From Pandemic to Epidemic: Lessons Learned From COVID-19 Applied to Mpox Outbreak Response, Westchester County, Metropolitan New York.

The COVID-19 pandemic vaccination infrastructure was redeployed to address the Mpox epidemic. The Westchester County Department of Health coordinated an effective vaccine distribution, tracking, and data collection process with community partners with real-time feedback of operational challenges and updated public health directives. Westchester County, which comprises 9% of the New York State population, administered 24% (6770 doses) of JYNNEOS (smallpox and monkeypox vaccine) across the state. Among first-dose recipients, 13% were Black and 25% were Hispanic, approaching countywide US Census race and ethnicity breakdowns. The operational template designed during COVID-19 can be readily redeployed for subsequent epidemics of even seemingly dissimilar infections like Mpox.

John Greenwood's sidenotes on a 1778 John Hunter text at The New York Academy of Medicine.

John Greenwood (1760-1819) was George Washington's preferred dentist. He practiced in New York and made at least one of eight sets of dentures Washington wore (currently in the collection of the New York Academy of Medicine (NYAM). We know very little about John Greenwood's (JG) formal education, except that he came from a famous family of dentists. He inherited from his father, Isaac Greenwood, one important book of the time, John Hunter's 1778 treatise, A Natural History of the Human Teeth. That copy was donated to the New York Academy of Medicine by descendants of John Greenwood. Recently, we became aware of extensive marginalia that John Greenwood wrote in this book. The present article describes John Greenwood's opinion on a variety of dental subjects such as the causes and mechanisms of tooth destruction and gum disease and the presence of microscopic annamalcula that were thought to be connected to poor oral hygiene. Although John Greenwood was self-educated, his observations are surprisingly insightful and at least 37 years ahead of what was described in the contemporary literature.

Assessing and complying with regulatory oversight on utility performance.

This paper emphasises the importance of - and the complexity inherent in - the navigation of regulatory oversight and legal requirements in the area of electric utility performance. With a particular focus on utility companies in New York State, it discusses recent measures taken to adapt to the changing demands of regulatory compliance.

Spatial variation in risk for tick-borne diseases in residential areas of Dutchess County, New York.

Although human exposure to the ticks that transmit Lyme-disease bacteria is widely considered to occur around people's homes, most studies of variation in tick abundance and infection are undertaken outside residential areas. Consequently, the patterns of variation in risk of human exposure to tick-borne infections in these human-dominated landscapes are poorly understood. Here, we report the results of four years of sampling for tick abundance, tick infection, tick encounters, and tick-borne disease reports on residential properties nested within six neighborhoods in Dutchess County, New York, USA, an area of high incidence for Lyme and other tick-borne diseases. All properties were within neighborhoods that had been randomly assigned as placebo controls in The Tick Project; hence, none were treated to reduce tick abundance during the period of investigation, providing a unique dataset of natural variation within and between neighborhoods. We estimated the abundance of host-seeking blacklegged ticks (Ixodes scapularis) in three types of habitats on residential properties-forests, lawns, and gardens. In forest and lawn habitats, some neighborhoods had consistently higher tick abundance. Properties within neighborhoods also varied consistently between years, suggesting hot spots and cold spots occurring at a small (~ 1-hectare) spatial scale. Across neighborhoods, the abundance of nymphal ticks was explained by neither the amount of forest in that neighborhood, nor by the degree of forest fragmentation. The proportion of ticks infected with three common tick-borne pathogens did not differ significantly between neighborhoods. We observed no effect of tick abundance on human encounters with ticks, nor on either human or pet cases of tick-borne diseases. However, the number of encounters between ticks and outdoor pets in a neighborhood was negatively correlated with the abundance of questing ticks in that neighborhood. Our results reinforce the need to understand how human behavior and neglected ecological factors affect variation in human encounters with ticks and cases of tick-borne disease in residential settings.

The 24-Hour Workday for New York State Home Health Care Workers: Institutional Racism in Health Care Delivery.

