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1.
J Nurs Care Qual ; 37(1): 21-27, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34751164

RESUMO

BACKGROUND: US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. PROBLEM: For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services. APPROACH: It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed. CONCLUSIONS: Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.


Assuntos
Prática Avançada de Enfermagem , Enfermeiras e Enfermeiros , Humanos , Missouri , Casas de Saúde , Admissão e Escalonamento de Pessoal , Serviço Social
3.
Artigo em Inglês | MEDLINE | ID: mdl-34770012

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The United States (U.S.) has the highest number of reported COVID-19 infections and related deaths in the world, accounting for 17.8% of total global confirmed cases as of August 2021. As COVID-19 spread throughout communities across the U.S., it became clear that inequities would arise among differing demographics. Several researchers have suggested that certain racial and ethnic minority groups may have been disproportionately impacted by the spread of COVID-19. In the present study, we used the daily data of COVID-19 cases in Kansas City, Missouri, to observe differences in COVID-19 clusters with respect to gender, race, and ethnicity. Specifically, we utilized a retrospective Poisson spatial scan statistic with respect to demographic factors to detect daily clusters of COVID-19 in Kansas City at the zip code level from March to November 2020. Our statistical results indicated that clusters of the male population were more widely scattered than clusters of the female population. Clusters of the Hispanic population had the highest prevalence and were also more widely scattered. This demographic cluster analysis can provide guidance for reducing the social inequalities associated with the COVID-19 pandemic. Moreover, applying stronger preventive and control measures to emerging clusters can reduce the likelihood of another epidemic wave of infection.


Assuntos
COVID-19 , Pandemias , Feminino , Humanos , Kansas/epidemiologia , Masculino , Grupos Minoritários , Missouri/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos
4.
Artigo em Inglês | MEDLINE | ID: mdl-34666370

RESUMO

This is the first description of Multiple Congenital Ocular Anomalies (MCOA) in a silver coat Missouri Fox Trotter determined to be heterozygous for the Silver PMEL17 missense mutation associated with MCOA and a silver coat in other breeds. The stallion was treated for meningoencephalitis and bilateral uveitis of unknown origin. A complete ophthalmic examination and ocular ultrasonography were performed. As an incidental finding, the patient exhibited bilateral cystic lesions restricted to the temporal anterior uvea consistent with the Cyst phenotype and was genotyped heterozygous for the Silver mutation. Additionally, 4 other non-silver colored Missouri Fox Trotters were genotyped homozygous for the wild-type allele. Screening for PMEL17 mutation in Missouri Fox Trotters accompanied by ophthalmic phenotype characterization is recommended to determine the allelic frequency and facilitate informed breeding decisions since the silver coat color is particularly popular.


Assuntos
Cavalos/genética , Mutação de Sentido Incorreto , Animais , Genótipo , Masculino , Missouri , Fenótipo
6.
Mo Med ; 118(5): 401-402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34658423
7.
Mo Med ; 118(5): 419, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34658431
8.
MMWR Morb Mortal Wkly Rep ; 70(43): 1501-1504, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34710080

RESUMO

During 2018-2019, the Rhode Island Department of Health (RIDOH) and the Missouri Department of Health and Senior Services (DHSS) investigated cases of metal poisonings associated with commercially and home-prepared cakes decorated with products referred to as luster dust. Several types of glitters and dusts, broadly known as luster dust,* for use on prepared foods can be purchased online and in craft and bakery supply stores (1). Decorating foods with luster dust and similar products is a current trend, popularized on television programs, instructional videos, blogs, and in magazine articles.† Some luster dusts are specifically produced with edible ingredients that can be safely consumed. Companies that make edible luster dust are required by law to include a list of ingredients on the label (2). Luster dusts that are safe for consumption are typically marked "edible" on the label. Some luster dusts used as cake decorations are not edible or food grade; labeled as "nontoxic" or "for decorative purposes only," these luster dusts are intended to be removed before consumption (3). RIDOH (2018) and Missouri DHSS (2019), investigated heavy metal poisonings associated with commercially and home-prepared cakes decorated with luster dust after receiving reports of children (aged 1-11 years) who became ill after consuming birthday cake. Cases in Rhode Island were associated with copper ingestion, and the case in Missouri was associated with a child's elevated blood lead level. In Rhode Island, luster dust products that had been used in cake frosting were found to contain high levels of multiple metals.§ These events indicate that increased vigilance by public health departments and further guidance to consumers and bakeries are needed to prevent unintentional poisonings. Labeling indicating that a product is nontoxic does not imply that the product is safe for consumption. Explicit labeling indicating that nonedible products are not safe for human consumption is needed to prevent illness from inappropriate use of inedible products on foods. Educating consumers, commercial bakers, and public health professionals about potential hazards of items used in food preparation is essential to preventing illness and unintentional poisoning from toxic metals and other nonedible ingredients.


