Imidacloprid exposure is detectable in over one third of wild bird samples from diverse Texas ecoregions.

Avian decline is occurring globally with neonicotinoid insecticides posed as a potentially contributing factor. Birds can be exposed to neonicotinoids through coated seeds, soil, water, and insects, and experimentally exposed birds show varied adverse effects including mortality and disruption of immune, reproductive, and migration physiology. However, few studies have characterized exposure in wild bird communities over time. We hypothesized that neonicotinoid exposure would vary temporally and based on avian ecological traits. Birds were banded and blood sampled at eight non-agricultural sites across four Texas counties. Plasma from 55 species across 17 avian families was analyzed for the presence of 7 neonicotinoids using high performance liquid chromatography-tandem mass spectrometry. Imidacloprid was detected in 36 % of samples (n = 294); this included quantifiable concentrations (12 %; 10.8-36,131 pg/mL) and concentrations that were below the limit of quantification (25 %). Additionally, two birds were exposed to imidacloprid, acetamiprid (18,971.3 and 6844 pg/mL) and thiacloprid (7022.2 and 17,367 pg/mL), whereas no bird tested positive for clothianidin, dinotefuran, nitenpyram, or thiamethoxam, likely reflecting higher limits of detection for all compounds compared to imidacloprid. Birds sampled in spring and fall had higher incidences of exposure than those sampled in summer or winter. Subadult birds had higher incidences of exposure than adult birds. Among the species for which we tested more than five samples, American robin (Turdus migratorius) and red-winged blackbird (Agelaius phoeniceus) had significantly higher incidences of exposure. We found no relationships between exposure and foraging guild or avian family, suggesting birds with diverse life histories and taxonomies are at risk. Of seven birds resampled over time, six showed neonicotinoid exposure at least once with three showing exposures at multiple time points, indicating continued exposure. This study provides exposure data to inform ecological risk assessment of neonicotinoids and avian conservation efforts.

Expanding a Regional Sickle Cell Disease Project ECHO® to Rapidly Disseminate COVID-19 Education.

Purpose: Healthcare providers faced numerous knowledge gaps and challenges with adapting practice behaviors in light of the COVID-19 pandemic. In response, an established virtual sickle cell disease (SCD) telementoring program rapidly expanded from monthly evidence-based didactic sessions focused on medical and psychosocial complications of sickle cell disease, to additional supplemental COVID-19 sessions with emerging pandemic topics and forums for shared experiences to address this timely educational need among multidisciplinary healthcare providers. Methods: In March 2020, the COVID-19 and Sickle Cell Disease Project ECHO® telementoring series was launched with a rapidly evolving curriculum of contemporary topics and case presentations. Topics included COVID-19 specific management for children and adults with sickle cell disease and strategies to adapt care and communication during the pandemic. Participants completed evaluations after each session. Results: From March 2020 to February 2022, there were 20 COVID-19 and SCD Project ECHO® sessions held with an average of 43 participants per session, which is over a 170% increase from the average SCD ECHO monthly attendance pre-pandemic. Participants represented 21 states and 3 countries. A majority of participants (91%) self-reported significantly improved knowledge of COVID-19. Conclusion: Project ECHO® is a successful educational strategy to diffuse knowledge using a virtual platform during a public health emergency, by facilitating shared learning among a community of practice that specializes in the management of sickle cell disease.

Educational Needs of School Nurses Regarding the Evidence-Based Management of Sickle Cell Disease.

Sickle cell disease (SCD) is a rare blood disorder that can have life-threatening complications. This presents a challenge for school nurses who may have had limited experience managing complications in the school setting. This study assessed the experience, self-reported knowledge, confidence and ability of school nurses in managing SCD in the school-setting and identified continuing educational needs and preferences. This study used a qualitative, descriptive approach. A survey was previously administered to over 400 school nurses who worked in K-12 schools in Ohio. Those participants who reported experience with managing SCD were invited to participate in a focus group or semi-structured interview. Data were interpreted using thematic analysis strategy. Four overarching themes emerged from the data: (1) perceived lack of support and resources, (2) self-reported lack of knowledge about SCD, (3) importance of partnerships with parents, and (4) need for continuing education and networking with other school nurses. Easily accessible, educational interventions, along with peer networking, can be designed to improve school nurse knowledge and confidence levels in managing SCD. These types of on-demand interventions are important as many school nurses reported infrequent exposure to students with SCD.

Translating sickle cell guidelines into practice for primary care providers with Project ECHO.

BACKGROUND: Approximately 100,000 persons with sickle cell disease (SCD) live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs) who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM) is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin. METHODS: STORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI) evidence-based guidelines for SCD. RESULTS: Network leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation. CONCLUSIONS: STORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.

Effects of modest testosterone supplementation and exercise for 12 weeks on body composition and quality of life in elderly men.

OBJECTIVE: One of the factors that may promote deterioration in quality of life and body composition in elderly men is the relative decline in serum testosterone levels with aging. In this study, we assessed the effects of modest doses of testosterone and a home-based strengthening program on quality of life and body composition in elderly men with relative testosterone insufficiency. DESIGN: Double-blind, placebo-controlled randomized study (testosterone), and additional randomization to a resistance exercise program or no additional exercise for 12 weeks in men between ages of 65 and 85 years with relative testosterone insufficiency. METHODS: Seventy sedentary, community dwelling men were randomized to a 5 mg testoderm transdermal system applied daily vs placebo system, and additionally randomized to a home-based resistance exercise program. Subjects were randomized to Group 1 (testosterone plus exercise), Group 2 (testosterone plus no exercise), Group 3 (placebo plus exercise), and Group 4 (placebo plus no exercise). Endpoints included quality of life (assessed by the short form-36 questionnaire) and body composition (measured by dual x-ray absorptiometry scan). RESULTS: Serum testosterone increased by a mean of 10.0 +/- 1.9, 6.6 +/- 1.6, 0.52 +/- 0.6, and 0.5 +/- 0.6 nmol/l in Groups 1, 2, 3, and 4 respectively. There was a significant interaction of testosterone and exercise on quality of life in the domains of physical functioning (P = 0.03), role physical (P = 0.01), general health (P = 0.049), and social functioning (P = 0.04). There were no effects of testosterone or exercise on quality of life alone, nor in body composition parameters. CONCLUSIONS: Modest testosterone supplementation to elderly men with relative testosterone insufficiency improved quality of life when accompanied by an exercise program. The combination of testosterone and exercise may be an important strategy in the elderly, though further studies are necessary to determine the long-term impact on body composition and function and for analysis of risk/benefit ratios as well.