Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24.311
Filtrar
1.
Zootaxa ; 4609(3): zootaxa.4609.3.2, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31717092

RESUMO

Woodland salamanders of the genus Plethodon are characterized by strong ecological and morphological conservatism. One assemblage, the Wehrle's salamander (Plethodon wehrlei Fowler Dunn) species group, is distributed from New York to Tennessee, USA, and includes several morphological variants, four of which are sufficiently distinct to have been recognized as species in the past. For many years after two of these species were placed in synonymy, only P. wehrlei and P. punctatus Highton were recognized. A recent phylogeographic study using mitochondrial DNA and nuclear DNA uncovered considerable genetic diversity within the group and conservatively resurrected one of the previously synonymized forms (P. dixi Pope Fowler). However, their analysis could not resolve all relationships among remaining populations of P. wehrlei, leaving the taxon paraphyletic. We re-evaluated the evolutionary history of this group using genomic data, recovered strong support for at least five distinct clades, and corroborated previously reported relationships. We also collected morphological data and demonstrated morphological distinctiveness for four of the five clades that we herein recognize as species. We resurrect the synonymized name P. jacksoni Newman to represent the southern clades of P. wehrlei in southwestern Virginia and North Carolina exclusive of P. dixi. In addition, we describe a yellow-spotted form of P. wehrlei endemic to the Cumberland Plateau as a new species. Although our proposed changes rectify the paraphyly of P. wehrlei, our sampling was not sufficient to resolve potential taxonomic issues remaining within the species herein recognized as P. jacksoni.


Assuntos
DNA Mitocondrial , Urodelos , Animais , Genômica , New York , North Carolina , Filogenia , Análise de Sequência de DNA , Tennessee , Virginia
2.
Zootaxa ; 4668(2): zootaxa.4668.2.11, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31716635

RESUMO

Polymorphus trochus Van Cleave, 1945, is an acanthocephalan with limited distribution to the Americas and a common parasite of birds of the Rallidae family (Kinsella et al. 1973, McDonald 1988 and Amin 1992), mainly of the American coot Fulica americana Gmelin, 1789; however, despite existing records of this species, the knowledge and descriptions of its morphological characteristics are not sufficient. Therefore, the identification of this species can be confusing, particularly because it depends on the form of the proboscis of the female. Van Cleave (1945) provided a description and illustrations of this species based on 14 females and 2 males specimens collected in the intestine of F. americana from Lake Buckeye in Ohio, Lake Oneida in New York, and the Illinois River in Illinois; however, this description does not mention many traits that are taxonomically important. Years later, Nickol (1966, thesis not published) provided a description of P. trochus based on 36 mature specimens (14 females and 22 male) from Louisiana, but the author illustrated only the proboscis and included a schematic of the female. He described the shape and size of the proboscis in both sexes, provided measurements of the apical, middle and basal hooks of the proboscis armor, and measurements of the eggs. However, he did not mention the exact distribution of the hooks and spines of the trunk, the measurement of a complete row of hooks nor the shape of all the sexual organs, especially the female ones, which are important taxonomic characteristics in the polymorphids.


Assuntos
Acantocéfalos , Helmintíase Animal , Animais , Feminino , Illinois , Masculino , México , New York , Ohio , Óvulo
3.
J Environ Qual ; 48(4): 1082-1090, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31589670

