Efficacy of Soil-Applied Neonicotinoid Insecticides for Long-term Protection Against Emerald Ash Borer (Coleoptera: Buprestidae).

Protection of green ash trees (Fraxinus pennsylvanica Marshall) from the emerald ash borer (EAB), Agrilus planipennis Fairmaire, by soil applications of neonicotinoids (imidacloprid, clothianidin, and dinotefuran) was tested at five locations between 2005 and 2013. Application rate and spring versus fall application dates were evaluated in tests with neighborhood street trees and in one plantation of 65 ash trees. Insecticide treatments of ash trees at all five sites were initiated as the leading edge of the EAB invasion began to kill the first ash trees at each location. Trees were treated and evaluated at each site for 4 to 7 yr. Spring applications of imidacloprid were more efficacious than fall applications. Application rates of 0.8 g a.i./cm dbh or greater per year gave a higher level of protection and were more consistent than rates of 0.56 g a.i./cm dbh per year or less. The number of years between the first observation of canopy loss due to EAB and death of most of the control trees varied from three to seven years among test sites, depending on how many non-treated ash trees were nearby.

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool.

BACKGROUND: The purpose of the Ambulatory Electronic Health Record (EHR) Evaluation Tool is to provide outpatient clinics with an assessment that they can use to measure the ability of the EHR system to detect and prevent common prescriber errors. The tool consists of a medication safety test and a medication reconciliation module. OBJECTIVES: The goal of this study was to perform a broad evaluation of outpatient medication-related decision support using the Ambulatory EHR Evaluation Tool. METHODS: We performed a cross-sectional study with 10 outpatient clinics using the Ambulatory EHR Evaluation Tool. For the medication safety test, clinics were provided test patients and associated medication test orders to enter in their EHR, where they recorded any advice or information they received. Once finished, clinics received an overall percentage score of unsafe orders detected and individual order category scores. For the medication reconciliation module, clinics were asked to electronically reconcile two medication lists, where modifications were made by adding and removing medications and changing the dosage of select medications. RESULTS: For the medication safety test, the mean overall score was 57%, with the highest score being 70%, and the lowest score being 40%. Clinics performed well in the drug allergy (100%), drug dose daily (85%), and inappropriate medication combinations (74%) order categories. Order categories with the lowest performance were drug laboratory (10%) and drug monitoring (3%). Most clinics (90%) scored a 0% in at least one order category. For the medication reconciliation module, only one clinic (10%) could reconcile medication lists electronically; however, there was no clinical decision support available that checked for drug interactions. CONCLUSION: We evaluated a sample of ambulatory practices around their medication-related decision support and found that advanced capabilities within these systems have yet to be widely implemented. The tool was practical to use and identified substantial opportunities for improvement in outpatient medication safety.

Progression of ash canopy thinning and dieback outward from the initial infestation of emerald ash borer (Coleoptera: Buprestidae) in southeastern Michigan.

Our objective was to characterize the rate at which ash (Fraxinus spp.) trees decline in areas adjacent to the leading edge of visible ash canopy thinning due to emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae). Trees in southeastern Michigan were surveyed from 2003 to 2006 for canopy thinning and dieback by comparing survey trees with a set of 11 standard photographs. Freeways stemming from Detroit in all directions were used as survey transects. Between 750 and 1,100 trees were surveyed each year. A rapid method of sampling populations of emerald ash borer was developed by counting emerald ash borer emergence holes with binoculars and then felling trees to validate binocular counts. Approximately 25% of the trees surveyed for canopy thinning in 2005 and 2006 also were sampled for emerald ash borer emergence holes using binoculars. Regression analysis indicates that 41-53% of the variation in ash canopy thinning can be explained by the number of emerald ash borer emergence holes per tree. Emerald ash borer emergence holes were found at every site where ash canopy thinning averaged > 40%. In 2003, ash canopy thinning averaged 40% at a distance of 19.3 km from the epicenter of the emerald ash borer infestation in Canton. By 2006, the point at which ash trees averaged 40% canopy thinning had increased to a distance of 51.2 km away from Canton. Therefore, the point at which ash trees averaged 40% canopy thinning, a state of decline clearly visible to the average person, moved outward at a rate of 10.6 km/yr during this period.

Chest wall surgery for asphyxiating thoracic surgery.

Our experience to date suggests that LTE is a safe and effective treatment of symptomatic patients with ATD. Patients uniformly are clinically improved. Measured increases in thoracic volume are offset by overall increases in body size keeping the percent of predicted volumes low, suggesting mechanisms other than pure thoracic volume increase to explain the observed clinical improvement. Long term follow-up is mandatory.