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1.
Sr Care Pharm ; 35(2): 75-80, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32019642

RESUMO

This report describes a case of hypertensive crisis identified by two pharmacists conducting a patient home visit. A 72-year-old woman living in a rural town in Eastern Washington state was referred for a pharmacist home visit by her care coordinator, who had concerns of possible medication-related issues. The patient had a history of type 2 diabetes mellitus, hypertension, ischemic stroke, heart failure with preserved ejection fraction, hypothyroidism, and unspecified back pain. This patient also experienced additional challenges resulting from living in a rural and medically underserved community. During the home visit, the patient's chief complaint was recurrent, painful migraine headaches that she self-treated with nonsteroidal anti-inflammatory medication. Upon examination, the pharmacists found the patient's blood pressure to be 223/132 mm Hg and her self-monitoring log consistently showed blood pressure readings greater than 180/110 mm Hg with a pulse between 75 bpm to 80 bpm. The patient was referred to the emergency department after determining her blood pressure met criteria for hypertensive crisis despite her adherence to her current antihypertensive regimen. She was hospitalized for three days. After her hospitalization, she was referred to her primary care providers and her pharmacist for follow up. The pharmacist reconciled her current medication regimen and made guideline-directed adjustments to her antihypertensive medications. Six months after her hospitalization her blood pressure was within goal and associated headaches had resolved.


Assuntos
Diabetes Mellitus Tipo 2 , Visita Domiciliar , Idoso , Anti-Hipertensivos , Feminino , Humanos , Farmacêuticos , Washington
2.
J Dent Hyg ; 93(6): 13-20, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31882557

RESUMO

Purpose: Higher education teaching has been traditionally delivered through a lecture format, limiting the opportunities for interpersonal communication between faculty and students. The purpose of this study was to determine whether entry-level dental hygiene (DH) students and faculty perceive social media (SM) applications as an effective out-of-class communication (OCC) tool for enhancing learning in a dental hygiene program.Methods: A cross-sectional, comparative research design was used for this pilot study. An investigator-designed, paper survey was administered to a convenience sample of entry-level DH students and faculty from nine dental hygiene programs in Utah, Idaho, Oregon, Washington, and California. Data were analyzed using descriptive and inferential statistics (p=0.05).Results: A total of 418 students and 149 faculty members met the eligibility criteria; 325 DH students (n=325) and 77 faculty completed the surveys (n=77) for a combined response rate of 70.9%. While most faculty and DH students agreed SM could enhance learning for OCC, their level of comfort using these applications varied. Both faculty and DH students use SM applications for questions about assignments, clarification on lecture topics, and feedback on assignments. Statistical significance was found for the frequency of using SM applications for OCC (X2 =16.92; df =4; p =.002). Learning management systems were used and preferred most by both groups followed by Facebook. Statistical significance was found between both groups when ranking electronic devices for OCC.Conclusion: Dental hygiene students and faculty differ in their frequency and levels of comfort in using SM for out-of-class communication. Additional research related to the phenomenon of social media and communication to enhance learning in dental hygiene should be explored.


Assuntos
Mídias Sociais , California , Comunicação , Estudos Transversais , Higienistas Dentários , Humanos , Idaho , Oregon , Projetos Piloto , Utah , Washington
3.
Zootaxa ; 4624(4): zootaxa.4624.4.2, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31716196

RESUMO

In this paper, the primary types of Centris described by the American doctor and naturalist William Henry Fox deposited at the Academy of Natural Sciences, Drexel University, Philadelphia and in the United States National Museum, Washington, United States were studied. To stabilize the application of some names, lectotypes were designated for C. atriventris Fox (= C. foxi Friese), C. cockerellii Fox, C. eisenii Fox, C. errans Fox, C. pallida Fox, C. subhyalina Fox (= C. lanosa Cresson), and C. xylocopoides Fox. This latter species is withdrawn from the synonymy of C. braccata Packard and subsequently revalidated. Centris foxi is removed from synonymy of C. atripes Mocsáry and revalidated, proposing this latter species as its new junior synonym. A taxonomic note on the primary type of C. marginata Fox (= C. caesalpiniae Cockerell) is also provided.