Racism named as a public health issue largely focuses on those at the care-receiving end of health care. Home health care workers (HHCWs) are predominantly Black, immigrant, and women; in New York state it is illegal for HHCWs to work 24 consecutive hours, but homecare agencies assign HHCWs to 24-hour shifts and only pay for 13 hours of work. The demanding work of HHCWs increases their risk for and experiences of injury, depression, cardiovascular disease, and cerebrovascular events. This manifestation of exploitation illustrates that racism affects health care workers as well as the public.

Whole-lake acoustic telemetry to evaluate survival of stocked juvenile fish.

Estimates of juvenile survival are critical for informing population dynamics and the ecology of fish, yet these demographic parameters are difficult to measure. Here, we demonstrate that advances in animal tracking technology provide opportunities to evaluate survival of juvenile tagged fish. We implemented a whole-lake telemetry array in conjunction with small acoustic tags (including tags < 1.0 g) to track the fate of stocked juvenile cisco (Coregonus artedi) as part of a native species restoration effort in the Finger Lakes region of New York, USA. We used time-to-event modeling to characterize the survival function of stocked fish, where we infer mortality as the cessation of tag detections. Survival estimates revealed distinct stages of juvenile cisco mortality including high immediate post-release mortality, followed by a period of elevated mortality during an acclimation period. By characterizing mortality over time, the whole-lake biotelemetry effort provided information useful for adapting stocking practices that may improve survival of stocked fish, and ultimately the success of the species reintroduction effort. The combination of acoustic technology and time-to-event modeling to inform fish survival may have wide applicability across waterbodies where receiver arrays can be deployed at scale and where basic assumptions about population closure can be satisfied.

Association Between the New York SAFE Act and Firearm Suicide and Homicide: An Analysis of Synthetic Controls, New York State, 1999‒2019.

Objectives. To assess the association between the New York Secure Ammunition and Firearms Enforcement Act (NY SAFE Act) and firearm suicide and homicide rates. Methods. We employed a synthetic controls approach to investigate the impact of the NY SAFE Act on firearm suicide and firearm homicide rates. We collected state-level data on firearm mortality from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER) database for the period 1999-2019. We derived statistical inference by using a permutation-based in-place placebo test. Results. The implementation of the NY SAFE Act was associated with a significant reduction in firearm homicide rates, demonstrating a decrease of 63%. This decrease corresponds to an estimated prevention of 1697 deaths between 2013 and 2019. However, there was no association between the NY SAFE Act and firearm suicide rates. Conclusions. As the responsibility for enacting firearm policies increasingly falls on states instead of the federal government, this study provides valuable information that can assist states in making evidence-based decisions regarding the development and implementation of firearm policies that prioritize public safety and aim to prevent firearm-related fatalities. (Am J Public Health. 2023;113(12):1309-1317. https://doi.org/10.2105/AJPH.2023.307400).

New York Heart Association Class and Kansas City Cardiomyopathy Questionnaire in Acute Heart Failure.