RESUMO

Phosphorus (P) loss from agricultural fields can contribute to water quality degradation. The current New York P index (NY-PI) scores fields on the basis of P sources and field characteristics that reflect risk of P transport (a source × transport approach). Recently, a transport × best management practice (BMP) approach was proposed, which first scores fields using landscape-driven transport factors and then offers various BMPs to reduce the score (i.e., risk of P transport). To analyze the score distribution of the current NY-PI and the incentivizing potential of the proposed structure, a database of 33,327 agricultural fields in New York was assembled in collaboration with nutrient management planners and farmers. Under the current NY-PI, no additional P could be applied to 2% of the fields, while for 3% the application rates should not exceed annual crop P removal. Flow distance (field to stream) was a major driver for NY-PI scores. The current NY-PI relies heavily on soil test P to assess runoff risk, allowing some low-P fields to receive manure independent of transport risk. A scenario evaluation showed that the proposed NY-PI limits P application on fields with high transport risk while simultaneously incentivizing adoption of BMPs in such areas. In the absence of farm-level water quality data, a farm field database can help set P index coefficients and assess implications of a new P index. This study emphasizes the value of involving stakeholders in assessing nutrient management tools, as well as the importance of using an incentive-driven approach for protecting water resources.


Assuntos
Agricultura , Fósforo , Fazendas , New York , Solo
5.
Plant Dis ; 103(12): 3083-3092, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31596693

RESUMO

A complex of foliar diseases affects onion production in New York, including Botrytis leaf blight (Botrytis squamosa), purple blotch (Alternaria porri), Stemphylium leaf blight (SLB; Stemphylium vesicarium), and downy mildew (Peronospora destructor). Surveys were conducted in 2015 and 2016 to evaluate the cause of severe premature foliar dieback in New York onion fields. SLB was the most prevalent disease among fields with the greatest incidence, surpassing downy mildew, purple blotch, and Botrytis leaf blight. Sequencing of the internal transcribed spacer region of ribosomal DNA and the glyceraldedyhe-3-phosphate dehydrogenase and calmodulin genes identified S. vesicarium as the species most commonly associated with SLB. S. vesicarium was typically associated with a broad range of necrotic symptoms but, most commonly, dieback of leaf tips and asymmetric lesions that often extended over the entire leaf. Because of the intensive use of fungicides for foliar disease control in onion crops in New York, the sensitivity of S. vesicarium populations to various fungicides with site-specific modes of action was evaluated. Sensitivity of S. vesicarium isolates collected in 2016 to the quinone outside inhibitor (QoI) fungicide, azoxystrobin, was tested using a conidial germination assay. Isolates representing a broad range of QoI sensitivities were selected for sequencing of the cytochrome b gene to evaluate the presence of point mutations associated with insensitivity to azoxystrobin. The G143A mutation was detected in all 74 S. vesicarium isolates with an azoxystrobin-insensitive phenotype (effective concentrations reducing conidial germination by 50%, EC50 = 0.2 to 46.7 µg of active ingredient [a.i.]/ml) and was not detected in all 31 isolates with an azoxystrobin-sensitive phenotype (EC50 = 0.01 to 0.16 µg a.i./ml). The G143A mutation was also associated with insensitivity to another QoI fungicide, pyraclostrobin. Sensitivity to other selected fungicides commonly used in onion production in New York was evaluated using a mycelial growth assay and identified isolates with insensitivity to boscalid, cyprodinil, and pyrimethanil, but not difenoconazole. The frequency of isolates sensitive to iprodione, fluxapyroxad, and fluopyram was high (93.5 to 93.6%). This article discusses the emergence of SLB as dominant in the foliar disease complex affecting onion in New York and the complexities of management posed by resistance to fungicides with different modes of action.


Assuntos
Ascomicetos , Farmacorresistência Fúngica , Fungicidas Industriais , Cebolas , Ascomicetos/efeitos dos fármacos , Ascomicetos/genética , Farmacorresistência Fúngica/genética , Fungicidas Industriais/farmacologia , New York , Cebolas/microbiologia
6.
J Dent Educ ; 83(9): 1057-1064, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31477584