Assuntos
Himenópteros , Distribuição Animal , Animais , Abelhas , Universidades , Washington
4.
Zootaxa ; 4657(3): zootaxa.4657.3.1, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31716768

RESUMO

A three-week intensive marine biodiversity survey was carried out at a small remote region of the central British Columbia coast at and near the Calvert Island Marine Station (Hakai Institute) July 21-August 11, 2017. The survey included daily sampling by the staff and a number of visiting taxonomists with specialties covering all the major groups of invertebrates. Many marine habitats were sampled: rocky and sand/gravel intertidal and tidepools, eelgrass meadows, shallow and deeper subtidal by snorkel and Scuba, plus artificial surfaces including the sides and bottom of the large floating dock at the Institute and settlement plates set out up to a year previously at various subtidal sites. Many new species were recorded by all the taxonomists. In this very biodiverse remote area 36 ascidian species were identified: 18 Aplousobranchia, 7 Phlebobranchia, and 11 Stolidobranchia, comprising a total of 15 solitary and 21 colonial species including two undescribed colonial species. This represents almost one third of all the known North American species from Alaska to southern California in this limited very remote area. Remarkably, only two are possible non-natives. Diplosoma listerianum (Milne-Edwards, 1841), was collected mostly on natural substrates including deeper areas sampled by Scuba, and one colony occurred on a settlement plate. A few Ciona savignyi Herdman, 1882 were collected, two from natural substrates and four from artificial surfaces. There were no botryllids, Styela clava Herdman, 1881, Didemnum vexillum Kott, 2002, or Molgula manhattensis (De Kay, 1843), though these are all common and sometimes very abundant non-natives in other parts of BC and along much of the U.S. west coast. Most of the species encountered are known in northern California, Washington, and southern BC, but only a small number are represented among the few known Alaska species.


Assuntos
Urocordados , Alaska , Animais , Colúmbia Britânica , California , Washington
5.
Zootaxa ; 4657(2): zootaxa.4657.2.7, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31716788

RESUMO

Urochordeumatidae Silvestri, 1909 includes a single species, Urochordeuma bumpusi Silvestri, 1909, with U. porona Chamberlin, 1941 as a new junior subjective synonym. The family Urochordeumatidae is removed from the superfamily Caseyoidea and transferred to the superfamily Striarioidea. The species is known only from four counties in Washington State in the North Cascades: Pierce, King, Thurston and Whatcom. The occurrence of U. bumpusi from Whatcom County is a significant range extension.


Assuntos
Artrópodes , Animais , Washington
6.
BMC Health Serv Res ; 19(1): 749, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651302

RESUMO

BACKGROUND: An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders. METHODS: This study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not? RESULTS: From baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen's d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen's d = 0.91) and Continuity of Care (p = 0.026, Cohen's d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen's d = 0.51) were found. CONCLUSIONS: Overall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders. TRAIL REGISTRATION: ClinicalTrials.gov, NCT03007940 . Retrospectively registered January 2017.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Comportamento Aditivo , Análise por Conglomerados , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/complicações , Washington
7.
Plant Dis ; 103(12): 3150-3153, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31596689

RESUMO

The objective of this research was to test the hypothesis that Verticillium isaacii causes diseases of sunflower and potato plants. Two sunflower genotypes and one potato cultivar were inoculated with five V. isaacii isolates and three pathogenic V. dahliae isolates. Biomass, disease expression, and stem colonization were quantified. Overt wilt symptoms were observed on both sunflower genotypes and potato plants inoculated with a subset of the V. isaacii isolates. Biomass of both sunflower genotypes was not affected by V. isaacii infection. Tuber yields either decreased in response to infection by one V. isaacii isolate or were not affected by infection. Stems of sunflower and potato plants were infected by at least four of the five V. isaacii isolates. A new disease of sunflower and potato is documented. Evidence that V. isaacii exhibits different lifestyles including pathogenicity and endophytism is presented. Finally, this research documents variation in fungal lifestyles that can exist in samples from a single field.


