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3.
Sci Total Environ ; 772: 146030, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-33676747

RESUMO

Contaminants of emerging concern (CECs), such as pharmaceuticals, personal care products, and hormones, are frequently found in aquatic ecosystems around the world. Information on sublethal effects from exposure to commonly detected concentrations of CECs is lacking and the limited availability of toxicity data makes it difficult to interpret the biological significance of occurrence data. However, the ability to evaluate the effects of CECs on aquatic ecosystems is growing in importance, as detection frequency increases. The goal of this study was to prioritize the chemical hazards of 117 CECs detected in subsistence species and freshwater ecosystems on the Grand Portage Indian Reservation and adjacent 1854 Ceded Territory in Minnesota, USA. To prioritize CECs for management actions, we adapted Minnesota Pollution Control Agency's Aquatic Toxicity Profiles framework, a tool for the rapid assessment of contaminants to cause adverse effects on aquatic life by incorporating chemical-specific information. This study aimed to 1) perform a rapid-screening assessment and prioritization of detected CECs based on their potential environmental hazard; 2) identify waterbodies in the study region that contain high priority CECs; and 3) inform future monitoring, assessment, and potential remediation in the study region. In water samples alone, 50 CECs were deemed high priority. Twenty-one CECs were high priority among sediment samples and seven CECs were high priority in fish samples. Azithromycin, DEET, diphenhydramine, fluoxetine, miconazole, and verapamil were high priority in all three media. Due to the presence of high priority CECs throughout the study region, we recommend future monitoring of particular CECs based on the prioritization method used here. We present an application of a chemical hazard prioritization process and identify areas where the framework may be adapted to meet the objectives of other management-related assessments.


Assuntos
Ecossistema , Poluentes Químicos da Água , Animais , Monitoramento Ambiental , Água Doce , Minnesota , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidade
4.
Sci Total Environ ; 772: 146188, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-33715861

RESUMO

Contaminants of emerging concern (CECs) include a variety of pharmaceuticals, personal care products, and hormones commonly detected in surface waters. Human activities, such as wastewater treatment and discharge, contribute to the distribution of CECs in water, but other sources and pathways are less frequently examined. This study aimed to identify anthropogenic activities and environmental characteristics associated with the presence of CECs, previously determined to be of high priority for further research and mitigation, in rural inland lakes in northeastern Minnesota, United States. The setting for this study consisted of 21 lakes located within both the Grand Portage Indian Reservation and the 1854 Ceded Territory, where subsistence hunting and fishing are important to the cultural heritage of the indigenous community. We used data pertaining to numbers of buildings, healthcare facilities, wastewater treatment plants, impervious surfaces, and wetlands within defined areas surrounding the lakes as potential predictors of the detection of high priority CECs in water, sediment, and fish. Separate models were run for each contaminant detected in each sample media. We used least absolute shrinkage and selection operator (LASSO) models to account for both predictor selection and parameter estimation for CEC detection. Across contaminants and sample media, the percentage of impervious surface was consistently positively associated with CEC detection. Number of buildings in the surrounding area was often negatively associated with CEC detection, though nonsignificant. Surrounding population, presence of wastewater treatment facilities, and percentage of wetlands in surrounding areas were positively, but inconsistently, associated with CECs, while catchment area and healthcare centers were generally not associated. The results of this study highlight human activities and environmental characteristics associated with CEC presence in a rural area, informing future work regarding specific sources and transport pathways. We also demonstrate the utility of LASSO modeling in the identification of these important relationships.


Assuntos
Lagos , Poluentes Químicos da Água , Animais , Monitoramento Ambiental , Humanos , Minnesota , Águas Residuárias , Poluentes Químicos da Água/análise
6.
Mayo Clin Proc ; 96(4): 912-920, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33714601

