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1.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 142-147, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465180

RESUMO

Introduction: The analysis of injuries caused by traffic from a physical and mathematical perspective can help improve road safety strategies. Objective: Predict the dynamics of traffic fatalities in the states of Maryland and Massachusetts for the years 2004 and 2014 in the context of probabilistic random walk. Methods: An analysis was made of the number of total fatalities caused by traffic per year, in the states of Maryland and Massachusetts between the years 1994-2003 and 1994-2013. The behavior of these values was analyzed as a probabilistic random walk; for this, the probabilistic lengths were found for each year, during the period studied and four probability spaces were analyzed, with which it was possible to analyze their behavior, to establish a prediction of the number of total fatalities caused by traffic for the years 2004 and 2014. Results: The predictions for the years 2014 and 2004 for Maryland and Massachusetts when compared with the real values, the percentage of success was 98%. Main conclusion: The predictions for the years 2014 and 2004 for Maryland and Massachusetts when compared with the real values, the percentage of success was 98%. Conclusions: the behavior of traffic fatalities in Maryland and Massachusetts presented a predictable self-organization from the context of probabilistic random walk, constituting a useful tool for analyzing the operation of road safety strategies.


Assuntos
Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/tendências , Humanos , Maryland/epidemiologia , Massachusetts/epidemiologia , Teoria da Probabilidade
2.
Am Surg ; 85(6): 595-600, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267899

RESUMO

Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.


Assuntos
Tratamento de Emergência/métodos , Cirurgia Geral/organização & administração , Avaliação de Resultados (Cuidados de Saúde) , Transferência de Pacientes/organização & administração , Qualidade da Assistência à Saúde , Estudos de Coortes , Bases de Dados Factuais , Emergências , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Relações Interinstitucionais , Tempo de Internação , Masculino , Maryland , Estudos Retrospectivos , Contrato de Transferência de Pacientes
3.
World J Pediatr Congenit Heart Surg ; 10(4): 446-453, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307305

RESUMO

BACKGROUND: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. METHODS: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. RESULTS: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. CONCLUSIONS: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/sangue , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente/tendências , Fragmentos de Peptídeos/sangue , Medição de Risco/métodos , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Alta do Paciente/tendências , Período Pós-Operatório , Prognóstico , Precursores de Proteínas , Estudos Retrospectivos , Taxa de Sobrevida/tendências
4.
Int J Syst Evol Microbiol ; 69(9): 2681-2686, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199223

RESUMO

Thirteen isolates of Gram-stain-negative, motile, violet-pigmented bacteria were isolated from marshes along tidal portions of the Potomac and James rivers in Maryland and Virginia, USA, respectively. 16S rRNA gene sequences and fatty acid analysis revealed a high degree of relatedness among the isolates, and genomic sequencing of two isolates, IIBBL 112-1T and IIBBL 274-1 (from the Potomac and James rivers, respectively), revealed highly similar genomic sequences, with a blast-based average nucleotide identity (ANIb) of ca. 98.7 %. Phylogenetic analysis of 16S rRNA gene sequences suggested that the species most highly related to IIBBL 112-1T were Chromobacterium amazonense, Chromobacterium subtsugae and Chromobacterium sphagni. However, deletion of a 25-nucleotide sequence that may have been horizontally acquired by both IIBBL 112-1T and C. amazonense resulted in a substantially different analysis; in the latter case, the species nearest IIBBL 112-1T were Chromobacterium violaceum, Chromobacterium vaccinii and Chromobacterium piscinae. Whole-genome alignments between either IIBBL 112-1T or IIBBL 274-1 and the type strains of C. vaccinii or C. violaceum resulted in ANIb values in the range of ca. 87 %, while alignment with C. amazonense CBMAI 310T resulted in an ANIb of ca. 83 %. Collectively, these data demonstrate that IIBBL 112-1T and IIBBL 274-1 represent a new taxon within the genus Chromobacterium. We propose the name Chromobacterium phragmitis sp. nov. for this taxon; the type strain is IIBBL 112-1T (=NRRL B-67132T=JCM 31884T).


