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1.
Environ Monit Assess ; 192(11): 706, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33064217

RESUMO

Recently, cyanobacteria blooms have become a concern for agricultural irrigation water quality. Numerous studies have shown that cyanotoxins from these harmful algal blooms (HABs) can be transported to and assimilated into crops when present in irrigation waters. Phycocyanin is a pigment known only to occur in cyanobacteria and is often used to indicate cyanobacteria presence in waters. The objective of this work was to identify the most influential environmental covariates affecting the phycocyanin concentrations in agricultural irrigation ponds that experience cyanobacteria blooms of the potentially toxigenic species Microcystis and Aphanizomenon using machine learning methodology. The study was performed at two agricultural irrigation ponds over a 5-month period in the summer of 2018. Phycocyanin concentrations, along with sensor-based and fluorometer-based water quality parameters including turbidity (NTU), pH, dissolved oxygen (DO), fluorescent dissolved organic matter (fDOM), conductivity, chlorophyll, color dissolved organic matter (CDOM), and extracted chlorophyll were measured. Regression tree analyses were used to determine the most influential water quality parameters on phycocyanin concentrations. Nearshore sampling locations had higher phycocyanin concentrations than interior sampling locations and "zones" of consistently higher concentrations of phycocyanin were found in both ponds. The regression tree analyses indicated extracted chlorophyll, CDOM, and NTU were the three most influential parameters on phycocyanin concentrations. This study indicates that sensor-based and fluorometer-based water quality parameters could be useful to identify spatial patterns of phycocyanin concentrations and therefore, cyanobacteria blooms, in agricultural irrigation ponds and potentially other water bodies.


Assuntos
Ficocianina , Tanques , Irrigação Agrícola , Monitoramento Ambiental , Maryland
2.
Zootaxa ; 4772(1): zootaxa.4772.1.4, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33055625

RESUMO

The early and mid-Pleistocene avian communities of North America are best known from the Rocky Mountain region and peninsular Florida. In the Appalachian Mountain region, only a small number of avian bones from mid-latitude cave deposits have been attributed to this time period. Here, I enlarge this record by reporting on bird bones from Cumberland Bone Cave in western Maryland, a well-known locality for large and small Irvingtonian mammals and other vertebrates. The taxa identified encompass ground birds, waterfowl, a hawk, two eagles, a vulture, an owl, a jay, a flycatcher, a junco or sparrow, and a finch. No purely boreal elements are confirmed as part of the avian assemblage, and all of the extant species that are positively or tentatively identified in the assemblage still occur in the region today. An immature bone referred to the Black Vulture (Coragyps atratus (Bechstein)) represents an Irvingtonian breeding record for the species in Maryland. This record occurs at the northern limit of the current breeding range for the genus. Extinct species in the assemblage include the Passenger Pigeon (Ectopistes migratorius (Linnaeus)), a large screech owl (Megascops guildayi (Brodkorb Mourer-Chauviré 1984)), and the large goose, Branta dickeyi Miller 1924. It can be argued that none of these represent the extinction of a phyletic lineage during the Irvingtonian. Based on the broad habitat preferences of modern counterparts of the birds in the assemblage, we can expect that Irvingtonian habitats near the site included mixed forest with mast-producing hardwoods and both early and later successional stages represented. There must have been fluvial, wetland, or lacustrine habitat suitable for waterbirds nearby, and probably also open woodland or grassy savannah areas, suitable for vulture foraging, turkey nesting, and booming by Ruffed Grouse.


Assuntos
Columbidae , Animais , Cavernas , Maryland
3.
Am J Public Health ; 110(11): 1635-1643, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32941069

RESUMO

In 2019, the National School Lunch Program and School Breakfast Program served approximately 15 million breakfasts and 30 million lunches daily at low or no cost to students.Access to these meals has been disrupted as a result of long-term school closures related to the COVID-19 pandemic, potentially decreasing both student nutrient intake and household food security. By the week of March 23, 2020, all states had mandated statewide school closures as a result of the pandemic, and the number of weekly missed breakfasts and lunches served at school reached a peak of approximately 169.6 million; this weekly estimate remained steady through the final week of April.We highlight strategies that states and school districts are using to replace these missed meals, including a case study from Maryland and the US Department of Agriculture waivers that, in many cases, have introduced flexibility to allow for innovation. Also, we explore lessons learned from the pandemic with the goal of informing and strengthening future school nutrition policies for out-of-school time, such as over the summer.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviços de Alimentação/organização & administração , Inovação Organizacional , Pandemias , Pneumonia Viral/epidemiologia , Instituições Acadêmicas/organização & administração , Betacoronavirus , Desjejum , Serviços de Alimentação/estatística & dados numéricos , Abastecimento de Alimentos/economia , Humanos , Almoço , Maryland , Pobreza/economia , Estados Unidos/epidemiologia
4.
Nurs Outlook ; 68(5): 657-670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32854936

