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1.
Medicine (Baltimore) ; 99(9): e19271, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118735

RESUMO

The objective of this study was to examine the association between county-level socioeconomic factors and brand-name drug prescription drug patterns among medical specialties with overall high brand-name outpatient prescription use.This cross-sectional study used data from 2 publicly available datasets. The 2015 Medicare Part D PUF data quantifies the prescription rates at the county-level and data from the US Census Bureau provides information on socioeconomic status at the county-level.We analyzed 3,821,523 brand-name claims and 14,088,613 generic claims reported by health providers from 40 specialties as provided by the 2015 Medicare Part D dataset. Internal Medicine, Family Practice, General Practice, Cardiology, and Ophthalmology accounted for 71% of the total amount of brand-name drugs filled under Medicare Part D in 2015. As the presence of individuals with an income ≥$100,000 increased in a given county, the likelihood of receiving a brand-name prescription claim increased.A county-level association exists involving socioeconomic factors and outpatient brand-name drug prescription patterns. Future interventions should consider these factors in order to reduce percentage of brand-name drugs filled and decrease health care expenditures.


Assuntos
Medicare Part D/estatística & dados numéricos , Padrões de Prática Médica , Medicamentos sob Prescrição/economia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Custos de Medicamentos , Medicamentos Genéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Rhode Island , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
2.
R I Med J (2013) ; 103(2): 21-23, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122095

RESUMO

The rate of nosocomial C. difficile in the state of Rhode Island is among the highest in the country. Multiple factors impact the occurrence of nosocomial C. difficile. Improvement in a single factor may not lead to a decrease in the rate. We report the results of a multidisciplinary team that implemented multiple interventions, which led to a 42% reduction of nosocomial C. difficile at The Miriam Hospital.


Assuntos
Infecções por Clostridium/prevenção & controle , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Segurança do Paciente , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitais , Humanos , Rhode Island/epidemiologia
3.
R I Med J (2013) ; 103(2): 24-27, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122096

RESUMO

C. difficile is a complication of antibiotic therapy. Certain antibiotics are associated with a higher rate of developing C. difficile. The charts of 54 patients with nosocomial C. difficile were reviewed and very few had received a high-risk antibiotic. Seven (13%) of 54 patients had not received any antibiotics in the hospital prior to the positive stool test for C. difficile. Moreover, 6 of the 7 had no documentation of receiving an antibiotic in the 56 days prior to admission suggesting that they might be colonized with C. difficile.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Clostridium difficile/efeitos dos fármacos , Infecção Hospitalar/tratamento farmacológico , Prescrição Inadequada/efeitos adversos , Pacientes Internados , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/microbiologia , Feminino , Hospitais , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Rhode Island/epidemiologia
4.
R I Med J (2013) ; 103(2): 28-30, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122097

RESUMO

The rate of nosocomial C. difficile in Rhode Island is among the highest in the country. Colonization with C. difficile is uncommon but can lead to falsely identifying a patient as having C. difficile infection. Additionally, unrecognized C. difficile colonization may act as a reservoir in the hospital. During a 19-day period, rectal swabs obtained for routine VRE surveillance were cultured for C. difficile. Overall, 51 (7.9%) of 649 patients had C. difficile by culture. The majority (n=36, 71%) of patients from whom a rectal swab grew C. difficile did not have a sample sent to the clinical laboratory. Hence, at least 5.5% of the 649 patients were colonized. One patient was classified as having hospital-acquired C. difficile since the clinical specimen was sent to the clinical laboratory on hospital day 4. This patient was culture positive on admission and hence misclassified as having hospital- acquired C. difficile.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Pacientes Internados/estatística & dados numéricos , Adulto , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Hospitais , Humanos , Tempo de Internação , Reto/microbiologia , Rhode Island
5.
R I Med J (2013) ; 103(2): 36-39, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122099