Assuntos
Chromobacterium/classificação , Estuários , Filogenia , Áreas Alagadas , Técnicas de Tipagem Bacteriana , Composição de Bases , Chromobacterium/isolamento & purificação , DNA Bacteriano/genética , Ácidos Graxos/química , Maryland , Pigmentação , RNA Ribossômico 16S/genética , Rios , Análise de Sequência de DNA , Virginia
5.
Medicine (Baltimore) ; 98(25): e16055, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232942

RESUMO

Patients with increased body mass index (BMI) are often denied reduction mammoplasty due to concern for high morbidity. There is a paucity of evidence identifying high BMI as a predictor of poor long-term outcomes in reduction mammoplasty. In this study, we investigated the influence of BMI on long-term patient satisfaction following reduction mammoplasty.All patients undergoing reduction mammoplasty over a 12-year period at a single institution were included in the study. A retrospective chart review was conducted to extract demographics, operative data, and postoperative course including complications. Patients were classified into 4 categories based on BMI (normal (<25), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40)). Patient satisfaction was assessed using a customized survey which was administered over the phone. Only patients with complete medical records who participated in the survey were included.The 70 patients met the inclusion criteria for the study. Median time from surgery to survey was 6 years. Overall satisfaction after reduction mammoplasty was high, 5 on a 5-point Likert scale. The amount of breast tissue resected correlated with patient BMI (P <.01). There was no statistical difference in satisfaction across BMI classes. Furthermore, high BMI (obese, and morbidly obese) was not associated with higher postoperative complications (P = .70). Those with a high overall satisfaction score had a significantly greater self-reported aesthetic score compared to those with low and mid satisfied scores (P <.01).Following reduction mammoplasty, patients report high satisfaction which is sustained over several years. Obesity is not associated with a higher incidence of complications or lower satisfaction. Our data suggest that patients with a high BMI should not be denied reduction mammoplasty out of concern for higher complication rate or reduced patient satisfaction due to BMI alone, but reduction mammoplasty should be considered in the setting of overall health counseling.


Assuntos
Índice de Massa Corporal , Mamoplastia/normas , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Idoso , Feminino , Humanos , Mamoplastia/métodos , Maryland/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
6.
J Environ Manage ; 246: 11-18, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31170619

RESUMO

Forest patches in developed landscapes perform ecohydrological functions that can reduce urban stormwater flows. However, urban forest patch contributions to runoff mitigation are not well understood due to a lack of performance data. In this study, we focus on the potential of urban forest patch soils to infiltrate rainfall by characterizing rates of unsaturated hydraulic conductivity (K) in 21 forest patches in Baltimore, Maryland. Soil bulk density, organic matter, soil moisture, percent of coarse fragments (≥2 mm), and texture were evaluated at the same locations to assess drivers of K. The K was significantly higher in soils with high sand content and related positively with the percent of coarse fragment material in the soil. Forest patch size did not impact K. We estimate that 68 percent of historic rainfall could be infiltrated by urban forest patch soils at the measured K rates. Continuous monitoring at one forest patch also showed that K is dynamic in time and influenced by antecedent soil moisture conditions. We conservatively estimate that unsaturated urban forest patch soils alone are capable of infiltrating most rain events of low to moderate intensities that fell within these forest patches in the Baltimore region. Considering this ecohydrologic function, the protection and expansion of forest patches can make substantial contributions to stormwater mitigation.


