Characteristics of Maine and Massachusetts nurses interested in advanced nursing degrees.

BACKGROUND: Maine (ME) and Massachusetts (MA) nursing programs aim to develop collaborative training programs, but need to identify which nurses have interest in such programs. PURPOSE: We sought to determine sociodemographics of nurses seeking advanced nursing degrees nationally, and in ME and MA using the 2018 publicly available, National Sample Survey of Registered Nurses (NSSRN). METHODS: Weighted multivariable logistic regression for advanced degree-seeking, adjusted for sociodemographics. RESULTS: Of the n = 47,274 nurses (weighted n [Wn] = 3,608,633), 90.7 % were female, 74.1 % were white, and 15.8 % sought an advanced nursing degree on average 12.7 (SD 0.2) years after their first. Females vs. males had lower odds (OR 0.63, 95%CI [0.44-0.90]) and Black vs. White race had higher odds (OR 1.30, 95%CI [1.05-1.60]) of seeking doctorates. In Maine (Wn = 20,389), age 24-29 had higher odds (OR 2.98 (95%CI [1.06-3.74]), but in Massachusetts (Wn = 101,984), age 30+ had lower odds (OR 0.32, 95%CI [0.13-0.78]) of degree-seeking vs. <24 years. Initial nursing degrees earned between 1980 and 1989 had higher odds (OR 1.99, 95%CI [1.06-3.74]) in Maine, but between 2010 and 2014 had lower odds (OR 0.32, 95%CI [0.14-0.72]) in Massachusetts of degree-seeking, vs. before 1980. CONCLUSIONS: Targets for advanced nursing training programs may vary by state and sociodemographic profile.

Pseudomonas Infection Outbreak Associated with a Hotel Swimming Pool - Maine, March 2023.

Treated recreational water venues (e.g., pools and hot tubs) located at hotels represent one third of sources of reported treated recreational water-associated outbreaks; when these outbreaks are caused by Pseudomonas aeruginosa, they predominantly occur during January-April. On March 8, 2023, the Maine Center for Disease Control and Prevention (Maine CDC) initiated an investigation in response to reports of illness among persons who had used a swimming pool at hotel A during March 4-5. A questionnaire was distributed to guests who were at hotel A during March 1-7. Among 35 guests who responded, 23 (66%) developed ear pain, rash, or pain or swelling in feet or hands within days of using the pool during March 4-5. P. aeruginosa, a chlorine-susceptible bacterium, was identified in cultures obtained from skin lesions of three patients; a difference of two single nucleotide polymorphisms was found between isolates from two patients' specimens, suggesting a common exposure. Hotel A management voluntarily closed the pool, and Maine CDC's Health Inspection Program identified multiple violations, including having no disinfectant feeder system, all of which had been identified during a previous inspection. Because chlorine had been added to the pool water after the pool was voluntary closed, environmental samples were not collected. The pool remained closed until violations were addressed. Health departments can play an important role in reducing the risk for outbreaks associated with hotel pools and hot tubs. This reduction in risk can be achieved by collaborating with operators to ensure compliance with public health codes, including maintaining chlorine concentration and otherwise vigilantly managing the pool, and by disseminating prevention messages to pool and hot tub users.

Population Structure and Reproductive Biology of Monilinia vaccinii-corymbosi in Vaccinium angustifolium in Maine.

The fungus Monilinia vaccinii-corymbosi (Mvc) causes mummy berry disease in blueberries including lowbush blueberry, Vaccinium angustifolium, and is a significant pathogen of concern for Maine lowbush blueberry growers. This disease is typically managed with fungicides or by burning of plant debris containing overwintering pseudosclerotia. The population structure of Mvc in various fields in Maine was investigated using microsatellites and isolates collected from three stages in the Mvc lifecycle. The impacts of management strategies were also examined. A high level of genetic diversity was observed in Mvc from 12 lowbush blueberry fields with 199 unique multilocus haplotypes (MLHs) occurring in an original sample of 232 isolates. Twelve private alleles, including six private alleles with frequencies above 0.05, which indicated gene flow, were observed in six out of 12 fields. The population of Mvc in Maine as a whole is mostly a sexual, outcrossing population, as was seen in the diversity of MLHs and low amounts of linkage disequilibrium, although some apothecia appear to result from selfing. Three fields appear to have some clonal reproduction but were not strictly clonal, as multiple MLHs were noted in these fields. Management does not appear to affect population structure, and Mvc may be one large statewide population in Maine.

