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1.
Environ Monit Assess ; 196(2): 217, 2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38286914

RESUMO

With loss of wetlands and their associated ecosystem services within landscapes, it is imperative to be able to understand the change in ecological functions underlying these services. Field-based functional assessments can produce a range of specific scores among a robust set of functions but are time and cost prohibitive as the number of wetlands assessed increases. Remote-based functional assessments are an alternative for broad scale assessments, but trade-off cost for limitations in scoring and functional assemblage. To address these concerns, we created a framework for the development of the Hydrogeomorphic Remote Assessment of Wetland Function (HGM-RAWF). Rooted in the hydrogeomorphic approach of an existing field-based functional assessment and its underlying models, this remote functional assessment substitutes field-based assessment methods with remotely assessed proxies. As potential remote proxies were determined through literature review and statistically screened for use in the remote assessment, a field-based reference wetland database of 222 freshwater wetlands in the Mid-Atlantic Region provided a baseline by which remote data could be compared and calibrated. The resulting HGM-RAWF protocol remotely assesses seven hydrology and biogeochemistry functions in the Mid-Atlantic with assessment scores similar to its field-based counterparts. With noted limitations, the HGM-RAWF framework provides the means to create desktop functional assessments across broad geographic scales with the diversity and specificity of field-based assessments at the reduced costs associated with remote assessments. Its basis in the HGM approach and use of public spatial datasets allows the framework to be adopted regionally and can be used as a model for national wetland functional assessment.


Assuntos
Ecossistema , Áreas Alagadas , Monitoramento Ambiental/métodos , Hidrologia , Mid-Atlantic Region , Conservação dos Recursos Naturais
2.
Child Dev ; 94(6): 1762-1778, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37381797

RESUMO

Racial disparities in school discipline may have collateral consequences on the larger non-suspended student population. The present study leveraged two longitudinal datasets with 1201 non-suspended adolescents (48% Black, 52% White; 55% females, 45% males; Mage : 12-13) enrolled in 84 classrooms in an urban mid-Atlantic city of the United States during the 2016-2017 and 2017-2018 academic years. Classmates' minor infraction suspensions predicted greater next year's defiant infractions among non-suspended Black adolescents, and this longitudinal relation was worse for Black youth enrolled in predominantly Black classrooms. For White youth, classmates' minor infraction suspensions predicted greater defiant infractions specifically when they were enrolled in predominantly non-White classrooms. Racial inequities in school discipline may have repercussions that disadvantage all adolescents regardless of race.


Assuntos
Negro ou Afro-Americano , Punição , Racismo , Instituições Acadêmicas , Estudantes , Brancos , Adolescente , Feminino , Humanos , Masculino , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Brancos/psicologia , Brancos/estatística & dados numéricos , Punição/psicologia , Fatores Raciais/estatística & dados numéricos , Criança , Mid-Atlantic Region/epidemiologia , População Urbana/estatística & dados numéricos , Racismo/etnologia , Racismo/psicologia , Racismo/estatística & dados numéricos
3.
Eye Contact Lens ; 49(7): 267-274, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37166232

RESUMO

OBJECTIVE: To examine the microbial distribution and antimicrobial susceptibility of culture-positive microbial keratitis at a large tertiary referral center in the mid-Atlantic region of the United States. METHODS: Retrospective review of culture-positive microbial keratitis cases at the Wilmer Eye Institute from 2016 through 2020. RESULTS: Of the 474 culture-positive microbial keratitis cases, most were bacterial (N=450, 94.9%), followed by fungal (N=48, 10.1%) and Acanthamoeba keratitis (N=15, 3.1%). Of the 450 bacterial isolates, 284 (69.5%) were gram-positive organisms, whereas 157 (28.4%) were gram-negative organisms. The most common bacterial species isolated was coagulase-negative Staphylococcus spp (N=154, 24.8%), and the most common gram-negative isolate was Pseudomonas aeruginosa (N=76, 12.3%). Among fungi, the most common isolates were Candida (N=25, 45.4%), whereas Fusarium (N=6, 10.9%) and Aspergillus (N=3, 5.5%) were less common. Of the 217 bacterial isolates tested for erythromycin susceptibility, 121 (55.7%; ∼60% of coagulase-negative staphylococci and corynebacteria tested) showed resistance to erythromycin. CONCLUSIONS: Microbial keratitis in the Baltimore Mid-Atlantic region of the United States is most commonly caused by bacteria, with fungi and acanthamoeba being less common. Gram-positive bacterial infections predominate. Among fungal keratitis cases, Candida species are more commonly encountered than are filamentous species. Use of erythromycin as infection prophylaxis should be reexamined. Findings from our study may guide empiric treatment in this geographic region.