RESUMO

Nurse leadership was identified as essential to the advancement of health care in the State of Maryland. The State's Health Services Cost Review Commission's (HSCRC) committed to building the next generation of nurse leaders as part of its vision for advancing healthcare in Maryland. In 2015, HSCRC approved a $2.5 million, multiyear grant that supported development of the Nurse Leadership Institute (NLI) at the University of Maryland School of Nursing. The NLI designed a leadership development program that prepared nurse faculty and clinicians with critical competencies needed for assuming leadership positions unique to complex adaptive systems, facilitating collaborative partnerships between academia and practice, and ultimately improving health outcomes for Maryland's residents. This article is the first in a series reporting on outcomes of this initiative, which describes the design and implementation of the Nurse Leadership Institute, its Leadership Development Program, and preliminary findings for the first 4 years.


Assuntos
Academias e Institutos , Fortalecimento Institucional , Liderança , Enfermagem , Desenvolvimento de Programas , Escolas de Enfermagem , Assistência à Saúde , Humanos , Maryland , Desenvolvimento de Pessoal
5.
N Engl J Med ; 383(6): 558-566, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32757524

RESUMO

BACKGROUND: Specialty drugs are used to treat complex or life-threatening conditions, often at high financial costs to both patients and health plans. Three states - Delaware, Louisiana, and Maryland - passed legislation to cap out-of-pocket payments for specialty drugs at $150 per prescription. A concern is that these caps could shift costs to health plans, increasing insurance premiums. Estimates of the effect of the caps on patient and health-plan spending could inform future policies. METHODS: We analyzed a sample that included 27,161 persons under 65 years of age who had rheumatoid arthritis, multiple sclerosis, hepatitis C, psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis and who were in commercial health plans from 2011 through 2016 that were administered by three large nationwide insurers. The primary outcome was the change in out-of-pocket spending among specialty-drug users who were in the 95th percentile for spending on specialty drugs. Other outcomes were changes in mean out-of-pocket and health-plan spending for specialty drugs, nonspecialty drugs, and nondrug health care and utilization of specialty drugs. We compared outcomes in the three states that enacted caps with neighboring control states that did not, 3 years before and up to 3 years after enactment of the spending cap. RESULTS: Caps were associated with an adjusted change in out-of-pocket costs of -$351 (95% confidence interval, -554 to -148) per specialty-drug user per month, representing a 32% reduction in spending, among users in the 95th percentile of spending on specialty drugs. This finding was supported by multiple sensitivity analyses. Caps were not associated with changes in other outcomes. CONCLUSIONS: Caps for spending on specialty drugs were associated with substantial reductions in spending on specialty drugs among patients with the highest out-of-pocket costs, without detectable increases in health-plan spending, a proxy for future insurance premiums. (Funded by the Robert Wood Johnson Foundation Health Data for Action Program.).


Assuntos
Doença Crônica/tratamento farmacológico , Custo Compartilhado de Seguro/legislação & jurisprudência , Custos de Medicamentos/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/economia , Governo Estadual , Adulto , Doença Crônica/economia , Custo Compartilhado de Seguro/economia , Delaware , Humanos , Seguro de Serviços Farmacêuticos/legislação & jurisprudência , Louisiana , Maryland , Pessoa de Meia-Idade , Honorários por Prescrição de Medicamentos/legislação & jurisprudência , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 69(32): 1089-1094, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32790661