Importance: Sparse data exist regarding how clinician-assigned New York Heart Association (NYHA) class compares with heart failure (HF)-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) in acute HF. Objective: To compare concordance between NYHA class and KCCQ overall summary score (KCCQ-OS) in acute HF and investigate associations of changes in NYHA class and KCCQ-OS with long-term outcomes. Design, Setting, and Participants: In this cohort study, patients with HF were enrolled from 52 hospitals in China between August 2016 and May 2018. Among patients with NYHA class and KCCQ-OS at admission and 1 month, levels of each scale were categorized into 4 groups from worst to best. Mild and moderate to severe discordance were defined as NYHA class and KCCQ-OS differing by 1 level or 2 or more levels, respectively. Multivariable models evaluated associations between improvements in the 2 measures and outcomes. Analysis was conducted from January to March 2023. Exposure: Changes in NYHA class and KCCQ-OS from admission to 1 month. Main Outcomes and Measures: All-cause mortality, cardiovascular death, or first HF rehospitalization. Results: A total of 2683 patients (1709 [63.7%] male; median [IQR] age, 66 [56-75] years) were included. NYHA class II, III, and IV were presented in 374 patients (13.9%), 1179 patients (44.0%), and 1130 patients (42.1%), respectively, and the median (IQR) KCCQ-OS was 44.4 (28.3-61.9). Concordance, mild discordance, and moderate to severe discordance between admission NYHA class and KCCQ-OS occurred in 954 patients (35.6%), 1203 patients (44.8%), and 526 patients (19.6%), respectively. For KCCQ-OS, kernel density overlaps were 73.6% between NYHA II and III, 63.8% between NYHA II and IV, and 88.3% between NYHA III and IV. Most patients experienced improvements in NYHA and KCCQ-OS from admission to 1 month. After adjustment, there was no significant association between improvements in NYHA class and 4-year all-cause mortality, whereas 5 or more point improvements in KCCQ-OS were independently associated with a lower risk of 4-year mortality (hazard ratio, 0.84; 95% CI, 0.74-0.96; P = .01). NYHA class and KCCQ-OS improvements were both associated with decreased risk of 1-year composite cardiovascular death or HF rehospitalization. Conclusions and Relevance: In this cohort study of acute HF, discordance between NYHA class and KCCQ was common, and KCCQ was more relevant to subsequent mortality than NYHA class.

Proceedings from the Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA).

Mucosal melanoma remains a rare cancer with high mortality and a paucity of therapeutic options. This is due in significant part to its low incidence leading to limited patient access to expert care and downstream clinical/basic science data for research interrogation. Clinical challenges such as delayed and at times inaccurate diagnoses, and lack of consensus tumor staging have added to the suboptimal outcomes for these patients. Clinical trials, while promising, have been difficult to activate and accrue. While individual institutions and investigators have attempted to seek solutions to such problems, international, national, and local partnership may provide the keys to more efficient and innovative paths forward. Furthermore, a mucosal melanoma coalition would provide a potential network for patients and caregivers to seek expert opinion and advice. The Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA) highlighted the current clinical challenges faced by patients, providers, and scientists, identified current and future clinical trial investigations in this rare disease space, and aimed to increase national and international collaboration among the mucosal melanoma community in an effort to improve patient outcomes. The included proceedings highlight the clinical challenges of mucosal melanoma, global clinical trial experience, basic science advances in mucosal melanoma, and future directions, including the creation of shared rare tumor registries and enhanced collaborations.

The Recent Rise of Eutylone Intoxications in Onondaga County and Surrounding Counties.

ABSTRACT: Eutylone is an emerging synthetic stimulant that is quickly gaining popularity due to its affordability and wide availability. A recent surge has been observed in Upstate New York. This study presents a retrospective review of deaths in which eutylone was identified in postmortem samples from January 2018 to December 2021 in the electronic database of the Onondaga County medical examiner's office in Syracuse, NY. Of the 176 subjects who met the study criteria, 128 (73%) were male and 48 (27%) were female, with a mean age of 37.6 years. Most of the subjects were listed as White (89%), followed by African American (9%). Most of the cases had multiple medical comorbidities (89%), with anxiety and hypertension being the most common illnesses. Chromatography/mass spectrometry was used to perform a qualitative analysis of femoral blood and urine samples to detect multiple drugs, including eutylone. Substance abuse disorder was present in 135 (77%) cases, with opiates and cocaine being the most common additional drugs detected. The most common cause and manner of death were drug toxicity and accident, in 137 (78%) and 143 (81%) cases, respectively. Overall, the study suggests that eutylone is a growing concern in Upstate New York, and its use is increasing in prevalence. Policymakers and health care providers should take steps to address this emerging issue and prevent further harm to individuals and communities affected by drug overdose.