Assuntos
Ceratite por Acanthamoeba , Infecções Oculares Bacterianas , Humanos , Coagulase/uso terapêutico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Bactérias , Staphylococcus , Mid-Atlantic Region , Ceratite por Acanthamoeba/tratamento farmacológico , Estudos Retrospectivos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Eritromicina/uso terapêutico , Testes de Sensibilidade Microbiana
4.
Public Health Rep ; 138(4): 633-644, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37013845

RESUMO

OBJECTIVE: The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement. METHODS: Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality). RESULTS: We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased. CONCLUSIONS: Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.


Assuntos
COVID-19 , Disparidades em Assistência à Saúde , Criança , Humanos , Assistência Ambulatorial , População Negra , COVID-19/epidemiologia , Estudos Transversais , Pandemias , Brancos , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Adulto Jovem , Mid-Atlantic Region
5.
J Food Prot ; 86(4): 100058, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37005038

RESUMO

Enteric bacterial pathogen levels can influence the suitability of irrigation water sources for fruits and vegetables. We hypothesize that stable spatial patterns of Salmonella enterica and Listeria monocytogenes levels may exist across surface water sources in the Mid-Atlantic U.S. Water samples were collected at four streams and two pond sites in the mid-Atlantic U.S. over 2 years, biweekly during the fruit and vegetable growing seasons, and once a month during nongrowing seasons. Two stream sites and one pond site had significantly different mean concentrations in growing and nongrowing seasons. Stable spatial patterns were determined for relative differences between the site concentrations and average concentration of both pathogens across the study area. Mean relative differences were significantly different from zero at four of the six sites for S. enterica and three of six sites for L. monocytogenes. There was a similarity between the mean relative difference distribution between sites over growing season, nongrowing season, and the entire observation period. Mean relative differences were determined for temperature, oxidation-reduction potential, specific electrical conductance, pH, dissolved oxygen, turbidity, and cumulative rainfall. A moderate-to-strong Spearman correlation (rs > 0.657) was found between spatial patterns of S. enterica and 7-day rainfall, and between relative difference patterns of L. monocytogenes and temperature (rs = 0.885) and dissolved oxygen (rs = -0.885). Persistence in ranking sampling sites by the concentrations of the two pathogens was also observed. Finding spatially stable patterns in pathogen concentrations highlights spatiotemporal dynamics of these microorganisms across the study area can facilitate the design of an effective microbial water quality monitoring program for surface irrigation water.


Assuntos
Listeria monocytogenes , Salmonella enterica , Mid-Atlantic Region , Qualidade da Água , Estações do Ano
6.
Surg Obes Relat Dis ; 19(9): 1049-1057, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36931965

