Leveraging Electronic Health Records to Assess Residential Mobility Among Veterans in the Veterans Health Administration.

BACKGROUND: Residential mobility, or a change in residence, can influence health care utilization and outcomes. Health systems can leverage their patients' residential addresses stored in their electronic health records (EHRs) to better understand the relationships among patients' residences, mobility, and health. The Veteran Health Administration (VHA), with a unique nationwide network of health care systems and integrated EHR, holds greater potential for examining these relationships. METHODS: We conducted a cross-sectional analysis to examine the association of sociodemographics, clinical conditions, and residential mobility. We defined residential mobility by the number of VHA EHR residential addresses identified for each patient in a 1-year period (1/1-12/31/2018), with 2 different addresses indicating one move. We used generalized logistic regression to model the relationship between a priori selected correlates and residential mobility as a multinomial outcome (0, 1, ≥2 moves). RESULTS: In our sample, 84.4% (n=3,803,475) veterans had no move, 13.0% (n=587,765) had 1 move, and 2.6% (n=117,680) had ≥2 moves. In the multivariable analyses, women had greater odds of moving [aOR=1.11 (95% CI: 1.10,1.12) 1 move; 1.27 (1.25,1.30) ≥2 moves] than men. Veterans with substance use disorders also had greater odds of moving [aOR=1.26 (1.24,1.28) 1 move; 1.77 (1.72,1.81) ≥2 moves]. DISCUSSION: Our study suggests about 16% of veterans seen at VHA had at least 1 residential move in 2018. VHA data can be a resource to examine relationships between place, residential mobility, and health.

e-Health for COVID-19 Epidemic: The Arizona Poison and Drug Information Center Experience.

Background: A significant challenge of the COVID-19 epidemic was the dissemination of accurate and timely information to the public, health care providers, and first responders. We describe the expansion of the Arizona Poison and Drug Information Center (APDIC) to fill such a need for residents of Arizona. Methodology: The original mission of the APDIC was recognition and management of chemical exposure, poisoning, envenomation, and drug-related medical problems. In response to COVID-19, APDIC expanded its personnel and facilities to accommodate telephone calls and teleconsults regarding COVID-19. Thirteen different topics dealing with COVID-19 were addressed and tracked and included: testing information, isolation, prevention, personal protective equipment, travel, vaccines, therapies, antibody testing, contact tracing, exposure to the virus and what to do in businesses, at work or at school regarding isolation and quarantine. Results: Responding to the public health needs, APDIC accepted >320,000 telephone calls and completed 48,346 teleconsults from March 3, 2020 to March 3, 2021. This represented a 15-fold increase in calls and twice the number of consults over 2019. Upon release of the vaccine, calls increased sharply with >7,000 calls in 1 day (February 7, 2021). Conclusion: In conclusion, the APDIC, rapidly expanded to address urgent public health information needs surrounding COVID-19 while still accomplishing its founding mission.

Power difference in a χ2 test vs generalized linear mixed model in the presence of missing data - a simulation study.

BACKGROUND: Longitudinal randomized controlled trials (RCTs) often aim to test and measure the effect of treatment between arms at a single time point. A two-sample χ2 test is a common statistical approach when outcome data are binary. However, only complete outcomes are used in the analysis. Missing responses are common in longitudinal RCTs and by only analyzing complete data, power may be reduced and estimates could be biased. Generalized linear mixed models (GLMM) with a random intercept can be used to test and estimate the treatment effect, which may increase power and reduce bias. METHODS: We simulated longitudinal binary RCT data to compare the performance of a complete case χ2 test to a GLMM in terms of power, type I error, relative bias, and coverage under different missing data mechanisms (missing completely at random and missing at random). We considered how the baseline probability of the event, within subject correlation, and dropout rates under various missing mechanisms impacted each performance measure. RESULTS: When outcome data were missing completely at random, both χ2 and GLMM produced unbiased estimates; however, the GLMM returned an absolute power gain up to from 12.0% as compared to the χ2 test. When outcome data were missing at random, the GLMM yielded an absolute power gain up to 42.7% and estimates were unbiased or less biased compared to the χ2 test. CONCLUSIONS: Investigators wishing to test for a treatment effect between treatment arms in longitudinal RCTs with binary outcome data in the presence of missing data should use a GLMM to gain power and produce minimally unbiased estimates instead of a complete case χ2 test.

Seasonal Flight Pattern of the Kissing Bugs Triatoma rubida and T. protracta (Hemiptera: Reduviidae: Triatominae) in Southern Arizona, United States.

The two most common kissing bugs, Triatoma rubida and T. protracta, in the Sonoran Desert around Tucson, Arizona are hematophagous vectors of Chagas disease and can induce potentially life-threatening allergic reactions. They were surveyed during their summer dispersal flight period to determine which environmental factors are correlated with flight activity. The two most important factors governing flights of T.rubida were temperatures in the range of 26-35 °C and wind speeds below 14 km/h (9 miles/h). Flights were reduced below or above those temperatures, or when wind speeds exceeding 14km/h. Relative humidity and presence or absence of moonshine appeared unimportant. During their dispersal flight periods of May through July and, especially, between the peak of the flight season, 20 June to 5 July, biologists seeking to collect bugs and homeowners wishing to exclude these biting bugs from entering their homes should be most attentive during evenings of average temperature and low wind speed.

