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2.
Am J Emerg Med ; 39: 164-167, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33131972

RESUMO

The SARS-CoV-2 is a respiratory virus of the coronavirus family responsible for a global pandemic since December 2019. More than 35 million people have been affected with the novel coronavirus disease (COVID-19), with more than one million deaths worldwide. Michigan was one of the top three states in the United States that was severely affected by the SAR-CoV-2 pandemic with more than 7000 deaths in adults and greater than 145,000 confirmed infections. However, compared to adults, the majority of children until recently were either asymptomatic or had a mild illness with SARS-CoV-2. Recently, a rare but potentially serious presentation associated with SARS-CoV-2 called multisystem inflammatory syndrome in children (MIS-C) has been recently reported and the Centers for Disease Control (CDC) released a case definition for the same. We report the clinical and laboratory presentations and outcomes of 34 children with MIS-C who were evaluated within a 12 week period at a pediatric emergency department (PED) of single institution in Michigan. These cases presented approximately three weeks after the peak of adult SAR-CoV-2 related deaths occurred in the state. While many children presented with clinical characteristics similar to incomplete Kawasaki disease (KD), they also exhibited certain unique features which differentiated MIS-C from KD. The information presented below will aid clinicians with early recognition, evaluation and management of MIS-C in the emergency department.


Assuntos
/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , /fisiopatologia , Criança , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Michigan , Síndrome de Linfonodos Mucocutâneos , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia
3.
Public Health Rep ; 136(1): 27-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33059533

RESUMO

An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.


Assuntos
/epidemiologia , Desinfetantes/toxicidade , Centros de Controle de Intoxicações/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Michigan/epidemiologia , Pandemias
4.
Sports Health ; 13(1): 91-94, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32662740

RESUMO

BACKGROUND: The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned. HYPOTHESIS: Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status. RESULTS: A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete's PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014). CONCLUSION: Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates. CLINICAL RELEVANCE: HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.


Assuntos
Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Exame Físico , Atenção Primária à Saúde/estatística & dados numéricos , Esportes , Vacinação/estatística & dados numéricos , Adolescente , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Michigan , Estudos Retrospectivos , Instituições Acadêmicas
5.
Curr Psychiatry Rep ; 22(12): 88, 2020 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-33289041

RESUMO

PURPOSE OF REVIEW: As a global pandemic, COVID-19 has profoundly disrupted the lives of individuals, families, communities, and nations. This report summarizes the expected impact of COVID-19 on behavioral health, as well as strategies to address mental health needs during the COVID-19 pandemic and its aftermath. The state of Michigan in the USA is used to illustrate the complexity of the mental health issues and the critical gaps in the behavioral health infrastructure as they pertain to COVID-19. Scoping review was conducted to identify potential mental health needs and issues during the COVID-19 pandemic and its aftermath. RECENT FINDINGS: The ramifications of COVID-19 on mental health are extensive, with the potential to negatively impact diverse populations including healthcare providers, children and adolescents, older adults, the LGBTQ community, and individuals with pre-existing mental illness. Suicide rates, alone, are expected to rise for Michiganders due to the economic downturn, isolation and quarantine, increased substance use, insomnia, and increased access to guns associated with the COVID-19 pandemic. This report promotes awareness of a behavioral health crisis due to COVID-19. Increasing access to behavioral health care should minimize COVID-19's negative influence on mental health in Michigan. We propose a three-prong approach to access: awareness, affordability, and technology. Addressing workforce development and fixing gaps in critical behavioral health infrastructure will also be essential. These actions need to be implemented immediately to prepare for the expected "surge" of behavioral health needs in the ensuing months.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Saúde Mental , Determinação de Necessidades de Cuidados de Saúde , Pneumonia Viral , Adolescente , Idoso , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Transtornos Mentais , Michigan/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia
6.
Environ Monit Assess ; 193(1): 7, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33313969