Does Implementation Matter? Associations Between Implementation of Maine's Anti- Bullying Law and Bullying Victimization Among High School Youth.

PURPOSE: To characterize the relationship between implementation of an antibullying law and bullying rates among high school youth. METHODS: School staff (administrators, counselors, and teachers) from public high schools in Maine completed a survey assessing: (1) the frequency with which they implemented 17 components of their district's antibullying policy as mandated by state law; and (2) confidence in implementing the law. Their responses were linked to data on bullying victimization among high school respondents to the Maine Integrated Youth Health Survey, which created a population-based dataset of 84 high schools with 29,818 student responses. RESULTS: Students in schools where administrators (adjusted odds ratio = 0.93; 95% CI: 0.89, 0.97) and counselors (adjusted odds ratio = 0.86; 95% CI: 0.81, 0.92) reported implementing more mandated components of the law experienced notable reductions in the odds of bullying, controlling for student-level characteristics (sex, race, grade) and for school-level bullying rates assessed prior to the passage of the law. With respect to specific implementation components, bullying was most consistently reduced in schools where staff reported increased referrals for counseling and other supports for targets of bullying and in schools where counselors and teachers were interviewed as part of bullying investigations. Students in schools where teachers reported increased confidence in implementing the antibullying law also had reduced odds of bullying. DISCUSSION: These data provide some of the first evidence that the efficacy of a state's antibullying law depends in part on the extent to which school personnel implement the law.

Management of per- and polyfluoroalkyl substances (PFAS)-laden wastewater sludge in Maine: Perspectives on a wicked problem.

This article discusses the challenges and potential solutions for managing wastewater sludge that contains per- and polyfluoroalkyl substances (PFAS), using the experience in Maine as a guide toward addressing the issue nationally. Traditional wastewater treatment, designed to remove excess organic waste and nutrients, does not eliminate persistent toxic pollutants like PFAS, instead partitioning the chemicals between discharged effluent and the remaining solids in sludge. PFAS chemistry, the molecular size, the alkyl chain length, fluorine saturation, the charge of the head group, and the composition of the surrounding matrix influence PFAS partitioning between soil and water. Land application of sludge, incineration, and storage in a landfill are the traditional management options. Land application of Class B sludge on agricultural fields in Maine peaked in the 1990s, totaling over 2 × 106 cu yd over a 40-year period and has contaminated certain food crops and animal forage, posing a threat to the food supply and the environment. Additional Class A EQ (Exceptional Quality) composted sludge was also applied to Maine farmland. The State of Maine banned the land application of wastewater sludge in August 2022. Most sludge was sent to the state-owned Juniper Ridge Landfill, which accepted 94 270 tons of dewatered sludge in 2022, a 14% increase over 2019. Between 2019 and 2022, the sum of perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) concentrations in sludge sent to the landfill ranged from 1.2 to 104.9 ng/g dw. In 2022, the landfill generated 71.6 × 106 l of leachate. The concentration of sum of six PFAS in the leachate increased sixfold between 2021 and 2022, reaching 2 441 ng/l. The retention of PFAS within solid-waste landfills and the potential for long-term release of PFAS through liners into groundwater require ongoing monitoring. Thermal treatment, incineration, or pyrolysis can theoretically mineralize PFAS at high temperatures, yet the strong C-F bond and reactivity of fluorine require extreme temperatures for complete mineralization. Future alternatives may include interim options such as preconditioning PFAS with nonpolar solvents prior to immobilization in landfills, removing PFAS from leachate, and interrupting the cycle of PFAS moving from landfill, via leachate, to wastewater treatment, and then back to the landfill via sludge. Long-term solutions may involve destructive technologies such as electron beam irradiation, electrochemical advanced oxidation, or hydrothermal liquefaction. The article highlights the need for innovative and sustainable solutions for managing PFAS-contaminated wastewater sludge.

Factors associated with injury among Maine logging workers.