Assuntos
Poeira , Contaminação de Alimentos , Intoxicação por Metais Pesados/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Missouri/epidemiologia , Rhode Island/epidemiologia
9.
JAMA Netw Open ; 4(9): e2123374, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468756

RESUMO

Importance: In the absence of a national strategy in response to the COVID-19 pandemic, many public health decisions fell to local elected officials and agencies. Outcomes of such policies depend on a complex combination of local epidemic conditions and demographic features as well as the intensity and timing of such policies and are therefore unclear. Objective: To use a decision analytical model of the COVID-19 epidemic to investigate potential outcomes if actual policies enacted in March 2020 (during the first wave of the epidemic) in the St Louis region of Missouri had been delayed. Design, Setting, and Participants: A previously developed, publicly available, open-source modeling platform (Local Epidemic Modeling for Management & Action, version 2.1) designed to enable localized COVID-19 epidemic projections was used. The compartmental epidemic model is programmed in R and Stan, uses bayesian inference, and accepts user-supplied demographic, epidemiologic, and policy inputs. Hospital census data for 1.3 million people from St Louis City and County from March 14, 2020, through July 15, 2020, were used to calibrate the model. Exposures: Hypothetical delays in actual social distancing policies (which began on March 13, 2020) by 1, 2, or 4 weeks. Sensitivity analyses were conducted that explored plausible spontaneous behavior change in the absence of social distancing policies. Main Outcomes and Measures: Hospitalizations and deaths. Results: A model of 1.3 million residents of the greater St Louis, Missouri, area found an initial reproductive number (indicating transmissibility of an infectious agent) of 3.9 (95% credible interval [CrI], 3.1-4.5) in the St Louis region before March 15, 2020, which fell to 0.93 (95% CrI, 0.88-0.98) after social distancing policies were implemented between March 15 and March 21, 2020. By June 15, a 1-week delay in policies would have increased cumulative hospitalizations from an observed actual number of 2246 hospitalizations to 8005 hospitalizations (75% CrI: 3973-15 236 hospitalizations) and increased deaths from an observed actual number of 482 deaths to a projected 1304 deaths (75% CrI, 656-2428 deaths). By June 15, a 2-week delay would have yielded 3292 deaths (75% CrI, 2104-4905 deaths)-an additional 2810 deaths or a 583% increase beyond what was actually observed. Sensitivity analyses incorporating a range of spontaneous behavior changes did not avert severe epidemic projections. Conclusions and Relevance: The results of this decision analytical model study suggest that, in the St Louis region, timely social distancing policies were associated with improved population health outcomes, and small delays may likely have led to a COVID-19 epidemic similar to the most heavily affected areas in the US. These findings indicate that an open-source modeling platform designed to accept user-supplied local and regional data may provide projections tailored to, and more relevant for, local settings.


Assuntos
COVID-19/mortalidade , Política de Saúde , Hospitalização/estatística & dados numéricos , Distanciamento Físico , Teorema de Bayes , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Missouri , Pandemias , SARS-CoV-2
10.
JAMA Otolaryngol Head Neck Surg ; 147(10): 879-886, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34499093