RESUMO

BACKGROUND: Eating disorders (EDs) are psychiatric illnesses with high rates of morbidity and mortality. Healthcare providers often receive inadequate training in evidence-based ED assessment and treatment. DESIGN: Project CORE (Creating Opportunities for Rhode Island Eating Disorders Professionals) was developed to disseminate ED training/education and treatment approaches to the healthcare workforce. An interdisciplinary research team partners with pediatric healthcare professionals/trainees and supports them to better understand how to diagnose, manage, and collaborate across disciplines in the care of patients with EDs. METHODS: Phase I involves a needs assessment of pediatric healthcare professionals' knowledge, attitudes and needs in treating EDs. Phase II involves the development of training/education approaches, and therapeutic interventions for patients with EDs. In Phase III approaches/interventions are further developed and disseminated across RI. PRINCIPAL CONCLUSIONS: Project CORE's goals will address barriers to effective ED treatment in RI and broaden the workforce of interdisciplinary providers trained to recognize and treat patients with EDs across multiple healthcare settings.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pediatras/educação , Adolescente , Adulto , Atitude do Pessoal de Saúde , Currículo , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Equipe de Assistência ao Paciente , Rhode Island
6.
R I Med J (2013) ; 103(2): 45-48, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122101

RESUMO

Pain is universal, yet the prevalence of overdose and treatment of pain varies significantly between the United States (US) and Western Europe. Overdose deaths are seven times more common in the US compared to Western Europe. Cultural perceptions of pain, perception and treatment of opioid use disorder, pharmaceutical advertising, and rates and regulation of prescribing of opioids represent examples of factors that may be related to such differences between the US and Western Europe. As Rhode Island continues to battle the devastating and well-documented national opioid overdose epidemic, we should consider how cultural, regulatory differences, and economic factors may influence pain and its treatment.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Overdose de Drogas/mortalidade , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Oxicodona/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Dor Aguda/tratamento farmacológico , Analgésicos Opioides/envenenamento , Comparação Transcultural , Overdose de Drogas/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Oxicodona/envenenamento , Manejo da Dor/métodos , Rhode Island/epidemiologia
7.
PLoS Med ; 16(11): e1002963, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31743335

RESUMO

BACKGROUND: In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD. METHODS AND FINDINGS: Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources. CONCLUSIONS: Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.


Assuntos
Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Analgésicos Opioides/uso terapêutico , Protocolos Clínicos , Estudos Transversais , Overdose de Drogas/psicologia , Overdose de Drogas/terapia , Humanos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos , Rhode Island/epidemiologia , Medição de Risco/métodos , Fatores de Risco , Serviço Social , Participação dos Interessados , Estados Unidos/epidemiologia
8.
Environ Entomol ; 48(5): 1203-1213, 2019 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-31504366

RESUMO

Native and introduced bees were attracted to and captured in commercially available Japanese beetle, Popillia japonica Newman (Coleoptera: Scarabaeidae), traps baited with floral lure components: geraniol, eugenol, and phenethyl propionate [PEP] in Rhode Island, Ohio, and Tennessee. Studies in Rhode Island showed that Bombus impatiens Cresson (Hymenoptera: Apidae) was significantly more attracted to geraniol alone and as a component in floral lure blends than to either eugenol or PEP alone. Xylocopa virginica (L.) (Hymenoptera: Apidae) was more selective in being primarily attracted to traps baited with higher amounts of geraniol in 2016. Removing geraniol from the floral lure blend did not significantly reduce Japanese beetle captures in 2017 and 2018 in Rhode Island and Ohio but did significantly reduce bee captures in Rhode Island in 2017 and 2018. Green, black, brown, and red traps captured significantly fewer bees than clear or standard yellow vane and green cage traps in 2018 in Rhode Island and Tennessee; however, there were no significant differences between Japanese beetle captures in any of the colored or clear traps. Our results show that using all green traps with a lure composed of eugenol and PEP and the Japanese beetle female produced sex pheromone can effectively capture Japanese beetles while minimizing bycatch of bees.


Assuntos
Besouros , Himenópteros , Animais , Abelhas , Feminino , Controle de Insetos , Japão , Ohio , Rhode Island , Tennessee
9.
Ecol Appl ; 29(8): e02006, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31541510

RESUMO

Adding to the challenge of predicting fishery recruitment in a changing environment is downscaling predictions to capture locally divergent trends over a species' range. In recent decades, the American lobster (Homarus americanus) fishery has shifted poleward along the northwest Atlantic coast, one of the most rapidly warming regions of the world's oceans. Building on evidence that early post-settlement life stages predict future fishery recruitment, we describe enhancements to a forecasting model that predict landings using an annual larval settlement index from 62 fixed sites among 10 study areas from Rhode Island, USA to New Brunswick, Canada. The model is novel because it incorporates local bottom temperature and disease prevalence to scale spatial and temporal changes in growth and mortality. For nine of these areas, adding environmental predictors significantly improved model performance, capturing a landings surge in the eastern Gulf of Maine, and collapse in southern New England. On the strength of these analyses, we project landings within the next decade to decline to near historical levels in the Gulf of Maine and no recovery in the south. This approach is timely as downscaled ocean temperature projections enable decision makers to assess their options under future climate scenarios at finer spatial scales.