INTRODUCTION: Despite dramatic improvements in safety, logging remains one of the most dangerous industries in the United States. The purpose of this study was to explore longitudinal injury trends among Maine logging workers. METHODS: Loggers participated in seven quarterly surveys, over the course of 18 months. Categorical and free text data related to traumatic and acute injury, musculoskeletal disorders (MSD), and chronic pain were exported from REDCap into SAS 9.4, Excel, and NVivo, for quantitative and qualitative analysis, respectively. Time to injury was modeled using two different approaches: (1) time to the occurrence of first injury modeled by proportional hazard regression and (2) an intensity model for injury frequency. Two research team members also analyzed qualitative data using a content analysis approach. RESULTS: During the study, 204 injuries were reported. Of the 154 participants, 93 (60.4%) reported musculoskeletal pain on at least one survey. The majority of injuries were traumatic, including fractures, sprains, and strains. Lack of health insurance was found to be related to increased risk of first injury [HR = 1.41, 95% CI = 0.97-2.04, p = 0.069]. Variables found to be related to injury intensity at the univariate level were: (1) a lack of health insurance [HR = 1.51, 95% CI = 1.04-2.20, p = 0.030], (2) age [HR for 10-year age increase;= 1.12, 95% CI = 0.99-1.27, p = 0.082], and (3) years employed in logging industry [HR for 10-year increase = 1.12, 95% CI = 0.99-1.26, p = 0.052]. Seeking medical attention for injury was not a priority for this cohort, and narratives revealed a trend for self-assessment. A variety of barriers, including finances, prevented loggers from seeking medical attention. DISCUSSION: We found that loggers still experience serious, and sometimes disabling, injuries associated with their work. It was unsurprising that many injuries were due to slips, trips, and falls, along with contact with logging equipment and trees/logs. The narratives revealed various obstacles preventing loggers from achieving optimal health. Examples included geographic distance from healthcare, lack of time to access care, and entrenched values that prioritized independence and traditional masculinity. Financial considerations were also consistently cited as a primary barrier to adequate care. CONCLUSION: There is a continued need to emphasize occupational health and safety in the logging industry. Implementation of relevant safety programs is key, but it is likely that the benefits of these will not be fully realized until a cultural shift takes place within this industry.

Hepatitis C Virus Cascade of Care Among Perinatal Patients in Maine Diagnosed With Opioid Use Disorder, 2015-2020.

OBJECTIVE: This is a quality improvement project to determine the best process to identify and address gaps in care for perinatal patients in receiving appropriate hepatitis C virus (HCV) testing and treatment across the largest health system in Maine. STUDY DESIGN: We reviewed electronic medical record data between October 1, 2015, and February 1, 2020, to investigate rates of HCV testing and treatment among 916 perinatal patients with opioid use disorder across 8 hospitals using a "cascade of care" framework, a model used previously to identify gaps in care and treatment of chronic diseases. MAIN OUTCOME MEASURE: We examined HCV testing and treatment rates along the cascade of care and patient characteristics associated with HCV antibody testing and treatment, separately, using log binomial regression models. Models were adjusted for age, residential distance to medical center, psychiatric diagnosis, and opioid agonist therapy at delivery. RESULTS: Of pregnant patients eligible for screening, 64% (582/916) received HCV antibody testing. Of 136 patients with active HCV infection, 32% (n = 43) received a referral for treatment, 21% (n = 28) were treated, and 13% (n = 18) achieved sustained virologic response. In the adjusted regression models, only opioid agonist therapy was associated with HCV antibody testing (adjusted risk ratio, 1.31; 95% confidence interval, 1.18-1.46), and no factors were significantly associated with receipt of treatment among HCV viremic patients. CONCLUSION: Low referral and treatment rates signify the need for quality improvement interventions to improve coordination of care between multiple disciplines and practice settings to increase access to HCV treatment.

Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine.

OBJECTIVE: Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. METHODS: We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. RESULTS: The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. CONCLUSION: Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.

The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State.

