RESUMEN
With the increasing affordability of next-generation sequencing technologies, genotype-by-sequencing has become a cost-effective tool for ecologists and conservation biologists to describe a species' evolutionary history. For hostparasite interactions, genotype-by-sequencing can allow the simultaneous examination of host and parasite genomes and can yield insight into co-evolutionary processes. The eastern oyster, Crassostrea virginica, is among the most important aquacultured species in the United States. Natural and farmed oyster populations can be heavily impacted by 'dermo' disease caused by an alveolate protist, Perkinsus marinus. Here, we used restricted site-associated DNA sequencing (RADseq) to simultaneously examine spatial population genetic structure of host and parasite. We analysed 393 single-nucleotide polymorphisms (SNPs) for P. marinus and 52,100 SNPs for C. virginica from 36 individual oysters from the Gulf of Mexico (GOM) and mid-Atlantic coastline. All analyses revealed statistically significant genetic differentiation between the GOM and mid-Atlantic coast populations for both C. virginica and P. marinus, and genetic divergence between Chesapeake Bay and the outer coast of Virginia for C. virginica, but not for P. marinus. A co-phylogenetic analysis confirmed significant coupled evolutionary change between host and parasite across large spatial scales. The strong genetic divergence between marine basins raises the possibility that oysters from either basin would not be well adapted to parasite genotypes and phenotypes from the other, which would argue for caution with regard to both oyster and parasite transfers between the Atlantic and GOM regions. More broadly, our results demonstrate the potential of RADseq to describe spatial patterns of genetic divergence consistent with coupled evolution.
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Alveolados , Crassostrea , Interacciones Huésped-Parásitos , Filogeografía , Polimorfismo de Nucleótido Simple , Animales , Crassostrea/parasitología , Crassostrea/genética , Alveolados/genética , Alveolados/clasificación , Golfo de México , Análisis de Secuencia de ADN , Genotipo , Mid-Atlantic RegionRESUMEN
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.
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Ecosistema , Humedales , Monitoreo del Ambiente/métodos , Hidrología , Mid-Atlantic Region , Conservación de los Recursos NaturalesRESUMEN
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.
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Infecciones por Bunyaviridae , Phlebovirus , Virosis , Estados Unidos/epidemiología , Humanos , Infecciones por Bunyaviridae/diagnóstico , Phlebovirus/genética , Mid-Atlantic RegionRESUMEN
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.
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Negro o Afroamericano , Castigo , Racismo , Instituciones Académicas , Estudiantes , Blanco , Adolescente , Femenino , Humanos , Masculino , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Estados Unidos/epidemiología , Blanco/psicología , Blanco/estadística & datos numéricos , Castigo/psicología , Factores Raciales/estadística & datos numéricos , Niño , Mid-Atlantic Region/epidemiología , Población Urbana/estadística & datos numéricos , Racismo/etnología , Racismo/psicología , Racismo/estadística & datos numéricosRESUMEN
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%; â¼60% 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.
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Queratitis por Acanthamoeba , Infecciones Bacterianas del Ojo , Humanos , Coagulasa/uso terapéutico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Bacterias , Staphylococcus , Mid-Atlantic Region , Queratitis por Acanthamoeba/tratamiento farmacológico , Estudios Retrospectivos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Eritromicina/uso terapéutico , Pruebas de Sensibilidad MicrobianaRESUMEN
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.
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Ascomicetos , Fungicidas Industriales , Malus , Frutas/microbiología , Fungicidas Industriales/farmacología , Malus/microbiología , Mid-Atlantic Region , Estados UnidosRESUMEN
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.
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Elevación del Nivel del Mar , Humedales , Ecosistema , Monitoreo del Ambiente , Estuarios , Mid-Atlantic RegionRESUMEN
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.
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Riego Agrícola , Enterovirus/aislamiento & purificación , Tobamovirus/aislamiento & purificación , Contaminantes del Agua/análisis , Monitoreo del Ambiente , Concentración de Iones de Hidrógeno , Mid-Atlantic Region , Oxígeno/análisis , Salinidad , Microbiología del Agua , Contaminación del Agua/análisisRESUMEN
Apple growers in the Mid-Atlantic region of the United States have been reporting an increase in losses to bitter rot of apple and are requesting up-to-date management recommendations. Management is complicated by variations in apple cultivar susceptibility, temperature, rainfall, and biology of the Colletotrichum spp. that cause bitter rot. Over 500 apple fruit with bitter rot were obtained from 38 orchards across the Mid-Atlantic and the causal species were identified as Colletotrichum fioriniae and C. nymphaeae of the C. acutatum species complex and C. chrysophilum, C. noveboracense, C. siamense, C. fructicola, C. henanense, and C. gloeosporioides sensu stricto of the C. gloeosporioides species complex, the latter two being first reports. Species with faster in vitro growth rates at higher temperatures were more abundant in warmer regions of the Mid-Atlantic, while those with slower growth rates at higher temperatures were more abundant in cooler regions. Regional bloom dates are earlier and weather data show a gradual warming trend that likely influenced but was not necessarily the main cause of the recent increase in bitter rot in the region. A grower survey of apple cultivar susceptibility showed high variation, with the increase in acres planted to the highly susceptible cultivar Honeycrisp broadly corresponding to the increase in reports of bitter rot. These results form a basis for future studies on the biology and ecology of the Colletotrichum spp. responsible, and suggest that integrated bitter rot management must begin with selection of less-susceptible apple cultivars.
Asunto(s)
Colletotrichum , Malus , Mid-Atlantic Region , Enfermedades de las Plantas , Estados Unidos , Tiempo (Meteorología)RESUMEN
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.
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Servicio de Urgencia en Hospital/organización & administración , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Cuidados Paliativos/organización & administración , Derivación y Consulta/organización & administración , Sepsis/terapia , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital/economía , Utilización de Instalaciones y Servicios/economía , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Modelos Lineales , Masculino , Mid-Atlantic Region , Cuidados Paliativos/economía , Cuidados Paliativos/métodos , Planificación de Atención al Paciente , Derivación y Consulta/economía , Estudios Retrospectivos , Factores de TiempoRESUMEN
Anthracnose fruit rot (AFR) and Botrytis fruit rot (BFR) are primary diseases affecting strawberry (Fragaria × ananassa), which typically drive fungicide applications throughout the growing season. The Strawberry Advisory System (StAS), a disease forecasting tool, was originally developed in Florida to better time the fungicide sprays by monitoring AFR and BFR infection risk based on leaf wetness and temperature input in real-time. Thirteen field trials were conducted in Maryland and Virginia between 2017 and 2019 to evaluate the StAS performance in the Mid-Atlantic region. As a result, 55, 18, and 31% fewer sprays were recorded on average in the model-based StAS treatment compared with the grower standard treatment in 2017, 2018, and 2019, respectively. Marketable yield, as well as AFR and BFR incidence, were largely comparable between the two treatments. However, poor disease control occurred during the StAS treatment in four trials in 2017, presumably because of a missed fungicide spray during a high-risk infection event and attributable to heavy rainfall that led to impassable fields. The implementation of the StAS may be further challenged by the employment of floating row covers that are essential for growing strawberries in plasticulture systems in open fields in the Mid-Atlantic region. Preliminary results indicated that row covers can alter canopy-level microclimatic conditions, possibly increasing the risk for disease occurrence. Overall, the StAS can be a valuable tool for Mid-Atlantic growers to control AFR and BFR, but sprays may need to be promptly applied when consecutive or heavy rainfalls are predicted, especially for highly susceptible cultivars. Complications in disease forecasting and management arising from the use of row covers need to be further addressed in this region because of its highly diverse climate.
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Fragaria , Fungicidas Industriales , Botrytis , Mid-Atlantic Region , Enfermedades de las PlantasRESUMEN
BACKGROUND AND OBJECTIVES: Many newly diagnosed breast cancer patients do not receive genetic counseling and testing at the time of diagnosis. We examined predictors of genetic testing (GT) in this population. METHODS: Within a randomized controlled trial of proactive rapid genetic counseling and testing vs usual care, patients completed a baseline survey within 6 weeks of breast cancer diagnosis but before a definitive survey. We conducted a multinomial logistic regression to identify predictors of GT timing/uptake. RESULTS: Having discussed GT with a surgeon was a dominant predictor (χ2 (2, N = 320) = 70.13; P < .0001). Among those who discussed GT with a surgeon, patients who had made a final surgery decision were less likely to receive GT before surgery compared with postsurgically (OR [odds ratio] = 0.24; 95% confidence interval [CI] = 0.12-0.49) or no testing (OR = 0.28; 95% CI = 0.14-0.56). Older patients (OR = 0.95; 95% CI = 0.91-0.99) and participants enrolled in New York/New Jersey (OR = 0.22; 95% CI = 0.07-0.72) were less likely to be tested compared with receiving results before surgery. Those with higher perceived risk (OR = 1.02; 95% CI = 1.00-1.03) were more likely to receive results before surgery than to not be tested. CONCLUSIONS: This study highlights the role of patient-physician communication about GT as well as patient-level factors that predict presurgical GT.
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Neoplasias de la Mama/genética , Pruebas Genéticas/estadística & datos numéricos , Adulto , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Toma de Decisiones , Femenino , Asesoramiento Genético/estadística & datos numéricos , Humanos , Modelos Logísticos , Mid-Atlantic Region/epidemiología , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Encuestas y CuestionariosRESUMEN
The distribution of violence, sexually transmitted infections, and substance use disorders is not random, but rather the product of disease, behavior, and social conditions that co-occur in synergistic ways (syndemics). Syndemics often disproportionately affect urban communities. Studies of syndemics, however, rarely apply consistent measures of social conditions. Here, the construct of social stability (SS) (housing, legal, residential, income, employment, and relationship stability) was evaluated as a consistent measure of social conditions related to sex, drug, and violence exposures in a new population in a Mid-Atlantic urban center. Lower SS predicted greater likelihood of any and combinations of risk. The magnitude varied based on specification: odds of sex-drug-violence exposure were greater for low vs. high latent SS class (OR = 6.25; 95%CI = 2.46, 15.96) compared with low vs. high SS category (OR = 2.64; 95%CI = 1.29, 5.39). A latent class characterized by residential instability was associated with greater likelihood of risk-a relationship that would have been missed with SS characterized only as an ordinal category. SS reliably captured social conditions associated with sexual, drug, and violence risks, and both quantity and quality of SS matter.
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Conducta Sexual , Condiciones Sociales , Trastornos Relacionados con Sustancias , Violencia , Adulto , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Mid-Atlantic Region/epidemiología , Persona de Mediana Edad , Condiciones Sociales/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Sindémico , Población Urbana/estadística & datos numéricos , Violencia/estadística & datos numéricosRESUMEN
Due to the increasing prevalence of Dinophysis spp. and their toxins on every US coast in recent years, the need to identify and monitor for problematic Dinophysis populations has become apparent. Here, we present morphological analyses, using light and scanning electron microscopy, and rDNA sequence analysis, using a ~2-kb sequence of ribosomal ITS1, 5.8S, ITS2, and LSU DNA, of Dinophysis collected in mid-Atlantic estuarine and coastal waters from Virginia to New Jersey to better characterize local populations. In addition, we analyzed for diarrhetic shellfish poisoning (DSP) toxins in water and shellfish samples collected during blooms using liquid-chromatography tandem mass spectrometry and an in vitro protein phosphatase inhibition assay and compared this data to a toxin profile generated from a mid-Atlantic Dinophysis culture. Three distinct morphospecies were documented in mid-Atlantic surface waters: D. acuminata, D. norvegica, and a "small Dinophysis sp." that was morphologically distinct based on multivariate analysis of morphometric data but was genetically consistent with D. acuminata. While mid-Atlantic D. acuminata could not be distinguished from the other species in the D. acuminata-complex (D. ovum from the Gulf of Mexico and D. sacculus from the western Mediterranean Sea) using the molecular markers chosen, it could be distinguished based on morphometrics. Okadaic acid, dinophysistoxin 1, and pectenotoxin 2 were found in filtered water and shellfish samples during Dinophysis blooms in the mid-Atlantic region, as well as in a locally isolated D. acuminata culture. However, DSP toxins exceeded regulatory guidance concentrations only a few times during the study period and only in noncommercial shellfish samples.
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Dinoflagelados , Toxinas Marinas , Dinoflagelados/genética , Golfo de México , Mar Mediterráneo , Mid-Atlantic RegionRESUMEN
We utilized a mixed methods approach to assess student attitudes towards tobacco use and campus tobacco policies. Interviews (N = 21), focus groups (N = 2 groups, 4-5 participants each), and an online survey (N = 636) were conducted among a sample of students attending a 4-year, urban, public university in the Mid-Atlantic region of the United States. In interviews and focus groups, students expressed skepticism about a tobacco-free campus policy due to perceived violations of personal rights and challenges with enforcement. Of the sample surveyed, 9.2% and 20.6% had used cigarettes or e-cigarettes within the past 30 days. The majority of students agreed that colleges have a responsibility to adopt tobacco-free policies that reduce the risk of tobacco addiction (62.4%) and ensure smoke-free air to breathe (81.5%). However, more than half (56.3%) also indicated that a policy allowing for designated smoking areas for cigarettes was best for campus, which runs counter to a comprehensive tobacco-free policy. Academic year, gender, and race/ethnicity were significant factors associated with support for tobacco-free policies. Current smokers and vapers were less likely to support tobacco-free policies that reduce the risk of tobacco addiction (OR = 0.3, 95% CI 0.1, 0.7 for smokers; OR = 0.3, 95% CI 0.1, 0.6 for vapers), but not policies that ensure smoke-free air to breathe. E-cigarettes pose a unique obstacle to tobacco-free policies, as students perceived e-cigarettes to be less harmful than cigarettes. To implement a tobacco-free campus policy, students suggested educational campaigns that focus on the potential health benefits of a tobacco-free campus.
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Nicotiana , Política para Fumadores , Universidades , Adolescente , Adulto , Actitud , Escolaridad , Sistemas Electrónicos de Liberación de Nicotina , Femenino , Grupos Focales , Humanos , Masculino , Mid-Atlantic Region , Política Pública , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Productos de Tabaco , Contaminación por Humo de Tabaco , Uso de Tabaco , Estados UnidosRESUMEN
BACKGROUND: Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress. PURPOSE: This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery. METHODS: The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications. RESULTS: Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers. IMPLICATIONS FOR PRACTICE: Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery. IMPLICATIONS FOR RESEARCH: Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.
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Recursos Audiovisuales , Cuidadores/educación , Cardiopatías Congénitas/enfermería , Cardiopatías Congénitas/cirugía , Cuidado del Lactante/métodos , Cuidado Intensivo Neonatal/métodos , Padres/educación , Adulto , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Masculino , Mid-Atlantic Region , Grupo de Atención al PacienteRESUMEN
The Undetectable = Untransmittable (U=U) campaign was launched in 2016 to simultaneously reduce human immunodeficiency virus (HIV) stigma and raise awareness about treatment as prevention. This research note assesses HIV-negative young men who have sex with men's U=U awareness and perceived accuracy to inform this population's combination HIV prevention strategies.