RESUMO

BACKGROUND: Traditional surgical outcomes are measured retrospectively and intermittently, limiting opportunities for early intervention. OBJECTIVES: The objective of this study was to use risk-adjusted cumulative sum (RA-CUSUM) to track perioperative surgical outcomes for laparoscopic gastric bypass. We hypothesized that RA-CUSUM could identify performance variations between surgeons. SETTING: Two mid-Atlantic quaternary care academic centers. METHODS: Patient-level data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) were abstracted for laparoscopic gastric bypasses performed by 3 surgeons at 2 high-volume centers from 2014 to 2021. Estimated probabilities of serious complications, reoperation, and readmission were derived from the MBSAQIP risk calculator. RA-CUSUM curves were generated to signal observed-to-expected odds ratios (ORs) of 1.5 (poor performance) and .5 (superior performance). Control limits were set based on a false positive rate of 5% (α = .05). RESULTS: We included 1192 patients: Surgeon A = 767, Surgeon B = 188, and Surgeon C = 237. Overall rates of serious complications, 30-day reoperations, and 30-day readmissions were 3.9%, 2.5%, and 5.2% respectively, with expected rates of 4.7%, 2.2%, and 5.8%. RA-CUSUM signaled lower-than-expected (OR < .5) rates of readmission and serious complication in Surgeon A, and higher-than-expected (OR > 1.5) readmission rate in Surgeon C. Surgeon A further demonstrated an early period of higher-than-expected (OR > 1.5) reoperation rate before April 2015, followed by superior performance thereafter (OR < .5). Surgeon B's performance generally reflected expected standards throughout the study period. CONCLUSIONS: RA-CUSUM adjusts for clinical risk factors and identifies performance outliers in real-time. This approach to analyzing surgical outcomes is applicable to quality improvement, root-cause analysis, and surgeon incentivization.


Assuntos
Derivação Gástrica , Laparoscopia , Garantia da Qualidade dos Cuidados de Saúde , Cirurgiões , Desempenho Profissional , Humanos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Centros Médicos Acadêmicos , Hospitais com Alto Volume de Atendimentos , Mid-Atlantic Region/epidemiologia , Reoperação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Risco Ajustado , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde/métodos
7.
Emerg Infect Dis ; 29(5): 992-996, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36821867

RESUMO

Heartland virus (HRTV) disease is an emerging tickborne illness in the midwestern and southern United States. We describe a reported fatal case of HRTV infection in the Maryland and Virginia region, states not widely recognized to have human HRTV disease cases. The range of HRTV could be expanding in the United States.


Assuntos
Infecções por Bunyaviridae , Phlebovirus , Viroses , Estados Unidos/epidemiologia , Humanos , Infecções por Bunyaviridae/diagnóstico , Phlebovirus/genética , Mid-Atlantic Region
8.
Environ Monit Assess ; 194(4): 292, 2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-35325310

RESUMO

Tidal wetlands in the Mid-Atlantic, USA, are experiencing high rates of relative sea level rise, and it is unclear whether they will be resilient in the face of future flooding increases. In a previous study, we found 80% of our study areas in tidal freshwater and salt marshes in the Delaware Estuary and Barnegat Bay had elevation change rates lower than the 19-year increase in mean sea level. Here, we examine relationships between marsh elevation dynamics and abiotic and biotic parameters in order to assess their utility as indicators of vulnerability to relative sea level rise. We further apply a range of marsh vulnerability indicators including elevation change rates to evaluate their ability to corroborate marsh habitat change over the last 30 years. Of the field measurements, soil bulk density and belowground plant biomass were among the strongest predictors of elevation change and accretion dynamics across all marsh types and settings. Both tidal freshwater and salt marshes tended to have higher rates of elevation increase and surface accretion in areas where soil bulk density and live belowground biomass were higher. Nine of the ten marshes experienced a net loss of area from the 1970s to 2015 ranging from 0.05 to 14%. Although tidal freshwater marshes were low in elevation and experienced variable elevation change rates, marsh area loss was low. Conversely, salt marshes closest to the coast and perched high in the tidal frame with a higher degree of human modification tended to experience the greatest marsh loss, which incorporated anthropogenic impacts and edge erosion. Thus, our regional assessment points to the need for a comprehensive understanding of factors that influence marsh resilience including human modifications and geomorphic settings.


