major goals of this project are to determine whether circulating levels of 25(OH)D or vitamin D intake are related to breast cancer recurrence within the WHEL study. This study was done with the Arizona Cancer Center at the University of Arizona. 

This project was designed to investigate the role of vitamin D and genetic differences in the Vitamin D pathway on the develop of the precursor to colon cancer. The research team is using combined approaches from epidemiology and molecular biology to study functional changes and the pathway and their effects on colorectal carcinogenesis. Project funding came from the National Cancer Institute. 

Epidemiological and laboratory research has shown that dietary intake of vitamin D and calcium may be associated with a decreased risk of colorectal neoplasia, and that polymorphisms of the vitamin D receptor (VDR) may also be associated with risk. In addition, it was reported that the potentially carcinogenic bile acid lithocholic acid (LCA) is a ligand for the VDR. The effects of LCA-VDR binding on colorectal neoplasia are unknown. Therefore, we conducted a study to investigate whether VDR polymorphisms are associated with the risk of colorectal adenoma recurrence and whether this association is modified by dietary intake of vitamin D, calcium, and fat. The combination of two study populations from separate nutrition intervention trials provided us with approximately 2500 participants and allowed us to perform the largest epidemiological study of this kind to date. In addition, we had the ability to conduct experiments in molecular biology to test the functional role of the VDR in colorectal neoplasia , including the translational effects of VDR polymorphisms and LCA binding in colon cancer cell lines. Completion of these objectives required thorough and detailed training in epidemiological design and analysis, statistical analyses of gene-nutrient interactions, and molecular approaches to laboratory experimentation. The sponsor for this proposal and project, Dr. David Alberts, and cosponsors, Dr. Mark Haussler, Dr. Elena Martinez, and Dr. Sylvan Green provided expertise, guidance, and support for the successful completion of the proposed research along with the Arizona Cancer Center (ACC) at the University of Arizona. This project was funded by the National Institutes of Health. 

Abstract not available.  Dr. Hu served as PI of subcontract from Harvard University.

Development of a multi-organ transplant information system

This project examines ADHS immunization and case data for trends over past 20 years. One paper has been published in connection with this project. A draft of another will be submitted soon.

The International Pancreas Transplant Registry (IPTR) was founded in 1980. In the beginning it collected information for pancreas and islet transplants but split in 1989 into the IPTR and the ‘International Islet Transplant Registry (ITR). Despite the split, the members of the IPTR are actively involved in the Collaborative Islet Transplant Registry (CITR) to promote its mission. This is especially important since physicians treating diabetic patients still underestimate the beneficial effect of ß-cell replacement therapy.  The IPTR has collected core information on over 50,000 pancreas transplants done worldwide; performed analyses on outcomes according to multiple variables; and communicated the information by publications and presentations at scientific meetings, making it freely available to the health care community as well as the general public to advance the field of ß-cell replacement therapy for diabetes mellitus.    To minimize transplant center effort, maximize data completeness, and work effectively, the IPTR cooperates with other registries such as the United Network for Organ Sharing (UNOS) and Eurotransplant. These core data from all centers is supported by more comprehensive information from the University of Minnesota’s and University of Arizona's multi-organ databases. We collect in-depth information about pre-transplant comorbidity, surgical techniques, donor pancreas quality, post-transplant complications, immunosuppressive protocols, and long-term follow-up. This enables us to do more comprehensive multivariate analyses for pancreas as well as for islet transplants.    Over the last decade we saw a substantial improvement in the short- and long-term outcome of pancreas transplants. We estimated that the risk-adjusted half-life of patients which received a simultaneous pancreas/kidney transplant in 1998/99 reached 148 months. Patients which received a solitary pancreas transplant are estimated to have a half-life of 74-79 month. The success can be attributed to the refinement in surgical technique, better less diabetogenic immunosuppressive drugs, and better pre- and post-operative prophylaxes. Since especially the long-term outcome of solitary pancreas transplants needs improvement more strategies and better immunosuppressive protocols have to be developed to reach this goal.     Pancreas transplantation is an invasive procedure with the risk of surgery. Islet transplantation in contrast contains a much lower risk. We plan to translate the lessons we learnt to improve pancreas transplantation into islet transplantation.   Models have to be refined to find the best kind of ß-cell replacement therapy for a patient with a specific comorbidity profile. Important impact factors on outcome are the status of secondary diabetic complications of a potential recipient.    There are also criteria to be developed for the allocation of a deceased donor pancreas. At the moment mostly older overweight donor pancreata are used for islet transplantation, while the better quality donors are used for whole organ transplants. More comprehensive models have to be developed to show the impact of those donor factors on the outcome of pancreas and islet transplants.    Answering such questions will allow us to improve the outcomes of pancreas transplants and also gain important information for the advancement of islet transplants. 

The goals of this study are to utilize existing and archived population-based questionnaire and biological data that describe food and water consumption histories and exposures to construct predictive models for urinary arsenic biomarkers that can be used as indicators of arsenic exposure and health effect outcomes. Five publications were published in relation to this study. This was an EPA funded study.