RESUMO

OBJECTIVE: To assess the prevalence and characteristics of coronavirus disease 2019 (COVID-19) cases during the reopening period in older adults, given that little is known about the prevalence of COVID-19 after the stay-at-home order was lifted in the United States, nor the actual effects of adherence to recommended public health measures (RPHM) on the risk of COVID-19. PATIENTS AND METHODS: This was a cross-sectional study nested in a parent prospective cohort study, which followed a population-based sample of 2325 adults 50 years and older residing in southeast Minnesota to assess the incidence of viral infections. Participants were instructed to self-collect both nasal and oropharyngeal swabs, which were tested by reverse transcription polymerase chain reaction-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay between May 8, 2020, and June, 30, 2020. We assessed the prevalence of COVID-19 cases and characteristics of study subjects. RESULTS: A total of 1505 eligible subjects participated in the study whose mean age was 68 years, with 885 (59%) women, 32 (2%) racial/ethnic minorities, and 906 (60%) with high-risk conditions for influenza. The prevalence of other Coronaviridae (human coronavirus [HCoV]-229E, HCoV-NL63, and HCoV-OC43) during the 2019 to 2020 flu season was 109 (7%), and none tested positive for SARS-CoV-2. Almost all participants reported adhering to the RPHM (1,488 [99%] for social distancing, 1,438 [96%] for wearing mask in a public space, 1,476 [98%] for hand hygiene, and 1,441 (96%) for staying home mostly). Eighty-six percent of participants resided in a single-family home. CONCLUSION: We did not identify SARS-COV-2 infection in our study cohort. The combination of participants' behavior in following the RPHM and their living environment may considerably mitigate the risk of COVID-19.


Assuntos
Controle de Doenças Transmissíveis , Fidelidade a Diretrizes/estatística & dados numéricos , Saúde Pública , Idoso , /epidemiologia , /psicologia , /estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Estudos Transversais , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Masculino , Minnesota/epidemiologia , Prevalência , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Comportamento de Redução do Risco , Precauções Universais/métodos , Precauções Universais/estatística & dados numéricos , Virologia/métodos
7.
South Med J ; 114(4): 218-222, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33787935

RESUMO

OBJECTIVES: Physician trainees in obstetrics and gynecology (OBGYN) experience unexpected outcomes similar to those of supervising physicians. A relative lack of experience and perspective may make them more vulnerable to second victim experience (SVE), however. The objectives of our study were to contrast the prevalence of SVE between supervising physicians and trainees and to identify their preferred methods of support. METHODS: In 2019, the Second Victim Experience and Support Tool, a validated survey with supplemental questions, was administered to healthcare workers caring for OBGYN patients at a large academic center in the midwestern United States. RESULTS: The survey was sent to 571 healthcare workers working in OBGYN. A total of 205 healthcare workers completed the survey, including 18 (43.9% of 41) supervising physicians and 12 (48.0% of 25) resident/fellow physicians. The mean scores for the Second Victim Experience and Support Tool dimensions and outcomes were similar between the two groups. Seven (58.3%) trainees reported feeling like a second victim after an adverse patient safety event at some point in their work experience compared with 10 (55.6%) of the supervising physicians. Five (41.7%) trainees identified as a second victim in the previous 12 months compared with 3 (16.7%) supervising physicians (P = 0.21). The most common form of desired support for both groups was conversations with their peers. CONCLUSIONS: Trainees and supervising physicians are both at risk of SVE after an unexpected medical event and prefer conversations with peers as a desired form of support. Because trainees commonly encounter SVEs early in their careers, program directors should consider implementing a program for peer support after an unexpected event.


Assuntos
Fadiga por Compaixão/epidemiologia , Ginecologia/educação , Internato e Residência , Obstetrícia/educação , Médicos/psicologia , Apoio Social , Fadiga por Compaixão/diagnóstico , Fadiga por Compaixão/etiologia , Fadiga por Compaixão/terapia , Inquéritos Epidemiológicos , Humanos , Relações Interprofissionais , Minnesota/epidemiologia , Prevalência , Fatores de Risco
8.
J Dairy Sci ; 104(4): 4665-4681, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33663824

