Age-dependent relationships among diet, body condition, and Echinococcus multilocularis infection in urban coyotes.

Urban coyotes (Canis latrans) in North America increasingly exhibit a high prevalence of Echinococcus multilocularis, a cestode of recent and rising public health concern that uses rodents as intermediate hosts and canids as definitive hosts. However, little is known about the factors that drive the high urban prevalence of this parasite. We hypothesized that the diet of urban coyotes may contribute to their higher E. multilocularis infection prevalence via either (a) greater exposure to the parasite from increased rodent consumption or (b) increased susceptibility to infection due to the negative health effects of consuming anthropogenic food. We tested these hypotheses by comparing the presence and intensity of E. multilocularis infection to physiological data (age, sex, body condition, and spleen mass), short-term diet (stomach contents), and long-term diet (δ13C and δ15N stable isotopes) in 112 coyote carcasses collected for reasons other than this study from Edmonton, Alberta and the surrounding area. Overall, the best predictor of infection status in this population was young age, where the likelihood of infection decreased with age in rural coyotes but not urban ones. Neither short- nor long-term measures of diet could predict infection across our entire sample, but we found support for our initial hypotheses in young, urban coyotes: both rodent and anthropogenic food consumption effectively predicted E. multilocularis infection in this population. The effects of these predictors were more variable in rural coyotes and older coyotes. We suggest that limiting coyote access to areas in which anthropogenic food and rodent habitat overlap (e.g., compost piles or garbage sites) may effectively reduce the risk of infection, deposition, and transmission of this emerging zoonotic parasite in urban areas.

Consensus on Social Determinants of Health Knowledge Topics and Behavior Learning Goals Across Primary Care Residencies: Results of a Delphi Study.

PURPOSE: Social determinants of health (SDH) are a substantial contributor to health outcomes and health inequities across populations. The Accreditation Council for Graduate Medical Education has called for the incorporation of SDH into graduate medical education (GME), yet there is no consensus on what SDH knowledge or skills residents in primary care specialties should have on completion of training. The aim of this study was to develop expert consensus on the most important SDH knowledge topics and behavior learning goals for residents in 4 primary care fields. METHOD: The authors used a modified Delphi technique to develop consensus among experts in internal medicine, pediatrics, family medicine, and obstetrics and gynecology across the United States via a survey administered between February and October 2021. They conducted a literature review on SDH in GME to develop an initial set of topics and learning goals and recruited experts who published about SDH and GME or led an SDH curriculum in GME. Consensus was determined a priori as 80% agreement that a topic or learning goal was very or extremely important. RESULTS: Forty-one experts participated in the first round of the survey and 33 participated in the second round (80% retention). Experts reached consensus on the importance of 22/51 (43%) topics and 18/47 (38%) learning goals. Topics reaching consensus emphasized structural forces, broad domains of SDH, resources for addressing SDH, and advocacy strategies and resources. Learning goals reaching consensus focused on individual- and interpersonal-level behaviors. CONCLUSIONS: To the authors' knowledge, this study represents the first rigorous evaluation of expert consensus on SDH in GME across 4 primary care specialties. The results could inform curriculum development and implementation and program evaluation, residency program goals, and shared GME milestones. Among other things, future studies can assess expert consensus on SDH in GME across nonprimary care specialties.

"Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology".

Social and environmental factors have an outsized effect on one's health. Children are particularly impacted by the adverse effects of poverty. While social determinants of health (SDH) screening in healthcare settings has proliferated there remain gaps in best practices for screening processes. As research has shown that patient navigation leads to an improvement in unmet social needs and family-reported child health, warm handoffs may be a key factor in assuring that the social needs of families are effectively addressed. Using quality improvement (QI) methods our pediatric clinic worked to increase the warm handoff rate between Community Health Workers (CHWs) and patients with unmet social needs. CHW warm handoff rates increased two-fold over the intervention period. Our results illustrate that QI methods can be used to optimize workflows to increase warm handoffs with CHWs. This is important as health centers work to improve their social needs screening and referral programs.

An altered microbiome in urban coyotes mediates relationships between anthropogenic diet and poor health.

Generalist species able to exploit anthropogenic food sources are becoming increasingly common in urban environments. Coyotes (Canis latrans) are one such urban generalist that now resides in cities across North America, where diseased or unhealthy coyotes are frequently reported in cases of human-wildlife conflict. Coyote health and fitness may be related to habitat use and diet via the gut microbiome, which has far-reaching effects on animal nutrition and physiology. In this study, we used stomach contents, stable isotope analysis, 16S rRNA gene amplicon sequencing, and measures of body condition to identify relationships among habitat use, diet, fecal microbiome composition, and health in urban and rural coyotes. Three distinct relationships emerged: (1) Urban coyotes consumed more anthropogenic food, which was associated with increased microbiome diversity, higher abundances of Streptococcus and Enterococcus, and poorer average body condition. (2) Conversely, rural coyotes harbored microbiomes rich in Fusobacteria, Sutterella, and Anaerobiospirillum, which were associated with protein-rich diets and improved body condition. (3) Diets rich in anthropogenic food were associated with increased abundances of Erysipelotrichiaceae, Lachnospiraceae, and Coriobacteriaceae, which correlated with larger spleens in urban coyotes. Urban coyotes also had an increased prevalence of the zoonotic parasite Echinococcus multilocularis, but there were no detectable connections between parasite infection and microbiome composition. Our results demonstrate how the consumption of carbohydrate-rich anthropogenic food by urban coyotes alters the microbiome to negatively affect body condition, with potential relationships to parasite susceptibility and conflict-prone behavior.

Mixed Reality for Veterinary Medicine: Case Study of a Canine Femoral Nerve Block.

The femoral nerve blockage is a procedure that aims to provide anesthesia to the hip, anterior thigh, and stifle. This procedure presents several challenges when performed in veterinary patients with diverse anatomy and physiology. Successful use of this technique will improve a dog's recovery time after surgery in comparison to the commonly used epidural block. A mixed reality application to guide practitioners in the femoral nerve block procedure was developed in Unity and Visual Studio. A 3D model for use within the application was created from pictures of a cadaver leg using photogrammetry software. The Microsoft HoloLens headset provides the mixed reality hardware platform. This paper presents the workflow used in developing the mixed reality application and custom 3D model, as well as initial results with respect to the utility of the application in guiding an anesthesiologist in the procedure of the femoral nerve block.

Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program.

Clinic-based social needs screening has been associated with increased access to social services and improved health outcomes. Using a pragmatic study design in an urban pediatric practice, we used logistic regression to identify factors associated with successful social service uptake. From December 2017 to November 2018, 4948 households were screened for social needs, and 20% self-reported at least one. Of the 287 households with unmet needs who were referred and interested in further assistance, 43% reported successful social service uptake. Greater than 4 outreach encounters (adjusted odds ratio = 1.92; 95% confidence interval = 1.06-3.49) and follow-up time >30 days (adjusted odds ratio = 0.43; 95% confidence interval = 0.25-0.73) were significantly associated with successful referrals. These findings have implementation implications for programs aiming to address social needs in practice. Less than half of households reported successful referrals, which suggests the need for additional research and an opportunity for further program optimization.

From Policy Statement to Practice: Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center.

Purpose: Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic. Methods: The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits. Discussion: Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.