Assuntos
Elevação do Nível do Mar , Áreas Alagadas , Ecossistema , Monitoramento Ambiental , Estuários , Mid-Atlantic Region
10.
Plant Dis ; 106(7): 1803-1817, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35156848

RESUMO

Apple orchards with minimal or reduced fungicide inputs in the Mid-Atlantic region of the United States have experienced outbreaks of severe premature defoliation with symptoms that matched those of apple blotch disease (ABD) caused by Diplocarpon coronariae. Fungal isolates obtained from symptomatic apple leaves and fruit produced uniform slow-growing, dark-gray colonies on peptone potato dextrose agar and had conidia. Internal transcribed spacer DNA sequences matched with D. coronariae and Koch's postulates were fulfilled when typical ABD symptoms occurred when reinoculated onto apple leaves and fruit. Spore dispersal in nonfungicide-treated orchards detected with quantitative PCR was low in early spring and dropped to undetectable levels in late May and early June before rising exponentially to highs in July and August, which coincided with symptom development. Only low spore numbers were detected in fungicide-treated orchards and nearby forests. In preliminary fungicide tests, fluxapyroxad, thiophanate methyl, and difenoconazole effectively inhibited mycelial growth of isolates in vitro. When apple cultivars Fuji and Honeycrisp were inoculated with D. coronariae, Honeycrisp showed delayed onset of symptoms and lower disease severity, and the transcription profile of seven host defense-related genes showed that PR-2, PR-8, LYK4, and CERK1 were highly induced in Honeycrisp at 2 and 5 days postinoculation. This is the first report of ABD in the Mid-Atlantic United States, which includes studies of seasonal D. coronariae spore dispersal patterns, preliminary fungicide efficacy, and host defense-related gene expression to assist development of best ABD management practices.


Assuntos
Ascomicetos , Fungicidas Industriais , Malus , Frutas/microbiologia , Fungicidas Industriais/farmacologia , Malus/microbiologia , Mid-Atlantic Region , Estados Unidos
11.
J Med Entomol ; 59(1): 1-13, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-34734628

RESUMO

In the current review, we examine the regional history, ecology, and epidemiology of eastern equine encephalitis virus (EEEV) to investigate the major drivers of disease outbreaks in the northeastern United States. EEEV was first recognized as a public health threat during an outbreak in eastern Massachusetts in 1938, but historical evidence for equine epizootics date back to the 1800s. Since then, sporadic disease outbreaks have reoccurred in the Northeast with increasing frequency and northward expansion of human cases during the last 20 yr. Culiseta melanura (Coquillett) (Diptera: Culicidae) serves as the main enzootic vector that drives EEEV transmission among wild birds, but this mosquito species will occasionally feed on mammals. Several species have been implicated as bridge vectors to horses and humans, with Coquilletstidia perturbans (Walker) as a leading suspect based on its opportunistic feeding behavior, vector competence, and high infection rates during recent disease outbreaks. A diversity of bird species are reservoir competent, exposed to EEEV, and serve as hosts for Cs. melanura, with a few species, including the wood thrush (Hlocichia mustelina) and the American robin (Turdus migratorius), contributing disproportionately to virus transmission based on available evidence. The major factors responsible for the sustained resurgence of EEEV are considered and may be linked to regional landscape and climate changes that support higher mosquito densities and more intense virus transmission.


Assuntos
Aves/virologia , Reservatórios de Doenças/virologia , Vírus da Encefalite Equina do Leste/fisiologia , Encefalomielite Equina , Doenças dos Cavalos , Mosquitos Vetores , Animais , Encefalomielite Equina/epidemiologia , Encefalomielite Equina/transmissão , Encefalomielite Equina/veterinária , Encefalomielite Equina/virologia , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/transmissão , Doenças dos Cavalos/virologia , Cavalos , Humanos , Mid-Atlantic Region/epidemiologia , New England/epidemiologia
12.
Am J Emerg Med ; 50: 773-777, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34698640