RESUMO

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in nursing homes once it is introduced (1,2). To prevent outbreaks, more data are needed to identify sources of introduction and means of transmission within nursing homes. Nursing home residents who receive hemodialysis (dialysis) might be at higher risk for SARS-CoV-2 infections because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers (3). Investigation of a COVID-19 outbreak in a Maryland nursing home (facility A) identified a higher prevalence of infection among residents undergoing dialysis (47%; 15 of 32) than among those not receiving dialysis (16%; 22 of 138) (p<0.001). Among residents with COVID-19, the 30-day hospitalization rate among those receiving dialysis (53%) was higher than that among residents not receiving dialysis (18%) (p = 0.03); the proportion of dialysis patients who died was 40% compared with those who did not receive dialysis (27%) (p = 0.42).Careful consideration of infection control practices throughout the dialysis process (e.g., transportation, time spent in waiting areas, spacing of machines, and cohorting), clear communication between nursing homes and dialysis centers, and coordination of testing practices between these sites are critical to preventing COVID-19 outbreaks in this medically vulnerable population.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Diálise/efeitos adversos , Surtos de Doenças , Casas de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Idoso , Humanos , Maryland/epidemiologia , Pandemias
7.
PLoS One ; 15(8): e0237558, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785285

RESUMO

BACKGROUND: The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations. OBJECTIVE: To evaluate risk factors for severe illness. DESIGN: Retrospective, observational case series. SETTING: Single-institution. PARTICIPANTS: First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020. EXPOSURE: None. MAIN OUTCOMES AND MEASURES: Intensive care unit admission or death. RESULTS: In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011-1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630-27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218-63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528-15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients. CONCLUSIONS: At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Hospitalização , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Alocação de Recursos para a Atenção à Saúde , Mortalidade Hospitalar , Hospitais Comunitários , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco
11.
JMIR Public Health Surveill ; 6(3): e22331, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32678799

RESUMO

Epidemiologic and syndromic surveillance metrics traditionally used by public health departments can be enhanced to better predict hospitalization for coronavirus disease (COVID-19). In Montgomery County, Maryland, measurements of oxygen saturation (SpO2) by pulse oximetry obtained by the emergency medical service (EMS) were added to these traditional metrics to enhance the public health picture for decision makers. During a 78-day period, the rolling 7-day average of the percentage of EMS patients with SpO2 <94% had a stronger correlation with next-day hospital bed occupancy (Spearman ρ=0.58, 95% CI 0.40-0.71) than either the rolling 7-day average of the percentage of positive tests (ρ=0.55, 95% CI: 0.37-0.69) or the rolling 7-day average of the percentage of emergency department visits for COVID-19-like illness (ρ=0.49, 95% CI: 0.30-0.64). Health departments should consider adding EMS data to augment COVID-19 surveillance and thus improve resource allocation.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Vigilância em Saúde Pública/métodos , Humanos , Maryland/epidemiologia , Pandemias
12.
Womens Health Issues ; 30(5): 345-352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32622582

RESUMO

PURPOSE: Despite the prevalence of alcohol, tobacco, and other drug (ATOD) use screening as part of prenatal care, pregnant women's perspectives on screening are largely absent from research and clinical practice. This study examines pregnant women's acceptability of ATOD screening and willingness to disclose their ATOD use in prenatal care. METHODS: Pregnant women completed a self-administered survey and structured interview at four prenatal care facilities in Louisiana and Maryland (N = 589). Participants reported the acceptability of screening and their willingness to honestly disclose their ATOD use to their provider. Data were analyzed through descriptive statistics, tests of proportions, simple regression models, and coding of open-ended responses. RESULTS: Nearly all pregnant women found screening acceptable for alcohol (97%), tobacco (98%), and other drug use (97%) during prenatal care. The acceptability of alcohol use screening was higher among those who reported binge drinking (98% vs. 96%; p = .002) and risky alcohol consumption (99% vs. 96%; p = .018). The acceptability of screening for other drugs was higher among women reporting binge drinking (98% vs. 96%; p = .032) and other drug use (98% vs. 96%; p = .058). Almost all pregnant women indicated that they were willing to disclose their alcohol (99%), tobacco (99%), and other drug use (98%) to their provider. CONCLUSIONS: Almost all women considered verbal screening for ATOD use during prenatal care acceptable and indicated that they were willing to honestly disclose their ATOD use. Verbal screening may allow for the opportunity to initiate safe, nonjudgmental conversations about women's substance use, risk, and goals for their ATOD use, pregnancy, and parenting.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Programas de Rastreamento/psicologia , Gestantes/psicologia , Autorrevelação , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Uso de Tabaco/epidemiologia , Adulto , Feminino , Humanos , Louisiana , Maryland , Gravidez , Cuidado Pré-Natal , Detecção do Abuso de Substâncias , Inquéritos e Questionários , Adulto Jovem
13.
J Appl Gerontol ; 39(11): 1175-1183, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32697126