Cardiovascular outcomes by time-varying New York Heart Association class among patients with obstructive hypertrophic cardiomyopathy: a retrospective cohort study.

AIMS: Assess the relationship between New York Heart Association (NYHA) functional class and cardiovascular (CV) outcomes in obstructive hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS: This retrospective cohort study used the Optum Market Clarity database with linked claims and electronic health records. Adults (aged ≥18 years) with obstructive HCM and ≥1 NYHA class assessment after first HCM diagnosis were eligible (selection period: 2007-2021). Thirteen outcomes were assessed following the index date (first documented NYHA class assessment after first HCM diagnosis in the study period): all-cause mortality; first occurrences of all-cause hospitalization; CV-related hospitalization; primary ischemic stroke or transient ischemic attack (TIA); myocardial infarction (MI); deep vein thrombosis (DVT) or pulmonary embolism (PE); and major adverse CV event (MACE); as well as first incident events of atrial fibrillation or flutter; primary ischemic stroke or TIA; heart failure; acute MI; DVT/PE; and a composite endpoint of pacemaker and cardiac resynchronization therapy. Their associations with the index NYHA class were described using the Kaplan-Meier method (mortality) or cumulative incidence functions (other outcomes). Hazard ratios between NYHA class over time and outcomes were evaluated using time-varying Cox models, adjusting for age at first observed HCM diagnosis, sex, and race. RESULTS: Among 4,631 eligible patients, the mean age was 59 years at the first observed HCM diagnosis (female, 47%; White, 77%). The risks of all outcomes increased with worse (higher) index NYHA class and worsening NYHA class over time. Deterioration in the NYHA class from the index date was associated with increased risks of outcomes. LIMITATIONS: The study population may not be representative of all patients with obstructive HCM in the real world. Documented NYHA classes may not fully reflect the longitudinal variation of NYHA class for each patient. CONCLUSIONS: Worsening NYHA class was associated with increased risks of all-cause mortality and CV outcomes in obstructive HCM.

The New York Heart Association (NYHA) class is a simple way for doctors to measure how bad a patient's heart failure is by how it affects a person's ability to do everyday activities. It is a 4-point scale from 1, indicating no limitations on activity and no shortness of breath, to 4, at which patients have symptoms even at rest and any activity leaves people struggling to catch their breath. NYHA class is also used to assess patients with obstructive hypertrophic cardiomyopathy (HCM), a disease that causes thickening of the heart muscle. While doctors know that as obstructive HCM becomes worse, patients are at greater risk of having to go to the hospital, getting other conditions (like atrial fibrillation or heart failure), having to have more treatments (like surgery), or even death, doctors and researchers do not know how much risk the patient has and how it changes as the disease changes over time. Although there have been some smaller studies that have estimated this risk, we studied a large, national database and found that patients with worse (higher) NYHA class over time had an increased risk of dying, having to go to the hospital for heart-related care, and developing other heart-related conditions. This finding suggests that it is important for doctors to follow up patients with obstructive HCM carefully and to adjust treatments in order to help patients to stay at lower NYHA classes to improve long-term outcomes.

Distribution and trends of mercury in aquatic and terrestrial biota of New York, USA: a synthesis of 50 years of research and monitoring.

Mercury (Hg) inputs have particularly impacted the northeastern United States due to its proximity to anthropogenic emissions sources and abundant habitats that efficiently convert inorganic Hg into methylmercury. Intensive research and monitoring efforts over the past 50 years in New York State, USA, have informed the assessment of the extent and impacts of Hg exposure on fishes and wildlife. By synthesizing Hg data statewide, this study quantified temporal trends of Hg exposure, spatiotemporal patterns of risk, the role that habitat and Hg deposition play in producing spatial patterns of Hg exposure in fish and other wildlife, and the effectiveness of current monitoring approaches in describing Hg trends. Most temporal trends were stable, but we found significant declines in Hg exposure over time in some long-sampled fish. The Adirondack Mountains and Long Island showed the greatest number of aquatic and terrestrial species with elevated Hg concentrations, reflecting an unequal distribution of exposure risk to fauna across the state. Persistent hotspots were detected for aquatic species in central New York and the Adirondack Mountains. Elevated Hg concentrations were associated with open water, forests, and rural, developed habitats for aquatic species, and open water and forested habitats for terrestrial species. Areas of consistently elevated Hg were found in areas driven by atmospheric and local Hg inputs, and habitat played a significant role in translating those inputs into biotic exposure. Continued long-term monitoring will be important in evaluating how these patterns continue to change in the face of changing land cover, climate, and Hg emissions.

