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1.
Sci Total Environ ; 773: 144757, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-33940701

RESUMO

The Clinch River watershed of the upper Tennessee River Basin of Virginia and Tennessee, USA supports one of North America's greatest concentrations of freshwater biodiversity, including 46 extant species of native freshwater mussels (Order Unionida), 20 of which are protected as federally endangered. Despite the global biological significance of the Clinch River, mussel populations are declining in some reaches, both in species richness and abundance. The aim of this study was to evaluate the exposure of adult resident mussels to a suite of inorganic and organic contaminant stressors in distinct sections of the Clinch River that encompassed a range of mussel abundance and health. To provide insight into the potential role of pollutants in the decline of mussels, including within a previously documented "zone of mussel decline", the mainstem Clinch River (8 sites) and its tributaries (4 sites) were examined over two consecutive years. We quantified and related metals and organic contaminant concentrations in mussels to their associated habitat compartments (bed sediment, suspended particulate sediment, pore water, and surface water). We found that concentrations of organic contaminants in resident mussels, particularly the suite of 42 polycyclic aromatic hydrocarbons (PAHs) analyzed, were related to PAH concentrations in all four habitat (media) compartments. Further, PAH concentrations in mussel tissue (range 37.8-978.1 ng/g dry weight in 2012 and 194.3-1073.7 ng/g dry weight in 2013) were negatively related to the spatial pattern in mussel densities (rs = -0.64, p ≤ 0.05 in 2012 and rs = -0.83, p ≤ 0.05 in 2013) within the river, and were highest in the "zone of mussel decline". In contrast, the suite of 22 metals analyzed in resident mussels were largely unrelated to the spatial pattern of variation of metals in the four habitat compartments except for Manganese (Mn; range 3630.5-23,749.2 µg/g dry weight in 2012 and 1540.4-12,605.8 µg/g dry weight in 2013) in surface water (rs = 0.58, p < 0.1) and pore water (rs = 0.76, p ≤ 0.05). This study revealed that PAHs and Mn are important pollutant stressors to mussels in the Clinch River and that they are largely being delivered through the Guest River tributary watershed. Accordingly, future conservation and management efforts would benefit by identifying, and ideally mitigating, the sources of PAHs, Mn, and other current or legacy mining-associated pollutants to the mainstem river and its tributaries.


Assuntos
Bivalves , Poluentes Ambientais , Poluentes Químicos da Água , Animais , Biodiversidade , Monitoramento Ambiental , Água Doce , Tennessee , Virginia , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidade
2.
Front Immunol ; 12: 663074, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33815424

RESUMO

Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers' quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.


Assuntos
/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Pré-Escolar , Humanos , Lactente , Pandemias , Pais , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Tennessee , Estados Unidos , Doenças Preveníveis por Vacina/imunologia , Vacinas/imunologia
3.
JMIR Mhealth Uhealth ; 9(3): e24275, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33690142