Assuntos
Helianthus , Solanum tuberosum , Verticillium , Endófitos/fisiologia , Genes Fúngicos/genética , Genótipo , Helianthus/microbiologia , Especificidade de Hospedeiro , Solanum tuberosum/microbiologia , Verticillium/genética , Verticillium/fisiologia , Washington
8.
Dis Aquat Organ ; 136(2): 157-162, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31621648

RESUMO

The prevalence of Ichthyophonus infection in Pacific herring Clupea pallasii was spatially heterogeneous in the southern Salish Sea, Washington State, USA. Over the course of 13 mo, 2232 Pacific herring were sampled from 38 midwater trawls throughout the region. Fork length was positively correlated with Ichthyophonus infection at all sites. After controlling for the positive relationship between host size and Ichthyophonus infection, the probability of infection was approximately 6-fold higher in North Hood Canal than in Puget Sound and the northern Straits (12 vs. 2% predicted probability for a 100 mm fish and 30 vs. 7% predicted probability for a 180 mm fish). Temporal changes in Ichthyophonus infection probability were explained by seasonal differences in fish length, owing to Pacific herring life history and movement patterns. Reasons for the spatial heterogeneity remain uncertain but may be associated with density-dependent factors inherent to the boom-bust cycles that commonly occur in clupeid populations.


Assuntos
Doenças dos Peixes , Infecções por Mesomycetozoea , Mesomycetozoea , Animais , Peixes , Oceanos e Mares , Washington
9.
MMWR Morb Mortal Wkly Rep ; 68(39): 845-850, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581164

RESUMO

Use of marijuana at an early age can affect memory, school performance, attention, and learning; conclusions have been mixed regarding its impact on mental health conditions, including psychosis, depression, and anxiety (1-3). Medical marijuana has been legal in Washington since 1998, and in 2012, voters approved the retail sale of marijuana for recreational use to persons aged ≥21 years. The first retail stores opened for business in July 2014. As more states legalize marijuana use by adults aged ≥21 years, the effect of legalization on use by youths will be important to monitor. To guide planning of activities aimed at reducing marijuana use by youths and to inform ongoing policy development, Public Health-Seattle & King County assessed trends and characteristics of past 30-day marijuana use among King County, Washington, public school students in grades 6, 8, 10, and 12. This report used biennial data for 2004-2016 from the Washington State Healthy Youth Survey. Among grade 6 students there was a decreasing trend in self-reported past 30-day marijuana use from 2004 to 2016, while the percentage of grade 8 students who had used marijuana during the past 30 days did not change during that period. Among students in grades 10 and 12, self-reported past 30-day use of marijuana increased from 2004 to 2012, then declined from 2012 to 2016. In 2016, the percentage of students with past 30-day marijuana use in King County was 0.6% among grade 6, 4.1% among grade 8, 13.9% among grade 10, and 25.5% among grade 12 students. Among grade 10 students, 24.0% of past 30-day marijuana users also smoked cigarettes, compared with 1.3% of nonusers. From 2004 to 2016 the prevalence of perception of great risk of harm from regular marijuana use decreased across all grades. Continued surveillance using consistent measures is needed to monitor the impact of marijuana legalization and emerging public health issues, given variable legislation approaches among jurisdictions.


Assuntos
Uso da Maconha/epidemiologia , Uso da Maconha/tendências , Setor Público , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/psicologia , Adolescente , Criança , Comércio/legislação & jurisprudência , Feminino , Inquéritos Epidemiológicos , Humanos , Legislação de Medicamentos/estatística & dados numéricos , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Prevalência , Medição de Risco , Estudantes/estatística & dados numéricos , Washington/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 68(38): 813-818, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31557149

RESUMO

Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease (1). Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication (2-5). Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica (6). This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.