Assuntos
Florestas , Solo , Maryland , Chuva
7.
Sci Total Environ ; 682: 282-290, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31121353

RESUMO

An important challenge in amphibian ecotoxicology and conservation is that amphibian toxicity tests are usually focused on a single chemical while populations experience multiple, simultaneous stressors. For example, about 14 million tons of road de-icing salts are used each year in North America with NaCl accounting for 98% of total salt use and, hence, elevated chloride is an important environmental stressor to aquatic organisms, including amphibians. As well, higher temperature as a result of climate change is becoming an increasingly important environmental stressor. There are no data on the combined effects of chloride and temperature on amphibians hinders conservation efforts. We conducted field studies to characterize chloride concentrations and water temperatures in known amphibian breeding habitats and performed toxicity tests to explore impacts of these two stressors on a common anuran, the green frog (Lithobates clamitans). A 96-hour acute toxicity test was conducted to first determine a chloride LC50 (2587.5 mg Cl-/L) at a single, neutral temperature, which was used to inform the treatment levels of the sub-chronic test, which also included a temperature range. In the sub-chronic study, green frog larvae were exposed to three temperatures (18, 22, and 25 °C), and four concentrations of chloride (0, 500, 1000, and 2000 mg Cl-/L) for 35 days. At all temperatures, tadpoles exposed to 2000 mg Cl-/L had significantly higher mortality. While there was no significant effect of temperature alone on mortality, survival of tadpoles was significantly lower at 1000 mg Cl-/L at the two higher temperatures suggesting a potentiation of chloride ion toxicity with increasing temperature. Comparing toxicity results to field measurements of chloride and temperature suggests green frog tadpoles and other species with similar sensitivity are likely negatively affected. Data on additional species and populations would further increase our understanding of how salt and temperature may shape aquatic communities.


Assuntos
Cloretos/toxicidade , Aquecimento Global , Temperatura Alta/efeitos adversos , Rana clamitans/metabolismo , Poluentes Químicos da Água/toxicidade , Animais , Mudança Climática , Relação Dose-Resposta a Droga , Larva/efeitos dos fármacos , Larva/crescimento & desenvolvimento , Maryland , Rana clamitans/crescimento & desenvolvimento , Testes de Toxicidade Subcrônica
8.
Sci Total Environ ; 683: 154-165, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31129325

RESUMO

Sediment contamination is a major environmental issue in many urban watersheds and coastal areas due to the potential toxic effects of contaminants on biota and human health. Characterizing and delineating areas of sediment contamination and toxicity are important goals of coastal resource management in terms of ecological and economical perspectives. Core and surficial sediment samples were collected from an industrialized urban watershed at the East Coast of the United Stated and analyzed to evaluate the PCB contamination profile and toxicity resulting from dioxin-like PCBs as well as reductive dechlorination potential of indigenous PCB halorespiring bacteria through dechlorination activity assays. To support the experimental results an anaerobic dechlorination model was applied to identify microbial dechlorination pathways. The total PCB concentration in core samples ranged from 3.9 to 225.6 ng/g·dry weight (dw) decreasing with depth compared to 353.2 to 1213.7 ng/g·dw in surficial samples. The results of this study indicated an increase in PCB contamination over the last century as the industrial activity intensified. The toxicity resulting from dioxin-like PCBs was reduced up to 94% in core samples via 21 pathways resulting from the dechlorination model. Dechlorination rates in surficial sediment were between 1.8 and 13.2 ·â€¯10-3 mol% PCB116/day, while lower rates occurred in the core sediment samples. Dechlorination was achieved mainly through meta followed by para dechlorination. However, the rarer ortho dechlorination was also observed. Detection of indigenous PCB dechlorinating bacteria in the sediments and reduction of toxicity indicated potential for natural attenuation when point and nonpoint source PCBs in the urban watershed are controlled and PCB loading reduced.