RESUMO

The Michigan Pollution Assessment Laboratory (MPAL) is a mobile air quality monitoring platform designed to measure conventional, toxic, and greenhouse gas (GHG) air pollutants. The spatially and temporally resolved data collected can be used for multiple purposes, such as mapping spatial patterns and identifying peaks. The truck-based platform includes instrumentation for 11 gaseous pollutants and for particulate matter (PM), size distribution (7 nm to 20 µm), PM10, black and brown carbon, and trace metals. MPAL is equipped with meteorological instruments, a high-accuracy GPS, forward and reverse cameras, and a data logging and display system. We selected commercially available instrumentation based on sensitivity, response time, and robustness. The vehicle's power system allows ~ 6.5 h of continuous operation with all instruments operating. This article details the design, construction, and evaluation of MPAL and summarizes data collected in its first year (March 2019 to March 2020) of operation. We completed a series of runs on 84 days in Detroit, Michigan, an area with a diverse set of traffic, industrial, and commercial emission sources, and collected 265,816 1-s observations (excluding collocations, zero checks, and other quality assurance measurements). Using data from these runs as well as special tests, we present results of performance evaluations that examined the response time, PM losses, and wind measurements and compare results to stationary regulatory monitoring data. We highlight key issues and provide practical solutions to help evaluate and resolve these issues and share many lessons learned in developing and using a mobile platform.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Ambientais , Gases de Efeito Estufa , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental , Gases , Michigan , Material Particulado/análise
7.
J Insect Sci ; 20(5)2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33141189

RESUMO

Ophiogomphus howei Bromley is a rare North American dragonfly, given a global conservation rank of Vulnerable by NatureServe. This species inhabits localized stretches of a limited number of typically undisturbed, high-quality, forested rivers in two disjunct regions in North America. We describe a new population in between the known ranges from an impaired river in a largely urban watershed in southern Michigan, United States. We also report a previously overlooked specimen from a new location in Pennsylvania, United States, and provide current occurrence and conservation status of the species in North America.


Assuntos
Distribuição Animal , Odonatos/fisiologia , Animais , Canadá , Traços de História de Vida , Michigan , Ninfa/crescimento & desenvolvimento , Ninfa/fisiologia , Odonatos/crescimento & desenvolvimento , Pennsylvania , Estados Unidos
8.
J Perinat Med ; 48(9): 883-891, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33151180

RESUMO

The outbreak of the SARS-CoV-2 elicited a surge in publications. Obstetric reports were with few exceptions characterized by small sample sizes with potentially limited generalizability. In this review, evidence suggests increased susceptibility to COVID-19 in pregnancy; common pregnancy comorbidities may help explain worse outcomes. While the risk of death is low, pregnancy may be associated with increased need for ventilation. Prematurity rates seem to be increased but may be accounted for in part by higher cesarean rates, to a large degree accounted for by elective decision to shorten the course of the labor. Though fetal/neonatal complication rates may be higher in the presence of COVID-19 infection, survival rates seem unaffected and vertical transmission is rare. As the outbreak continues in the USA with resurgence in many other western countries that achieved initial success in suppressing the virus, much remains to be learned. For example, the question related to the degree to pregnancy modifying symptomatology remains open. Currently, routine polymerase chain reaction testing remains limited by supply shortages possibly delaying diagnosis until later in the course of the disorder and thus altering the symptom complex at presentation. To add to the knowledge base, we initiated a regional COVID-19 in pregnancy collaborative observational study with a coordinating center, standardized data collection and a shared database. This was facilitated by a longstanding tradition of collaboration among regional obstetric services. Over an anticipated two-year study duration, we expect to study 400 documented and suspected COVID-19 pregnancies with time and site of services controls for cohort effect and high power to detect several adverse maternal/infant outcomes. We include a complete listing of variables in our database, which, along with our experience in setting up our regional collaborative, we hope and believe will be of use in other settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Colaboração Intersetorial , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Suscetibilidade a Doenças , Feminino , Humanos , Metanálise como Assunto , Michigan/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Sistema de Registros , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Revisões Sistemáticas como Assunto , Resultado do Tratamento
11.
JAMA Netw Open ; 3(10): e2017659, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33084898