Assuntos
Manufaturas/efeitos adversos , Indústria Manufatureira , Exposição Ocupacional/efeitos adversos , Silicose/diagnóstico , Adulto , California/epidemiologia , Colorado/epidemiologia , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Silicose/epidemiologia , Texas/epidemiologia , Washington/epidemiologia
11.
Arch Environ Contam Toxicol ; 77(4): 549-574, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31538223

RESUMO

Railway transport of coal poses an environmental risk, because coal dust contains polycyclic aromatic hydrocarbons (PAHs), mercury, and other trace metals. In the Pacific Northwest of the United States, proposed infrastructure projects could result in an increase in coal transport by train through the Columbia River corridor. Baseline information is needed on current distributions, levels, and spatial patterns of coal dust-derived contaminants in habitats and organisms adjacent to existing coal transport lines. To that end, we collected aquatic surface sediments, aquatic insects, and juvenile fish in 2014 and 2015 from Horsethief Lake State Park and Steigerwald National Wildlife Refuge, both located in Washington state close to the rail line and within the Columbia River Gorge National Scenic Area. Two subsites in each area were selected: one close to the rail line and one far from the rail line. Detected PAH concentrations were relatively low compared with those measured at more urbanized areas. Some contaminants were measured at higher concentrations at the subsites close to the rail line, but it was not possible to link the contaminants to a definitive source. Trace metal concentrations were only slightly higher than background concentrations, but a few of the more sensitive benchmarks were exceeded, including those for arsenic, lead, and selenium in fish tissue and fluoranthene, cadmium, copper, manganese, nickel, zinc, iron, and arsenic in sediments. At Horsethief Lake, Chinook salmon and yellow perch showed lower total mercury body burdens than other species, but PAH body burdens did not differ significantly among species. Differences in the species caught among subsites and the low number of invertebrate samples rendered food web comparisons difficult, but these data show that the PAHs and trace metals, including mercury, are accumulating in these wetland sites and in some resident organisms.


Assuntos
Peixes , Sedimentos Geológicos/análise , Invertebrados/efeitos dos fármacos , Metais/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Químicos da Água/análise , Animais , Carvão Mineral , Ecossistema , Monitoramento Ambiental , Cadeia Alimentar , Lagos/análise , Ferrovias , Rios/química , Salmão , Inquéritos e Questionários , Washington
12.
Accid Anal Prev ; 132: 105284, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31518764

RESUMO

Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.


Assuntos
Acidentes de Trânsito/mortalidade , Uso da Maconha/legislação & jurisprudência , Colorado/epidemiologia , Estudos Controlados Antes e Depois , Feminino , Humanos , Washington/epidemiologia
13.
Sr Care Pharm ; 34(7): 432-438, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31383053

RESUMO

OBJECTIVE: To describe an interdisciplinary academic detailing project implemented to address low pneumococcal immunization rates. SETTING: Two medical clinics and four community pharmacies in rural Washington state. PRACTICE DESCRIPTION: The two medical clinics and four community pharmacies were all located in two rural counties and serve geographically large rural areas. PRACTICE INNOVATION: Academic detailing is an evidence-based approach designed to change clinical practice and improve decision-making. Our team utilized the academic detailing model to provide educational outreach to local rural health care providers. The detailing team visited each clinic and pharmacy on a defined schedule and provided information to physicians, clinic administrators, nurses, pharmacists, pharmacy technicians, medical assistants, and clinic front-end staff. MAIN OUTCOME MEASUREMENTS: The project team maintained detailed field notes from each academic detailing the visit and met to debrief about each encounter. From the field notes, through the process of thematic analysis and analytic memoing, the project team produced a list of "lessons learned" that could be used to guide other interprofessional teams wishing to embark on an academic detailing project. RESULTS: We have identified four key "lessons learned": Interprofessional team members bring different strengths to the project; using same-discipline team members paved the way for success; involving students aids in educating future practitioners in interprofessional practice; and scheduling meetings in advance is important. CONCLUSION: We described an approach to enhanced academic detailing using interprofessional team delivery, bringing interprofessional practice into the real-world practice setting.


Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinação , Idoso , Assistência à Saúde , Humanos , Washington
14.
J Insect Sci ; 19(4)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31393980

RESUMO

Trissolcus japonicus (Ashmead), an Asian parasitoid of Halyomorpha halys (Stål) (Hemiptera: Pentatomidae), was first detected in North America in 2014. Although testing in quarantine facilities as a candidate for classical biological control is ongoing, adventive populations have appeared in multiple sites in the United States, Canada, and Europe. Extensive laboratory testing of T. japonicus against other North American pentatomids and H. halys has revealed a higher rate of parasitism of H. halys, but not complete host specificity. However, laboratory tests are necessarily artificial, in which many host finding and acceptance cues may be circumvented. We offered sentinel egg masses of three native pentatomid (Hemiptera: Pentatomidae) pest species (Chinavia hilaris (Say), Euschistus conspersus Uhler, and Chlorochroa ligata (Say)) in a field paired-host assay in an area with a well-established adventive population of T. japonicus near Vancouver, WA. Overall, 67% of the H. halys egg masses were parasitized by T. japonicus during the 2-yr study. Despite the 'worst case' scenario for a field test (close proximity of the paired egg masses), the rate of parasitism (% eggs producing adult wasps) on all three native species was significantly less (0.4-8%) than that on H. halys eggs (77%). The levels of successful parasitism of T. japonicus of the three species are C. hilaris > E. conspersus > C. ligata. The potential impact of T. japonicus on these pentatomids is probably minimal.


Assuntos
Heterópteros/parasitologia , Interações Hospedeiro-Parasita , Vespas/fisiologia , Animais , Feminino , Heterópteros/crescimento & desenvolvimento , Espécies Introduzidas , Ninfa/parasitologia , Washington
15.
Phytopathology ; 109(12): 2022-2032, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31433274

RESUMO

Huanglongbing (HLB) is a severe, incurable citrus disease caused by the bacterium 'Candidatus Liberibacter asiaticus' (CLas). Although citrus leaves serve as the site of initial infection, CLas is known to migrate to and colonize the root system; however, little is known about the impact of CLas infection on root metabolism and resident microbial communities. Scions of 'Lisbon' lemon and 'Washington Navel' orange grafted onto 'Carrizo' rootstock were grafted with either CLas-infected citrus budwood or uninfected budwood. Roots were obtained from trees 46 weeks after grafting and analyzed via 1H nuclear magnetic resonance spectroscopy to identify water-soluble root metabolites and high-throughput sequencing of 16S rRNA and ITS gene amplicons to determine the relative abundance of bacterial and fungal taxa in the root rhizosphere and endosphere. In both citrus varieties, 27 metabolites were identified, of which several were significantly different between CLas(+) and control plants. CLas infection also appeared to alter the microbial community structure near and inside the roots of citrus plants. Nonmetric multidimensional scaling (NMDS) and a principal coordinate analysis (PCoA) revealed distinct metabolite and microbial profiles, demonstrating that CLas impacts the root metabolome and microbiome in a manner that is variety-specific.