Examining Health Care Mobility of Transgender Veterans Across the Veterans Health Administration.

Purpose: Transgender veterans are overrepresented in the Veterans Health Administration (VHA) compared with in the general population. Utilization of multiple different health care systems, or health care mobility, can affect care coordination and potentially affect outcomes, either positively or negatively. This study examines whether transgender veterans are more or less health care mobile than nontransgender veterans and compares the patterns of geographic mobility in these groups. Methods: Using an established cohort (n = 5,414,109), we identified 2890 transgender veterans from VHA electronic health records from 2000 to 2012. We compared transgender and nontransgender veterans on sociodemographic, clinical, and health care system-level measures and conducted conditional logistic regression models of mobility. Results: Transgender veterans were more likely to be younger, White, homeless, have depressive disorders, post-traumatic stress disorder (PTSD), and hepatitis C. Transgender veterans were more likely to have been health care mobile (9.9%) than nontransgender veterans (5.2%) (unadjusted odds ratio = 2.02, 95% confidence interval = 1.73-2.36). In a multivariable model, transgender status, being separated/divorced, receiving care in less-complex facilities, and diagnoses of depression, PTSD, or hepatitis C were associated with more mobility, whereas older age was associated with less mobility. For the top three health care systems utilized, a larger proportion of transgender veterans visited a second health care system in a different state (56.2%) than nontransgender veterans (37.5%). Conclusions: Transgender veterans were more likely to be health care mobile and more likely to travel out of state for health care services. They were also more likely to have complex chronic health conditions that require multidisciplinary care.

Evaluation of Direct Enrichment at Elevated Temperature for Recovery of Salmonellae from Oysters 1.

A comparison of the recovery of salmonellae from naturally contaminated oysters was made by using either Lactose broth preenrichment at 35°C followed by selective enrichment in Tetrathionate and Selenite Cystine broths at 35, 41 and 43°C, or direct enrichment in Tetrathionate and Selenite Cystine broths with incubation at 35, 41 and 43°C. Direct enrichment in Selenite Cystine broth at both elevated temperatures produced the greatest number of positive samples. Similar results were obtained with artificially contaminated oyster samples (1 Salmonella /5 g of meat). Statistical analysis of the data showed that significantly higher recovery of salmonellae was obtained by using direct enrichment of samples in Selenite Cystine broth at the elevated temperature.

Evaluation of a Fluorogenic MPN Procedure for Determining Escherichia coli in Oysters 1.

Application of a fluorogenic assay using 4-methylumbelliferone glucuronide (MUG) for detecting Escherichia coli in oysters was not workable due to the presence of an interfering endogenous glucuronidase in the oysters. Modification of the assay by incorporating the MUG into EC broth, rather than LST broth, eliminated the interference. When 25 oyster samples were analyzed for E. coli , 127 of the EC tubes were positive for gas. Of these, 103 were fluorescent and 102 yielded E. coli on isolation. The modification still results in saving approximately 4 d when analyzing for E. coli in oysters.

Plesiomonas shigelloides : An Opportunistic Food and Waterborne Pathogen 1.

Plesiomonas shigelloides is an oxidase-positive, gram-negative rod that has been implicated as an agent of human gastroenteritis for almost 40 years. Reports of gastroenteritis associated with Plesiomonas have been increasing in recent years, although inadequacies in isolation techniques and recognition procedures have undoubtedly resulted in the underreporting of this organism in the past. Existing information indicates that P. shigelloides , while mainly an aquatic species, is widely distributed in the environment. Recent outbreaks of gastroenteritis associated with consumption of oysters contaminated with P. shigelloides have resulted in an increased awareness of this organism by public health officials.

Evaluation of Inositol Brilliant Green Bile Salts and Plesiomonas Agars for Recovery of Plesiomonas shigelloides from Aquatic Samples in a Seasonal Survey of the Suwannee River Estuary.

Two plating media, inositol brilliant green bile salts (IBB) and plesiomonas (PL) agars, were compared using surface plating procedures for the recovery of Plesiomonas shigelloides . IBB was more effective in both the percentage of positive samples recovered and the percentage of isolates confirmed as P. shigelloides . Pure culture studies of heat- and cold-injured cells, however, showed that IBB agar failed to recover many of these organisms. Samples examined were from the Suwannee River estuary and included water, sediment, fish, crabs and mollusks. This survey found a high incidence (58.7%) of Plesiomonas in environmental samples. Counts of P. shigelloides per gram of sample differed among the various types of samples, ranging from 101 CFU/g in water and oysters to 106 CFU/g in bream.

Tolerance of Plesiomonas shigelloides to pH, Sodium Chloride and Temperature1.

Forty strains of Plesiomonas shigelloides representing environmental and clinical isolates were characterized as to their tolerance to sodium chloride, acid and alkaline conditions and growth temperatures. In Tryptone broth all isolates grew in 3% but not 4% sodium chloride; whereas, in Trypticase Soy broth all isolates grew in 4% and 65% of them grew in 5% sodium chloride. All isolates initiated growth at pH 4.5 and 8.5 and 58% of the isolates grew at pH 4.0. Only 22% of the isolates grew at 8°C and 25% of them grew at 45°C. Heating at 60°C for 30 min destroyed all isolates tested.