Assuntos
Mudança Climática , Nephropidae , Animais , Canadá , Larva , Maine , New England , Oceanos e Mares , Rhode Island , Temperatura Ambiente
10.
Nutrients ; 11(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31500153

RESUMO

Limited data is available on the micronutrient intake and adequacy in preschool children enrolled in family child care homes (FCCH). The goal of this paper is to describe the micronutrient adequacy relative to age-specific recommendations of preschool-aged children (aged 2-5 years) attending FCCH in Rhode Island (RI). Dietary data among younger preschoolers (aged 2-3 years), n = 245) and older preschoolers (aged 4-5 years), n = 121) in 118 RI FCCH (N = 366 children) were analyzed. Nutrient adequacy was assessed as the amount of nutrient per 1000 kcal of the diet that would meet the Institute of Medicine nutrient requirements (critical nutrient density), and it was compared to the observed nutrient densities of the children. The sodium:potassium ratio was also calculated. For most micronutrients, the observed density met or exceeded the recommendation, meaning the children's intake was adequate. However, a high proportion of children had nutrient densities under the recommendation for vitamins D, E, K, and potassium (86.1%, 89.1%, 70.8%, and 99.2% of children, respectively). The mean vitamin B12, potassium, and zinc densities were statistically higher in younger vs. older preschoolers (p < 0.05 for all). Low densities in calcium and vitamins K and B5 were more frequent in older children vs. younger children (p < 0.05). In addition, older preschoolers had a higher sodium:potassium ratio than younger children (p < 0.05). The micronutrient intake density was adequate for most nutrients. However, intake of some nutrients was of concern. Further attention to training and compliance in FCCH may improve the diet quality of those cared for in these settings.


Assuntos
Cuidado da Criança , Creches , Fenômenos Fisiológicos da Nutrição Infantil , Micronutrientes/administração & dosagem , Estado Nutricional , Valor Nutritivo , Recomendações Nutricionais , Fatores Etários , Pré-Escolar , Feminino , Humanos , Masculino , Massachusetts , Ensaios Clínicos Controlados Aleatórios como Assunto , Rhode Island
11.
R I Med J (2013) ; 102(6): 15-18, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398962

RESUMO

Since the early 2000s, three-dimensional (3D) printing has become a well-rounded, evolving technology which has begun to revolutionize healthcare. 3D printing enables rapid creation and manufacture of individual patient models from original designs or medical imaging data. These models can be used for surgical planning, procedural training for residents and medical students, and the design and manufacture of surgical instruments, implants and prostheses. Current availability of this advanced technology at the Lifespan 3D Printing Lab permits Rhode Island physicians to utilize 3D printing in multiple, diverse settings to help improve their medical practice and optimize healthcare outcomes. This article describes three case-based examples to demonstrate varies used of 3D printing in Medicine.


Assuntos
Tecnologia Biomédica/tendências , Impressão Tridimensional , Difusão de Inovações , Educação Médica , Humanos , Modelos Anatômicos , Planejamento de Assistência ao Paciente , Próteses e Implantes , Rhode Island , Cirurgia Assistida por Computador
12.
R I Med J (2013) ; 102(6): 24-26, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398964

RESUMO

The opioid epidemic presents an urgent public health problem. Rhode Island has enacted comprehensive rules to address primary prevention of opioid overdose. This study evaluates the efficacy of those regulations in altering prescribing behavior, specifically regarding the initial prescription. Using data extracted from the Rhode Island Prescription Drug Monitoring Program (PDMP), before and after the publication of updated acute pain management regulations, we studied the rate of opioid prescribing using statistical process control (SPC) charts and found that the rate of prescribing unsafe doses of opioids, more than 30 morphine milligram equivalents (MMEs) per day or more than 20 doses to opioid naïve patients, decreased significantly.


Assuntos
Overdose de Drogas/epidemiologia , Prescrição Inadequada/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Programas de Monitoramento de Prescrição de Medicamentos/legislação & jurisprudência , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/prevenção & controle , Humanos , Prescrição Inadequada/prevenção & controle , Análise de Séries Temporais Interrompida , Padrões de Prática Médica/normas , Programas de Monitoramento de Prescrição de Medicamentos/normas , Medicamentos sob Prescrição/uso terapêutico , Rhode Island/epidemiologia
13.
R I Med J (2013) ; 102(6): 27-30, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398965

RESUMO

In the United States, high concern for iatrogenic reactivation to tuberculosis (TB) disease secondary to prescribed immunosuppression has resulted in increased use of the QuantiFERON-TB Gold In-Tube test (QFT-GIT) to screen for Mycobacterium tuberculosis (Mtb) infection. The aim of our study was to determine indications for QFT-GIT testing and risk factors for indeterminate QFT-GIT results. We retrospectively identified patients with QFT-GIT testing over a six-month period in a tertiary care academic health care system and performed a record review. Inpatients were 11 times more likely to have an indeterminate QFT-GIT result than outpatients (95% CI 7.6-16.2). 61.5% inpatient QFT-GITs were ordered during workup of active TB. Providers treating exogenously or endogenously immunosuppressed patients ordered the most QFT-GITs. We highlight the significant limitations of TB screening tests in the inpatient setting and the need to test earlier in those requiring immunosuppressive therapy to avoid indeterminate results.


Assuntos
Hospedeiro Imunocomprometido , Testes de Liberação de Interferon-gama/estatística & dados numéricos , Programas de Rastreamento/métodos , Tuberculose/diagnóstico , Adulto , Idoso , Feminino , Hospitalização , Humanos , Pacientes Internados , Testes de Liberação de Interferon-gama/normas , Tuberculose Latente/diagnóstico , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Estudos Retrospectivos , Rhode Island , Fatores de Risco
14.
R I Med J (2013) ; 102(6): 31-34, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398966

RESUMO

Corporal punishment (CP) is defined as inflicting pain to redirect an undesired behavior. The objective of the current study is to assess Rhode Island physicians' perceptions, experiences and education regarding CP. Our data may be used to inform future research and education/training for health care providers on how to provide guidance and have conversations surrounding CP. We developed an anonymous survey that assessed the perceptions, experiences and training of Hasbro Children Hospital physicians regarding CP in the medical setting. A total of 58 physicians responded; participants responded that CP was never effective for improving behavior (67.2%) and never recommended CP (98.2%) to patient families. However, most participants reported never received education on CP (67.9%). Our findings highlight that pediatric providers do not find CP an appropriate method of discipline and underscore the need for standardized training and education surrounding this issue.


Assuntos
Atitude do Pessoal de Saúde , Relações Pais-Filho , Pediatria/educação , Médicos/psicologia , Punição , Adulto , Criança , Comportamento Infantil , Pré-Escolar , Feminino , Humanos , Relações Interpessoais , Masculino , Médicos/estatística & dados numéricos , Rhode Island , Inquéritos e Questionários
15.
R I Med J (2013) ; 102(6): 35-40, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398967

RESUMO

OBJECTIVE: Our objective was to identify patterns of opioid use among pregnant women enrolled in RI Medicaid. METHODS: This study used linked RI Medicaid and RI Birth Certificate data from 01/01/2006 to 12/31/2016. We examined temporal trends of prescription opioid dispensings and identified risk factors associated with opioids use during pregnancy. RESULTS: Among 25,500 RI Medicaid enrolled pregnant women who delivered a live baby from 2008 to 2016, 1,914 (7.5%) received at least one prescription for an opioid medication during pregnancy, 810 (3.2%) were during the first trimester, 633 (2.5%) during the second trimester, and 866 (3.4%) during the third trimester. Of these, 213 (0.8%) women received 3 or more opioids during pregnancy. The prevalence of prescription opioids dispensed in pregnant women increased from 4.9% in 2008 to 9.6% in 2015 (ß±SD: 0.66±0.28, P=0.05). CONCLUSIONS: Prescription opioid use during pregnancy has increased among women enrolled in RI Medicaid.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Gravidez , Adolescente , Adulto , Feminino , Humanos , Hidrocodona/uso terapêutico , Modelos Logísticos , Análise Multivariada , Oxicodona/uso terapêutico , Dor/tratamento farmacológico , Trimestres da Gravidez , Estudos Retrospectivos , Rhode Island , Estados Unidos , Adulto Jovem
16.
Med Care ; 57(10): 801-808, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31464841

RESUMO

OBJECTIVE: To estimate the effect of patient-centered medical home (PCMH) participation on cost and utilization of care for patients in Rhode Island's statewide, multipayer PCMH program, which serves over one-third of the state population. DATA SOURCES/STUDY SETTING: 2009-2014 claims data from all payers in Rhode Island, representing >743,000 unique patients. STUDY DESIGN: A propensity score-matched difference-in-differences framework was used to separately estimate the effect of the PCMH on 3 patient cohorts, which were defined by their intervention start dates and amounts of implementation time. Outcomes included patient costs (total, inpatient, outpatient, professional, pharmacy) and utilization [emergency department (ED) visits, preventable ED visits, inpatient admissions, preventable inpatient admissions, all-cause 30-day readmissions]. Interaction effects were estimated to assess heterogeneity among clinical risk groups and payers. PRINCIPAL FINDINGS: There was no evidence of a PCMH effect on total costs, though we observed evidence of an increase in the odds of PCMH patients having outpatient and professional costs, and in one cohort, a decrease in inpatient costs for those with an inpatient visit. We also observed evidence of reduced ED visits, preventable ED visits, and inpatient admissions for PCMH patients. While subgroup effects varied by cohort and measure, high-risk patients often experienced the largest reductions in ED visits. CONCLUSIONS: All PCMH cohorts experienced statistically significant reductions in some types of utilization in as little as 1.25 years. Reductions were greatest for measures included in the PCMH contractual agreement. While PCMH programs may not expect cost savings in the short-term, costs could potentially be reduced in the longer-term through avoided ED and inpatient expenses.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/economia , Feminino , Implementação de Plano de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/economia , Avaliação de Programas e Projetos de Saúde , Pontuação de Propensão , Rhode Island
17.
Sci Total Environ ; 695: 133849, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31425983

RESUMO

Oil spills are a widespread problem in the marine environment and can have extensive acute and chronic adverse impacts to resident and migratory biota. On 19 January 1996, the North Cape oil tanker caught fire and grounded on the coast of Rhode Island resulting in the spill of 828,000 gal (3134 metric tonnes) of home heating oil. It resulted in the estimated death of nearly 2300 birds, including a projected 402 common loons (Gavia immer) and 12 red-throated loons (Gavia stellata). Based on existing demographic data, a resource equivalency analysis (REA) calculated that the total loss, as measured through dead adults and their foregone young over their expected lifetimes, was 2920 discounted loon-years. To generate compensatory loon years, it was initially estimated that 25 common loon nests would need protection from development for 100 years. Following a $3 million settlement with the parties responsible for the spill, we conducted surveys to identify the highest quality breeding loon habitat for protection. Monitoring efforts included 184 loon territories from 2000 to 2009, representing 866 loon territory-years on 70 lakes in four regions of Maine. To evaluate restoration effectiveness, an updated REA was conducted using productivity data collected from these surveys. Results from the updated REA indicated that were these site-specific data available when the REA was originally generated, 70 nests would have been required to offset the lost loon-years - this project permitted the protection of 119 nests. Future REAs should incorporate site specific productivity data whenever possible to most accurately scale restoration to injury. Ranking lake habitat quality further optimizes restoration effectiveness. Our results indicate breeding success was highest on 24-81 ha lakes and that emphasizing protection of lakes with loon territories in this size class is optimal. Our results demonstrate a need for site-specific restoration plans to achieve the greatest restoration benefits.