Assuntos
Citrus , Metaboloma , Microbiota , Rhizobiaceae , Biodiversidade , Citrus/microbiologia , DNA Espaçador Ribossômico/genética , Interações Microbianas , Microbiota/genética , Doenças das Plantas/microbiologia , Raízes de Plantas/microbiologia , RNA Ribossômico 16S/genética , Rhizobiaceae/fisiologia , Washington
16.
Environ Pollut ; 254(Pt B): 113058, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454571

RESUMO

Dairy cattle of different ages experience different living conditions and varied frequency of antibiotic administration that likely influence the distribution of microbiome and resistome in ways that reflect different risks of microbial transmission. To assess the degree of variance in these distributions, fecal and soil samples were collected from six distinct housing areas on commercial dairy farms (n = 7) in Washington State. 16S rRNA gene sequencing indicated that the microbiota differed between different on-farm locations in feces and soil, and in both cases, the microbiota of dairy calves was often distinct from others (P < 0.05). Thirty-two specific antibiotic resistance genes (ARGs) were widely distributed on dairies, of which several clinically relevant ARGs (including cfr, cfrB, and optrA) were identified for the first time at U.S. dairies. Overall, ARGs were observed more frequently in feces and soil from dairy calves and heifers than from hospital, fresh, lactation and dry pens. Droplet-digital PCR demonstrated that the absolute abundance of floR varied greatly across housing areas and this gene was enriched the most in calves and heifers. Furthermore, in an extended analysis with 14 dairies, environmental soils in calf pens had the most antibiotic-resistant Escherichia coli followed by heifer and hospital pens. All soil E. coli isolates (n = 1,905) are resistant to at least 4 different antibiotics, and the PFGE analysis indicated that florfenicol-resistant E. coli is probably shared across geographically-separated farms. This study identified a discrete but predictable distribution of antibiotic resistance genes and organisms, which is important for designing mitigation for higher risk areas on dairy farms.


Assuntos
Indústria de Laticínios , Resistência Microbiana a Medicamentos/genética , Antibacterianos/farmacologia , Monitoramento Ambiental , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/veterinária , Fazendas , Fezes , Habitação , Microbiota/efeitos dos fármacos , Prevalência , RNA Ribossômico 16S , Solo , Microbiologia do Solo , Washington
17.
Gynecol Oncol ; 155(1): 88-92, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31375270

RESUMO

OBJECTIVES: To estimate the frequency of abnormal surveillance cytology leading to high-grade dysplasia after surgical management for high-grade vulvar intraepithelial neoplasia (VIN) and vulvar cancer and to determine whether prior hysterectomy reduces this risk. METHODS: Women who underwent surgery for high-grade VIN or vulvar cancer between 2006 and 2014 were identified retrospectively. Patients who underwent prior hysterectomy for any indication were included. Univariate and multivariate logistic regression analyses were used to identify clinical correlates of abnormal cytology after surgical treatment for VIN and vulvar cancer. RESULTS: During a median follow-up for 72 months, 302 women underwent surveillance with cytologic screening after vulvar surgery including 99 (33%) women with prior hysterectomy. 75 (25%) women had abnormal cytology results. Of those, 47 (63%) were low-grade and 28 (37%) were high-grade, including 2 (3%) cases of invasive cancer. The rates of high-grade vaginal intraepithelial neoplasia (VAIN), cervical intraepithelial neoplasia (CIN), or cancer were not significantly different despite prior hysterectomy (9% VAIN 2+, 7% CIN 2+). Multivariate analysis showed that correlates of high-grade cytology following treatment for VIN or vulvar cancer included non-white race [odds radio (OR) 3.6, 95% confidence interval (CI) 1.7-7.8], prior abnormal cytology (OR 3.5, 95% CI 1.6-7.6), and immunodeficiency (OR 3.4, 95% CI 1.3-8.8). Prior hysterectomy did not significantly decrease risk of high-grade cytology (OR 0.87, 95% CI 0.5-1.6). CONCLUSIONS: Women treated surgically for VIN/vulvar cancer have an 8% risk of at least high-grade dysplasia from surveillance screening and prior hysterectomy does not mitigate the risk. Extrapolating from current guidelines, we recommend surveillance cytology screening at least 6-12 months after treatment.