RESUMO

INTRODUCTION: While the role of palliative care in the emergency department is recognized, barriers against the effective integration of palliative interventions and emergency care remain. We examined the association between goals-of-care and palliative care consultations and healthcare utilization outcomes in older adult patients who presented to the emergency department (ED) with sepsis. METHODS: We performed a retrospective review of 197 patients aged 65 years and older who presented to the ED with sepsis or septic shock. Healthcare utilization outcomes were compared between patients divided into 3 groups: no palliative care consultation, palliative care consultation within 4 days of admission (i.e., early consultation), and palliative care consultation after 4 days of admission (i.e., late consultation). RESULTS: 51% of patients did not receive any palliative consultation, 39% of patients underwent an early palliative care consultation (within 4 days), and 10% of patients underwent a late palliative care consultation (after 4 days). Patients who received late palliative care consultation had a significantly increased number of procedures, total length of stay, ICU length of stay, and cost (p < .01, p < .001, p < .05, p < .001; respectively). Regarding early palliative care consultation, there were no statistically significant associations between this intervention and our outcomes of interest; however, we noted a trend towards decreased total length of stay and decreased healthcare cost. CONCLUSION: In patients aged 65 years and older who presented to the ED with sepsis, early palliative consultations were associated with reduced healthcare utilization as compared to late palliative consultations.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Utilização de Instalações e Serviços/estatística & dados numéricos , Cuidados Paliativos/organização & administração , Encaminhamento e Consulta/organização & administração , Sepse/terapia , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/economia , Utilização de Instalações e Serviços/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Modelos Lineares , Masculino , Mid-Atlantic Region , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Planejamento de Assistência ao Paciente , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Fatores de Tempo
13.
Vector Borne Zoonotic Dis ; 21(11): 843-853, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34463140

RESUMO

Three tick species that can transmit pathogen causing disease are commonly found parasitizing people and animals in the mid-Atlantic United States: the blacklegged tick (Ixodes scapularis Say), the American dog tick (Dermacentor variabilis [Say]), and the lone star tick (Amblyomma americanum [L.]) (Acari: Ixodidae). The potential risk of pathogen transmission from tick bites acquired at schools in tick-endemic areas is a concern, as school-aged children are a high-risk group for tick-borne disease. Integrated pest management (IPM) is often required in school districts, and continued tick range expansion and population growth will likely necessitate IPM strategies to manage ticks on school grounds. However, an often-overlooked step of tick management is monitoring and assessment of local tick species assemblages to inform the selection of control methodologies. The purpose of this study was to evaluate tick species presence, abundance, and distribution and the prevalence of tick-borne pathogens in both questing ticks and those removed from rodent hosts on six school properties in Maryland. Overall, there was extensive heterogeneity in tick species dominance, abundance, and evenness across the field sites. A. americanum and I. scapularis were found on all sites in all years. Overall, A. americanum was the dominant tick species. D. variabilis was collected in limited numbers. Several pathogens were found in both questing ticks and those removed from rodent hosts, although prevalence of infection was not consistent between years. Borrelia burgdorferi, Ehrlichia chaffeensis, Ehrlichia ewingii, and Ehrlichia "Panola Mountain" were identified in questing ticks, and B. burgdorferi and Borrelia miyamotoi were detected in trapped Peromyscus spp. mice. B. burgdorferi was the dominant pathogen detected. The impact of tick diversity on IPM of ticks is discussed.


Assuntos
Amblyomma , Dermacentor , Ixodes , Doenças Transmitidas por Carrapatos/epidemiologia , Animais , Camundongos , Mid-Atlantic Region/epidemiologia , Ninfa , Controle de Ácaros e Carrapatos
14.
Int Emerg Nurs ; 58: 101044, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34329827

RESUMO

INTRODUCTION: Emergency nurses work under sometimes uncertain conditions to provide care to patients with all kinds of illnesses and afflictions from all segments of the population. Despite implications that they must work together to provide efficient and effective patient care, few studies explore reciprocal workplace relationships of emergency nurses. AIM: This research sought to illuminate the lived experience of workplace reciprocity of emergency nurses. METHODS: Using a phenomenological approach with snowball sampling technique, unstructured, open-ended interviews were conducted with emergency nurses in the mid-Atlantic region of the United States. The original study was conducted in 2013 (n = 9) and a replication study in 2018 (n = 7). Data were collected and analyzed using Giorgi's Phenomenological Method. Results from each study were evaluated for thematic congruence. RESULTS: Six themes of workplace reciprocity of emergency nurses were identified for both studies: emergency department (ED) culture, balancing, technology, caring, bridging, and connection. An additional theme, bonding, was identified with the replication study. CONCLUSIONS: Exploring workplace reciprocity of emergency nurses provided insight the influences on workplace relationships. Establishing and nurturing workplace reciprocity may create a culture of safety, connection, enhance work engagement, and influence nurse recruitment and retention.


Assuntos
Enfermeiras e Enfermeiros , Local de Trabalho , Serviço Hospitalar de Emergência , Humanos , Mid-Atlantic Region , Pesquisa Qualitativa , Estados Unidos
15.
J Med Entomol ; 58(6): 2030-2037, 2021 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-34080018

RESUMO

Tick-borne illnesses have been on the rise in the United States, with reported cases up sharply in the past two decades. In this literature review, we synthesize the available research on the relationship between vegetation and tick abundance for four tick species in the northeastern United States that are of potential medical importance to humans. The blacklegged tick (Ixodes scapularis) (Say; Acari: Ixodidae) is found to be positively associated with closed canopy forests and dense vegetation thickets, and negatively associated with open canopy environments, such as grasslands or old agricultural fields. The American dog tick (Dermacentor variabilis) (Say; Acari: Ixodidae) has little habitat overlap with I. scapularis, with abundance highest in grasses and open-canopy fields. The lone star tick (Amblyomma americanum) (Linnaeus; Acari: Ixodidae) is a habitat generalist without consistent associations with particular types of vegetation. The habitat associations of the recently introduced Asian longhorned tick (Haemaphysalis longicornis) (Neumann; Acari: Ixodidae) in the northeastern United States, and in other regions where it has invaded, are still unknown, although based on studies in its native range, it is likely to be found in grasslands and open-canopy habitats.


Assuntos
Distribuição Animal , Vetores Aracnídeos/fisiologia , Ixodidae/fisiologia , Plantas , Animais , Biota , Mid-Atlantic Region , New England , Ontário , Dinâmica Populacional , Wisconsin
16.
Surgery ; 170(5): 1554-1560, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34175115

RESUMO

BACKGROUND: Perforated peptic ulcer is a morbid emergency general surgery condition. Best practices for postoperative care remain undefined. Surgical dogma preaches practices such as peritoneal drain placement, prolonged nil per os, and routine postoperative enteral contrast imaging despite a lack of evidence. We aimed to evaluate the role of postoperative enteral contrast imaging in postoperative perforated peptic ulcer care. Our primary objective was to assess effects of routine postoperative enteral contrast imaging on early detection of clinically significant leaks. METHODS: We conducted a multicenter retrospective cohort study of patients who underwent repair of perforated peptic ulcer between July 2016 and June 2018. We compared outcomes between those who underwent routine postoperative enteral contrast imaging and those who did not. RESULTS: Our analysis included 95 patients who underwent primary/omental patch repair. The mean age was 60 years, and 54% were male. Thirteen (14%) had a leak. Eighty percent of patients had a drain placed. Nine patients had leaks diagnosed based on bilious drain output without routine postoperative enteral contrast imaging. Use of routine postoperative enteral contrast imaging varied significantly between institutions (30%-87%). Two late leaks after initial normal postoperative enteral contrast imaging were confirmed by imaging after a clinical change triggered the second study. Two patients had contained leaks identified by routine postoperative enteral contrast imaging but remained clinically well. Duration of hospital stay was longer in those who received routine postoperative enteral contrast imaging (12 vs 6 days, median; P = .000). CONCLUSION: Routine postoperative enteral contrast imaging after perforated peptic ulcer repair likely does not improve the detection of clinically significant leaks and is associated with increased duration of hospital stay.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Úlcera Péptica Perfurada/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Colorado/epidemiologia , Meios de Contraste , Feminino , Humanos , Masculino , Mid-Atlantic Region/epidemiologia , Pessoa de Meia-Idade , Úlcera Péptica Perfurada/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Radiografia , Estudos Retrospectivos
17.
Appl Environ Microbiol ; 87(13): e0021121, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-33893119

RESUMO

Enteric viruses (EVs) are the largest contributors to foodborne illnesses and outbreaks globally. Their ability to persist in the environment, coupled with the challenges experienced in environmental monitoring, creates a critical aperture through which agricultural crops may become contaminated. This study involved a 17-month investigation of select human EVs and viral indicators in nontraditional irrigation water sources (surface and reclaimed waters) in the Mid-Atlantic region of the United States. Real-time quantitative PCR was used for detection of Aichi virus, hepatitis A virus, and norovirus genotypes I and II (GI and GII, respectively). Pepper mild mottle virus (PMMoV), a common viral indicator of human fecal contamination, was also evaluated, along with atmospheric (air and water temperature, cloud cover, and precipitation 24 h, 7 days, and 14 days prior to sample collection) and physicochemical (dissolved oxygen, pH, salinity, and turbidity) data, to determine whether there were any associations between EVs and measured parameters. EVs were detected more frequently in reclaimed waters (32% [n = 22]) than in surface waters (4% [n = 49]), similar to PMMoV detection frequency in surface (33% [n = 42]) and reclaimed (67% [n = 21]) waters. Our data show a significant correlation between EV and PMMoV (R2 = 0.628, P < 0.05) detection levels in reclaimed water samples but not in surface water samples (R2 = 0.476, P = 0.78). Water salinity significantly affected the detection of both EVs and PMMoV (P < 0.05), as demonstrated by logistic regression analyses. These results provide relevant insights into the extent and degree of association between human (pathogenic) EVs and water quality data in Mid-Atlantic surface and reclaimed waters, as potential sources for agricultural irrigation. IMPORTANCE Microbiological analysis of agricultural waters is fundamental to ensure microbial food safety. The highly variable nature of nontraditional sources of irrigation water makes them particularly difficult to test for the presence of viruses. Multiple characteristics influence viral persistence in a water source, as well as affecting the recovery and detection methods that are employed. Testing for a suite of viruses in water samples is often too costly and labor-intensive, making identification of suitable indicators for viral pathogen contamination necessary. The results from this study address two critical data gaps, namely, EV prevalence in surface and reclaimed waters of the Mid-Atlantic region of the United States and subsequent evaluation of physicochemical and atmospheric parameters used to inform the potential for the use of indicators of viral contamination.


Assuntos
Irrigação Agrícola , Enterovirus/isolamento & purificação , Tobamovirus/isolamento & purificação , Poluentes da Água/análise , Monitoramento Ambiental , Concentração de Íons de Hidrogênio , Mid-Atlantic Region , Oxigênio/análise , Salinidade , Microbiologia da Água , Poluição da Água/análise
18.
AANA J ; 89(2): 133-140, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33832573

RESUMO

Certified Registered Nurse Anesthetists (CRNAs) are uniquely skilled anesthesia providers with substantial experience managing critically ill patients. During the coronavirus disease 2019 (COVID) pandemic, CRNAs at a large academic medical center in the Mid-Atlantic United States experienced a shift in their daily responsibilities. As the hospital transitioned to the management of patients who tested positive for the virus that causes COVID, the severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2), CRNAs were redeployed into the roles of respiratory therapists and intensive care unit registered nurses. Although facing the stress of the global pandemic, this facility's CRNAs proved to be flexible, capable, and necessary members of the care team for patients with COVID-19.