Assuntos
Aves , Conservação dos Recursos Naturais/métodos , Poluição por Petróleo , Animais , Rhode Island
18.
Mar Pollut Bull ; 146: 236-246, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426152

RESUMO

Bivalves facilitate microbial nitrogen cycling, which can produce nitrous oxide (N2O), a potent greenhouse gas. Potential N2O production by three marine bivalves (Mytilus edulis, Mercenaria mercenaria and Crassostrea virginica) was measured in the laboratory including responses to nitrogen (N) loading and/or warming over short-terms (up to 14 or 28 days). N additions (targeting 100 µM-N ammonium nitrate) or warming (22 °C) individually and in combination were applied with experimental controls (20 µM-N, 19 °C). N2O production rates were higher with N additions for all species, but warming lacked significant direct effects. Ammonium and nitrate concentrations varied but were consistent with nitrification as a potential N2O source for all bivalves. Highest N2O emissions (7.5 nmol N2O g-1 h-1) were from M. edulis under hypoxic conditions coincident with a drop in pH. Macro-epifauna on M. edulis did not significantly alter N2O production. Thus, under short-term hypoxic conditions, micro-organisms in M. edulis guts may be a particularly significant source of N2O.


Assuntos
Crassostrea/metabolismo , Mercenaria/metabolismo , Mytilus edulis/metabolismo , Óxido Nitroso/metabolismo , Compostos de Amônio/metabolismo , Exoesqueleto/fisiologia , Animais , Crassostrea/fisiologia , Concentração de Íons de Hidrogênio , Mercenaria/fisiologia , Mytilus edulis/fisiologia , Nitratos/metabolismo , Nitrificação , Ciclo do Nitrogênio , Nutrientes/metabolismo , Rhode Island , Água do Mar/química , Temperatura Ambiente , Qualidade da Água
19.
Mar Pollut Bull ; 146: 711-717, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426213

RESUMO

Narragansett Bay is an urban estuary that historically has been impacted by long-term discharge of sanitary wastewater (WW) effluents. High-density water sampling was conducted in Narragansett Bay, RI, USA, in an effort to understand the distribution and behavior of sucralose, an artificial sweetener that has shown utility as a sanitary wastewater tracer. Water samples were collected at sixty-seven sites and analyzed for sucralose, whose performance was compared to other tracers present in wastewater effluents. Concentrations of sucralose were much higher than the other tracers measured, carbamazepine and caffeine, ranging from 18 to 3180 ng/L and corresponded well with salinity (r2 = 0.88), demonstrating conservative behavior throughout the Bay. Mapped interpolation data using an empirical bayesian kriging model clearly show the spatial trends of WW and how estuarine processes influence dilution and dispersion throughout the Bay. These findings provide further evidence of the efficacy of sucralose as a wastewater tracer in large urban estuaries where continuous high-volume discharge of WW occur.


Assuntos
Monitoramento Ambiental/métodos , Sacarose/análogos & derivados , Águas Residuárias/análise , Poluentes Químicos da Água/análise , Teorema de Bayes , Baías , Cafeína/análise , Estuários , Hidrologia/métodos , Rhode Island , Salinidade , Sacarose/análise , Edulcorantes/análise
20.
Home Healthc Now ; 37(4): 208-212, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274583

RESUMO

In 2010, the Institute of Medicine published the vision for how to transform healthcare to achieve a more seamless patient-centered, high-quality system of care. Among the recommendations were four specifically focused on leveraging nursing which is the largest group of healthcare workers: (1) Ensure that nurses can practice to the full extent of their education and training, (2) Improve nursing education, (3) Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts, and (4) Improve data collection for workforce planning and policy making. At the Care New England Health Care System's Visiting Nurse Association, located in the state of Rhode Island, we redesigned access to end-of-life care by leveraging these recommendations. An experienced palliative care nurse practitioner (NP) leads the program development to improve care delivered by home healthcare nurses and NP specialists. This program was designed to allow patients to remain in their preferred setting of care-their home-until the end of their life. In the 5 years of this program's existence, it has achieved a yearly impact on community-based palliative care and hospice services. The number of documented advance directives increased by 75%, referrals to palliative care and hospice increased by 300% and the length of time on hospice doubled. In addition, NP home visits became an accepted referral source and improvements in both the quality and satisfaction scores for the home healthcare agency were realized.


Assuntos
Acesso aos Serviços de Saúde , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Guias de Prática Clínica como Assunto , Assistência Terminal , Acesso aos Serviços de Saúde/organização & administração , Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Rhode Island , Assistência Terminal/métodos , Assistência Terminal/organização & administração , Assistência Terminal/normas , Assistência Terminal/estatística & dados numéricos
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