PURPOSE: The Maine Cancer Genomics Initiative (MCGI) aimed to overcome patient- and provider-level barriers to using genomic tumor testing (GTT) in rural practices by providing genomic tumor boards (GTBs), clinician education, and access to comprehensive large-panel next-generation sequencing to all patients with cancer in Maine. This paper describes the successful implementation of the initiative and three key services made operative between 2016 and 2020. METHODS: A community-inclusive, hub-and-spoke approach was taken to implement the three program components: (1) a centralized GTB program; (2) a modular online education program, designed using an iterative approach with broad clinical stakeholders; and (3) GTT free of charge to clinicians and patients. Implementation timelines, participation metrics, and survey data were used to describe the rollout. RESULTS: The MCGI was launched over an 18-month period at all 19 oncology practices in the State. Seventy-nine physicians (66 medical oncologists, 5 gynecologic oncologists, 1 neuro-oncologist, and 7 pediatric oncologists) enrolled on the study, representing 100% of all practicing oncologists in Maine. Between July 2017 and September 2020, 1610 patients were enrolled. A total of 515 cases were discussed by 47 (73%) clinicians in 196 GTBs. Clinicians who participated in the GTBs enrolled significantly more patients on the study, stayed in Maine, and reported less time spent in clinical patient care. CONCLUSION: The MCGI was able to engage geographically and culturally disparate cancer care practices in a precision oncology program using a hub-and-spoke model. By facilitating access to GTT, structured education, and GTBs, we narrowed the gap in the implementation of precision oncology in one of the most rural states in the country.

Risk and Protective Factors for Vaping and Smoking Among High School Students in Maine.

INTRODUCTION: Vaping rates are rising among adolescents across the country, and smoking rates remain high. Understanding risk and protective factors associated with vaping and smoking can guide public health interventions. This study examined risk and protective factors associated with vaping and smoking among high school students in Maine. METHODS: We used 2019 Maine Integrated Youth Health Survey (MIYHS) data to examine risk and protective factors for vaping and smoking among Maine high school students. Our analytic sample consisted of 17,651 Maine high school students. In addition to bivariate analyses, we used unadjusted and adjusted logistic regression models to assess risk and protective factors. RESULTS: Factors with the greatest effect on students' likelihood to vape, smoke, or do both were parental attitude toward adolescent smoking and depressive symptoms. Students who reported their parents feel it is a little wrong or not wrong at all if they smoked had 4.9 times higher adjusted odds of smoking and 4.6 times higher adjusted odds of vaping and smoking compared with students who said their parents feel it would be wrong or very wrong if they smoked. Students who reported depressive symptoms had 2.1 times higher adjusted odds of vaping, 2.7 times higher adjusted odds of smoking, and 3.0 times higher adjusted odds of vaping and smoking compared with students who did not report depressive symptoms. CONCLUSION: Understanding risk and protective factors for smoking and vaping among high school students can help tailor adolescent-focused vaping and smoking public health interventions to increase effectiveness.

Modeling Opioid Abuse: A Case Study of the Opioid Crisis in New England.

For the past two decades, the USA has been embroiled in a growing prescription drug epidemic. The ripples of this epidemic have been especially apparent in the state of Maine, which has fought hard to mitigate the damage caused by addiction to pharmaceutical and illicit opioids. In this study, we construct a mathematical model of the opioid epidemic incorporating novel features important to better understanding opioid abuse dynamics. These features include demographic differences in population susceptibility, general transmission expressions, and combined consideration of pharmaceutical opioid and heroin abuse. We demonstrate the usefulness of this model by calibrating it with data for the state of Maine. Model calibration is accompanied by sensitivity and uncertainty analysis to quantify potential error in parameter estimates and forecasts. The model is analyzed to determine the mechanisms most influential to the number of opioid abusers and to find effective ways of controlling opioid abuse prevalence. We found that the mechanisms most influential to the overall number of abusers in Maine are those involved in illicit pharmaceutical opioid abuse transmission. Consequently, preventative strategies that controlled for illicit transmission were more effective over alternative approaches, such as treatment. These results are presented with the hope of helping to inform public policy as to the most effective means of intervention.

A direct examination of microbial specialized metabolites associated with ocean sediments from Baffin Bay and the Gulf of Maine.