RESUMO

Pipeline programs aim to increase the representation of underrepresented minorities in the dental profession. At New York University College of Dentistry (NYUCD), two dental students initiated the development of a pipeline program for high school students called Saturday Academy. The purpose of the program is twofold: to mentor and coach underrepresented minority and low-income high school students through the college application process, and to expose them to the field of dentistry as a viable career option through both didactic and hands-on learning. The aim of this pilot study was to determine outcomes for the first five years (2013-17) of the Saturday Academy pipeline program at NYUCD with regard to the high school students' experience with the program and their career interests after high school graduation. Across five cohorts, a total of 82 students participated in Saturday Academy. A "where are you now?" survey sent to 72 participants who reported high school graduation years between 2013 and 2018 received a response rate of 76%. The survey results showed that all (100%) of the responding Saturday Academy participants had graduated from high school and were enrolled in college, and 71% were interested in health profession careers. Almost half (47%) of the students self-identified as being pre-dental, and 96% reported that Saturday Academy had increased their interest in the dental profession. These pilot results justified an expansion of Saturday Academy at NYUCD in both size and creation of an alumni outreach initiative. Other dental schools may benefit from the strategies used by this program in establishing or expanding their pipeline programs.


Assuntos
Escolha da Profissão , Odontologia , Educação em Odontologia , Faculdades de Odontologia , Estudantes de Odontologia/estatística & dados numéricos , Estudantes/psicologia , Feminino , Ocupações em Saúde , Humanos , Masculino , Grupos Minoritários/estatística & dados numéricos , Saúde das Minorias , New York , Projetos Piloto , Pobreza , Instituições Acadêmicas , Inquéritos e Questionários , Universidades
7.
Br J Anaesth ; 123(5): 679-687, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31561883

RESUMO

BACKGROUND: While increased surgical-provider volume has been associated with improved outcomes, research regarding volume-outcome relationships within high-volume institutions and the role of anaesthesiologists is limited. Further, the effect of anaesthesia-care-team composition remains understudied. This analysis aimed to identify the impact of anaesthesiologist and surgeon volume on adverse events after total joint arthroplasties. METHODS: We retrospectively identified 40 437 patients who underwent total joint arthroplasties at a high-volume institution from 2005 to 2014. The main effects of interest were anaesthesiologist and surgeon volume and experience along with anaesthesia-care-team composition. Multivariable logistic regression models were used to evaluate three outcomes: any complication, cardiopulmonary complication, and length of stay (>5 days). Odds ratios (ORs) and 99.75% confidence intervals (CIs) were reported. RESULTS: Across all three models, anaesthesiologist volume and experience, and anaesthesia-care-team composition were not significant predictors. Surgeon annual case volume >50 was associated with significantly reduced odds of any complication (annual case volume: 50-149; OR: 0.80; CI: 0.66-0.98) and prolonged length of stay (OR: 0.69; CI: 0.60-0.80). Surgeon experience >20 yr was associated with significantly reduced odds of prolonged length of stay (OR: 0.85; CI: 0.75-0.95). CONCLUSIONS: Anaesthesiologist volume and experience, and anaesthesia-care-team composition did not impact the odds of an adverse outcome, although a higher surgeon volume was associated with decreased odds of complications and prolonged length of stay. Further study is necessary to determine if these findings can be extrapolated to less specialised, lower volume surgical settings.


Assuntos
Anestesiologia/estatística & dados numéricos , Artroplastia de Quadril/normas , Artroplastia do Joelho/normas , Competência Clínica/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Idoso , Anestesia/métodos , Anestesia/normas , Anestesia/estatística & dados numéricos , Anestesiologia/organização & administração , Anestesiologia/normas , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Comorbidade , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Pediatr Dent ; 41(4): 279-284, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31439087