RESUMO

The etiology of mastitis is crucial information to use antimicrobials prudently for control and treatment. This study aimed to evaluate the effects of mastitis diagnosis and treatment strategies with on-farm testing, on cure, new intramammary infections (IMI), somatic cell count (SCC), and antimicrobial use, compared with farmers' current diagnosis and treatment strategies. The on-farm tests used, CHROMagar Mastitis (CHROMagar, Paris, France) and Minnesota Easy Culture System II Tri-plate (University of Minnesota, St. Paul, MN), both had etiological groups of IMI as result, being gram-positive growth, gram-negative growth, or culture negative. Two randomized controlled trials were conducted on 15 herds: trial 1 prospectively enrolled 155 cows with clinical mastitis, and trial 2 cross-sectionally included 78 cows with subclinical mastitis. In both trials, cows were randomly distributed over 3 equal-sized groups: a test group using CHROMagar, a test group using Minnesota, and a control group not using on-farm tests. Farmers decided whether or not to treat, and which antimicrobial treatment would be applied, using information available on the day of enrollment (control group), complemented with the on-farm test result 1 d after enrollment (both test groups). For clinical mastitis, an antimicrobial treatment was given in 58% of cases that used CHROMagar, in 80% that used Minnesota, and in 86% of the controls. For subclinical mastitis, an antimicrobial treatment was given in 50% of cases that used CHROMagar, in 54% that used Minnesota, and in 4% of the controls. Bacteriological cure rate of clinical mastitis was lowest in the CHROMagar group [odds ratio 0.18 (95%CI 0.03-0.99)] compared with the controls. Using the Minnesota on-farm test for subclinical mastitis diagnosis and treatments resulted in fewer new IMI on d 21 [odds ratio 0.06 (95%CI 0.00-0.74)] compared with the controls. Clinical cure rate, percentage of new IMI, and SCC on d 21 of clinical mastitis were comparable among the groups. Using on-farm tests in farmers' decision-making process resulted in more treatments in accordance with the etiology of mastitis than without on-farm testing. A diagnosis and treatment strategy with on-farm testing is advised in cows with clinical mastitis to enhance prudent antimicrobial use. For subclinical mastitis, however, on-farm testing may lead to an unacceptable increase in use of antimicrobials and thus should not be advised as the common approach.


Assuntos
Doenças dos Bovinos , Mastite Bovina , Mastite , Animais , Antibacterianos/uso terapêutico , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Contagem de Células/veterinária , Fazendas , Feminino , França , Lactação , Glândulas Mamárias Animais , Mastite/tratamento farmacológico , Mastite/veterinária , Mastite Bovina/diagnóstico , Mastite Bovina/tratamento farmacológico , Leite , Minnesota
9.
Mayo Clin Proc ; 96(3): 677-687, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673918

RESUMO

OBJECTIVE: To evaluate the clinical outcomes of patients with primary plasma cell leukemia (pPCL) defined by 5% or greater clonal circulating plasma cells on peripheral blood smear and treated with novel agent induction therapies. PATIENTS AND METHODS: A cohort of 68 patients with pPCL diagnosed at the Mayo Clinic in Rochester, Minnesota, from January 1, 2000, to December 31, 2019, and treated with novel agent induction therapies was evaluated. RESULTS: The median follow-up was 46 (95% CI, 41 to 90) months. The median bone marrow plasma cell content was 85% (range, 10% to 100%) and median clonal circulaitng plasma cell percentage on the peripheral blood smear was 26% (range, 5% to 93%). There was a preponderance of t(11;14) primary cytogenetic abnormality in this cohort. The median time to next therapy (TTNT) and overall survival (OS) for all patients with pPCL patients in this cohort was 13 (95% CI, 9 to 17) and 23 (95% CI, 19 to 38) months, respectively. However, when stratified by cytogenetic risk, the median TTNT and OS were 16 and 51 months for standard risk vs 9 and 19 months for high risk (P=.01 for OS). CONCLUSION: Primary plasma cell leukemia remains an aggressive disease with poor prognosis despite novel agent-based therapies. Some patients have better than expected survival and this phenomenon may be influenced by the absence of high-risk cytogenetics. Newer treatment regimens are needed to improve the prognosis of this devastating disease.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Leucemia Plasmocitária/mortalidade , Leucemia Plasmocitária/terapia , Adulto , Estudos de Coortes , Feminino , Humanos , Leucemia Plasmocitária/diagnóstico , Leucemia Plasmocitária/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Minnesota , Prognóstico , Análise de Sobrevida , Transplante Autólogo , Resultado do Tratamento
10.
MMWR Morb Mortal Wkly Rep ; 70(10): 346-347, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33705367