RESUMO

Importance: A patient's decision to undergo surgery may be fraught with uncertainty and decisional conflict. The unpredictable nature of the COVID-19 pandemic warrants further study into factors associated with patient decision-making. Objective: To assess decisional conflict and patient-specific concerns for people undergoing otolaryngologic surgery during the pandemic. Design, Setting, Participants: This prospective cross-sectional survey study was conducted via telephone from April 22 to August 31, 2020. English-speaking adults scheduled for surgery from a single academic surgical center were invited to participate. Individuals who were non-English speaking, lacked autonomous medical decision-making capacity, scheduled for emergent surgery, or had a communication disability were excluded. For race and ethnicity reporting, participants were classified dichotomously as White according to the Behavioral Risk Factor Surveillance System from the Centers for Disease Control and Prevention or non-White as a collective term including Black or African American, American Indian or Alaska Native, Asian, or Pacific Islander race and ethnicity. Exposures: The SURE Questionnaire (sure of myself, understand information, risks/benefits ratio, and encouragement) was used to screen for decisional conflict, with a total score greater than or equal to 3 indicating clinically significant decisional conflict. Participants were asked to share their specific concerns about having surgery. Main Outcome and Measures: Decisional conflict and patient demographic data were assessed via bivariate analyses, multivariable logistic regression and conjunctive consolidation. Patient-specific concerns were qualitatively analyzed for summative themes. Results: Of 444 patients screened for eligibility, 182 (40.9%) respondents participated. The median age was 60.5 years (interquartile range, 48-70 years). The racial and ethnic identity of the participants was classified as binary White (84% [153 of 182]) and non-White (16% [29 of 182]). The overall prevalence of decisional conflict was 19% (34 of 182). Decisional conflict was more prevalent among non-White than White participants (proportion difference 18.8%, 95% CI, 0.6%-37.0% and adjusted odds ratio 3.0; 95% CI, 1.2-7.4). Combining information from multiple variables through conjunctive consolidation, the group with the highest rate of decisional conflict was non-White patients with no college education receiving urgent surgery (odds ratio, 10.8; 95% CI, 2.6-45.0). Intraoperative and postoperative concerns were the most common themes expressed by participants. There was a clinically significant difference in the proportion of participants who screened positive for decisional conflict (30%) and expressed postoperative concerns than those who screened negative for decisional conflict (17%) (proportion difference, 13%; 95% CI, 1%-25%). Among patients reporting concerns about COVID-19, most screened positive for decisional conflict. Conclusions and Relevance: Results of this cross-sectional survey study suggest that the COVID-19 pandemic was associated with decisional conflict in patients undergoing otolaryngologic surgery. Consistent discussion of risks and benefits is essential. The role of race and ethnicity in decisional conflict warrants further study.


Assuntos
COVID-19 , Conflito Psicológico , Tomada de Decisão Compartilhada , Procedimentos Cirúrgicos Otorrinolaringológicos , Pandemias , Idoso , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Inquéritos e Questionários
11.
MMWR Morb Mortal Wkly Rep ; 70(36): 1245-1248, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34499631

RESUMO

Universities open for in-person instruction during the 2020-21 academic year implemented a range of prevention strategies to limit the transmission of SARS-CoV-2, the virus that causes COVID-19, including physical distancing, mask use, vaccination, contact tracing, case investigation, and quarantine protocols (1). However, in some academic programs, such as health-related programs, aviation, and kindergarten through grade 12 (K-12) education, maintaining physical distance while still providing instruction is difficult; for universities with such programs, a single confirmed case of COVID-19 could result in a large number of students, staff members, and instructors being designated close contacts and requiring quarantine if they are not fully vaccinated, even if masks were worn when contact occurred. In January 2021, the St. Louis City Health Department allowed Saint Louis University (SLU) to implement a modified quarantine protocol that considered mask use when determining which close contacts required quarantine.* To assess the impact of the protocol, SLU assessed positive SARS-CoV-2 test result rates by masking status of the persons with COVID-19 and their close contacts. During January-May 2021, 265 students received a positive SARS-CoV-2 test result; these students named 378 close contacts. Compared with close contacts whose exposure only occurred when both persons were masked (7.7%), close contacts with any unmasked exposure (32.4%) had higher adjusted odds ratios (aORs) of receiving a positive SARS-CoV-2 test result (aOR = 4.9; 95% confidence interval [CI] = 1.4-31.1). Any additional exposures were associated with a 40.0% increase in odds of a positive test result (aOR = 1.4; 95% CI = 1.2-1.6). These findings reinforce that universal masking and having fewer encounters in close contact with persons with COVID-19 prevents the spread of SARS-CoV-2 in a university setting. Universities opening for in-person instruction could consider taking mask use into account when determining which unvaccinated close contacts require quarantine if enforced testing protocols are in place. However, this study was conducted before the B.1.617.2 (Delta) variant became the dominant strain of SARS-CoV-2 in the United States, which could have affected these findings given that the Delta variant has been found to be associated with increased transmissibility compared to previous variants.