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Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/estadística & datos numéricos , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios Transversales , Infecciones por VIH/psicología , Promoción de la Salud/métodos , Humanos , Masculino , Mid-Atlantic Region , Conducta Sexual/estadística & datos numéricos , Estigma Social , Adulto JovenRESUMEN
In recent years, several methods have emerged to estimate the emissions and health, environmental, and climate change damages avoided by interventions such as energy efficiency, demand response, and the integration of renewables. However, differing assumptions employed in these analyses could yield contradicting recommendations regarding intervention implementation. We test the magnitude of the effect of using different key assumptions-average vs marginal emissions, year of calculation, temporal and regional scope, and inclusion of nonemitting generation-to estimate Mid-Atlantic region power pool (PJM) emissions and damage factors. We further highlight the importance of factor selection by evaluating three illustrative 2017 power system examples in PJM. We find that for a simple building lighting intervention, using average emissions factors incorporating nonemitting generation underestimates avoided damages by 45% compared to marginal factors. For PJM demand response, outdated marginal emissions factors from 2016 overestimate avoided damages by 25% compared to 2017 factors. Our assessment of PJM summer load further suggests that fossil-only average emissions factors overestimate damages by 63% compared to average factors incorporating nonemitting generation. We recommend that energy modelers carefully select appropriate emissions metrics when performing their analyses. Furthermore, since the U.S. electric grid is rapidly changing, we urge decision-makers to frequently update (and consider forecasting) grid emissions factors.
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Electricidad , Mid-Atlantic RegionRESUMEN
The United States Environmental Protection Agency has established aggressive nutrient reduction goals to achieve water quality objectives for the Chesapeake Bay estuary. Nitrogen (N) reduction goals are proving particularly difficult to meet with an additional 20.4 million kg of annual nitrogen reductions needed by 2025, and many of the easily achievable and low-cost N reductions have been realized. We assess the feasibility of employing woodchip denitrifying bioreactors to treat legacy N derived from spring discharge in the Mid-Atlantic region. We estimate that in excess of 6100 kg of soluble N is discharged daily from United States Geological Survey identified springs in four Mid-Atlantic states within the Chesapeake Bay watershed. Based on typical bioreactor removal efficiency (30-55%) and potentially treatable flows (<6000 m3/d), widespread adoption of bioreactors to treat legacy N from 231 springs could conservatively result in 420-770 kg N removed per day, while strategic adoption targeting 48 springs with N concentrations of at least 3 mg/L and flows of at least 500 m3/d could result in 322-590 kg N removed per day more cost-effectively and with far fewer installations. A cost analysis indicates bioreactors can be a cost-effective N removal strategy, generally removing N for less than $5/kg·y. Relative to other nonpoint source pollution control practices, bioreactors also offer the ability to remove larger quantities of N per installation and are more easily monitored to quantify N reductions.
Asunto(s)
Nitrógeno , Calidad del Agua , Bahías , Reactores Biológicos , Estudios de Factibilidad , Objetivos , Mid-Atlantic RegionRESUMEN
During the investigation of dechlorane-related chemicals in North American wildlife, two unknown polychlorinated compounds (referred to as U1 and U2) were discovered. After extensive sample cleanup, structural information on U1 and U2 was characterized by gas chromatography (GC) coupled with single quadrupole mass spectrometer (MS) or GC-quadrupole time-of-flight (QToF) MS. Mass spectral evidence suggests that both U1 and U2 are structurally related to Dechlorane 603 (Dec603; C17H8Cl12), an analogue of the chlorinated flame retardant Dechlorane Plus. From the results we suspect U1 (C17H9Cl11) to be a monohydro analogue of Dec603 (i.e., one chlorine atom in Dec603 is replaced by a hydrogen atom). U1 may be formed via the degradation of Dec603's stereoisomers or present as an impurity in commercial Dec603 products. Mass spectral characterization of U2 (C17H7OCl11) suggests it is a carbonylic derivative of Dec603, likely formed via metabolic transformation of Dec603 or its photoisomer. Semiquantitative measurement revealed that U1 and U2 were present at estimated median concentrations of 49 ng/g lipid weight (lw) and 59 ng/g lw in peregrine falcon ( Falco peregrinus) eggs, from the mid-Atlantic region of the United States, and 4.6 and 3.0 ng/g lw in shortfin mako shark ( Isurus oxyrinchus) livers from the western North Atlantic Ocean, respectively. Our results demonstrate the occurrence of these two novel Dec603-related chemicals in both terrestrial and aquatic ecosystems.