Assuntos
Bactérias/metabolismo , Cloro/metabolismo , Sedimentos Geológicos/análise , Bifenilos Policlorados/análise , Poluentes Químicos da Água/análise , Biodegradação Ambiental , Cloro/análise , Maryland , Bifenilos Policlorados/metabolismo , Poluentes Químicos da Água/metabolismo
9.
Plant Dis ; 103(6): 1189-1195, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30964416

RESUMO

Brown marmorated stink bug (Halyomorpha halys Stål) is an invasive agricultural pest that causes severe damage to many crops. To determine potential associations between H. halys feeding damage, Fusarium infection, and mycotoxin contamination in field corn, a field survey was conducted in eight counties in Virginia. Results indicated an association between H. halys feeding damage and fumonisin contamination. Subsequent field experiments in Delaware, Maryland, and Virginia examined the ability of H. halys to increase Fusarium verticillioides (Sacc.) Nirenberg infection and fumonisin concentrations in corn. At the milk stage, H. halys (0 or 4 adults) and Fusarium (with or without F. verticillioides inoculum) treatments were applied to bagged ears in a two by two factorial randomized complete block design with 12 replicates. H. halys treatments increased levels of feeding damage (P < 0.0001) and Fusarium infection (P = 0.0380). Interaction between H. halys and Fusarium treatments influenced severity of infection (P = 0.0018) and fumonisin concentrations (P = 0.0360). Results suggest H. halys has the ability to increase both Fusarium infection and fumonisin concentrations in field corn. Further studies are needed to understand mechanisms by which H. halys increases fumonisin and to develop management strategies to mitigate impacts of H. halys on field corn in the region.


Assuntos
Fumonisinas , Fusarium , Hemípteros , Zea mays , Animais , Delaware , Fumonisinas/análise , Fusarium/química , Fusarium/fisiologia , Hemípteros/química , Hemípteros/microbiologia , Maryland , Virginia , Zea mays/química , Zea mays/microbiologia
10.
Adv Emerg Nurs J ; 41(2): 172-182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033665

RESUMO

The American College of Radiology (ACR) developed Appropriateness Criteria (ACR-AC) for diagnostic imaging to reduce overuse and promote high-yield, cost-effective, evidence-based decision-making. For adult headaches, there are 16 variants with specific imaging recommendations. Headache accounts for 4.5% of emergency department (ED) visits, and 61% are chronic. Imaging for headaches has increased in the past 2 decades, with intracranial pathology diagnoses going down. Evidence suggests that there is poor knowledge of the ACR-AC among advanced practice nurses (APNs) and nonradiologist physicians. The ACR-AC recommendations were examined using the Health Care Cost and Utilization Project State Emergency Department Data (HCUP SEDD) from Maryland in 2013. Imaging proportions were examined, as well as differences between residency program hospitals and hospitals that have APNs in the ED. Of the 11,109 chronic headache visits, a quarter underwent computed tomography ([CT]; 26.9%) and 3.6% underwent magnetic resonance imaging (MRI); the ACR-AC does not recommend use of either of these in patients with chronic headache. There were significant practice differences related to hospital teaching and whether APNs were employed in the ED or not. For patients with posttraumatic headache, there were no significant differences in practice. Computed tomography was used in 76.4% of posttraumatic headache visits. It is unknown whether the ACR-AC are being used in the ED, and there is variability in following the recommendations. Posttraumatic headache protocol is well established in the ED, but chronic headache continues to be a problem in imaging overuse despite recommendations. Radiological education, including the ACR-AC, as well as radiation dosing and exposure information should be part of APN, physician, and registered nurse education, as well as continuing education. Continuing education is critical for adherence to the ACR-AC, as the recommendations are complex and continuously evolving. In addition, to minimize overuse of CT in headaches, the ACR-AC should be integrated into clinical decision support to promote best imaging practices.


Assuntos
Enfermagem em Emergência , Serviço Hospitalar de Emergência , Fidelidade a Diretrizes , Cefaleia/diagnóstico por imagem , Cefaleia/enfermagem , Neuroimagem , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Idoso , Tomada de Decisões , Humanos , Maryland , Pessoa de Meia-Idade
11.
Bull World Health Organ ; 97(4): 252-253, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940981

RESUMO

Mirfin Mpundu spoke to Gary Humphreys about his experiences in African countries and in the United States of America, the prospects for containing antimicrobial resistance, and the contribution that faith-based organizations make to health systems in African countries.


Assuntos
Gestão de Antimicrobianos , Doenças Transmissíveis/tratamento farmacológico , Resistência Microbiana a Medicamentos , África , Gestão de Antimicrobianos/métodos , Infecções por HIV/tratamento farmacológico , Humanos , Malária/tratamento farmacológico , Maryland , Farmacêuticos , Religião , Tuberculose/tratamento farmacológico , Estados Unidos , Organização Mundial da Saúde
12.
Environ Monit Assess ; 191(5): 265, 2019 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-30953208

RESUMO

The Anacostia River, a Chesapeake Bay tributary running through Washington, D.C., is small but highly polluted with nutrients and contaminants. There is currently a multi-billion dollar tunnel project underway, being built in several phases, aimed at diverting effluent to sewage treatment, especially during high flow periods, and improving water quality of the Anacostia and the river into which it flows, the Potomac. Here, 4 years of biweekly to monthly nutrient and phytoplankton data are analyzed to assess pre-tunnel eutrophication status and relationships to flow conditions. Under all flow conditions, nutrients prior to tunnel implementation were well in excess of values normally taken to be limiting for growth, and hypoxia was apparent during summer. Chlorophyll a was higher in summer (averaging 26.9 µg L-1) than in spring (averaging 14.8 µg L-1), and based on pigment composition, summer communities had proportionately more cyanobacteria (> 2-fold higher zeaxanthin to chlorophyll a ratios) compared to spring, which had proportionately more diatoms (> 2-fold higher fucoxanthin to chlorophyll a ratios). When all data from all years and sites were considered, there was a decrease in diatoms and increase in cyanobacteria with decreasing NO3- and increasing NH4+ concentrations, increasing ratios of NH4+ to NO3-, and increasing temperature. Tunnel implementation and associated nutrient reductions may reduce the severity of summer blooms but reductions of spring assemblages may be even greater because river flows are typically higher at that time of year.


Assuntos
Monitoramento Ambiental , Política Ambiental , Poluição da Água/prevenção & controle , Baías , Clorofila/análise , Clorofila A , Cianobactérias , District of Columbia , Eutrofização , Maryland , Nitrogênio/análise , Fósforo/análise , Fitoplâncton/crescimento & desenvolvimento , Rios/química , Estações do Ano , Poluição da Água/estatística & dados numéricos
13.
Sci Total Environ ; 666: 1151-1160, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30970480

RESUMO

The occurrence of antimicrobials and other pharmaceuticals in streams is increasingly being reported, yet the impacts of these contaminants of emerging concern on aquatic ecosystems are relatively unknown. Bacteria and fungi are vital components of stream environments and, therefore, exposure to antimicrobials may have important consequences for ecosystem services, such as carbon cycling. The objective of this study was to investigate how two antimicrobials, ciprofloxacin and climbazole, impact detrital biofilm metabolism in urban and rural streams. To establish baseline conditions, the biological oxygen demand (BOD) of red maple (Acer rubrum) biofilms was measured in one urban and one rural stream. In mesocosm studies, the BOD of biofilms on single- and mixed-species leaf litter from the same sites was measured after exposure to 10 µg/L of the antimicrobials, both in combination and individually. The presence of ciprofloxacin and climbazole did not affect BOD compared to the controls at the urban site, although significant differences were identified for select treatments at the rural site. In addition, the BOD of mixed-leaf biofilms was not significantly different from that of single species litter after exposure. Overall, exposure to 10 µg/L of the antimicrobials did not significantly impact community-level carbon processing by the leaf biofilms, and leaf mixtures did not result in increased biofilm BOD compared to single species leaves. The outcomes of this work demonstrate a need for further research for the understanding the effects of antimicrobials on rural streams to prevent unintended consequences to ecological processes and biota from future development, leaking septic systems, and wastewater spills.