RESUMO

Purpose: The purposes of this study were to: (1) assess the prevalence of dental caries experience in a sample of 543 low-income children, ages six months to 17 years, in the Bronx, New York; and (2) determine the existence of any association between maternal active decay and child's caries experience. Methods: Caries risk assessment forms completed in the pediatric clinic of an urban safety-net hospital in the Bronx were analyzed. Descriptive statistics and multiple logistic regression models assessed associations between maternal active decay and child's caries experience. Results: Active decay in the past 12 months was seen in 43.8 percent of mothers or primary caregivers. Prevalence of white spots and obvious decay and presence of restorations in their children were 26.5 percent, 23.8 percent, and 16.4 percent, respectively. Children of mothers or primary caregivers who had active decay in the past 12 months had more than double the odds (odds ratio equals 2.18; 95 percent confidence interval equals 1.53 to 3.09) of experiencing dental caries (P<0.0001). Conclusions: This study highlights the significant impact that a mother's oral health has on a child's risk of experiencing dental caries. Incorporating oral health risk assessments in adult and pediatric primary care is strongly recommended.


Assuntos
Cárie Dentária , Adulto , Criança , Feminino , Humanos , Lactente , Mães , New York , Saúde Bucal , Fatores de Risco
9.
BMC Infect Dis ; 19(1): 703, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395019

RESUMO

BACKGROUND: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. METHODS: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. RESULTS: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. CONCLUSION: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. TRIAL REGISTRATION: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).


Assuntos
Continuidade da Assistência ao Paciente , Hepatite C/tratamento farmacológico , Prisioneiros/estatística & dados numéricos , Adulto , Serviços de Saúde Comunitária , Feminino , Hepatite C/virologia , Hispano-Americanos , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , New York , Navegação de Pacientes , Prisões , Estudos Prospectivos , Transtornos Relacionados ao Uso de Substâncias/terapia , Resposta Viral Sustentada
10.
Diabetes Res Clin Pract ; 155: 107811, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31401151

RESUMO

AIMS: To evaluate the effects of pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) on macrosomia and birth defects. METHODS: Existing birth registry data from the Perinatal Data System in Upstate New York was analysed. 650,914 women with a singleton term pregnancy (≥37 weeks) aged 18-55 years from 2004 to 2016 were included. RESULTS: The prevalence of macrosomia in infants born to women with PGDM and GDM were 26.0% and 16.4%, respectively, higher than that in the controls (11.2%). Compared with the controls (0.8%), the PGDM and GDM groups had higher prevalence of any birth defect (1.8% and 1.0%). The PGDM group had the highest prevalence of cyanotic heart disease (0.6%). Moreover, the PGDM group had higher prevalence of cleft lip and palate, cleft palate alone, hypospadias and limb reduction defect compared to the GDM and control groups (p < 0.05). However, these birth defects in the GDM group were similar to those in the controls. Both the PGDM and GDM groups had significantly elevated odds of macrosomia, cyanotic heart disease and any birth defect than controls. The PGDM group had higher odds of cleft lip and palate, cleft palate alone, hypospadias and limb reduction defect. CONCLUSIONS: Using the Perinatal Data System database, PGDM and GDM, especially PGDM, was associated with higher prevalence of macrosomia, cyanotic heart disease and any birth defect in singleton term pregnancy in Upstate New York. PGDM, not GDM had higher prevalence of cleft lip and palate, cleft palate alone, hypospadias and limb reduction defect.


Assuntos
Diabetes Gestacional/epidemiologia , Macrossomia Fetal/complicações , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , New York , Gravidez , Prevalência , Ganho de Peso , Adulto Jovem
11.
Gynecol Oncol ; 155(1): 51-57, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421916