RESUMO

Background: The Theory of Planned Behavior (TPB) and the Health Belief Model (HBM) were used to examine the opinion and behaviors of older adults regarding Coronavirus Disease 2019 (COVID-19), social distancing practices, stay-at-home orders, and hypothetical public policy messaging strategies. Method: A convenience sample (N = 242) of adults 60 and older in the state of Maryland took part in an online survey. Respondents filled out questions regarding demographic information, political affiliation, current social distancing behaviors, and TPB and HBM constructs in our proposed model. Linear regression analysis and analysis of covariance (ANCOVA) were conducted to test the model. Results: Attitude toward social isolation was affected by perceived benefits and barriers to social distancing measures, perceived severity of COVID-19, and political affiliation. Behavior intention was influenced by attitude, subjective norms, political affiliation, and messaging strategies. Conclusion: The study provides support for the conceptual model and has public policy implications as authorities begin to lift stay-at-home orders.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Isolamento de Pacientes/métodos , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Política de Saúde , Humanos , Masculino , Maryland , Máscaras/estatística & dados numéricos , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Formulação de Políticas , Saúde Pública , Inquéritos e Questionários
14.
Sci Total Environ ; 744: 141012, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-32693269

RESUMO

To control the novel coronavirus disease (COVID-19) outbreak, state and local governments in the United States have implemented several mitigation efforts that resulted in lower emissions of traffic-related air pollutants. This study examined the impacts of COVID-19 mitigation measures on air pollution levels and the subsequent reductions in mortality for urban areas in 10 US states and the District of Columbia. We calculated changes in levels of particulate matter with aerodynamic diameter no larger than 2.5 µm (PM2.5) during mitigation period versus the baseline period (pre-mitigation measure) using the difference-in-difference approach and the estimated avoided total and cause-specific mortality attributable to these changes in PM2.5 by state and district. We found that PM2.5 concentration during the mitigation period decreased for most states (except for 3 states) and the capital. Decreases of average PM2.5 concentration ranged from 0.25 µg/m3 (4.3%) in Maryland to 4.20 µg/m3 (45.1%) in California. On average, PM2.5 levels across 7 states and the capital reduced by 12.8%. We estimated that PM2.5 reduction during the mitigation period lowered air pollution-related total and cause-specific deaths. An estimated 483 (95% CI: 307, 665) PM2.5-related deaths was avoided in the urban areas of California. Our findings have implications for the effects of mitigation efforts and provide insight into the mortality reductions can be achieved from reduced air pollution levels.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , Humanos , Maryland , Material Particulado/análise , Estados Unidos
16.
Environ Res ; 188: 109773, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32559686

RESUMO

Campylobacter is a leading cause of bacterial foodborne illness in the United States. Campylobacter infections have most often been associated with food-related risk factors, such as the consumption of poultry and raw milk. Socioeconomic, agricultural and environmental factors, including drinking water source, can also influence the risk of campylobacteriosis. Approximately 19% of Maryland residents rely on private wells as their sole source of water. Given that the federal Safe Drinking Water Act does not regulate the water quality of private wells, these could be important non-foodborne transmission pathways for Campylobacter. To address this issue, data on the number of culture-confirmed cases of Campylobacter infection in Maryland between 2007 and 2016 were obtained from the Foodborne Diseases Active Surveillance Network. Cases were linked by zip code with data from the Maryland well permits registry, the 2010 U.S. Census, the 2016 American Community Survey, and the USDA Agricultural Census. Campylobacteriosis incidence rates and well prevalence were calculated by zip code. Negative binomial regression models were then constructed to evaluate the association between the prevalence of private wells, presence/absence of animal feeding operations and the incidence of campylobacteriosis across the physiographic provinces in Maryland. From 2007 to 2016, a total of 5746 cases of campylobacteriosis were reported in Maryland, and annual incidence rates ranged from 6.65 to 11.59 per 100,000 people. In our statewide analysis, a significant positive association was observed between well prevalence and increased campylobacteriosis incidence at the zip code level (Incidence Rate Ratio (IRR) = 1.35, 95% Confidence Interval (CI) = 1.11, 1.63). A significant positive association was also observed between well prevalence and increased campylobacteriosis incidence in the Appalachian and Coastal provinces of Maryland (IRR = 2.94, 95% CI = 1.11, 7.76 and IRR = 1.70, 95% CI = 1.25, 2.31, respectively). The presence of broiler chicken operations, increasing median age and percentage of residents living in poverty were also significantly associated with campylobacteriosis incidence at the zip code level in some physiographic provinces in Maryland. To our knowledge, these are the first US data to demonstrate an association between prevalence of private wells and campylobacteriosis incidence at the zip code level.