Assuntos
Antibacterianos/efeitos adversos , Antifúngicos/efeitos adversos , Fenômenos Fisiológicos Bacterianos/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Ciprofloxacino/efeitos adversos , Imidazóis/efeitos adversos , Rios/microbiologia , Análise da Demanda Biológica de Oxigênio , Cidades , Maryland , Folhas de Planta/microbiologia
15.
Vet Pathol ; 56(4): 576-585, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30917748

RESUMO

Postmortem evaluation of racehorses has focused primarily on musculoskeletal injuries; however, horses also die suddenly on the track (sudden death [SD]). Although cardiac conditions are frequently suspected as a cause of death, SD racehorses are often autopsy negative; however, previous studies have been limited due to inconsistent or insufficient cardiac sampling and lack of controls. SD in New York (NY) and Maryland (MD) racehorses was evaluated in an observational case vs control study comparing clinical information, postmortem evaluation including cardiac dissection, and cardiac conduction system histopathology. In the study period, there were 40 cases of SD. In NY, SD occurred in 12% (37/316) of submissions, and 36 (11%) cases of SD were exercise associated (EASD); 3 EASD cases occurred in MD. In NY/MD EASD cases with histologic examination of the heart, 11 of 36 (31%) had significant lesions, including mesenteric artery rupture (1), axial trauma (2), systemic inflammation (2), pulmonary hemorrhage (1), and cardiac disease (5). Mild myocardial fibrosis, mild inflammation, coronary arteriosclerosis, and variation in cardiac nodal connective tissue were present in both SD cases and controls and thus were not considered to be causes of SD. While not excluding a genetic basis for SD, analysis of the genotypes (GGP Equine 70 K Array) of cases and controls did not reveal significant differences in allele frequencies at any locus. Most SD racehorses were autopsy negative; further research using standardized protocols and controls is needed to understand the underlying causes of SD, which is crucial to protecting the viability of racing.


Assuntos
Doença da Artéria Coronariana/veterinária , Morte Súbita Cardíaca/veterinária , Hemorragia/veterinária , Doenças dos Cavalos/patologia , Pneumopatias/veterinária , Animais , Autopsia/veterinária , Doença da Artéria Coronariana/patologia , Morte Súbita Cardíaca/patologia , Feminino , Genômica , Hemorragia/patologia , Doenças dos Cavalos/diagnóstico , Cavalos , Pneumopatias/patologia , Masculino , Maryland , Miocárdio/patologia , New York , Condicionamento Físico Animal , Estudos Retrospectivos
16.
Zoonoses Public Health ; 66(4): 382-392, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30891945

RESUMO

Salmonella Kentucky is among the most frequently isolated S. enterica serovars from food animals in the United States. Recent research on isolates recovered from these animals suggests there may be geographic and host specificity signatures associated with S. Kentucky strains. However, the sources and genomic features of human clinical S. Kentucky isolated in the United States remain poorly described. To investigate the characteristics of clinical S. Kentucky and the possible sources of these infections, the genomes of all S. Kentucky isolates recovered from human clinical cases in the State of Maryland between 2011 and 2015 (n = 12) were sequenced and compared to a database of 525 previously sequenced S. Kentucky genomes representing 12 sequence types (ST) collected from multiple sources on several continents. Of the 12 human clinical S. Kentucky isolates from Maryland, nine were ST198, two were ST152, and one was ST314. Forty-one per cent of isolates were recovered from patients reporting recent international travel and 58% of isolates encoded genomic characteristics similar to those originating outside of the United States. Of the five isolates not associated with international travel, three encoded antibiotic resistance genes conferring resistance to tetracycline or aminoglycosides, while two others only encoded the cryptic aac(6')-Iaa gene. Five isolates recovered from individuals with international travel histories (ST198) and two for which travel was not recorded (ST198) encoded genes conferring resistance to between 4 and 7 classes of antibiotics. Seven ST198 genomes encoded the Salmonella Genomic Island 1 and substitutions in the gyrA and parC genes known to confer resistance to ciprofloxacin. Case report data on food consumption and travel were, for the most part, consistent with the inferred S. Kentucky phylogeny. Results of this study indicate that the majority of S. Kentucky infections in Maryland are caused by ST198 which may originate outside of North America.