Specialized metabolites produced by microorganisms found in ocean sediments display a wide range of clinically relevant bioactivities, including antimicrobial, anticancer, antiviral, and anti-inflammatory. Due to limitations in our ability to culture many benthic microorganisms under laboratory conditions, their potential to produce bioactive compounds remains underexplored. However, the advent of modern mass spectrometry technologies and data analysis methods for chemical structure prediction has aided in the discovery of such metabolites from complex mixtures. In this study, ocean sediments were collected from Baffin Bay (Canadian Arctic) and the Gulf of Maine for untargeted metabolomics using mass spectrometry. A direct examination of prepared organic extracts identified 1468 spectra, of which ∼45% could be annotated using in silico analysis methods. A comparable number of spectral features were detected in sediments collected from both locations, but 16S rRNA gene sequencing revealed a significantly more diverse bacterial community in samples from Baffin Bay. Based on spectral abundance, 12 specialized metabolites known to be associated with bacteria were selected for discussion. The application of metabolomics directly on marine sediments provides an avenue for culture-independent detection of metabolites produced under natural settings. The strategy can help prioritize samples for novel bioactive metabolite discovery using traditional workflows.

Driver, roadway, and weather factors on severity of lane departure crashes in Maine.

INTRODUCTION: In Maine, lane departure crashes account for over 70% of roadway fatalities. The majority of roadways in Maine are rural. Moreover, Maine has aging infrastructure, houses the oldest population in the United States, and experiences the third coldest weather in the United States. METHODS: This study analyzes the impact of roadway, driver, and weather factors on the severity of single-vehicle lane departure crashes occurring from 2017 to 2019 on rural roadways in Maine. Rather than using police reported weather, weather station data were utilized. Four facility types: Interstates, minor arterials, major collectors, and minor collectors were considered for analysis. The Multinomial Logistic Regression model was used for the analysis. The property damage only (PDO) outcome was considered as the reference (or base) category. RESULTS: The modeling results show that the odds of a crash leading to major injury or fatality (KA outcome) increases by 330%, 150%, 243%, and 266% for older drivers (65 or above) compared to young drivers (29 or less) on Interstates, minor arterials, major collectors, and minor collectors, respectively. During the winter period (October to April), the odds of KA severity outcome (with respect to the PDO) decreases by 65%, 65%, 65%, and 48% on Interstates, minor arterials, major collectors, and minor collectors, respectively, presumably due to reduced speeds during winter weather events. CONCLUSION: In Maine, factors such as older drivers, operating under the influence, speeding, precipitation, and not wearing a seatbelt showed higher odds of leading to injury. PRACTICAL APPLICATIONS: This study provides safety analysts and practitioners in Maine a comprehensive study of factors that influence the severity of crashes in Maine at different facilities to improve maintenance strategies, enhance safety using proper safety countermeasures, or increase awareness across the state.

Overabundant deer and invasive plants drive widespread regeneration debt in eastern United States national parks.

Advanced regeneration, in the form of tree seedlings and saplings, is critical for ensuring the long-term viability and resilience of forest ecosystems in the eastern United States. Lack of regeneration and/or compositional mismatch between regeneration and canopy layers, called regeneration debt, can lead to shifts in forest composition, structure, and, in extreme cases, forest loss. In this study, we examined status and trends in regeneration across 39 national parks from Virginia to Maine, spanning 12 years to apply the regeneration debt concept. We further refined the concept by adding new metrics and classifying results into easily interpreted categories adapted from the literature: imminent failure, probable failure, insecure, and secure. We then used model selection to determine the potential drivers most influencing patterns of regeneration debt. Status and trends indicated widespread regeneration debt in eastern national parks, with 27 of 39 parks classified as imminent or probable failure. Deer browse impact was consistently the strongest predictor of regeneration abundance. The most pervasive component of regeneration debt observed across parks was a sapling bottleneck, characterized by critically low sapling density of native canopy species and significant declines in native canopy sapling basal area or density for most parks. Regeneration mismatches also threaten forest resilience in many parks, where native canopy seedlings and saplings were outnumbered by native subcanopy species, particularly species that are less palatable deer browse. The devastating impact of emerald ash borer eliminating ash as a native canopy tree also drove regeneration mismatches in many parks that contain abundant ash regeneration, demonstrating the vulnerability of forests that lack diverse understories to invasive pests and pathogens. These findings underscore the critical importance of an integrated forest management approach that promotes an abundant and diverse regeneration layer. In most cases, this can only be achieved through long-term (i.e., multidecadal) management of white-tailed deer and invasive plants. Small-scale disturbances that increase structural complexity may also promote regeneration where stress from deer and invasive plants is minimal. Without immediate and sustained management intervention, the forest loss we are already observing may become a widespread pattern in eastern national parks and the broader region.