Assuntos
COVID-19/enfermagem , COVID-19/psicologia , Enfermeiras Anestesistas/psicologia , Papel do Profissional de Enfermagem/psicologia , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Papel Profissional , Carga de Trabalho/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Mid-Atlantic Region , Pessoa de Meia-Idade , Enfermeiras Anestesistas/estatística & dados numéricos , Pandemias , SARS-CoV-2
19.
Am J Manag Care ; 27(2): e54-e63, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33577162

RESUMO

OBJECTIVES: To describe real-time changes in medical visits (MVs), visit mode, and patient-reported visit experience associated with rapidly deployed care reorganization during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Cross-sectional time series from September 29, 2019, through June 20, 2020. METHODS: Responding to official public health and clinical guidance, team-based systematic structural changes were implemented in a large, integrated health system to reorganize and transition delivery of care from office-based to virtual care platforms. Overall and discipline-specific weekly MVs, visit mode (office-based, telephone, or video), and associated aggregate measures of patient-reported visit experience were reported. A 38-week time-series analysis with March 8, 2020, and May 3, 2020, as the interruption dates was performed. RESULTS: After the first interruption, there was a decreased weekly visit trend for all visits (ß3 = -388.94; P < .05), an immediate decrease in office-based visits (ß2 = -25,175.16; P < .01), increase in telephone-based visits (ß2 = 17,179.60; P < .01), and increased video-based visit trend (ß3 = 282.02; P < .01). After the second interruption, there was an increased visit trend for all visits (ß5 = 565.76; P < .01), immediate increase in video-based visits (ß4 = 3523.79; P < .05), increased office-based visit trend (ß5 = 998.13; P < .01), and decreased trend in video-based visits (ß5 = -360.22; P < .01). After the second interruption, there were increased weekly long-term visit trends for the proportion of patients reporting "excellent" as to how well their visit needs were met for all visits (ß5 = 0.17; P < .01), telephone-based visits (ß5 = 0.34; P < .01), and video-based visits (ß5 = 0.32; P < .01). Video-based visits had the highest proportion of respondents rating "excellent" as to how well their scheduling and visit needs were met. CONCLUSIONS: COVID-19 required prompt organizational transformation to optimize the patient experience.


Assuntos
Agendamento de Consultas , Atenção à Saúde/organização & administração , Programas de Assistência Gerenciada/organização & administração , Visita a Consultório Médico/tendências , Telemedicina/tendências , COVID-19/epidemiologia , Estudos Transversais , Atenção à Saúde/economia , Humanos , Análise de Séries Temporais Interrompida , Programas de Assistência Gerenciada/economia , Mid-Atlantic Region
20.
Artigo em Inglês | MEDLINE | ID: mdl-33567686

RESUMO

While urban greenspace is increasingly recognized as important to mental health, its role in substance use is understudied. This exploratory study investigates the interaction of greenspace with peer network health, sex, and executive function (EF) in models of substance use among a sample of disadvantaged, urban youth. Adolescents and their parents were recruited from a hospital in the mid-Atlantic region of the U.S. Residential greenspace at the streetscape level was derived from analysis of Google Street View imagery. Logistic regression models were used to test the moderating effect of greenspace on the association between peer network health and substance use, as well as additional moderating effects of sex and EF. The significant negative association of peer network health with substance use occurred only among youth residing in high greenspace environments, a moderating effect which was stronger among youth with high EF deficit. The moderating effect of greenspace did not differ between girls and boys. Greenspace may play an important role in moderating peer influences on substance use among disadvantaged, urban adolescents, and such moderation may differ according to an individual's level of EF. This research provides evidence of differences in environmental susceptibility regarding contextual mechanisms of substance use among youth, and it informs the development of targeted substance use interventions that leverage social and environmental influences on adolescent substance use.


Assuntos
Parques Recreativos , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Função Executiva , Feminino , Humanos , Masculino , Mid-Atlantic Region , Grupo Associado , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
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