Assuntos
COVID-19/transmissão , Busca de Comunicante , Máscaras/estatística & dados numéricos , Estudantes/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , Vacinas contra COVID-19/administração & dosagem , Feminino , Humanos , Masculino , Missouri/epidemiologia , SARS-CoV-2/isolamento & purificação , Universidades
12.
J Nutr Health Aging ; 25(8): 971-978, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34545916

RESUMO

OBJECTIVES: 1) Explain the financial benefit of potential revenue recapture (PRR) for non-billable days due to hospitalizations of nursing home (NH) residents using a six-year longitudinal analysis of 11 of 16 NHs participating in the Missouri Quality Initiative (MOQI); and 2) Discuss the work-flow benefits of early detection of changes in health status using qualitative data from all MOQI homes. DESIGN: A CMS funded demonstration project with full-time advanced practice registered nurses (APRN) and operations support team focused on reducing avoidable hospitalizations for long stay NH residents (2012-2020). SETTING AND PARTICIPANTS: Setting was a sample of 11 of 16 US NHs participating in the CMS project. The NHs ranged in size between 121 and 321 beds located in urban and rural areas in one midwestern geographic region. METHODS: Financial and occupancy data were analyzed using descriptive methods. Data are readily available from most NH financial systems and include information about short and long stay residents to calculate non-billable days due to hospitalizations. Average hospital transfer rates per 1000 resident days were used. Qualitative data collected in MOQI informed the work-flow benefits analysis. RESULTS: There was over $2.6 million in actual revenue recapture due to hospitalization of long stay residents in the 11 participating NHs during five years, 2015-2019, with 2014 as baseline; savings to payers was more than $31 million during those same years. The PRR for both short and long stay residents combined totaled $32.5 million for six years (2014-2019); for each NH this ranged from $590,000 to over $5 million. On average, an additional $500,000 of revenue each year per 200 beds could have been recaptured by further reducing hospitalizations. Workflow improved for nurses and nursing assistants using INTERACT and focusing on early detection of health changes. CONCLUSIONS: Reducing avoidable hospitalizations reduces costs to payers and increases revenue by substantially recapturing revenue lost each day of hospitalization. IMPLICATIONS: Focusing nursing staff on early illness recognition and management of condition changes within NHs has benefits for residents as the stress of hospital transfer and resulting functional decline is avoided. Nurses and nursing assistants benefit from workflow improvements by focusing on early illness detection, managing most condition changes within NHs. NHs benefit financially from increased revenue by reducing empty bed days.


Assuntos
Prática Avançada de Enfermagem , Casas de Saúde , Hospitalização , Humanos , Missouri , Fluxo de Trabalho
13.
Child Obes ; 17(S1): S39-S47, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34569843

RESUMO

Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families who are disproportionately affected by obesity. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project (CORD 3.0), the Missouri team (MO-CORD) aims to increase access to and dissemination of an efficacious pediatric obesity treatment, specifically family-based behavioral treatment (FBT), for low-income families. Methods/Design: The implementation pilot study is a multisite matched-comparison group pilot of packaged FBT in pediatric clinics for low-income children with obesity, of ages 5 to 12 years old. The study is implemented in two Missouri pediatric primary care clinical sites, Freeman Health System Pediatric Clinics (rural Joplin) and Children's Mercy Hospital Pediatric Clinics (urban Kansas City). The design focuses on pragmatism through utilization of PRECIS (Pragmatic Explanatory Continuum Indicator Summary) domains, such as open eligibility criteria, limited follow-up intensity, reliance on medical records for creating a usual care comparison group data, and unobtrusive measurement of participant and provider adherence. The evaluation focuses on effectiveness as well as implementation outcomes and barriers to inform implementation scale up. Conclusions: Findings from this study will advance both science and practice by providing novel and immediately useful information to families, health care providers, health care organizations, payers, and other state Medicaid plans by developing and optimizing evidence-based pediatric weight management treatment for implementation and dissemination in health systems to address health disparities among low-income populations most affected by overweight and obesity.


Assuntos
Obesidade Pediátrica , Terapia Comportamental , Criança , Pré-Escolar , Humanos , Missouri/epidemiologia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Projetos Piloto , Atenção Primária à Saúde , Estados Unidos
14.
PLoS Med ; 18(8): e1003732, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34464379