The impact of 1-star physician ratings on new patient volume.

OBJECTIVES: To quantify the impact of 1-star reviews across multiple physician rating websites (PRWs) on new patient volume. STUDY DESIGN: Retrospective analysis of 1.12 million new patient appointments and 12,882 physician reviews from a proprietary data set from a large single-specialty practice in the New York and New Jersey area. METHODS: We compiled new patient appointments scheduled and kept between January 1, 2015, and April 25, 2018, and the reviews of the practice's affiliated physicians from 10 PRWs. Assuming that reviews are read prior to appointment creation, an ordinary least squares regression model was run with a time series analysis to compare patient volume in the period immediately prior to the posting of a 1-star review with patient volume in the period immediately after a 1-star review was posted. An additional sensitivity analysis was performed at 4, 6, 8, 10, 12, 14, and 16 weeks to validate a robust effect. RESULTS: The majority of reviews on PRWs were overwhelmingly positive, with only 6.7% of reviews (n = 733) rating a physician with 1 star. A mean of 6.2 new patient appointments were made per half-day session. The mean new patient volume decreased 2.3% to 2.6% following a 1-star review, with effects of the 1-star review affecting patient volume for at least 16 weeks. CONCLUSIONS: Given the limited yet longitudinal negative impact of 1-star reviews and the growing influence of PRWs, physicians should consider the magnitude of the effect as they consider responding to bad reviews.

Racial and Socioeconomic Equity of Tecovirimat Treatment during the 2022 Mpox Emergency, New York, New York, USA.

We assessed tecovirimat treatment equity for 3,740 mpox patients in New York, New York, USA, during the 2022 mpox emergency; 32.4% received tecovirimat. Treatment rates by race/ethnicity were 38.8% (White), 31.3% (Black/African American), 31.0% (Hispanic/Latino), and 30.1% (Asian/Pacific Islander/other). Future public health emergency responses must prioritize institutional and structural racism mitigation.

Environmental exposure disparities in ultrafine particles and PM2.5 by urbanicity and socio-demographics in New York state, 2013-2020.

BACKGROUND: The spatiotemporal and demographic disparities in exposure to ultrafine particles (UFP; number concentrations of particulate matter (PM) with diameter ≤0.1 µm), a key subcomponent of fine aerosols (PM2.5; mass concentrations of PM ≤ 2.5 µm), have not been well studied. OBJECTIVE: To quantify and compare the aerosol pollutant exposure disparities for UFP and PM2.5 by socio-demographic factors in New York State (NYS). METHODS: Ambient atmospheric UFP and PM2.5 were quantified using a global three-dimensional model of chemical transport with state-of-the-science aerosol microphysical processes validated extensively with observations. We matched these to U.S. census demographic data for varied spatial scales (state, county, county subdivision) and derived population-weighted aerosol exposure estimates. Aerosol exposure disparities for each demographic and socioeconomic (SES) indicator, with a focus on race-ethnicity and income, were quantified for the period 2013-2020. RESULTS: The average NYS resident was exposed to 4451 #·cm-3 UFP and 7.87 µg·m-3 PM2.5 in 2013-2020, but minority race-ethnicity groups were invariably exposed to greater daily aerosol pollution (UFP: +75.0% & PM2.5: +16.2%). UFP has increased since 2017 and is temporally and seasonally out-of-phase with PM2.5. Race-ethnicity exposure disparities for PM2.5 have declined over time; by -6% from 2013 to 2017 and plateaued thereafter despite its decreasing concentrations. In contrast, these disparities have increased (+12.5-13.5%) for UFP. The aerosol pollution exposure disparities were the highest for low-income minorities and were more amplified for UFP than PM2.5. DISCUSSION: We identified large disparities in aerosol pollution exposure by urbanization level and socio-demographics in NYS residents. Jurisdictions with higher proportions of race-ethnicity minorities, low-income residents, and greater urbanization were disproportionately exposed to higher concentrations of UFP and PM2.5 than other NYS residents. These race-ethnicity exposure disparities were much larger, more disproportionate, and unabating over time for UFP compared to PM2.5 across various income strata and levels of urbanicity.