RESUMO

BACKGROUND: The COVID-19 pandemic has forced drastic changes to daily life, from the implementation of stay-at-home orders to mandating facial coverings and limiting in-person gatherings. While the relaxation of these control measures has varied geographically, it is widely agreed that contact tracing efforts will play a major role in the successful reopening of businesses and schools. As the volume of positive cases has increased in the United States, it has become clear that there is room for digital health interventions to assist in contact tracing. OBJECTIVE: The goal of this study was to evaluate the use of a mobile-friendly app designed to supplement manual COVID-19 contact tracing efforts on a university campus. Here, we present the results of a development and validation study centered around the use of the MyCOVIDKey app on the Vanderbilt University campus during the summer of 2020. METHODS: We performed a 6-week pilot study in the Stevenson Center Science and Engineering Complex on Vanderbilt University's campus in Nashville, TN. Graduate students, postdoctoral fellows, faculty, and staff >18 years who worked in Stevenson Center and had access to a mobile phone were eligible to register for a MyCOVIDKey account. All users were encouraged to complete regular self-assessments of COVID-19 risk and to key in to sites by scanning a location-specific barcode. RESULTS: Between June 17, 2020, and July 29, 2020, 45 unique participants created MyCOVIDKey accounts. These users performed 227 self-assessments and 1410 key-ins. Self-assessments were performed by 89% (n=40) of users, 71% (n=32) of users keyed in, and 48 unique locations (of 71 possible locations) were visited. Overall, 89% (202/227) of assessments were determined to be low risk (ie, asymptomatic with no known exposures), and these assessments yielded a CLEAR status. The remaining self-assessments received a status of NOT CLEAR, indicating either risk of exposure or symptoms suggestive of COVID-19 (7.5% [n=17] and 3.5% [n=8] of self-assessments indicated moderate and high risk, respectively). These 25 instances came from 8 unique users, and in 19 of these instances, the at-risk user keyed in to a location on campus. CONCLUSIONS: Digital contact tracing tools may be useful in assisting organizations to identify persons at risk of COVID-19 through contact tracing, or in locating places that may need to be cleaned or disinfected after being visited by an index case. Incentives to continue the use of such tools can improve uptake, and their continued usage increases utility to both organizational and public health efforts. Parameters of digital tools, including MyCOVIDKey, should ideally be optimized to supplement existing contact tracing efforts. These tools represent a critical addition to manual contact tracing efforts during reopening and sustained regular activity.


Assuntos
Busca de Comunicante , Processamento Eletrônico de Dados , Aplicativos Móveis , Adulto , /prevenção & controle , Busca de Comunicante/métodos , Docentes/psicologia , Docentes/estatística & dados numéricos , Humanos , Aplicativos Móveis/estatística & dados numéricos , Projetos Piloto , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Tennessee/epidemiologia , Universidades , Adulto Jovem
4.
J Subst Abuse Treat ; 124: 108270, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33771275

RESUMO

The COVID-19 pandemic created a number of rapidly emerging and unprecedented challenges for those engaged in substance use disorder (SUD) treatment, forcing service providers to improvise their treatment strategies as the crisis deepened. Drawing from five ongoing federally funded SUD projects in Appalachian Tennessee and hundreds of hours of meetings and interviews, this article explores the pandemic's impact on an already structurally disadvantaged region, its recovery community, and those who serve it. More specifically, we note detrimental effects of increased isolation since the implementation of COVID-19 safety measures, including stakeholders' reports of higher incidences of relapse, overdose, and deaths in the SUD population. Treatment providers have responded with telehealth services, but faced barriers in technology access and computer literacy among clients. Providers have also had to restrict new clients to accommodate social distancing, faced delays in health screening those they can accept, and denied family visitations, which has affected retention. In light of these challenges, several promising lessons for the future emerged--such as preparing for an influx of new and returning clients in need of SUD treatment; making arrangements for long-term housing and facility modification; developing a hybrid care delivery model, taking advantage of new regulations enabling telemedicine; budgeting for and storing personal protective equipment (PPE) and related supplies; and developing disaster protocols to withstand threats to intake, retention, and financial solvency.


Assuntos
Assistência à Saúde/economia , Acesso aos Serviços de Saúde/economia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Telemedicina/economia , Região dos Apalaches , Humanos , Equipamento de Proteção Individual/provisão & distribução , Transtornos Relacionados ao Uso de Substâncias/economia , Tennessee
5.
J Environ Manage ; 287: 112300, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33706090