Assuntos
Infecções por Campylobacter , Campylobacter , Água Potável , Doenças Transmitidas por Alimentos , Animais , Infecções por Campylobacter/epidemiologia , Galinhas , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Incidência , Maryland/epidemiologia , Estados Unidos/epidemiologia , Conduta Expectante
17.
Environ Sci Technol ; 54(13): 7922-7931, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32506903

RESUMO

To advance our understanding of the mercury (Hg) biogeochemical cycle, concentrations and chemistry of gaseous oxidized Hg (GOM), particulate-bound Hg (PBM), and reactive Hg (RM = GOM + PBM) need to be known. The UNR-RMAS 2.0 provides a solution that will advance knowledge. From 11/2017 to 02/2019, the RMAS 2.0 was deployed in Hawai'i, Nevada, Maryland, and Utah to test system performance and develop an understanding of RM at locations impacted by different atmospheric oxidants. Mauna Loa Observatory, Hawai'i, impacted by the free troposphere and the marine boundary layer, had primarily -Br/Cl RM compounds. The Nevada location, directly adjacent to a major interstate highway and experiences inputs from the free troposphere, exhibited -Br/Cl, -N, -S, and organic compounds. In Maryland, compounds observed were -N, -S, and organic-Hg. This site is downwind of coal-fired power plants and located in a forested area. The location in Utah is in a basin impacted by oil and natural gas extraction, multiday wintertime inversion episodes, and inputs from the free troposphere. Compounds were -Br/Cl or -O, -N, and -Br/Cl. The chemical forms of RM identified were consistent with the air source areas, predominant ion chemistry, criterion air pollutants, and meteorology.


Assuntos
Poluentes Atmosféricos , Mercúrio , Poluentes Atmosféricos/análise , Monitoramento Ambiental , Maryland , Mercúrio/análise , Nevada , Utah
18.
PLoS One ; 15(6): e0234973, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559244

RESUMO

BACKGROUND: On-line tutorials are being increasingly used in medical education, including in teaching housestaff skills regarding end of life care. Recently an on-line tutorial incorporating interactive clinical vignettes and communication skills was used to prepare housestaff at Johns Hopkins Hospital to use the Maryland Orders for Life Sustaining Treatment (MOLST) form, which documents patient preferences regarding end of life care. 40% of housestaff who viewed the module felt less than comfortable discussing choices on the MOLST with patients. We sought to understand factors beyond knowledge that contributed to housestaff discomfort in MOLST discussions despite successfully completing an on-line tutorial. METHODS: We conducted semi-structured telephone interviews with 18 housestaff who completed the on-line MOLST training module. Housestaff participants demonstrated good knowledge of legal and regulatory issues related to the MOLST compared to their peers, but reported feeling less than comfortable discussing the MOLST with patients. Transcripts of interviews were coded using thematic analysis to describe barriers to using the MOLST and suggestions for improving housestaff education about end of life care discussions. RESULTS: Qualitative analysis showed three major factors contributing to lack of housestaff comfort completing the MOLST form: [1] physician barriers to completion of the MOLST, [2] perceived patient barriers to completion of the MOLST, and [3] design characteristics of the MOLST form. Housestaff recommended a number of adaptations for improvement, including in-person training to improve their skills conducting conversations regarding end of life preferences with patients. CONCLUSIONS: Some housestaff who scored highly on knowledge tests after completing a formal on-line curriculum on the MOLST form reported barriers to using a mandated form despite receiving training. On-line modules may be insufficient for teaching communication skills to housestaff. Additional training opportunities including in-person training mechanisms should be incorporated into housestaff communication skills training related to end of life care.