RESUMO

BACKGROUND: The standard of care treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy, which is typically preceded by neoadjuvant chemotherapy. However, the inability to assess minimal residual disease (MRD) noninvasively limits our ability to offer bladder-sparing treatment. Here, we sought to develop a liquid biopsy solution via urine tumor DNA (utDNA) analysis. METHODS AND FINDINGS: We applied urine Cancer Personalized Profiling by Deep Sequencing (uCAPP-Seq), a targeted next-generation sequencing (NGS) method for detecting utDNA, to urine cell-free DNA (cfDNA) samples acquired between April 2019 and November 2020 on the day of curative-intent radical cystectomy from 42 patients with localized bladder cancer. The average age of patients was 69 years (range: 50 to 86), of whom 76% (32/42) were male, 64% (27/42) were smokers, and 76% (32/42) had a confirmed diagnosis of MIBC. Among MIBC patients, 59% (19/32) received neoadjuvant chemotherapy. utDNA variant calling was performed noninvasively without prior sequencing of tumor tissue. The overall utDNA level for each patient was represented by the non-silent mutation with the highest variant allele fraction after removing germline variants. Urine was similarly analyzed from 15 healthy adults. utDNA analysis revealed a median utDNA level of 0% in healthy adults and 2.4% in bladder cancer patients. When patients were classified as those who had residual disease detected in their surgical sample (n = 16) compared to those who achieved a pathologic complete response (pCR; n = 26), median utDNA levels were 4.3% vs. 0%, respectively (p = 0.002). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD detection was highly correlated with the absence of pCR (p < 0.001) with a sensitivity of 81% and specificity of 81%. Leave-one-out cross-validation applied to the prediction of pathologic response based on utDNA MRD detection in our cohort yielded a highly significant accuracy of 81% (p = 0.007). Moreover, utDNA MRD-positive patients exhibited significantly worse progression-free survival (PFS; HR = 7.4; 95% CI: 1.4-38.9; p = 0.02) compared to utDNA MRD-negative patients. Concordance between urine- and tumor-derived mutations, determined in 5 MIBC patients, was 85%. Tumor mutational burden (TMB) in utDNA MRD-positive patients was inferred from the number of non-silent mutations detected in urine cfDNA by applying a linear relationship derived from The Cancer Genome Atlas (TCGA) whole exome sequencing of 409 MIBC tumors. We suggest that about 58% of these patients with high inferred TMB might have been candidates for treatment with early immune checkpoint blockade. Study limitations included an analysis restricted only to single-nucleotide variants (SNVs), survival differences diminished by surgery, and a low number of DNA damage response (DRR) mutations detected after neoadjuvant chemotherapy at the MRD time point. CONCLUSIONS: utDNA MRD detection prior to curative-intent radical cystectomy for bladder cancer correlated significantly with pathologic response, which may help select patients for bladder-sparing treatment. utDNA MRD detection also correlated significantly with PFS. Furthermore, utDNA can be used to noninvasively infer TMB, which could facilitate personalized immunotherapy for bladder cancer in the future.


Assuntos
Biomarcadores Tumorais/análise , Cistectomia/estatística & dados numéricos , DNA de Neoplasias/análise , Neoplasia Residual/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Urina/química , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Invasividade Neoplásica/patologia , Neoplasia Residual/etiologia , Intervalo Livre de Progressão , Neoplasias da Bexiga Urinária/etiologia
15.
mSphere ; 6(4): e0045021, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34346705

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity was assessed for 3,066 individuals visiting hospitals in St. Louis, Missouri, during July 2020, November 2020, or January 2021. Seropositivity in children increased from 5.22% in July to 21.16% in January. In the same time frame, seropositivity among adults increased from 4.52% to 19.03%, prior to initiation of mass vaccination. IMPORTANCE This study determined the percentage of children and adult samples from the St. Louis metropolitan area in Missouri with SARS-CoV-2 antibodies during three collection periods spanning July 2020 to January 2021. By January 2021, 20.68% of the tested individuals had antibodies. These results show the evolution of the SARS-CoV-2 pandemic in St. Louis, Missouri, and provide a snapshot of the extent of infection just prior to the start of mass vaccination.


Assuntos
COVID-19/imunologia , SARS-CoV-2/imunologia , Adolescente , Adulto , Idoso , Anticorpos Antivirais/imunologia , Teste Sorológico para COVID-19/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Pandemias/prevenção & controle , Estudos Soroepidemiológicos , Adulto Jovem
16.
Avian Dis ; 65(1): 59-62, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34339123

RESUMO

Here, we report three detections of H7N1 low pathogenicity avian influenza viruses (LPAIV) from poultry in Missouri (n = 2) and Texas (n = 1) during February and March 2018. Complete genome sequencing and comparative phylogenetic analysis suggest that the H7 LPAIV precursor viruses were circulating in wild birds in North America during the fall and winter of 2017 and spilled over into domestic poultry in Texas and Missouri independently during the spring of 2018.