Organizational Health Literacy and Health Among New York State Medicaid Members.

BACKGROUND: The definition of health literacy has recently expanded beyond the idea of individual skills to include the system and environment the individual interacts with to receive care, known as organizational health literacy (OHL). However, neither the prevalence of OHL nor the impact of OHL on individuals' perceptions of their health and healthcare have been examined in New York's Medicaid managed care population. OBJECTIVE: This study aimed to estimate the prevalence of organizational health literacy in the New York State (NYS) Medicaid Managed Care (MMC) program. METHODS: A brief measure to assess organizational health literacy was developed from responses to two questions in the 2018 NYS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Generalized Estimating Equation models were developed to analyze the association between organizational health literacy and three aspects of perceptions of health and health care, controlling for demographic differences and clustering effects from health insurance plans. Missing data were handled using multiple imputation. KEY RESULTS: Among 3,598 members included in the study, 20% of the MMC members reported inadequate organizational health literacy. These members were more likely to be older, less educated, from racial and ethnic minority groups, and less fluent with English. They are more likely to have poorer self-reported health (odds ratio [OR] 1.49), lower perceived access to health care (OR 6.97), and lower satisfaction with their health care (OR 6.49) than members who did not report inadequate organizational health literacy. CONCLUSIONS: Our results suggest that a proportion of the NYS MMC population faces inadequate organizational health literacy, which can present a barrier to health care access and result in patients having a significantly poorer health care experience. Using an existing data source that is part of existing data collection allows for routine assessment of organizational health literacy, which can help inform health plans about areas for potential improvement. [HLRP: Health Literacy Research and Practice. 2023;7(3):e154-e164.].

PLAIN LANGUAGE SUMMARY: Our study looked at the impact of organizational health literacy on the perceptions of health and health care of NYS Medicaid Managed Care population. We used existing CAHPS questions to assess organizational health literacy and found that lower organizational health literacy led to worse perceptions of health and health care. This article illustrates an opportunity to demonstrate how organizational health literacy can be measured with annual CAHPS collections.

Carbapenem-Resistant Klebsiella pneumoniae in Large Public Acute-Care Healthcare System, New York, New York, USA, 2016-2022.

Controlling the spread of carbapenem-resistant Enterobacterales is a global priority. Using National Healthcare Safety Network data, we characterized the changing epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a large public health system in New York, New York, USA. During 2016-2020, CRKP cases declined; however, during 2021-June 2022, a notable increase occurred. Of 509 cases, 262 (51%) were considered community-onset, including 149 in patients who were living at home. Of 182 isolates with proven or presumptive (ceftazidime/avibactam susceptible) enzymes, 143 were serine carbapenemases; most confirmed cases were K. pneumoniae carbapenemase. The remaining 39 cases were proven or presumptive metallo-ß-lactamases; all confirmed cases were New Delhi metallo-ß-lactamases. After 2020, a marked increase occurred in the percentage of isolates possessing metallo-ß-lactamases. Most patients with metallo-ß-lactamases originated from long-term care facilities. An aggressive and universal program involving surveillance and isolation will be needed to control the spread of CRKP in the city of New York.