RESUMO

Climate stationarity is a traditional assumption in the design of the urban drainage network, including green infrastructure practices such as bioretention cells. Predicted deviations from historic climate trends associated with global climate change introduce uncertainty in the ability of these systems to maintain service levels in the future. Climate change projections are made using output from coarse-scale general circulation models (GCMs), which can then be downscaled using regional climate models (RCMs) to provide predictions at a finer spatial resolution. However, all models contain sources of error and uncertainty, and predicted changes in future climate can be contradictory between models, requiring an approach that considers multiple projections. The performance of bioretention cells were modeled using USEPA's Storm Water Management Model (SWMM) to determine how design modifications could add resilience to these systems under future climate conditions projected for Knoxville, Tennessee, USA. Ten downscaled climate projections were acquired from the North American Coordinated Regional Downscaling Experiment program, and model bias was corrected using Kernel Density Distribution Mapping (KDDM). Bias-corrected climate projections were used to assess bioretention hydrologic function in future climate conditions. Several scenarios were evaluated using a probabilistic approach to determine the confidence with which design modifications could be implemented to maintain historic performance for both new and existing (retrofitted) bioretention cells. The largest deviations from current design (i.e., concurrently increasing ponding depths, thickness of media layer, media conductivity rates, and bioretention surface areas by 307%, 200%, 200%, and 300%, respectively, beyond current standards) resulted in the greatest improvements on historic performance with respect to annual volumes of infiltration and surface overflow, with all ten future climate scenarios across various soil types yielding increased infiltration and decreased surface overflow compared to historic conditions. However, lower performance was observed for more conservative design modifications; on average, between 13-82% and 77-100% of models fell below historic annual volumes of infiltration and surface overflow, respectively, when ponding zone depth, media layer thickness, and media conductivity were increased alone. Findings demonstrate that increasing bioretention surface area relative to the contributing catchment provides the greatest overall return on historic performance under future climate conditions and should be prioritized in locations with low in situ soil drainage rates. This study highlights the importance of considering local site conditions and management objectives when incorporating resiliency to climate change uncertainty into bioretention designs.


Assuntos
Mudança Climática , Modelos Teóricos , Hidrologia , Tennessee , Incerteza
6.
Nutr Metab Cardiovasc Dis ; 31(4): 1227-1237, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33549435

RESUMO

BACKGROUND AND AIMS: High Protein diets may be associated with endocrine responses that favor improved metabolic outcomes. We studied the response to High Protein (HP) versus High Carbohydrate (HC) Diets in terms of incretin hormones GLP-1 and GIP, the hunger hormone ghrelin and BNP, which is associated with cardiac function. We hypothesized that HP diets induce more pronounced release of glucose lowering hormones, suppress hunger and improve cardiac function. METHODS AND RESULTS: 24 obese women and men with prediabetes were recruited and randomized to either a High Protein (HP) (n = 12) or High Carbohydrate (HC) (n = 12) diet for 6 months with all food provided. OGTT and MTT were performed and GLP-1, GIP, Ghrelin, BNP, insulin and glucose were measured at baseline and 6 months on the respective diets. Our studies showed that subjects on the HP diet had 100% remission of prediabetes compared to only 33% on the HC diet with similar weight loss. HP diet subjects had a greater increase in (1) OGTT GLP-1 AUC(p = 0.001) and MTT GLP-1 AUC(p = 0.001), (2) OGTT GIP AUC(p = 0.005) and MTT GIP AUC(p = 0.005), and a greater decrease in OGTT ghrelin AUC(p = 0.005) and MTT ghrelin AUC(p = 0.001) and BNP(p = 0.001) compared to the HC diet at 6 months. CONCLUSIONS: This study demonstrates that the HP diet increases GLP-1 and GIP which may be responsible in part for improved insulin sensitivity and ß cell function compared to the HC diet. HP ghrelin results demonstrate the HP diet can reduce hunger more effectively than the HC diet. BNP and other CVRF, metabolic parameters and oxidative stress are significantly improved compared to the HC diet. CLINICALTRIALS. GOV IDENTIFIER: NCT01642849.