Assuntos
Galinhas , Vírus da Influenza A Subtipo H7N1/isolamento & purificação , Influenza Aviária/virologia , Doenças das Aves Domésticas/virologia , Perus , Animais , Vírus da Influenza A Subtipo H7N1/patogenicidade , Missouri , Texas , Virulência
17.
Mo Med ; 118(4): 308-309, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34373655
18.
Front Public Health ; 9: 600906, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34458216

RESUMO

Objectives: This study aims to evaluate the impact of Microburst Insulin Infusion (MII) treatment on Type 1 and 2 diabetic patients' HbA1c, lipids, peripheral neuropathy, and patient-reported health status. Methods: We reviewed clinical charts, including lab results, for more than 80 diabetic and pre-diabetic patients treated at one U.S. outpatient clinic in St. Louis, Missouri between February 2017 and December 2019. Data included patient demographics, treatment data, lab and neuropathy tests, and self-reported patient health status questions. The explanatory variable was number of months of MII treatment. Treatments are 3-4 h in length, with two intensive infusions the first week and one treatment each week thereafter, usually for 12 weeks total. Lab tests were at 12-week intervals. Generalized linear modeling and t-tests assessed the significance of differences between patients' baseline lab values, neuropathy measures, and health status before treatment vs. after final treatment. Results: Number of MII treatments per patient ranged from 1 to 262, over 1-24 months. Time in MII treatment was significantly associated with reductions in HbA1c by nearly 0.04 points per month, and triglycerides declined 3 points per month. Neuropathy measures of large toe vibratory sensation (clanging tuning fork) improved significantly, as did patient-reported health and feelings of improvement since beginning treatment. Discussion: The MII therapy appears to be efficacious in treating diabetic patients, particularly those with complications like neuropathy. Our findings affirmed several other studies. We uniquely incorporated patient health questionnaires, and empirically studied MII treatment efficacy for diabetes in a population large enough to permit statistically valid inferences. With multiple waves of data for over 80 patients, this is one of the most extensive quantitative studies of microburst insulin infusion therapy conducted to date, with protocols more uniformly implemented and survey instruments more consistently administered by the same clinical team. Given the advances in insulin infusion therapy brought by MII, and early indications of its efficacy, the time is right for more in-depth studies of the outcomes patients can achieve, the physiological mechanisms by which they occur, MII's comparative effectiveness vis-à-vis traditional treatments, and cost-effectiveness.


Assuntos
Diabetes Mellitus , Insulina , Análise Custo-Benefício , Humanos , Missouri , Inquéritos e Questionários
19.
Emerg Infect Dis ; 27(11): 2966-2968, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34463239

RESUMO

Although Bordetella hinzii coccobacilli is most commonly identified in respiratory tracts of birds and rodents, this organism has occasionally been isolated in human infections. We describe a case of B. hinzii spontaneous bacterial peritonitis in Missouri, USA. Whole-genome sequencing of blood and peritoneal fluid isolates confirmed B. hinzii infection.


Assuntos
Infecções por Bordetella , Bordetella , Peritonite , Bordetella/genética , Infecções por Bordetella/diagnóstico , Humanos , Missouri , Peritonite/diagnóstico
20.
Viruses ; 13(8)2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34452511

RESUMO

Sequencing Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from wastewater has become a useful tool in monitoring the spread of viral variants. Approaches to this task have been varied, relying on differing sequencing methods and computational analyses. We used a novel computation workflow based on amplicon sequencing of SARS-CoV-2 spike domains in order to track viral populations in wastewater. As part of this workflow, we developed a program, SAM Refiner, that has a variety of outputs, including novel variant reporting as well as functions designed to remove polymerase chain reaction (PCR) generated chimeric sequences. With these methods, we were able to track viral population dynamics over time. We report here on the emergence of two variants of concern, B.1.1.7 (Alpha) and P.1 (Gamma), and their displacement of the D614G B.1 variant in a Missouri sewershed.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , SARS-CoV-2 , Análise de Sequência de RNA , Software , Águas Residuárias/virologia , Vigilância Epidemiológica Baseada em Águas Residuárias , Algoritmos , Missouri/epidemiologia , Epidemiologia Molecular , RNA Viral/genética , SARS-CoV-2/genética , SARS-CoV-2/fisiologia , Glicoproteína da Espícula de Coronavírus/genética
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