Assuntos
Farmacorresistência Bacteriana Múltipla/genética , Genoma Bacteriano , Filogenia , Infecções por Salmonella/microbiologia , Salmonella enterica/isolamento & purificação , Animais , Ciprofloxacino/farmacologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Maryland/epidemiologia , Testes de Sensibilidade Microbiana , Infecções por Salmonella/epidemiologia , Salmonelose Animal/transmissão , Salmonella enterica/genética , Sorogrupo , Doença Relacionada a Viagens
17.
Sci Total Environ ; 670: 732-740, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-30909049

RESUMO

The microbial quality of irrigation water is typically assessed by measuring the concentrations of E. coli in irrigation water reservoirs that are variable in space and time. E. coli concentrations are affected by water quality parameters that co-vary with E. coli concentrations and may be easily measured with currently available sensors. The objective of this work was to identify the most influential environmental covariates affecting E. coli concentrations during a three-month biweekly monitoring period within two irrigation ponds in Maryland during the summer of 2017. E. coli levels as well as sensor-based water quality parameters including turbidity, pH, dissolved oxygen, dissolved fluorescent organic matter, conductivity, and chlorophyll were measured at 23 and 34 locations in ponds 1 and 2, respectively. Regression tree analyses were used to determine the most influential water quality parameters for the prediction of E. coli levels. Correlations between E. coli and water quality covariates were not strong and were inconsistently significant. Shoreline sample locations had higher E. coli concentrations than interior pond samples and significant differences were observed when comparing these two groups. Regression trees provided fairly accurate predictions of E. coli levels based on water quality parameters with R2 values ranging from 0.70 to 0.93. Factors identified via the regression trees varied by sampling date but common leading covariates included cyanobacteria, organic matter, and turbidity. Results indicated environmental covariates, sensed either remotely or in situ, could be useful to delineate areas with different E. coli survival conditions across irrigation ponds and potentially other water bodies such as lakes, rivers, or bays.


Assuntos
Irrigação Agrícola , Monitoramento Ambiental , Escherichia coli/crescimento & desenvolvimento , Tanques/microbiologia , Microbiologia da Água , Maryland , Estações do Ano
18.
J Wound Ostomy Continence Nurs ; 46(2): 98-105, 2019 Mar/Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30844867

RESUMO

The purpose of this quality improvement project was to determine hospitalists' knowledge, practices, and perspectives related to management of pressure injuries and neuropathic/diabetic foot complications (having a foot ulcer or subsequent development of a foot infection because of a foot ulcer). We also sought to identify resources for and knowledge-based barriers to management of these wounds. This quality improvement effort targeted an interdisciplinary group of 55 hospitalists in internal medicine that consisted of 8 nurse practitioners, 10 physician assistants, and 38 physicians. The site of this initiative was the Johns Hopkins Bayview Medical Center, a 342-bed academic hospital located in the mid-Atlantic United States (Baltimore Maryland). The first phase of our quality improvement project comprised an online survey to identify hospitalists' knowledge, practices, and opinions on inpatient management of pressure injuries and diabetic foot complications. The second phase involved semistructured focus groups attended by hospitalists to identify resource gaps and barriers inferred by survey results. Twenty-nine of 55 (52%) hospitalists responded to the survey; 72% indicated no formal training in wound care. Over 90% had little to no confidence in management of pressure injuries and diabetic foot complications. In a separate ranking section of the survey, respondents selected lack of knowledge/confidence 12 of 29 (41.3%) and resources 9 of 29 (31.0%) as number 1 barriers to wound care. Managing patients with obesity was identified as a second major barrier from 10 of 29 selected options (34.5%). Eighteen of 55 (33%) hospitalists attended focus group sessions acknowledging barriers to wound care that included provider education, information technology, system factors, and interprofessional engagement. Attendees welcomed additional educational and ancillary resource support.