RESUMO

OBJECTIVES: Immune checkpoint inhibitors (ICIs) have modest activity in ovarian cancer (OC), yet little is known about their effects on subsequent treatment. Preclinical studies suggest immunotherapy may enhance response to chemotherapy. We sought to evaluate the impact of ICIs on subsequent therapies and survival in recurrent OC. METHODS: A retrospective review was conducted to identify women with recurrent OC who received ICI from 01/2013 to 5/2017 and ≥1 subsequent treatment. Treatment duration after ICI was calculated using time-to-event analysis. Kaplan-Meier survival analysis and Cox proportional hazards models were used to calculate overall survival (OS) from first treatment after ICI and to assess survival differences by clinical benefit from ICI, defined by long (≥24 weeks) versus short (<24 weeks) ICI treatment duration. RESULTS: Of 79 evaluable women identified, 66 (84%) had platinum-resistant OC. Median age at diagnosis was 57 years. Median time from diagnosis to ICI was 39.7 months, with median of 4 prior treatments (range, 1-12). Median number of treatments after ICI was 2 (range, 1-8). Median duration of first-line treatment after ICI was 3.7 months (95% CI, 2.9-6.0) and declined with each subsequent line. The most common therapies after ICI were taxanes, platinum-based regimens, and pegylated liposomal doxorubicin. Bevacizumab was used in 47 women (59%). Median OS after ICI was 18.3 months (95% CI, 11.8-22.7) and did not differ between long versus short ICI. CONCLUSIONS: In this heavily pretreated population of patients with recurrent OC, therapies after ICI resulted in promising survival, suggesting that ICI may improve efficacy of subsequent chemotherapy.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Epitelial do Ovário/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Idoso , Antígeno B7-H1/antagonistas & inibidores , Bevacizumab/administração & dosagem , Antígeno CTLA-4/antagonistas & inibidores , Carcinoma Epitelial do Ovário/imunologia , Carcinoma Epitelial do Ovário/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/mortalidade , New York/epidemiologia , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/mortalidade , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Estudos Retrospectivos , Adulto Jovem
12.
JAMA ; 322(3): 240-250, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31310298

RESUMO

Importance: Beginning in 2013, New York State implemented regulations mandating that hospitals implement evidence-based protocols for sepsis management, as well as report data on protocol adherence and clinical outcomes to the state government. The association between these mandates and sepsis outcomes is unknown. Objective: To evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. Design, Setting, and Participants: Retrospective cohort study of adult patients hospitalized with sepsis in New York State and in 4 control states (Florida, Maryland, Massachusetts, and New Jersey) using all-payer hospital discharge data (January 1, 2011-September 30, 2015) and a comparative interrupted time series analytic approach. Exposures: Hospitalization for sepsis before (January 1, 2011-March 31, 2013) vs after (April 1, 2013-September 30, 2015) implementation of the 2013 New York State sepsis regulations. Main Outcomes and Measures: The primary outcome was 30-day in-hospital mortality. Secondary outcomes were intensive care unit admission rates, central venous catheter use, Clostridium difficile infection rates, and hospital length of stay. Results: The final analysis included 1 012 410 sepsis admissions to 509 hospitals. The mean age was 69.5 years (SD, 16.4 years) and 47.9% were female. In New York State and in the control states, 139 019 and 289 225 patients, respectively, were admitted before implementation of the sepsis regulations and 186 767 and 397 399 patients, respectively, were admitted after implementation of the sepsis regulations. Unadjusted 30-day in-hospital mortality was 26.3% in New York State and 22.0% in the control states before the regulations, and was 22.0% in New York State and 19.1% in the control states after the regulations. Adjusting for patient and hospital characteristics as well as preregulation temporal trends and season, mortality after implementation of the regulations decreased significantly in New York State relative to the control states (P = .02 for the joint test of the comparative interrupted time series estimates). For example, by the 10th quarter after implementation of the regulations, adjusted absolute mortality was 3.2% (95% CI, 1.0% to 5.4%) lower than expected in New York State relative to the control states (P = .004). The regulations were associated with no significant differences in intensive care unit admission rates (P = .09) (10th quarter adjusted difference, 2.8% [95% CI, -1.7% to 7.2%], P = .22), a significant relative decrease in hospital length of stay (P = .04) (10th quarter adjusted difference, 0.50 days [95% CI, -0.47 to 1.47 days], P = .31), a significant relative decrease in the C difficile infection rate (P < .001) (10th quarter adjusted difference, -1.8% [95% CI, -2.6% to -1.0%], P < .001), and a significant relative increase in central venous catheter use (P = .02) (10th quarter adjusted difference, 4.8% [95% CI, 2.3% to 7.4%], P < .001). Conclusions and Relevance: In New York State, mandated protocolized sepsis care was associated with a greater decrease in sepsis mortality compared with sepsis mortality in control states that did not implement sepsis regulations. Because baseline mortality rates differed between New York and comparison states, it is uncertain whether these findings are generalizable to other states.


