Long-Term Air Pollution Exposure and COVID-19 Mortality: A Patient-Level Analysis from New York City.

Rationale: Risk factors for coronavirus disease (COVID-19) mortality may include environmental exposures such as air pollution. Objectives: To determine whether, among adults hospitalized with PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), long-term air pollution exposure is associated with the risk of mortality, ICU admission, or intubation. Methods: We performed a retrospective analysis of SARS-CoV-2 PCR-positive patients admitted to seven New York City hospitals from March 8, 2020, to August 30, 2020. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. We estimated the annual average fine particulate matter (particulate matter ⩽2.5 µm in aerodynamic diameter [PM2.5]), nitrogen dioxide (NO2), and black carbon (BC) concentrations at patients' residential address. We employed double robust Poisson regression to analyze associations between the annual average PM2.5, NO2, and BC exposure level and COVID-19 outcomes, adjusting for age, sex, race or ethnicity, hospital, insurance, and the time from the onset of the pandemic. Results: Among the 6,542 patients, 41% were female and the median age was 65 (interquartile range, 53-77) years. Over 50% self-identified as a person of color (n = 1,687 [26%] Hispanic patients; n = 1,659 [25%] Black patients). Air pollution exposure levels were generally low. Overall, 31% (n = 2,044) of the cohort died, 19% (n = 1,237) were admitted to the ICU, and 16% (n = 1,051) were intubated. In multivariable models, a higher level of long-term exposure to PM2.5 was associated with an increased risk of mortality (risk ratio, 1.11 [95% confidence interval, 1.02-1.21] per 1-µg/m3 increase in PM2.5) and ICU admission (risk ratio, 1.13 [95% confidence interval, 1.00-1.28] per 1-µg/m3 increase in PM2.5). In multivariable models, neither NO2 nor BC exposure was associated with COVID-19 mortality, ICU admission, or intubation. Conclusions: Among patients hospitalized with COVID-19, a higher long-term PM2.5 exposure level was associated with an increased risk of mortality and ICU admission.

Creative Interventions for Preparing and Disclosing Trauma Narratives in Group Therapy for Child Sexual Abuse.

Group therapy is a widely utilized and empirically supported treatment for victims of child sexual abuse (CSA). An important aspect of trauma-focused groups for CSA is the composition and presentation of a trauma narrative as part of a gradual exposure process. One challenge in the creation of a trauma narrative in group is the contagious avoidance that may be present if group members are reluctant to engage in the development of a trauma narrative. Creative group therapeutic interventions can assist in mitigating avoidance, a hallmark of posttraumatic stress disorder (PTSD), by reducing resistance to constructing and processing the trauma narrative in CSA group treatment. Additionally, creative expressive arts interventions are a developmentally tailored approach to trauma narratives for young children with limited language as well as for traumatized youth who do not have words accessible to describe their CSA. This manuscript presents a wide array of creative therapeutic activities that can be utilized for creation and processing of the trauma narrative and facilitating cohesion and coping in group therapy for CSA. Using these expressive arts techniques can support youth in preparing for the trauma narrative and providing a space to process their CSA.

Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent.

Cryptococcus exposure in certain global regions is common and yet virulence in the immunocompetent host remains rare. Radiological findings of pulmonary cryptococcosis may include nonspecific lung nodules or masses indistinguishable from lung cancer or pulmonary tuberculosis. We present a case of an immunocompetent diabetic female who presented with progressively worsening pleuritic chest pain and cough with travel between Tibet and New York 2 months earlier. Chest imaging demonstrated a large lobulated mass, acid-fast bacillus smears were negative, and our patient underwent pulmonary biopsy, which grew rare budding yeast later confirmed by mucicarmine staining as Cryptococcus. Our patient was successfully treated with fluconazole therapy. We hypothesize that the high altitude of Tibet may allow for clinical latency followed by symptomatic reactivation on descent. A raised index of suspicion for pulmonary cryptococcosis with careful attention to travel history is expected to facilitate timely diagnosis.

Safety and Quality of Fish and Game Meats Prepared by First Nations Communities in British Columbia, Canada.

ABSTRACT: Canadian First Nations communities rely on traditional preservation methods such as the smoking, drying, and canning of fish and game meats to ensure long-term food security. Unlike commercial food production, there are no recognized official standards for these methods, rendering their efficacy in producing microbiologically safe foods relatively unknown. In this study, 81 fresh or processed fish and game samples obtained from four British Columbia First Nations communities were analyzed for quality indicator microbes, foodborne pathogens, and mineral levels. Aerobic counts, coliforms (CC), Escherichia coli (EC), lactic acid bacteria, Staphylococcus aureus (STA), and yeast and molds (YM) were enumerated using the TEMPO, whereas the presence of E. coli O157:H7, Listeria monocytogenes, and Salmonella were detected using the VIDAS immunoassay system. The opportunistic pathogens Enterococcus faecalis and Enterococcus faecium were additionally detected using culture methods with subsequent PCR confirmation, and minerals (Ca, Cu, K, Mg, Mn, Na, and Zn) were detected using mass spectrometry. With the exception of STA, microbial loads were significantly (P < 0.05) higher in processed fish and meat samples compared with unprocessed samples, and game samples contained higher microbial levels than fish; however, differences were only significant (P < 0.05) for coliforms, E. coli, and STA. E. coli O157:H7 was detected in one smoked moose sample, and E. faecalis and E. faecium were isolated from 21 and 2 samples, respectively. Although smoked samples contained significantly higher Na levels, they were effective in reducing microbial levels. These results indicate that current food preservation methods practiced by British Columbia First Nations communities are infrequently effective at reducing microbial populations, and in many cases, resulted in increased microbial loads. More efforts should be made to improve the dissemination of safe food handling and processing knowledge to ensure long-term food security and well-being.