Assuntos
Carcinoma in Situ/cirurgia , Lesões Pré-Cancerosas/patologia , Displasia do Colo do Útero/patologia , Doenças Vaginais/patologia , Neoplasias Vulvares/cirurgia , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Lesões Pré-Cancerosas/epidemiologia , Estudos Retrospectivos , Displasia do Colo do Útero/epidemiologia , Doenças Vaginais/epidemiologia , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologia , Washington/epidemiologia
18.
Sci Total Environ ; 693: 133404, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31377372

RESUMO

Major and trace element deposition across western Washington, USA was assessed in 2016 and 2017 by analyzing tissue metal concentrations in the epiphytic mosses Isothecium stoloniferum (Bridel) and Kindbergia praelonga (Hedw.) Ochyra. We used an intensive, vertically stratified sampling approach in Acer macrophyllum canopies in the Hoh Rainforest on the Olympic Peninsula, WA and in Seattle, WA to collect 214 samples of I. stoloniferum. An extensive, ground-based sampling approach was used across an urban-to-wildland gradient to collect 59 K. praelonga samples. Intensive samples were collected four times (April, July, and October of 2016 and in January 2017) and extensive samples three times (April, July, and October 2016) to assess seasonal differences in metal concentrations across sampling locations. A total of 273 moss samples were analyzed for Cd, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, Sr, Ti, and Zn concentrations. Elevated concentrations of these elements were found in moss samples from both intensive and extensive sampling efforts across all seasons. Sampling location for both intensive and extensive sampling efforts was found to be a significant factor in determining moss metal concentrations. Metal deposition in and around Seattle appears to be derived from the regional transportation sector and other industrial sources. Ten I. stoloniferum samples from Seattle and the Hoh Rainforest were analyzed for Pb and Sr isotope ratios to help differentiate between natural and industrial-based emission sources. Hoh Rainforest Pb isotopes appear to be explained by a mixture of long-range Asian Pb influences and natural Pb sources, whereas Seattle Pb isotopes appear driven by industrial and road dust sources.


Assuntos
Poluentes Atmosféricos/metabolismo , Bryopsida/química , Monitoramento Ambiental , Metais Pesados/metabolismo , Oligoelementos/metabolismo , Estações do Ano , Washington
20.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31391213

RESUMO

BACKGROUND: Preterm infants are at increased risk for vaccine-preventable infections and associated complications. Limited studies describe timely vaccination of these vulnerable infants. METHODS: This retrospective cohort study included Washington State infants with birth hospitalizations at an urban academic medical center between 2008 and 2013. Demographic, clinical, and visit data from electronic health records were linked to vaccine data from the Washington State Immunization Information System. Completion of the recommended 7-vaccine series by 19 months of age was compared between preterm infants (born at <37 weeks' gestation) and term/postterm infants (born at 37-43 weeks' gestation) by using Pearson's χ2 test and multivariable logistic regression. Secondary outcomes included 7-vaccine series completion by 36 months of age and receipt of individual vaccines in the series. Rotavirus, hepatitis A, and influenza vaccination was also assessed. RESULTS: Of study infants (n = 10 367), 19.3% were born prematurely. Preterm infants had lower 7-vaccine series completion compared with term/postterm infants by 19 months (47.5% vs 54.0%; adjusted odds ratio 0.77 [95% confidence interval 0.65-0.90]) and 36 months (63.6% vs 71.3%; adjusted odds ratio 0.73 [95% confidence interval 0.61-0.87]). Early preterm (23-33 weeks' gestation) and late preterm (34-36 weeks' gestation) infants had a lower rate of 7-vaccine series completion compared with term/postterm infants. Full influenza vaccination coverage by 19 months also differed between groups (early preterm: 47.7%; late preterm: 41.5%; term/postterm: 44.7%; P = .02). CONCLUSIONS: Over half of preterm infants were undervaccinated at 19 months; one-third failed to catch up by 36 months. Strategies to improve vaccination of these high-risk infants are needed.


Assuntos
Recém-Nascido Prematuro , Vacinação/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Esquemas de Imunização , Recém-Nascido , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Fatores de Risco , Washington
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