Assuntos
Regulamentação Governamental , Mortalidade Hospitalar , Guias de Prática Clínica como Assunto , Sepse/terapia , Adulto , Idoso , Cateteres Venosos Centrais/estatística & dados numéricos , Infecções por Clostridium/epidemiologia , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Análise de Séries Temporais Interrompida , Tempo de Internação , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Sepse/mortalidade , Estados Unidos/epidemiologia
13.
Chirurg ; 90(9): 762-768, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31309248

RESUMO

Professor Antoni Jurasz was one of the most eminent Polish surgeons in the period between the two World Wars. He founded the Polish School of Medicine at the University of Edinburgh and the Polish Paderewski Hospital in Edinburgh in 1941. Having served in the Prussian Army he was also a co-founder of the military health service of the Polish Armed Forces. He was an educator of great format and a fierce patriot. This is an opportunity to remember a man and surgeon who devoted the last years of his life to the cause of closer rapprochement between nations in the name of well-conceived service to Poland and to humanity. The establishment of a Polish School of Medicine within the framework of Edinburgh University is a magnificent example of international academic collaboration. Extensive research was undertaken to collect the literature and documents in Polish, German and British libraries and archives in order to prepare this study.


Assuntos
Cirurgia Geral , Cirurgiões , Cirurgia Geral/história , História do Século XX , Humanos , New York , Polônia , Universidades
15.
Plast Reconstr Surg ; 144(2): 159e-166e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348328

RESUMO

BACKGROUND: Postmastectomy reconstruction remains underused. In 2011, new legislation in New York State mandated discussion of reconstructive options before mastectomy. This study assesses the impact of this policy on immediate breast reconstruction rates. METHODS: The Statewide Planning and Research Cooperative System database was queried to identify women undergoing mastectomy from January of 2005 to October of 2015 and follow them for at least 1 year postoperatively to determine the incidence and timing of reconstruction. Demographic and socioeconomic characteristics were collected. Chi-square test and multivariable logistic regression were used to compare periods before (2005 to 2010) and after (2011 to 2015) the legislative change. RESULTS: Of 52,837 records, there were 24,340 patients (46 percent) who underwent immediate breast reconstruction. The incidence of immediate breast reconstruction increased over the study period, most significantly in 2008 to 2009. Rates of immediate breast reconstruction continued to increase, although at a slower rate, after 2011 compared with before 2011 across all subgroups. Both implant and autologous reconstructive techniques increased over time. Implant-based reconstruction increased steadily, whereas autologous reconstruction increased most significantly between 2008 and 2009. CONCLUSIONS: Despite an overall increase in immediate breast reconstruction, there was an overall lack of effect on post-2011 reconstructive rates attributable to the legislative changes. Reconstructive rates have increased significantly in New York State over the past decade, and these changes appear to be largely independent of the 2011 New York State Breast Reconstruction Act. There are likely nonlegislative drivers of breast reconstruction use.