The impact of ABO and RhD blood types on Babesia microti infection.

BACKGROUND: Babesiosis is an emerging infectious disease caused by intraerythrocytic Babesia parasites that can cause severe disease and death. While blood type is known to affect the mortality of Plasmodium falciparum malaria patients, associations between red blood cell (RBC) antigens and Babesia microti infection and disease severity are lacking. METHODS: We evaluated RhD and ABO blood types of Babesia-infected (18S rRNA reactive) blood donors in 10 endemic states in the Northeastern and northern Midwestern United States. We also assessed possible associations between RhD and ABO blood types and disease severity among hospitalized babesiosis patients in Connecticut. RESULTS: A total of 768 Babesia-infected blood donors were analyzed, of which 750 (97.7%) had detectable B. microti-specific antibodies. B. microti-infected blood donors were more likely to be RhD- (OR of 1.22, p-value 0.024) than RhD+ donors. Hospitalized RhD- babesiosis patients were more likely than RhD+ patients to have high peak parasitemia (p-value 0.017), which is a marker for disease severity. No differences in RhD+ blood type were noted between residents of the Northeast (OR of 0.82, p-value 0.033) and the Midwest (OR of 0.74, p-value 0.23). Overall, ABO blood type was not associated with blood donor B. microti infection, however, B. microti-infected donors in Maine and New Jersey were more likely to be blood type B compared to non-type B (OR 2.49 [p = 0.008] and 2.07 [p = 0.009], respectively), while infected donors from Pennsylvania were less likely to be type B compared to non-type B (OR 0.32 [p = 0.02]). CONCLUSIONS: People expressing RhD antigen may have a decreased risk of B. microti infection and babesiosis severity. The association of B antigen with B. microti infection is less clear because the antigen appeared to be less prevalent in infected Pennsylvania blood donors but more prevalent in Maine and New Jersey infected donors. Future studies should quantify associations between B. microti genotypes, RBC antigens, and the frequency and severity of B. microti infection to increase our understanding of human Babesia pathogenesis and improve antibody, vaccine, and RBC exchange transfusion strategies.

Patterns and Ecological Mechanisms of Tick-Borne Disease Exposure Risk in Acadia National Park, Mount Desert Island, Maine, United States.

National parks are unique and significant vector-borne pathogen transmission settings, engaging over 300 million people in outdoor recreation per year. In this study, we integrated vector surveys and ecological habitat feature data in spatial models to characterize tick-borne disease exposure risk in Acadia National Park (ANP), Maine. To determine the broad-scale patterns of blacklegged tick Ixodes scapularis Say (Acari: Ixodidae) densities in ANP, we conducted host-seeking tick collections at 114 sites across the park over two years. Using these tick survey data and geospatial landscape feature data (i.e., land cover, elevation, forest patch size, and aspect) we developed a random forest model of nymphal tick density. We found that host-seeking tick density varies significantly across the park and is particularly high in areas characterized by deciduous forest cover and relatively low elevation. To explore potential fine-scale ecological drivers of tick density spatial patterns, we quantified microclimate conditions, host activity, and vegetation characteristics at a subset of 19 sites. We identified significant differences in microclimate conditions but not host activity or vegetation metrics across broad-scale landscape feature classes. Mean temperature and mean humidity were correlated to nymphal densities and therefore may provide a mechanistic link between landscape features and blacklegged tick densities. Finally, we detected multiple tick-borne pathogens in both ticks and small mammals sampled in ANP, including Borrelia burgdorferi, Babesia microti, and Anaplasma phagocytophilum. Our findings demonstrate the value of using ecological metrics to estimate vector-borne disease exposure risk and provide insight into habitat characteristics that may drive tick-borne disease exposure risk.

Risk Evaluation of Benzovindiflupyr Resistance of Verticillium dahliae Population in Maine.