RESUMO

Importance: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous antimicrobial therapy. However, inappropriate PICC use may lead to patient harm. Objective: To evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications. Design, Setting, and Participants: This cohort study of 21 653 PICCs placed for a primary indication of intravenous antimicrobial therapy between January 1, 2015, and July 26, 2019, was conducted in 42 hospitals participating in a quality collaborative across Michigan among hospitalized medical patients. Main Outcomes and Measures: Appropriateness of PICCs was defined according to the Michigan Appropriateness Guide for Intravenous Catheters as a composite measure of (1) single-lumen catheter use, (2) avoiding use of PICCs for 5 days or less, and (3) avoiding use of PICCs for patients with chronic kidney disease (defined as an estimated glomerular filtration rate <45 mL/min/1.73 m2). Complications related to PICCs included catheter occlusion, deep vein thrombosis, and central line-associated bloodstream infection. The association between infectious disease physician approval, device appropriateness, and catheter complications was assessed using multivariable models, adjusted for patient comorbidities and hospital clustering. Results were expressed as odds ratios with 95% CIs. Results: A total of 21 653 PICCs were placed for intravenous antimicrobials (11 960 PICCs were placed in men [55.2%]; median age, 64.5 years [interquartile range, 53.4-75.4 years]); 10 238 PICCs (47.3%) were approved by an infectious disease physician prior to placement. Compared with PICCs with no documented approval, PICCs with approval by an infectious disease physician were more likely to be appropriately used (72.7% [7446 of 10 238] appropriate with approval vs 45.4% [5180 of 11 415] appropriate without approval; odds ratio, 3.53; 95% CI, 3.29-3.79; P < .001). Furthermore, approval was associated with lower odds of a PICC-related complication (6.5% [665 of 10 238] with approval vs 11.3% [1292 of 11 415] without approval; odds ratio, 0.55; 95% CI, 0.50-0.61). Conclusions and Relevance: This cohort study suggests that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications. Policies aimed at ensuring infectious disease physician approval prior to PICC placement for antimicrobials may improve patient safety.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Cateterismo Periférico/normas , Doenças Transmissíveis/terapia , Médicos/estatística & dados numéricos , Autorização Prévia/estatística & dados numéricos , Autorização Prévia/normas , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
12.
Proc Natl Acad Sci U S A ; 117(45): 28175-28182, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33106397

RESUMO

Excessive nitrogen (N) and phosphorus (P) loading is one of the greatest threats to aquatic ecosystems in the Anthropocene, causing eutrophication of rivers, lakes, and marine coastlines worldwide. For lakes across the United States, eutrophication is driven largely by nonpoint nutrient sources from tributaries that drain surrounding watersheds. Decades of monitoring and regulatory efforts have paid little attention to small tributaries of large water bodies, despite their ubiquity and potential local importance. We used a snapshot of nutrient inputs from nearly all tributaries of Lake Michigan-the world's fifth largest freshwater lake by volume-to determine how land cover and dams alter nutrient inputs across watershed sizes. Loads, concentrations, stoichiometry (N:P), and bioavailability (percentage dissolved inorganic nutrients) varied by orders of magnitude among tributaries, creating a mosaic of coastal nutrient inputs. The 6 largest of 235 tributaries accounted for ∼70% of the daily N and P delivered to Lake Michigan. However, small tributaries exhibited nutrient loads that were high for their size and biased toward dissolved inorganic forms. Higher bioavailability of nutrients from small watersheds suggests greater potential to fuel algal blooms in coastal areas, especially given the likelihood that their plumes become trapped and then overlap in the nearshore zone. Our findings reveal an underappreciated role that small streams may play in driving coastal eutrophication in large water bodies. Although they represent only a modest proportion of lake-wide loads, expanding nutrient management efforts to address smaller watersheds could reduce the ecological impacts of nutrient loading on valuable nearshore ecosystems.


Assuntos
Ecossistema , Lagos/química , Rios/química , Disponibilidade Biológica , Monitoramento Ambiental , Eutrofização/fisiologia , Michigan , Nitrogênio/análise , Fósforo/análise
13.
Artigo em Inglês | MEDLINE | ID: mdl-33096838

RESUMO

Phosphorus (P) is a valuable, nonrenewable resource in agriculture promoting crop growth. P losses through surface runoff and subsurface drainage discharge beneath the root zone is a loss of investment. P entering surface water contributes to eutrophication of freshwater environments, impacting tourism, human health, environmental safety, and property values. Soluble P (SP) from subsurface drainage is nearly all bioavailable and is a significant contributor to freshwater eutrophication. The research objective was to select phosphorus sorbing media (PSM) best suited for removing SP from subsurface drainage discharge. From the preliminary research and literature, PSM with this potential were steel furnace slag (SFS) and a nano-engineered media (NEM). The PSM were evaluated using typical subsurface drainage P concentrations in column experiments, then with an economic analysis for a study site in Michigan. Both the SFS and generalized NEM (GNEM) removed soluble reactive phosphorus from 0.50 to below 0.05 mg/L in laboratory column experiments. The most cost-effective option from the study site was the use of the SFS, then disposing it each year, costing $906/hectare/year for the case study. GNEM that was regenerated onsite had a very similar cost. The most expensive option was the use of GNEM to remove P, including regeneration at the manufacturer, costing $1641/hectare/year. This study suggests that both SFS and NEM are both suited for treating drainage discharge. The use of SFS was more economical for the study site, but each site needs to be individually considered.


Assuntos
Fósforo , Água , Adsorção , Agricultura , Humanos , Michigan , Fósforo/análise , Movimentos da Água , Purificação da Água
15.
JAMA Netw Open ; 3(10): e2025197, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33084902

RESUMO

Importance: Black patients are overrepresented in the number of COVID-19 infections, hospitalizations, and deaths in the US. Reasons for this disparity may be due to underlying comorbidities or sociodemographic factors that require further exploration. Objective: To systematically determine patient characteristics associated with racial/ethnic disparities in COVID-19 outcomes. Design, Setting, and Participants: This retrospective cohort study used comparative groups of patients tested or treated for COVID-19 at the University of Michigan from March 10, 2020, to April 22, 2020, with an outcome update through July 28, 2020. A group of randomly selected untested individuals were included for comparison. Examined factors included race/ethnicity, age, smoking, alcohol consumption, comorbidities, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and residential-level socioeconomic characteristics. Exposure: In-house polymerase chain reaction (PCR) tests, commercial antibody tests, nasopharynx or oropharynx PCR deployed by the Michigan Department of Health and Human Services and reverse transcription-PCR tests performed in external labs. Main Outcomes and Measures: The main outcomes were being tested for COVID-19, having test results positive for COVID-19 or being diagnosed with COVID-19, being hospitalized for COVID-19, requiring intensive care unit (ICU) admission for COVID-19, and COVID-19-related mortality (including inpatient and outpatient). Medical comorbidities were defined from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, codes and were aggregated into a comorbidity score. Associations with COVID-19 outcomes were examined using odds ratios (ORs). Results: Of 5698 patients tested for COVID-19 (mean [SD] age, 47.4 [20.9] years; 2167 [38.0%] men; mean [SD] BMI, 30.0 [8.0]), most were non-Hispanic White (3740 patients [65.6%]) or non-Hispanic Black (1058 patients [18.6%]). The comparison group included 7168 individuals who were not tested (mean [SD] age, 43.1 [24.1] years; 3257 [45.4%] men; mean [SD] BMI, 28.5 [7.1]). Among 1139 patients diagnosed with COVID-19, 492 (43.2%) were White and 442 (38.8%) were Black; 523 (45.9%) were hospitalized, 283 (24.7%) were admitted to the ICU, and 88 (7.7%) died. Adjusting for age, sex, socioeconomic status, and comorbidity score, Black patients were more likely to be hospitalized compared with White patients (OR, 1.72 [95% CI, 1.15-2.58]; P = .009). In addition to older age, male sex, and obesity, living in densely populated areas was associated with increased risk of hospitalization (OR, 1.10 [95% CI, 1.01-1.19]; P = .02). In the overall population, higher risk of hospitalization was also observed in patients with preexisting type 2 diabetes (OR, 1.82 [95% CI, 1.25-2.64]; P = .02) and kidney disease (OR, 2.87 [95% CI, 1.87-4.42]; P < .001). Compared with White patients, obesity was associated with higher risk of having test results positive for COVID-19 among Black patients (White: OR, 1.37 [95% CI, 1.01-1.84]; P = .04. Black: OR, 3.11 [95% CI, 1.64-5.90]; P < .001; P for interaction = .02). Having any cancer was associated with higher risk of positive COVID-19 test results for Black patients (OR, 1.82 [95% CI, 1.19-2.78]; P = .005) but not White patients (OR, 1.08 [95% CI, 0.84-1.40]; P = .53; P for interaction = .04). Overall comorbidity burden was associated with higher risk of hospitalization in White patients (OR, 1.30 [95% CI, 1.11-1.53]; P = .001) but not in Black patients (OR, 0.99 [95% CI, 0.83-1.17]; P = .88; P for interaction = .02), as was type 2 diabetes (White: OR, 2.59 [95% CI, 1.49-4.48]; P < .001; Black: OR, 1.17 [95% CI, 0.66-2.06]; P = .59; P for interaction = .046). No statistically significant racial differences were found in ICU admission and mortality based on adjusted analysis. Conclusions and Relevance: These findings suggest that preexisting type 2 diabetes or kidney diseases and living in high-population density areas were associated with higher risk for COVID-19 hospitalization. Associations of risk factors with COVID-19 outcomes differed by race.


Assuntos
Afro-Americanos , Infecções por Coronavirus/etnologia , Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Hospitalização , Pneumonia Viral/etnologia , Adulto , Idoso , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Nefropatias/epidemiologia , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Obesidade/epidemiologia , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Densidade Demográfica , Estudos Retrospectivos , Fatores de Risco
16.
West J Emerg Med ; 21(6): 99-106, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-33052819

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers. In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion. The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle. Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure. This educational advance seeks to use and study in-situ simulation as a means to rapidly implement a process for airway management in patients with COVID-19. METHODS: Using an airway algorithm developed by the authors, we designed an in-situ simulation scenario to train physicians, nurses, and respiratory therapists in best practices for airway management of patients with COVID-19. Physician participants were surveyed using a five-point Likert scale with regard to their comfort level with various aspects of the airway algorithm both before and after the simulation in a retrospective fashion. Additionally, we obtained feedback from all participants and used it to refine the airway algorithm. RESULTS: Over a two-week period, 93 physicians participated in the simulation. We received 81 responses to the survey (87%), which showed that the average level of comfort with personal protective equipment procedures increased significantly from 2.94 (95% confidence interval, 2.71-3.17) to 4.36 (4.24-4.48), a difference of 1.42 (1.20-1.63, p < 0.001). There was a significant increase in average comfort level in understanding the physician role with scores increasing from 3.51 (3.26-3.77) to 4.55 (2.71-3.17), a difference of 1.04 (0.82-1.25, p < 0.001). There was also increased comfort in performing procedural tasks such as intubation, from 3.08 (2.80-3.35) to 4.38 (4.23-4.52) after the simulation, a difference of 1.30 points (1.06-1.54, p < 0.001). Feedback from the participants also led to refinement of the airway algorithm. CONCLUSION: We successfully implemented a new airway management guideline for patients with suspected COVID-19. In-situ simulation is an essential tool for both dissemination and onboarding, as well as process improvement, in the context of an epidemic or pandemic.


Assuntos
Manuseio das Vias Aéreas/métodos , Infecções por Coronavirus/terapia , Pessoal de Saúde/educação , Pneumonia Viral/terapia , Treinamento por Simulação , Algoritmos , Betacoronavirus , Serviço Hospitalar de Emergência , Humanos , Michigan , Pandemias , Equipamento de Proteção Individual , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
17.
J Dent Hyg ; 94(5): 44-52, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33008949

RESUMO

Purpose: Examining the long-term outcomes of education programs delivered online can help assess the impact of the program on graduates and the value of the delivery format. The purpose of this study was to measure the overall outcomes of an online dental hygiene degree completion program and identify key alumni outcomes.Methods: A 35 item electronic survey was delivered via email to all graduates (2009-2017) of an online degree completion program based in Ann Arbor, Michigan, two years following program completion. Survey items included Likert scale, closed and open-ended questions focusing on career characteristics, leadership, scholarly activities, evidence- and community-based practices, professional confidence, and transformative learning. Descriptive and inferential statistics were used to analyze the data.Results: Of the nine alumni cohorts (n=75), 50 graduates participated in the survey for a response rate of 67%. Eighty-two percent of respondents felt they had more career options after graduation and reported post-degree career activities that included dental hygiene instruction (36%), public health (32%), and administration (14%). There was a statistically significant increase in the instructor/educator role of the participants post-graduation (p = 0.000). The majority (94%) indicated the program improved their competency in areas of leadership and evidence-based practice and all (100%) indicated a greater responsibility to use their professional skills to address oral health disparities in their communitiesConclusion: Graduates of the online degree completion program reported ongoing activities in key areas of leadership, evidence- and community-based practice. Future research should focus on ensuring that program goals reflect the evolving dental hygiene profession and program delivery practices meet the needs of the working professional student.


Assuntos
Higienistas Dentários , Higiene Bucal , Humanos , Estudos Longitudinais , Michigan , Inquéritos e Questionários
18.
Med Educ Online ; 25(1): 1827532, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33012265

RESUMO

BACKGROUND: Resident continuity clinics (RCCs), where residents see patients largely independently, is a common requirement for residency programs in the USA. Students often participate in these clinics but it is unknown how this effects resident learning or student satisfaction. OBJECTIVE: This study aims to describe effects on the learning environment when students and residents work together in an RCC. DESIGN: Separate surveys were administered to residents and students working at St. Joseph Mercy Hospital (SJMH) in Ann Arbor, Michigan, from 2016-2018. RESULTS: Response rates were 79/116 (68.1%) for students and 21/24 (87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test whether most five-level Likert-type scale responses were 'agree' or 'strongly agree.' Of medical students, 88.6% enjoyed working with residents (p < 0.001) with 60.8% indicating residents were effective teachers (p < 0.001). The majority of residents (85.7%) were neutral, agreed, or strongly agreed that they enjoyed working with students (p < 0.001). However, 61.9% of residents believed they were too busy to be effective teachers (p < 0.001). CONCLUSIONS: Both residents and students positively viewed their interactions in RCCs. Although most students felt residents were effective teachers, most residents worried about their ability to balance clinical care and teaching responsibilities.


Assuntos
Internato e Residência , Relações Interprofissionais , Estudantes de Medicina , Adulto , Feminino , Humanos , Aprendizagem , Masculino , Michigan , Satisfação Pessoal , Inquéritos e Questionários
19.
Plant Dis ; 104(12): 3135-3142, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33079631

RESUMO

Fusarium root rot (FRR) is a global limiter of dry bean (Phaseolus vulgaris L.) production. In common bean and other legumes, resistance to FRR is related to both root development and root architecture, providing a breeding strategy for FRR resistance. Here, we describe the relationships between root traits and FRR disease symptoms. Using "shovelomics" techniques, a subset of recombinant inbred lines was phenotyped for root architecture traits and disease symptoms across three Michigan fields, including one field with artificially increased Fusarium brasiliense disease pressure. At the early growth stages, stem diameter, basal root number, and distribution of hypocotyl-borne adventitious roots were all significantly related to FRR disease scores. These results demonstrate that root architecture is a component of resistance to FRR in the field at early growth stages (first expanded trifoliate) complementing previous studies that evaluated root traits at later developmental stages (flowering, pod fill, etc.). Correlation matrices of root traits indicate that resistant and susceptible lines have statistically different root systems and show that basal root number is a key feature in resistant root systems while adventitious root distribution is an important feature in susceptible root systems. Based on the results of this study, selection for increased basal root number, increased adventitious root number, and even distribution of adventitious roots in early growth stages (first expanded trifoliate) would positively impact resistance to FRR.


Assuntos
Fusarium , Phaseolus , Michigan , Phaseolus/genética , Raízes de Plantas , Estados Unidos
20.
Environ Int ; 144: 106062, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32871381

RESUMO

BACKGROUND: Lead (Pb) is an environmentally ubiquitous heavy metal associated with a wide range of adverse health effects in children. Both lead exposure and the early life microbiome- which plays a critical role in human development-have been linked to similar health outcomes, but it is unclear if the adverse effects of lead are partially driven by early life gut microbiota dysbiosis. The objective of this study was to examine the association between in utero and postnatal lead levels (measured in deciduous baby teeth) and early life bacterial and fungal gut microbiota in the first year of life. METHODS: Data from the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) birth cohort were analyzed. Tooth lead levels during the 2nd and 3rd trimesters and postnatally (<1 year of age) were quantified using high-resolution microspatial mapping of dentin growth rings. Early life microbiota were measured in stool samples collected at approximately 1 and 6 months of age, using both 16S rRNA (bacterial) and ITS2 (fungal) sequencing. Of the 1,258 maternal-child pairs in WHEALS, 146 had data on both tooth metals and early life microbiome. RESULTS: In utero tooth lead levels were significantly associated with gut fungal community composition at 1-month of age, where higher levels of 2nd trimester tooth lead was associated with lower abundances of Candida and Aspergillus and higher abundances of Malassezia and Saccharomyces; 3rd trimester lead was also associated with lower abundances of Candida. Though lead did not significantly associate with the overall structure of the infant gut bacterial community, it associated with the abundance of some specific bacterial taxa, including the increased abundance of Collinsella and Bilophila and a decreased abundance of Bacteroides taxa. CONCLUSIONS: The observed associations between lead exposure and infant gut microbiota could play a role in the impact of lead on childhood development. Given the paucity of research examining these associations in humans-particularly for fungal microbiota-further investigation is needed.


Assuntos
Microbioma Gastrointestinal , Criança , Fezes , Humanos , Lactente , Chumbo/toxicidade , Estudos Longitudinais , Michigan , Ohio , RNA Ribossômico 16S/genética
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