Assuntos
Médicos Hospitalares/psicologia , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Percepção , Cicatrização , Adulto , Competência Clínica/normas , Pé Diabético/terapia , Feminino , Grupos Focais/métodos , Médicos Hospitalares/tendências , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Lesão por Pressão/terapia , Melhoria de Qualidade , Inquéritos e Questionários
19.
Br J Anaesth ; 122(4): 480-489, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30857604

RESUMO

BACKGROUND: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function. METHODS: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0-2] or lighter (OAA/S 3-5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan-Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return. RESULTS: One-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02-1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60-0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84-0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03-1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24-2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53-0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10-0.97; P=0.04]. CONCLUSIONS: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00590707.


Assuntos
Sedação Consciente/métodos , Sedação Profunda/métodos , Delírio do Despertar/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Raquianestesia , Sedação Consciente/efeitos adversos , Relação Dose-Resposta a Droga , Delírio do Despertar/etiologia , Delírio do Despertar/mortalidade , Feminino , Força da Mão , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Estimativa de Kaplan-Meier , Masculino , Maryland/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Propofol/administração & dosagem , Propofol/efeitos adversos , Recuperação de Função Fisiológica
20.
Immunogenetics ; 71(4): 335-346, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30761419

RESUMO

Infectious diseases are causing catastrophic losses to global biodiversity. Iridoviruses in the genus Ranavirus are among the leading causes of amphibian disease-related mortality. Polymorphisms in major histocompatibility complex (MHC) genes are significantly associated with variation in amphibian pathogen susceptibility. MHC genes encode two classes of polymorphic cell-surface molecules that can recognize and bind to diverse pathogen peptides. While MHC class I genes are the classic mediators of viral-acquired immunity, larval amphibians do not express them. Consequently, MHC class II gene diversity may be an important predictor of Ranavirus susceptibility in larval amphibians, the life stage most susceptible to Ranavirus. We surveyed natural populations of larval wood frogs (Rana sylvatica), which are highly susceptible to Ranavirus, across 17 ponds and 2 years in Maryland, USA. We sequenced the peptide-binding region of an expressed MHC class IIß locus and assessed allelic and genetic diversity. We converted alleles to functional supertypes and determined if supertypes or alleles influenced host responses to Ranavirus. Among 381 sampled individuals, 26% were infected with Ranavirus. We recovered 20 unique MHC class IIß alleles that fell into two deeply diverged clades and seven supertypes. MHC genotypes were associated with Ranavirus infection intensity, but not prevalence. Specifically, MHC heterozygotes and supertype ST1/ST7 had significantly lower Ranavirus infection intensity compared to homozygotes and other supertypes. We conclude that MHC class IIß functional genetic variation is an important component of Ranavirus susceptibility. Identifying immunogenetic signatures linked to variation in disease susceptibility can inform mitigation strategies for combatting global amphibian declines.


Assuntos
Antígenos de Histocompatibilidade Classe II/imunologia , Polimorfismo Genético , Ranavirus/imunologia , Ranidae/imunologia , Alelos , Animais , Frequência do Gene , Predisposição Genética para Doença/genética , Antígenos de Histocompatibilidade Classe II/classificação , Antígenos de Histocompatibilidade Classe II/genética , Larva/genética , Larva/imunologia , Larva/virologia , Maryland , Filogenia , Ranavirus/fisiologia , Ranidae/genética , Ranidae/virologia
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