Verticillium dahliae causes Verticillium wilt, resulting in significant losses to potato production. Benzovindiflupyr, a succinate dehydrogenase inhibitor, effectively controls V. dahliae. However, frequent applications of the chemical may expedite the development of fungicide resistance in the pathogen population. To evaluate the risk of benzovindiflupyr resistance, 38 V. dahliae strains were obtained from diseased potatoes in Maine. The sensitivity of the field population was determined based on effective concentration for 50% inhibition (EC50), which ranged from 0.07 to 11.28 µg ml-1 with a median of 1.08. Segregated clusters of EC50 values indicated that Maine V. dahliae populations have developed benzovindiflupyr resistance. By exposing conidia of V. dahliae to a high concentration of benzovindiflupyr, 18 benzovindiflupyr-resistant mutants were obtained. To examine their fitness, the mutants were continuously subculture-transferred for up to 10 generations. Mycelial growth, conidial production, competitiveness, pathogenicity, and cross resistance of the 10th generation mutants were examined. Results showed that 50% of the resistant mutants retained an adaptive level in mycelial growth, and 60% maintained conidial production similar to their parents. Pathogenicity did not change for any of the mutants. No cross resistance was detected between benzovindiflupyr and either azoxystrobin, boscalid, fluopyram, or pyrimethanil. Thus, the resistance risk in V. dahliae to benzovindiflupyr should be considered in Maine potato production.

The Maine vein of Marshall ethanol experience: learning curve and safety.

BACKGROUND: The marginal benefit of ethanol infusion into the vein of Marshall (VOM) as an adjunct to atrial fibrillation ablation has shown promise in a single randomized study and case series from very experienced centers. However, adoption has not been widespread and the impact on real-world outcomes outside of leading centers is not established. The objective in this study is to understand the learning curve, and explore procedural outcomes and safety with VOM ethanol infusion from a large single medical center. METHODS: One hundred twenty nine atrial ablation cases wherein VOM ethanol infusion was attempted were identified from the time of the program's inception in 2019 at Maine Medical Center (Portland, ME). Our technical approach, procedural success, and complications were adjudicated from the medical record. RESULTS: The overall VOM ethanol infusion success was 90%. Infusion success rates improved and fluoroscopy utilization decreased with experience. Arrhythmia recurrence was 14% after a mean follow-up of 9.5 months. Complications occurred in 5.4% of patients, including a 3.1% risk of delayed tamponade. CONCLUSION: In our single center experience, VOM ethanol infusion was feasible with a high technical success rate. These positive results are balanced against a concerning rate of delayed tamponade.

Persistent organic pollutants in female humpback whales Megaptera novaeangliae from the Gulf of Maine.

Contaminant studies in cetaceans can provide information about pollutant levels and patterns in a given region. Due to the confounding effects of reproductive status and maternal offloading in females, these studies typically focus on males. However, an improved understanding of contaminant burdens in female cetaceans is needed to better assess potential impacts to populations. The objectives of this study were to characterize concentrations of persistent organic pollutants (POPs) in blubber of female humpback whales across age classes and to also better characterize maternal offloading of these pollutants to their offspring. A total of 36 blubber biopsy samples of female humpback whales (Megaptera novaeangliae) from the Gulf of Maine were analyzed to examine contaminant loads across females of different ages. Sampled individuals were individually-identified from longitudinal studies and assigned to age class (i.e., adult, subadult, juvenile, calf). Analysis was performed using gas chromatography/mass spectrometry (GC/MS) of POPs including polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethanes (DDTs), chlordanes (CHLDs), polybrominated diphenyl ethers (PBDEs), hexachlorocyclohexanes (HCHs). The most abundant POPs were PCB congeners, with summed values ranging from 280 to 12,000 ng/g, lipid weight, which is above recent estimates of the threshold for adverse health effects. We found significant differences in mean values between adults and juveniles and between adults and subadults, with the exception of the less persistent HCHs for the latter. We also found significant differences in mean levels of ∑HCHs between the juveniles and subadults. Changes over age are consistent with maternal offloading and potentially important for evaluating population health and viability.

A qualitative evaluation of the "RISE" elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap.

Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.