Assuntos
Diretivas Antecipadas/psicologia , Reanimação Cardiopulmonar/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Ordens quanto à Conduta (Ética Médica)/psicologia , Adulto , Diretivas Antecipadas/legislação & jurisprudência , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Maryland , Relações Médico-Paciente , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Inquéritos e Questionários
19.
PLoS One ; 15(6): e0234442, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555585

RESUMO

Seasonal migrations are key to the production and persistence of marine fish populations but movements within shelf migration corridors or, "flyways", are poorly known. Atlantic sturgeon and striped bass, two critical anadromous species, are known for their extensive migrations along the US Mid-Atlantic Bight. Seasonal patterns of habitat selection have been described within spawning rivers, estuaries,and shelf foraging habitats, but information on the location and timing of key coastal migrations is limited. Using a gradient-based array of acoustic telemetry receivers, we compared the seasonal incidence and movement behavior of these species in the near-shelf region of Maryland, USA. Atlantic sturgeon incidence was highest in the spring and fall and tended to be biased toward shallow regions, while striped bass had increased presence during spring and winter months and selected deeper waters. Incidence was transient (mean = ~2 d) for both species with a pattern of increased residency (>2 d) during autumn and winter, particularly for striped bass, with many individuals exhibiting prolonged presence on the outer shelf during winter. Flyways also differed spatially between northern and southern migrations for both species and were related to temperature: striped bass were more likely to occur in cool conditions while Atlantic sturgeon preferred warmer temperatures. Observed timing and spatial distribution within the Mid-Atlantic flyway were dynamic between years and sensitive to climate variables. As shelf ecosystems come under increasing maritime development, gridded telemetry designs represent a feasible approach to provide impact responses within key marine flyways like those that occur within the US Mid-Atlantic Bight.


Assuntos
Migração Animal , Bass/fisiologia , Monitorização de Parâmetros Ecológicos/estatística & dados numéricos , Animais , Oceano Atlântico , Monitorização de Parâmetros Ecológicos/instrumentação , Monitorização de Parâmetros Ecológicos/métodos , Estuários , Maryland , Tecnologia de Sensoriamento Remoto/instrumentação , Tecnologia de Sensoriamento Remoto/estatística & dados numéricos , Estações do Ano , Água do Mar , Análise Espaço-Temporal , Temperatura
20.
Ann Epidemiol ; 45: 40-46.e4, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32371044

RESUMO

PURPOSE: Cohort participants usually have lower mortality rates than nonparticipants, but it is unclear if this survival advantage decreases or increases as cohort studies age. METHODS: We used a 1975 private census of Washington County, Maryland, to compare mortality among cohort participants to nonparticipants for three cohorts, Campaign Against Cancer and Stroke (CLUE I), Campaign Against Cancer and Heart Disease (CLUE II), and Atherosclerosis Risk In Communities (ARIC) initiated in 1974, 1989, and 1986, respectively. We analyzed mortality risk using time-truncated Cox regression models. RESULTS: Participants had lower mortality risk in the first 10 years of follow-up compared with nonparticipants (fully adjusted average hazard ratio [95% confidence intervals] were 0.72 [0.68, 0.77] in CLUE I, 0.69 [0.65, 0.73] in CLUE II, and 0.74 [0.63, 0.86] in ARIC), which persisted over 20 years of follow-up (0.81 [0.78, 0.84] in CLUE I, 0.87 [0.84, 0.91] in CLUE II, and 0.90 [0.83, 0.97] in ARIC). This lower average hazard for mortality among participants compared with nonparticipants attenuated with longer follow-up (0.99 [0.96, 1.01] after 30+ years in CLUE I, 1.02 [0.99, 1.05] after 30 years in CLUE II, and 0.95 [0.89, 1.00] after 30+ years in ARIC). In ARIC, participants who did not attend visits had higher mortality, but those who did attend visits had similar mortality to the community. CONCLUSIONS: Our results suggest the volunteer selection for mortality in long-standing epidemiologic cohort studies often diminishes as the cohort ages.


Assuntos
Aterosclerose/mortalidade , Cardiopatias/mortalidade , Neoplasias/mortalidade , Acidente Vascular Cerebral/mortalidade , Idoso , Estudos de Coortes , Pesquisa Participativa Baseada na Comunidade , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Mortalidade/tendências , Fatores de Risco , Viés de Seleção , Estados Unidos/epidemiologia
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