Assuntos
Dieta Rica em Proteínas , Carboidratos da Dieta/administração & dosagem , Incretinas/sangue , Obesidade/dietoterapia , Estado Pré-Diabético/dietoterapia , Adulto , Regulação do Apetite , Biomarcadores/sangue , Feminino , Polipeptídeo Inibidor Gástrico/sangue , Grelina/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Fome , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Obesidade/sangue , Obesidade/diagnóstico , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estudos Prospectivos , Indução de Remissão , Tennessee , Fatores de Tempo , Resultado do Tratamento , Perda de Peso , Adulto Jovem
7.
Med Ref Serv Q ; 40(1): 56-66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33625333

RESUMO

The ability to be flexible and adapt quickly to changing circumstances is a crucial skill for librarians to develop in a world increasingly characterized by rapid change. It can take a crisis to learn how effective librarians have become in developing the needed adaptive behaviors, including a willingness to change workstyles, experiment with new technologies and readily move on from failed experiments. In this paper, librarians from the Preston Medical Library at the University of Tennessee Graduate School of Medicine, prompted by the crisis of COVID-19, present their response. Beginning with a description of how services were provided prior to the pandemic, librarians detail their response in several key areas and show how they implemented new approaches to teaching, collaboration, and mutual support, working together to handle patron issues and pursue scholarly activities.


Assuntos
Adaptação Psicológica , Disseminação de Informação/métodos , Bibliotecários/psicologia , Bibliotecas Digitais/organização & administração , Bibliotecas Médicas/organização & administração , /estatística & dados numéricos , Adulto , Feminino , Humanos , Bibliotecas Digitais/estatística & dados numéricos , Bibliotecas Médicas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tennessee
8.
Mayo Clin Proc ; 96(2): 314-321, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33549253

RESUMO

OBJECTIVE: To determine at which phase in the recruitment process for participation in clinical research studies do health literacy and other patient characteristics influence recruitment outcomes. PATIENTS AND METHODS: Using a sample of 5872 patients hospitalized with cardiovascular disease approached for participation in the Vanderbilt Inpatient Cohort Study from October 2011 through December 2015, we examined the independent association of patients' health literacy with two steps in their research participation decision-making process: (1) research interest - willingness to hear more about a research study; and (2) research participation - the decision to enroll after an informed consent discussion. Best practices for effective health communication were implemented in recruitment approaches and informed consent processes. Using logistic regression models, we determined patient characteristics independently associated with patients' willingness to hear about and participate in the study. RESULTS: In unadjusted analyses, participants with higher health literacy, and those who were younger, female, or had more education had higher levels of both research interest and research participation. Health literacy remained independently associated with both outcomes in multivariable models, after adjustment for sociodemographic factors. CONCLUSION: Because identical variables predicted both research interest and eventual consent, efforts to recruit broad populations must include acceptable methods of approaching potential participants as well as explaining study materials.


Assuntos
Pesquisa Biomédica , Doenças Cardiovasculares/terapia , Letramento em Saúde , Consentimento Livre e Esclarecido , Participação do Paciente , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Tennessee
9.
South Med J ; 114(2): 70-72, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33537785

RESUMO

OBJECTIVES: This study is a follow-up to previous research regarding buprenorphine medication-assisted therapy (MAT) in Johnson City, Tennessee. For-profit MAT clinics were surveyed to determine changes in tapering practice patterns and insurance coverage during the last 3 years. METHODS: Johnson City for-profit MAT clinics; also called office based opioid treatment centers, were surveyed by telephone. Clinic representatives were asked questions regarding patient costs for therapy, insurance coverage, counseling offered onsite, and opportunities for tapering while pregnant. RESULTS: All of the MAT clinics representatives indicated that tapering in pregnancy could be considered even though tapering in pregnancy is contrary to current national guidelines. Forty-three percent of the clinics now accept insurance as compared with 0% in the 2016 study. The average weekly cost per visit remained consistent. CONCLUSIONS: The concept of tapering buprenorphine during pregnancy appears to have become a standard of care for this community, as representatives state it is offered at all of the clinics that were contacted. Representatives from three clinics stated the clinics require tapering, even though national organizations such as the American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine do not recommend this approach. Although patients who have government or other insurance are now able to obtain buprenorphine with no expense at numerous clinics, the high cost for uninsured patients continues to create an environment conducive to buprenorphine diversion.


Assuntos
/economia , Tratamento de Substituição de Opiáceos/economia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Centros de Tratamento de Abuso de Substâncias/economia , Adulto , Assistência Ambulatorial/economia , Analgésicos Opioides/economia , Analgésicos Opioides/uso terapêutico , Região dos Apalaches , Buprenorfina/economia , Buprenorfina/uso terapêutico , Feminino , Seguimentos , Hospitais com Fins Lucrativos , Humanos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/economia , Gravidez , Complicações na Gravidez/economia , Tennessee
10.
J Food Prot ; 84(2): 240-248, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497441

RESUMO

ABSTRACT: Hot-air drying processes are used to provide specific quality attributes to products, such as dehydrated apple pieces. To comply with the U.S. Food and Drug Administration Food Safety Modernization Act, there is a need to understand microbial lethality during these processes. The objective of this study was to determine the level of inactivation provided by hot-air drying on a Salmonella cocktail inoculated onto apple cubes and to evaluate the performance of Enterococcus faecium as a surrogate. A cocktail of Salmonella serovars (Agona, Tennessee, Montevideo, Mbandaka, and Reading) and E. faecium were individually inoculated onto cored, peeled Gala apple cubes at 9.2 ± 0.3 and 8.8 ± 0.1 log CFU per sample, respectively. Apple cubes were dried at 104 or 135°C in ∼1.5-kg batches using a hot-air dryer with a vertically directed heat source and without mixing. Three subsamples, consisting of four inoculated cubes, were enumerated at each time point (n ≥ 5) from multiple product bed depths. Water activity decreased throughout the duration of the study, with samples drying faster at 135 than 104°C. Samples at the bottom bed depth, closer to the heat source, dried faster than those at the higher bed depth, regardless of temperature. Significant microbial inactivation was not seen immediately. It took >10 min at the bottom bed depth or >40 min of drying at the top bed depth, regardless of temperature (P < 0.05). By the end of drying, average Salmonella inactivation of greater than 5 log CFU per sample was achieved. At temperature conditions evaluated, E. faecium inactivation was slower than Salmonella, indicating that it would likely serve as a good surrogate for in-plant validation studies. Case hardening did not inhibit microbial inactivation in the conditions tested. Hot-air drying under the conditions evaluated may provide a preventive control in the production of dehydrated products, such as apples.


Assuntos
Enterococcus faecium , Malus , Contagem de Colônia Microbiana , Manipulação de Alimentos , Microbiologia de Alimentos , Temperatura Alta , Salmonella , Tennessee
11.
Am J Health Syst Pharm ; 78(8): 705-711, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33506860

RESUMO

PURPOSE: The purpose of this descriptive report is to share experiences in crisis response planning and risk mitigation at a university health system department of pharmacy with an integrated clinical practice model in the early months of the coronarvirus disease 2019 (COVID-19) pandemic. SUMMARY: The department of pharmacy's COVID-19 pandemic response included successful planning and implementation of measures to maintain pharmacy operations and minimize COVID-19 exposure of patients and staff. These measures included ensuring adequate personnel staffing using flexible staffing solutions, ongoing assessment of supply chain integrity, and continuation of integrated clinical pharmacy services 24/7 throughout the initial phase of the COVID-19 pandemic. Information technology (IT) and educational program modifications are also discussed. CONCLUSION: This report describes successful crisis planning and risk mitigation in the setting of COVID-19, which was facilitated by the department of pharmacy's integrated clinical practice model. This model enabled uninterrupted personnel scheduling, supply chain integrity, continued provision of 24/7 integrated clinical services, adaptive use of IT tools, and continuation of educational programs. The experiences described may be instructive to other pharmacy departments in evaluating their response to the COVID-19 pandemic and in planning for similar pandemic or other emergency scenarios.


Assuntos
/tratamento farmacológico , Defesa Civil , Assistência à Saúde , Serviço de Farmácia Hospitalar , Hospitais Universitários , Humanos , Modelos Teóricos , Inquéritos e Questionários , Tennessee
12.
Environ Sci Technol ; 55(3): 1626-1636, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33471994

RESUMO

Uranium contamination of soils and groundwater in the United States represents a significant health risk and will require multiple remediation approaches. Microbial phosphatase activity coupled to the addition of an organic P source has recently been studied as a remediation strategy that provides an extended release of inorganic P (Pi) into U-contaminated sites, resulting in the precipitation of meta-autunite minerals. Previous laboratory- and field-based biomineralization studies have investigated environments with relatively high U concentrations (>20 µM). However, most contaminated sites have much lower U concentrations (<2 µM). The Environmental Protection Agency (EPA) limit for U in drinking water is 0.126 µM. Reaching this regulatory limit becomes challenging as U concentrations approach autunite solubility. We studied the precipitation of U(VI)-phosphate minerals by an environmental isolate of Caulobacter sp. (strain OR37) from an Oak Ridge, Tennessee, U-contaminated site. Abiotic U(VI) solubility experiments reveal that U(VI)-phosphate minerals do not form in the presence of excess Pi (500 µM) when U(VI) concentrations are <1 µM and pH is <5. When OR37 cells are reacted under the same conditions with Pi or glycerol-2-phosphate, U(VI)-phosphate mineral formation was observed, along with the formation of intracellular polyphosphate granules. These results show that bacteria provide supersaturated microenvironments needed for U(VI)-phosphate mineralization while hydrolyzing organic P sources. This provides a pathway to lower U concentrations to below EPA limits for drinking water.


Assuntos
Caulobacter , Urânio , Biomineralização , Concentração de Íons de Hidrogênio , Fosfatos , Tennessee , Urânio/análise
13.
J Environ Qual ; 50(2): 429-440, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33410534

RESUMO

Sinking Creek (HUC 06010103046), in the Watauga watershed of northeast Tennessee, is impaired due to Escherichia coli. To assess how E. coli and other water quality parameters fluctuated during storm events, water samples were collected with automated samplers during eight storms at two locations: Sinking Creek and a feeder spring. Turbidity and electrical conductivity data loggers were deployed in the creek, and dissolved oxygen (DO) was measured in situ. The presence of optical brighteners, used in detergents and an indicator of residential wastewater, was assessed using cotton fabric deployed at both sites and analyzed by an external laboratory. The Colilert Quanti-Tray method was used to process water samples for E. coli. Relationships between water quality parameters and lagged precipitation were assessed using cross-correlation. At the creek, E. coli and turbidity increased within 2 h of precipitation, exceeding the single sample water quality standard of 941 cfu 100 ml-1 during the storm. At the spring, E. coli became elevated more quickly than at the stream, within 30 min of precipitation, and decreased below the standard during the event. Electrical conductivity decreased within 1.5 h of the storm at the creek, and DO levels were higher at the creek than at the spring. Optical brightener analysis indicated possible presence of residential wastewater during one of two sampled storms. Targeted sampling and dye tracing are recommended to validate this hypothesis. These results may be used to inform field methods in similar storm sampling studies and will be useful in watershed restoration efforts in Sinking Creek.


Assuntos
Monitoramento Ambiental , Qualidade da Água , Escherichia coli , Tennessee , Tempo (Meteorologia)
14.
J Med Libr Assoc ; 109(1): 133-136, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33424475

RESUMO

Internet and communication technologies enable the creation of tremendous amounts of textual, graphic, and pictorial information. User-generated content published through personal web pages, blogs, and social media platforms has not only increased the amount of information available, but also expanded its reach. However, this ubiquity of information and empowerment of its creators leads to potentially controversial, futile, and inaccurate content circulating throughout the world. In the case of the COVID-19 pandemic, this can create false hope, fear, anxiety, harm, and confusion amongst information stakeholders. The World Health Organization recently applied the term "infodemic" to the COVID-19 pandemic. This commentary briefly discusses the current infodemic, its potential consequences, and the role of libraries-specifically health sciences, biomedical, and medical libraries-to help counter the COVID-19 infodemic. The discussion also has relevance for infodemics relating to other health and non-health affairs.


Assuntos
Acesso à Informação , Confiabilidade dos Dados , Guias como Assunto , Bibliotecas Médicas/normas , Pandemias/estatística & dados numéricos , Papel Profissional , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Tennessee
15.
J Psychiatr Pract ; 27(1): 48-51, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33438867

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic thrust health care professionals around the globe to the frontlines to care for those affected by this medical crisis. While many surgical and procedural medical subspecialties experienced drastic declines in patient visits during this time, the demand for psychiatric services was more stable. In response to statewide stay at home orders, third-year residents in the psychiatry outpatient clinic described in this article quickly transitioned to telepsychiatry to continue providing care to their patients. While providing care from home, these residents experienced a number of challenges that serve as important lessons for enhancing competence in telepsychiatry services.


Assuntos
/psicologia , Psiquiatria/métodos , Telemedicina/métodos , /epidemiologia , Humanos , Internato e Residência/métodos , Transtornos Mentais/terapia , Tennessee
17.
Am J Physiol Renal Physiol ; 320(3): F342-F350, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33356958

RESUMO

The Vanderbilt O'Brien Kidney Center (VOKC) is one of the eight National Institutes of Health P30-funded centers in the United States. The mission of these core-based centers is to provide technical and conceptual support to enhance and facilitate research in the field of kidney diseases. The goal of the VOKC is to provide support to understand mechanisms and identify potential therapies for acute and chronic kidney disease. The services provided by the VOKC are meant to help the scientific community to have the right support and tools as well as to select the right animal model, statistical analysis, and clinical study design to perform innovative research and translate discoveries into personalized care to prevent, diagnose, and cure kidney disease. To achieve these goals, the VOKC has in place a program to foster collaborative investigation into critical questions of kidney disease, to personalize diagnosis and treatment of kidney disease, and to disseminate information about kidney disease and the benefits of VOKC services and research. The VOKC is complemented by state-of-the-art cores and an education and outreach program whose goals are to provide an educational platform to enhance the study of kidney disease, to publicize information about services available through the VOKC, and to provide information about kidney disease to patients and other interested members of the community. In this review, we highlight the major services and contributions of the VOKC.


Assuntos
Pesquisa Biomédica/organização & administração , Nefrologia/organização & administração , Projetos de Pesquisa , Animais , Pesquisa Biomédica/educação , Relações Comunidade-Instituição , Comportamento Cooperativo , Educação Profissionalizante/organização & administração , Educação em Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , Nefrologia/educação , Tennessee
18.
MMWR Morb Mortal Wkly Rep ; 69(5152): 1633-1637, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33382676

RESUMO

To prevent further transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), CDC currently recommends that persons who have been in close contact with someone with SARS-CoV-2 infection should quarantine (stay away from other persons) for 14 days after the last known contact.* However, quarantine might be difficult to maintain for a prolonged period. A shorter quarantine might improve compliance, and CDC recommends two options to reduce the duration of quarantine for close contacts without symptoms, based on local circumstances and availability of testing: 1) quarantine can end on day 10 without a test or 2) quarantine can end on day 7 after receiving a negative test result.† However, shorter quarantine might permit ongoing disease transmission from persons who develop symptoms or become infectious near the end of the recommended 14-day period. Interim data from an ongoing study of household transmission of SARS-CoV-2 were analyzed to understand the proportion of household contacts that had detectable virus after a shortened quarantine period. Persons who were household contacts of index patients completed a daily symptom diary and self-collected respiratory specimens for 14 days. Specimens were tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). Among 185 household contacts enrolled, 109 (59%) had detectable SARS-CoV-2 at any time; 76% (83/109) of test results were positive within 7 days, and 86% (94 of 109) were positive within 10 days after the index patient's illness onset date. Among household contacts who received negative SARS-CoV-2 test results and were asymptomatic through day 7, there was an 81% chance (95% confidence interval [CI] = 67%-90%) of remaining asymptomatic and receiving negative RT-PCR test results through day 14; this increased to 93% (95% CI = 78%-98%) for household members who were asymptomatic with negative RT-PCR test results through day 10. Although SARS-CoV-2 quarantine periods shorter than 14 days might be easier to adhere to, there is a potential for onward transmission from household contacts released before day 14.


Assuntos
/diagnóstico , Busca de Comunicante , Características da Família , Quarentena/estatística & dados numéricos , Humanos , Tennessee/epidemiologia , Fatores de Tempo , Wisconsin/epidemiologia
19.
J Environ Manage ; 279: 111718, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33310242

RESUMO

Continued urbanization has led to tremendous changes on the landscape. These changes have exacerbated the effects of extreme climatic events such as flooding because of constrained water infiltration and increased surface flow. Typical runoff control measures involve sophisticated gray infrastructure that guide excess surface flow into storage and disposal sites. In a dynamic climate system, these measures are not sustainable since they cannot be easily modified to accommodate large volumes of runoff. Green Infrastructure (GI) is an adaptable technique that can be used to minimize runoff, in addition to offering an array of additional benefits (urban heat regulation, aesthetics, improved air quality etc.). Strategic placement of GI is key to achieving maximum utility. While physical site characteristics play a major role in determining suitable GI placement sites, knowledge of future precipitation patterns is crucial to ensure successful flood mitigation. In this paper, suitable GI sites within the city of Knoxville, Tennessee, were determined based on potential impact of an extreme flood event as indicated by site characteristics. Then, the relative potential likelihood of a flood event was determined based on projected precipitation data and knowledge of existing flood zones. By combining potential impact with likelihood information, low, medium, and high priority GI implementation sites were established. Results indicate that high priority sites are in the central parts of the city with priority decreasing outward. The GI prioritization scheme presented here, offers valuable guidance to city planners and policy makers who wish to exploit the GI approach for flood mitigation.


Assuntos
Inundações , Urbanização , Cidades , Previsões , Tennessee
20.
Acad Med ; 96(4): 558-567, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332904

RESUMO

PURPOSE: This qualitative study examined fiscal and administrative (i.e., pre- and post-award grants process) barriers and facilitators to community-engaged research among stakeholders across 4 Clinical and Translational Science Awards (CTSA) institutions. METHOD: A purposive sample of 24 key informants from 3 stakeholder groups-community partners, academic researchers, and research administrators-from the CTSA institutions at the University of North Carolina at Chapel Hill, Medical University of South Carolina, Vanderbilt University Medical Center, and Yale University participated. Semistructured interviews were conducted in March-July 2018, including questions about perceived challenges and best practices in fiscal and administrative processes in community-engaged research. Transcribed interviews were independently reviewed and analyzed using the Rapid Assessment Process to facilitate key theme and quote identification. RESULTS: Community partners were predominantly Black, academic researchers and research administrators were predominantly White, and women made up two-thirds of the overall sample. Five key themes were identified: level of partnership equity, partnership collaboration and communication, institutional policies and procedures, level of familiarity with varying fiscal and administrative processes, and financial management expectations. No stakeholders reported best practices for the institutional policies and procedures theme. Cross-cutting challenges included communication gaps between stakeholder groups; lack of or limits in supporting community partners' fiscal capacity; and lack of collective awareness of each stakeholder group's processes, procedures, and needs. Cross-cutting best practices centered on shared decision making and early and timely communication between all stakeholder groups in both pre- and post-award processes. CONCLUSIONS: Findings highlight the importance of equitable processes, triangulated communication, transparency, and recognizing and respecting different financial management cultures within community-engaged research. This work can be a springboard used by CTSA institutions to build on available resources that facilitate co-learning and discussions between community partners, academic researchers, and research administrators on fiscal readiness and administrative processes for improved community-engaged research partnerships.


Assuntos
Pesquisa Participativa Baseada na Comunidade/economia , Pesquisa Participativa Baseada na Comunidade/estatística & dados numéricos , Relações Comunidade-Instituição , Financiamento Governamental/economia , Pesquisa Médica Translacional/economia , Pesquisa Médica Translacional/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Connecticut , Feminino , Financiamento Governamental/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Pesquisa Qualitativa , South Carolina , Tennessee , Estados Unidos
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