Assuntos
Neoplasias da Mama/cirurgia , Política de Saúde/legislação & jurisprudência , Mamoplastia/legislação & jurisprudência , Mamoplastia/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/patologia , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Feminino , Humanos , Incidência , Modelos Logísticos , Mastectomia/métodos , Pessoa de Meia-Idade , Análise Multivariada , New York , Formulação de Políticas , Período Pós-Operatório , Estudos Retrospectivos , Medição de Risco , Fatores Socioeconômicos
16.
Bull Environ Contam Toxicol ; 103(3): 385-390, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256200

RESUMO

Amynthas agrestis and Metaphire hilgendorfi are being distributed across North America with unknown ecosystem impacts. Forest soils in urban areas sequester trace elements and earthworms may be bioaccumulating them. This study examined Cd, Cr, Co, Cu, Mn, Ni, Pb, V, and Zn in soils and earthworm tissues at 28 urban forest sites in and surrounding Poughkeepsie, NY, USA. Megascolecidae were present at 22 sites with means of 12 to 27 individuals m-2 and 4 to 12 dry weight g m-2. Urban forest soils within commercial uses had Mn, Pb, and Zn concentrations higher than within residential and agricultural uses. Earthworm trace element concentrations were poorly predicted by their respective soil concentrations, except for Pb. Urban forests in commercial uses and land-preserves, earthworm Cd and Pb concentrations were at or above concentrations known to negatively impact small mammal and bird health ( > 10 mg kg-1) with Co and V approaching toxic concentrations.


Assuntos
Monitoramento Ambiental , Oligoquetos/química , Poluentes do Solo/análise , Oligoelementos/análise , Agricultura , Animais , Florestas , Humanos , Metais Pesados/análise , New York , América do Norte , Solo/química
17.
MMWR Morb Mortal Wkly Rep ; 68(26): 583-586, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31269011

RESUMO

During 2014-2017, CDC Emerging Infections Program surveillance data reported that the occurrence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections associated with injection drug use doubled among persons aged 18-49 years residing in Monroe County in western New York.* Unpublished surveillance data also indicate that an increasing proportion of all Candida spp. bloodstream infections in Monroe County and invasive group A Streptococcus (GAS) infections in 15 New York counties are also occurring among persons who inject drugs. In addition, across six surveillance sites nationwide, the proportion of invasive MRSA infections that occurred in persons who inject drugs increased from 4.1% of invasive MRSA cases in 2011 to 9.2% in 2016 (1). To better understand the types and frequency of these infections and identify prevention opportunities, CDC and public health partners conducted a rapid assessment of bacterial and fungal infections among persons who inject drugs in western New York. The goals were to assess which bacterial and fungal pathogens most often cause infections in persons who inject drugs, what proportion of persons who inject use opioids, and of these, how many were offered medication-assisted treatment for opioid use disorder. Medication-assisted treatment, which includes use of medications such as buprenorphine, methadone, and naltrexone, reduces cravings and has been reported to lower the risk for overdose death and all-cause mortality in persons who use opioids (2,3). In this assessment, nearly all persons with infections who injected drugs used opioids (97%), but half of inpatients (22 of 44) and 12 of 13 patients seen only in the emergency department (ED) were not offered medication-assisted treatment. The most commonly identified pathogen was S. aureus (80%), which is frequently found on skin. Health care visits for bacterial and fungal infections associated with injection opioid use are an opportunity to treat the underlying opioid use disorder with medication-assisted treatment. Routine care for patients who continue to inject should include advice on hand hygiene and not injecting into skin that has not been cleaned or to use any equipment contaminated by reuse, saliva, soil, or water (4,5).


Assuntos
Infecções Bacterianas/epidemiologia , Micoses/epidemiologia , Vigilância da População , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Adulto Jovem
18.
Parasitol Res ; 118(7): 2257-2262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31177405