RESUMO

Since December 2020, the Minnesota Department of Health (MDH) Public Health Laboratory has been receiving 100 specimens per week (50 from each of two clinical partners) with low cycle threshold (Ct) values for routine surveillance for SARS-CoV-2, the virus that causes COVID-19. On January 25, 2021, MDH identified the SARS-CoV-2 variant P.1 in one specimen through this surveillance system using whole genome sequencing, representing the first identified case of this variant in the United States. The P.1 variant was first identified in travelers from Brazil during routine airport screening in Tokyo, Japan, in early January 2021 (1). This variant has been associated with increased transmissibility (2), and there are concerns that mutations in the spike protein receptor-binding domain might disrupt both vaccine-induced and natural immunity (3,4). As of February 28, 2021, a total of 10 P.1 cases had been identified in the United States, including the two cases described in this report, followed by one case each in Alaska, Florida, Maryland, and Oklahoma (5).


Assuntos
/diagnóstico , Vigilância em Saúde Pública , /isolamento & purificação , /epidemiologia , Humanos , Minnesota/epidemiologia , Doença Relacionada a Viagens , Estados Unidos/epidemiologia
11.
Clin Biochem ; 90: 15-22, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33539808

RESUMO

OBJECTIVES: To avoid the significant risks posed by the use of COVID-19 serology tests with supply chain constraints or poor performance characteristics, we developed an in-house SARS-CoV-2 total antibody test. Our test was compared with three commercial methods, and was used to determine COVID-19 seroprevalence among healthcare workers and outpatients in Minnesota. METHODS: Seventy-nine plasma and serum samples from 50 patients 4-69 days after symptom onset who tested positive by a SARS-CoV-2 PCR method using a nasopharyngeal (NP) swab were used to evaluate our test's clinical performance. Seropositive samples were analyzed for IgG titers in a follow-up assay. Thirty plasma and serum from 12 patients who tested negative by a SARS-CoV-2 PCR method using a nasopharyngeal (NP) swab and 210 negative pre-pandemic serum samples were also analyzed. Among samples from patients > 14 days after symptom onset, the assay had 100% clinical sensitivity and 100% clinical specificity, 100% positive predictive value and 100% negative predictive value. Analytical specificity was 99.8%, indicating minimal cross-reactivity. A screening study was conducted to ascertain COVID-19 seroprevalence among healthcare workers and outpatients in Minnesota. RESULTS: Analysis of serum collected between April 13 and May 21, 2020 indicated a COVID-19 seroprevalence of 2.96% among 1,282 healthcare workers and 4.46% among 2,379 outpatients. CONCLUSIONS: Our in-house SARS-CoV-2 total antibody test can be used to conduct reliable epidemiological studies to inform public health decisions during the COVID-19 pandemic.


Assuntos
/métodos , /epidemiologia , Pessoal de Saúde , Pacientes Ambulatoriais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Soroepidemiológicos , Adulto Jovem
12.
Eur J Endocrinol ; 184(4): 597-606, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33606665

RESUMO

Objective: Several small studies reported increased prevalence and incidence of asymptomatic vertebral fractures in patients with non-functioning adrenal adenomas and adenomas with mild autonomous cortisol secretion. However, the risk of symptomatic fractures at vertebrae, and at other sites remains unknown. Our objective was to determine the prevalence and incidence of symptomatic site-specific fractures in patients with adrenal adenomas. Design: Population-based cohort study, Olmsted County, Minnesota, USA, 1995-2017. Methods: Participants were the patients with adrenal adenoma and age/sex-matched referent subjects. Patients with overt hormone excess were excluded. Main outcomes measures were prevalence and incidence of bone fractures. Results: Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years (20-96). At the time of diagnosis, patients had a higher prevalence of previous fractures than referent subjects (any fracture: 47.9% vs 41.3%, P = 0.003, vertebral fracture: 6.4% vs 3.6%, P = 0.004, combined osteoporotic sites: 16.6% vs 13.3%, P = 0.04). Median duration of follow-up was 6.8 years (range: 0-21.9 years). After adjusting for age, sex, BMI, tobacco use, prior history of fracture, and common causes of secondary osteoporosis, patients with adenoma had hazard ratio of 1.27 (95% CI: 1.07-1.52) for developing a new fracture during follow up when compared to referent subjects. Conclusions: Patients with adrenal adenomas have higher prevalence of fractures at the time of diagnosis and increased risk to develop new fractures when compared to referent subjects.


Assuntos
Adenoma/epidemiologia , Neoplasias das Glândulas Suprarrenais/epidemiologia , Fraturas Ósseas/epidemiologia , Adenoma/complicações , Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Fraturas Ósseas/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Adulto Jovem
13.
Am J Public Health ; 111(4): 658-662, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33600248

RESUMO

The COVID-19 pandemic has disproportionately affected underserved and minority populations in the United States. This is partially attributable to limited access to diagnostic testing from deeply rooted structural inequities precipitating higher infection and mortality rates. We describe the process of establishing a drive-through collection site by leveraging an academic-community partnership between a medical institution and a federally qualified health center in Minnesota. Over 10 weeks, 2006 COVID-19 tests were provided to a socioeconomically disadvantaged population of racial/ethnic minorities and low-income essential workers.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Disparidades em Assistência à Saúde/etnologia , Provedores de Redes de Segurança , /mortalidade , Grupos de Populações Continentais , Grupos Étnicos/estatística & dados numéricos , Humanos , Área Carente de Assistência Médica , Minnesota , Grupos Minoritários/estatística & dados numéricos , Parcerias Público-Privadas , Fatores Socioeconômicos
14.
Heart Lung ; 50(3): 363-368, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33618146

RESUMO

BACKGROUND: Buddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF). PURPOSE: To determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF. METHODS: Patients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training. RESULTS: The study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses. CONCLUSIONS: The six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.


Assuntos
Insuficiência Cardíaca , Meditação , Idoso , Terapia por Exercício , Tolerância ao Exercício , Insuficiência Cardíaca/terapia , Humanos , Minnesota , Qualidade de Vida , Caminhada
15.
J Am Geriatr Soc ; 69(4): 868-873, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33619724

RESUMO

BACKGROUND: Residents of nursing homes and long-term care facilities are at increased risk for severe coronavirus disease-19 (COVID-19) but may not be able to access monoclonal antibody therapies offered at outpatient infusion centers due to frailty and logistical issues. We describe a mobile monoclonal antibody infusion program for patients with COVID-19 in skilled nursing facilities and provide descriptive data on its outcomes. DESIGN: Retrospective cohort study. SETTING: Collaboration between Mayo Clinic and skilled nursing facilities in Southeast Minnesota was developed to administer anti-spike monoclonal antibodies under the FDA Emergency Use Authorization. PARTICIPANTS: Seventy five residents of skilled nursing facilities at high risk of COVID-19 complications. EXPOSURE: Emergency use treatment with bamlanivimab and casirivimab-imdevimab. MEASUREMENTS: Hospitalization and medically attended visits. RESULTS: The mobile infusion unit, staffed by Mayo Clinic Infusion Therapy registered nurses and supported by the skilled nursing facility staff, infused anti-spike monoclonal antibodies to 45 of 75 patients (average age, 77.8 years) in December 2020. The infusions occurred at an average of 4.3 days after COVID-19 diagnosis. Fourteen days after infusion, there were no deaths, two emergency department visits, and three hospitalizations, for a combined event rate of 11.1%. There was one reported adverse event. CONCLUSION: The implementation of a mobile infusion unit embedded in a collaborative process resulted in rapid infusion of monoclonal antibodies to high-risk COVID-19 patients in skilled nursing facilities, who would otherwise be unable to access the novel therapies. The therapies were well tolerated and appear beneficial. Further study is warranted to explore the scalability and efficacy of this program.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Unidades Móveis de Saúde , Instituições de Cuidados Especializados de Enfermagem , Idoso , Combinação de Medicamentos , Feminino , Humanos , Masculino , Minnesota , Pacientes/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos
16.
Diagn Microbiol Infect Dis ; 100(1): 115307, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33571863

RESUMO

Point-of-care (POC) tests are in high demand in order to facilitate rapid care decisions for patients suspected of SARS-CoV-2. We conducted a clinical validation study of the Cue Health POC nucleic acid amplification test (NAAT) using the Cue lower nasal swab, compared to a reference NAAT using standard nasopharyngeal swab, in 292 symptomatic and asymptomatic outpatients for SARS-CoV-2 detection in a community drive through collection setting. Positive percent agreement between Cue COVID-19 and reference SARS-CoV-2 test was 91.7% (22 of 24); or 95.7% (22 of 23) when one patient with no tie-breaker method was excluded. Negative percent agreement was 98.4% (239 of 243), and there were 25 (8.6%) invalid or canceled results. The Cue COVID-19 test demonstrated very good positive and negative percent agreement with central laboratory tests and will be useful in settings where accurate POC testing is needed to facilitate management of patients suspected of COVID-19.


Assuntos
/métodos , Nasofaringe/virologia , Técnicas de Amplificação de Ácido Nucleico/métodos , Manejo de Espécimes/métodos , Portador Sadio , Humanos , Minnesota , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Sensibilidade e Especificidade , Manejo de Espécimes/instrumentação
17.
J Dairy Sci ; 104(4): 4936-4941, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33612204

RESUMO

On-farm culture (OFC) systems facilitate pathogen-based mastitis management and can facilitate antimicrobial stewardship on dairy farms. Interpretation of the results, however, may present a challenge for those with limited microbiology experience. Here, we compared results of 3 OFC systems interpreted by trained and untrained observers against results of a standard laboratory reference method (aerobic culture and mass spectrometry). Milk samples (280 quarter and 60 composite) were selected from submissions for routine diagnostic testing to Quality Milk Production Services (Cornell University, Ithaca, NY) between August 2017 and January 2018. Samples were cultured simultaneously using the standard laboratory reference method and 3 commercially available OFC systems that varied in detail of pathogen identification (provided in parentheses) as follows: (1) Minnesota Easy Culture System II Bi-plate (University of Minnesota Laboratory for Udder Health, St. Paul; gram-positive, gram-negative), (2) Minnesota Easy Culture System II Tri-plate (gram-positive, gram-negative, some genus level), and (3) FERA Diagnostics and Biologicals AccuMast plate (Ithaca, NY; genus level, some species level). After 18 to 24 h of incubation, OFC plates were interpreted by 1 trained observer (>10 yr of experience in milk microbiology) and 6 untrained observers with no previous milk microbiology training, using only the manufacturers' instructions for guidance. Strength of agreement (κ) between observer groups and the reference method was determined for the available outcomes of each system. Interpreted by the trained observer, agreement was moderate for identifying gram-positive organisms (Bi-plate, κ = 0.56) and substantial for Streptococcus spp. (Tri-plate, κ = 0.64, AccuMast κ = 0.61). Interpretation by untrained observers resulted in fair agreement (κ = 0.29-0.37) for these organisms. Moderate agreement (κ = 0.43-0.59) was found across all 3 OFC for the identification of gram-negative organisms (Bi-plate), non-aureus staphylococci (Tri-plate and AccuMast), Lactococcus spp., and Enterococcus spp. (AccuMast) when interpreted by the trained observer, and fair to moderate agreement was found (κ = 0.31-0.53) among untrained observers. Across all 3 OFC, agreement was almost perfect (κ = 0.80-0.89) for Staphylococcus aureus for the trained observer, and moderate to substantial (κ = 0.56-0.61) for untrained observers. We concluded that all 3 OFC appeared suitable to support pathogen-based mastitis management when operated by trained observers. Training beyond the instruction manual is a prerequisite to make OFC systems useful for pathogen-based mastitis management.


Assuntos
Doenças dos Bovinos , Mastite Bovina , Mastite , Animais , Bovinos , Fazendas , Feminino , Mastite/veterinária , Mastite Bovina/diagnóstico , Leite , Minnesota , Sensibilidade e Especificidade
18.
J Dent Hyg ; 95(1): 36-42, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33627451

RESUMO

Purpose: Obstructive sleep apnea (OSA) is a common breathing disorder; however, many individuals remain undiagnosed. The purpose of this study was to assess the comfort level of community-dwelling adults to participate in OSA screening in a dental office setting and survey the OSA risk levels of an adult population.Methods: This cross-sectional study was conducted among adults presenting at the University of Minnesota Driven to Discover Research Facility during the 2018 Minnesota State Fair. Participants completed a brief survey including the eight-item STOP-Bang questionnaire for OSA screening. Electronic tablets were used for data capture. Data analyses included descriptive statistics, t-tests, and Chi-square tests.Results: A total of 639 adults met the survey inclusion criteria (n=639). The majority of participants (88%) reported no prior OSA diagnosis. Based on STOP-Bang criteria, 61% (n=344) of the participants were at low, 29% (n=161) intermediate, and 10% (n= 56) high risk of OSA. A majority (64%) of participants reported being either "comfortable" or "very comfortable'"with OSA screening performed in a dental office setting.Conclusion: Over one third of participants with no prior OSA diagnosis were at moderate to high risk for OSA, and the majority stated that they would be comfortable undergoing OSA screening in a dental office setting. Dental hygienists screening patients for OSA with the STOP-BANG questionnaire are likely to have a high level of patient acceptance. Referring patients to the appropriate health care provider for further testing may increase timely diagnoses and treatment of OSA.


Assuntos
Consultórios Odontológicos , Apneia Obstrutiva do Sono , Adulto , Estudos Transversais , Humanos , Minnesota , Pesquisa , Apneia Obstrutiva do Sono/diagnóstico
19.
MMWR Morb Mortal Wkly Rep ; 70(8): 278-279, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33630825

RESUMO

On January 9, 2021, the Minnesota Department of Health (MDH) announced the identification of the SARS-CoV-2 variant of concern (VOC) B.1.1.7, also referred to as 20I/501Y.V1 and VOC 202012/01, in specimens from five persons; on January 25, MDH announced the identification of this variant in specimens from three additional persons. The B.1.1.7 variant, which is reported to be more transmissible than certain other SARS-CoV-2 lineages*,† (1), was first reported in the United Kingdom in December 2020 (1). As of February 14, 2021, a total of 1,173 COVID-19 cases of the B.1.1.7 variant had been identified in 39 U.S. states and the District of Columbia (2). Modeling data suggest that B.1.1.7 could become the predominant variant in the United States in March 2021 (3).


Assuntos
/diagnóstico , /genética , Adolescente , Adulto , Humanos , Minnesota/epidemiologia , Viagem/estatística & dados numéricos , Adulto Jovem
20.
PLoS One ; 16(2): e0247161, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33596257

RESUMO

Regularly scheduled intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are essential to maintaining and/or improving many ocular conditions including: neovascular age-related macular degeneration (nAMD), diabetic retinopathy, and retinal vein occlusions with macular edema (RVO). This study aims to assess the effect of unintended delays in anti-VEGF treatment during the first wave of the COVID-19 pandemic. This retrospective case series identified patients receiving regularly scheduled anti-VEGF intravitreal injections based on current procedural terminology (CPT) code at two practices in Minnesota. Diagnoses were limited to nAMD, diabetic macular edema (DME), proliferative diabetic retinopathy, and RVO. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit by more than two weeks beyond the recommended treatment interval during the COVID-19 lockdown. The 'COVID-19 lockdown' was defined as the period after March, 28th, 2020, when a lockdown was declared in Minnesota. We then compared the visual acuity and structural changes to the retina using ocular coherence tomography (OCT) to assess whether delayed treatment resulted in worse visual outcomes. A total of 167 eyes from 117 patients met criteria for inclusion in this study. In the delayed group, the average BCVA at the pre- and post-lockdown visits were 0.614 and 0.715 (logMAR) respectively (p = 0.007). Central subfield thickness (CST) increased from 341 to 447 in the DME delayed group (p = 0.03) while the CST increased from 301 to 314 (p = 0.4) in the nAMD delayed group. The results of this pilot study suggests that treatment delays may have a negative impact on the visual and anatomic outcomes of patients with nAMD and DME. Future studies with larger sample sizes are required for further investigation.


Assuntos
/epidemiologia , Doenças Retinianas/tratamento farmacológico , Tempo para o Tratamento/estatística & dados numéricos , Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Feminino , Humanos , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Pandemias/estatística & dados numéricos , Projetos Piloto , Quarentena/métodos , Quarentena/psicologia , Oclusão da Veia Retiniana/tratamento farmacológico , Estudos Retrospectivos , Acuidade Visual/efeitos dos fármacos
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