RESUMO

The New England cottontail rabbit (NEC, Sylvilagus transitionalis) population has decreased dramatically in New York, USA, and the role of parasites in limiting the population has never been examined. The closely related and sympatric eastern cottontail rabbit (EC, Sylvilagus floridanus) was introduced into the range of NEC by humans and is currently thriving. This study aimed to investigate gastrointestinal parasites of the NEC and the EC and compare their parasite communities. Fecal pellets from 195 NEC and 125 EC were collected from the Hudson Valley, New York, in the winter of 2013-2014. Centrifugal fecal floats were performed in Sheather's sugar solution, and parasite ova and cysts were examined microscopically to identify gastrointestinal parasites present. For all pellets combined (n = 320), 91% were found to harbor at least 1 parasite species, with Eimeria species being the most common. Genetic analysis of pellets using microsatellite DNA identified 248 individual rabbits, with parasite prevalence (94%) similar to the prevalence estimate based on all pellets (91%). EC samples had a significantly higher (p < 0.05) parasite species richness (1.73, range 0-4) than NEC (1.20, range 0-3). EC and NEC shared 3 moderate to high (9-89%) prevalence parasites, in which EC prevalence was consistently higher. One parasite species was only found in NEC, and two were only found in EC, but the majority of these were of low abundance, precluding further statistical analyses.


Assuntos
Coccidiose/veterinária , Eimeria/classificação , Enteropatias Parasitárias/veterinária , Repetições de Microssatélites/genética , Parasitos/classificação , Coelhos/parasitologia , Animais , Coccidiose/epidemiologia , Coccidiose/parasitologia , Eimeria/genética , Eimeria/isolamento & purificação , Meio Ambiente , Fezes/parasitologia , Feminino , Geografia , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , New York/epidemiologia , Óvulo , Parasitos/genética , Parasitos/isolamento & purificação , Dinâmica Populacional , Inquéritos e Questionários , Simpatria
19.
BMC Health Serv Res ; 19(1): 407, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234842

RESUMO

BACKGROUND: Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. METHODS: We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. RESULTS: The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools -- decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. CONCLUSIONS: SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).


Assuntos
Programas de Imunização/economia , Vacinas contra Influenza/economia , Serviços de Saúde Escolar/economia , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Criança , Análise Custo-Benefício , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , New York , Avaliação de Programas e Projetos de Saúde
20.
Bone Joint J ; 101-B(6): 646-651, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31154834

RESUMO

AIMS: A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications. PATIENTS AND METHODS: The electronic medical records of all patients who underwent primary elective THA at a single large-volume arthroplasty centre, between 2011 and 2016, with at least two years of follow-up, were reviewed. After exclusion, 3574 consecutive patients were included in the study. There were 1571 men (44.0%) and 2003 women (56.0%). Their mean age and body mass index (BMI) was 63.0 years (sd 11.8) and 29.1 kg/m2 (sd 6.1), respectively. Data gathered included the age of the patient, BMI, the American Society of Anesthesiologists (ASA) score, estimated blood loss (EBL), length of stay (LOS), operating time, the presence of intra- or postoperative complications, type of complication, and the surgical approach. The approaches used during the study were posterior, anterior, direct lateral, anterolateral, and the northern approach. The complications that were recorded included prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture. Finally, the need for re-operation was recorded. Means were compared using analysis of variance (ANOVA) and Student's t-tests where appropriate and proportions were compared using the chi-squared test. RESULTS: A total of 248 patients had 263 complications related to the surgery, with an incidence of 6.94%. The anterior approach had the highest incidence of complications (8.5% (113/1329)) and the posterior approach had the lowest, at 5.85% (97/1657; p = 0.006). Most complications were due to deep infection (22.8%), periprosthetic fracture (22.4%), and prolonged wound drainage (21.3%). The rate of dislocation was 0.84% (14/1657) with the posterior approach and 1.28% (17/1329) with the anterior approach (p = 0.32). CONCLUSION: Overall, THA has a relatively low complication rate. However, the surgical approach plays a role in the incidence of complications. We found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate. Periprosthetic fracture and surgical site infection contributed most to the early complication rates. Cite this article: Bone Joint J 2019;101-B:646-651.


Assuntos
Artroplastia de Quadril/métodos , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Duração da Cirurgia , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA