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1.
BMJ Open ; 11(6): e046904, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135051

RESUMO

OBJECTIVES: Though dissertation is mandatory for postgraduates (PG), it is unknown if adequate knowledge on plagiarism exists at that level. Thus, we intended to study the knowledge and attitude towards plagiarism among junior doctors in India. DESIGN: Cross-sectional study SETTING: PG medical residents and Junior faculty from various teaching institutions across south India. PARTICIPANTS: A total of N=786 doctors filled the questionnaires of which approximately 42.7% were from government medical colleges (GMCs) and the rest from private institutions. METHODS: Participants were given a pretested semistructured questionnaire which contained: (1) demographic details; (2) a quiz developed by Indiana University, USA to assess knowledge and (3) Attitudes towards Plagiarism Questionnaire (ATPQ). OUTCOME MEASURES: The Primary outcome measure was knowledge about plagiarism. The secondary outcome measure was ATPQ scores. RESULTS: A total of N=786 resident doctors and junior faculty from across 11 institutions participated in this study. Of this, 42.7% were from GMCs and 60.6% were women. The mean (SD) knowledge score was 4.43 (1.99) out of 10. The factors (adjusted OR; 95% CI; p value) that emerged as significant predictors of knowledge were number of years in profession (-0.181; -0.299 to -0.062; 0.003), no previous publication (0.298; 0.099 to 0.498; 0.003) and working in a GMC (0.400; 0.106 to 0.694; 0.008). The overall mean (SD) scores of the three attitude components were: Permissive attitudes-37.33 (5.33), critical attitudes -20.32 (4.82) and subjective norms-31.05 (4.58), all of which corresponded to the moderate category. CONCLUSION: Participants lacked adequate knowledge on how to avoid plagiarism suggesting a need for a revamp in medical education curriculum in India by incorporating research and publication ethics.


Assuntos
Docentes de Medicina , Plágio , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Indiana , Masculino , Inquéritos e Questionários
2.
Sci Total Environ ; 786: 147451, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971608

RESUMO

The building of an effective wastewater-based epidemiological model that can translate SARS-CoV-2 concentrations in wastewater to the prevalence of virus shedders within a community is a significant challenge for wastewater surveillance. The objectives of this study were to investigate the association between SARS-CoV-2 wastewater concentrations and the COVID-19 cases at the community-level and to assess how SARS-CoV-2 wastewater concentrations should be integrated into a wastewater-based epidemiological statistical model that can provide reliable forecasts for the number of COVID-19 infections and the evolution over time as well. Weekly variations on the SARS-CoV-2 wastewater concentrations and COVID-19 cases from April 29, 2020 through February 17, 2021 were obtained in Borough of Indiana, PA. Vector autoregression (VAR) model with different data forms were fitted on this data from April 29, 2020 through January 27, 2021, and the performance in three weeks ahead forecasting (February 3, 10, and 17) were compared with measures of Mean Absolute Error (MAE) and Mean Absolute Percentage Error (MAPE). A stationary block bootstrapping VAR method was also presented to reduce the variability in the forecasting values. Our results demonstrate that VAR(1) estimated with the logged data has the best interpretation of the data, but a VAR(1) estimated with the original data has a stronger forecasting ability. The forecast accuracy, measured by MAPE, for 1 week, 2 weeks, and 3 weeks in the future can be as low as 11.85%, 8.97% and 21.57%. The forecasting performance of the model on a short time span is unfortunately not very impressive. Also, a single increase in the SARS-CoV-2 concentration can impact the COVID-19 cases in an inverted-U shape pattern with the maximum impact occur in the third week after. The flexibility of this approach and easy-to-follow explanations are suitable for many different locations where the wastewater surveillance system has been implemented.


Assuntos
COVID-19 , Previsões , Humanos , Indiana , SARS-CoV-2 , Águas Residuárias
3.
Prev Med ; 149: 106605, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33992657

RESUMO

Nonfatal firearm assault incidents are more prevalent than gun homicides, however, little is understood about nonfatal firearm assault incidents due to a lack of accurate data in the United States. This is a descriptive study of all nonfatal firearm assault incidents identified through police and clinical records from 2007 to 2016 in Indianapolis, Indiana. Records were linked at the incident level to demonstrate the overlap and non-overlap of nonfatal firearm assault incidents in police and clinical records and describe differences in demographic characteristics of the victims. Incidents were matched within a 24-h time window of the recorded date of the police incident. Data were analyzed in fall 2020. There were 3797 nonfatal firearm assault incidents identified in police reports and 3131 clinical encounters with an ICD 9/10 diagnosis-based nonfatal firearm-related injury. 62% (n = 2366) of nonfatal firearm assault incidents matched within 24 h to a clinical encounter, 81% (n = 1905) had a firearm related ICD code: 40% (n = 947) were coded as a firearm-related assault, 32% (n = 754) were coded as a firearm-related accident; and 8.6% (n = 198) were coded as undetermined, self-inflicted or law enforcement firearm-related. The other 20% (n = 461) did not have an ICD firearm related diagnosis code. Results indicate most nonfatal firearm assault incidents overlap between police and clinical records systems, however, discrepancies between the systems exist. These findings also demonstrate an undercounting of nonfatal firearm assault incidents when relying on clinical data systems alone and more efforts are needed to link administrative police and clinical data in the study of nonfatal firearm assaults.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Estudos de Coortes , Homicídio , Humanos , Indiana/epidemiologia , Polícia , Estados Unidos
4.
BMC Public Health ; 21(1): 908, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33980203

RESUMO

BACKGROUND: Recreational trails abound across the United States and represent high risk areas for tick exposure. Although online reviews represent a rich source of user information, they have rarely been used in determining the risk of tick exposure during recreational trail use. Based on online user reviews and comments, the purpose of this study was to determine risk factors and behavioral recommendations associated with tick encounters (Tick Presence) on recreational trails in the state of Indiana, U.S. METHODS: We reviewed 26,016 user comments left on AllTrails.com for 697 Indiana trails. Reviews were evaluated to determine Tick Presence/Absence, the total number of Tick Presence Reviews per trail, and multiple trail and user behavioral characteristics. We used hot spot (Getis-Ord Gi*) analysis to test the hypothesis of whether there are clusters in the number of Tick Presence Reviews. Pearson chi-square tests of independence evaluated whether tick presence was associated with several trail characteristics. Finally, negative binomial regression evaluated the strength of the association between the number of Tick Presence Reviews and several trail characteristics. RESULTS: Tick Presence was recorded at 10% (n = 65) of trails and occurred most frequently in May. Hot spot analysis revealed statistically significant clusters of Tick Presence Reviews on trails in the Southern Indiana State Region. Results of χ2 tests indicated significant associations between Tick Presence Reviews and (a) State Region and (b) Land Management Type; Mann-Whitney U tests detected significant differences in Tick Presence Reviews based on Trail Length and Elevation Gain. Subsequent results of a negative binomial regression model indicated that Southern Indiana State Region, Federal and Private Land Management Type, and Elevation Gain were factors significantly associated with Tick Presence Reviews. Content of user reviews indicated several behaviors employed to prevent tick encounters, particularly Repellent Application and Recreational Deterrence; 25% included a behavior Recommendation to others. CONCLUSIONS: Online, user-generated trail reviews have the potential to serve as rich data sources for identifying recreational trails, where 1) the risk of tick exposure is great, 2) more robust active tick and tick-borne pathogen surveillance may be warranted, and 3) tailored prevention interventions are needed.


Assuntos
Carrapatos , Animais , Distribuição de Qui-Quadrado , Humanos , Indiana , Recreação , Fatores de Risco
6.
Environ Manage ; 67(6): 1088-1099, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33818641

RESUMO

Effective invasive plant management requires collective action. However, little is known about what motivates individuals to work collectively. We conducted a mail survey of 2,600 randomly selected family forest owners in Indiana, USA to examine factors associated with community-led collective action. Specifically, we examined the role of perceived self-efficacy, perceived collective efficacy, concerns about invasive plants, and social norms associated with invasive plant management in shaping family forest owners' self-reported likelihood to work with their neighbors to remove invasive plants. We found that past experience talking to others or working with neighbors to remove invasive plants were important predictors of landowners' intention to work collectively, as were perceived self-efficacy in their own ability to manage invasive plants, perceived need for collective action, social norms, and concerns about invasive plants on neighboring or nearby properties. However, most socio-demographic characteristics (e.g., age, gender, education level, income) and land ownership characteristics (e.g., residence status, having a written forest management plan) were not statisically significant predictors of family forest owners' likelihood to work with their neighbors. Our findings suggest that building individual sense of competence, facilitating neighbor interactions, and strengthening shared concerns may facilitate community-led collective action to manage invasive plants.


Assuntos
Conservação dos Recursos Naturais , Florestas , Humanos , Indiana , Propriedade , Inquéritos e Questionários
7.
BMC Med Inform Decis Mak ; 21(1): 112, 2021 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-33812369

RESUMO

BACKGROUND: Many patients with atrial fibrillation (AF) remain undiagnosed despite availability of interventions to reduce stroke risk. Predictive models to date are limited by data requirements and theoretical usage. We aimed to develop a model for predicting the 2-year probability of AF diagnosis and implement it as proof-of-concept (POC) in a production electronic health record (EHR). METHODS: We used a nested case-control design using data from the Indiana Network for Patient Care. The development cohort came from 2016 to 2017 (outcome period) and 2014 to 2015 (baseline). A separate validation cohort used outcome and baseline periods shifted 2 years before respective development cohort times. Machine learning approaches were used to build predictive model. Patients ≥ 18 years, later restricted to age ≥ 40 years, with at least two encounters and no AF during baseline, were included. In the 6-week EHR prospective pilot, the model was silently implemented in the production system at a large safety-net urban hospital. Three new and two previous logistic regression models were evaluated using receiver-operating characteristics. Number, characteristics, and CHA2DS2-VASc scores of patients identified by the model in the pilot are presented. RESULTS: After restricting age to ≥ 40 years, 31,474 AF cases (mean age, 71.5 years; female 49%) and 22,078 controls (mean age, 59.5 years; female 61%) comprised the development cohort. A 10-variable model using age, acute heart disease, albumin, body mass index, chronic obstructive pulmonary disease, gender, heart failure, insurance, kidney disease, and shock yielded the best performance (C-statistic, 0.80 [95% CI 0.79-0.80]). The model performed well in the validation cohort (C-statistic, 0.81 [95% CI 0.8-0.81]). In the EHR pilot, 7916/22,272 (35.5%; mean age, 66 years; female 50%) were identified as higher risk for AF; 5582 (70%) had CHA2DS2-VASc score ≥ 2. CONCLUSIONS: Using variables commonly available in the EHR, we created a predictive model to identify 2-year risk of developing AF in those previously without diagnosed AF. Successful POC implementation of the model in an EHR provided a practical strategy to identify patients who may benefit from interventions to reduce their stroke risk.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Indiana , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
8.
PLoS One ; 16(3): e0241875, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33760821

RESUMO

BACKGROUND: Prior studies examining symptoms of COVID-19 are primarily descriptive and measured among hospitalized individuals. Understanding symptoms of SARS-CoV-2 infection in pre-clinical, community-based populations may improve clinical screening, particularly during flu season. We sought to identify key symptoms and symptom combinations in a community-based population using robust methods. METHODS: We pooled community-based cohorts of individuals aged 12 and older screened for SARS-CoV-2 infection in April and June 2020 for a statewide prevalence study. Main outcome was SARS-CoV-2 positivity. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for individual symptoms as well as symptom combinations. We further employed multivariable logistic regression and exploratory factor analysis (EFA) to examine symptoms and combinations associated with SARS-CoV-2 infection. RESULTS: Among 8214 individuals screened, 368 individuals (4.5%) were RT-PCR positive for SARS-CoV-2. Although two-thirds of symptoms were highly specific (>90.0%), most symptoms individually possessed a PPV <50.0%. The individual symptoms most greatly associated with SARS-CoV-2 positivity were fever (OR = 5.34, p<0.001), anosmia (OR = 4.08, p<0.001), ageusia (OR = 2.38, p = 0.006), and cough (OR = 2.86, p<0.001). Results from EFA identified two primary symptom clusters most associated with SARS-CoV-2 infection: (1) ageusia, anosmia, and fever; and (2) shortness of breath, cough, and chest pain. Moreover, being non-white (13.6% vs. 2.3%, p<0.001), Hispanic (27.9% vs. 2.5%, p<0.001), or living in an Urban area (5.4% vs. 3.8%, p<0.001) was associated with infection. CONCLUSIONS: Symptoms can help distinguish SARS-CoV-2 infection from other respiratory viruses, especially in community or urgent care settings where rapid testing may be limited. Symptoms should further be structured in clinical documentation to support identification of new cases and mitigation of disease spread by public health. These symptoms, derived from asymptomatic as well as mildly infected individuals, can also inform vaccine and therapeutic clinical trials.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Programas de Rastreamento/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ageusia/epidemiologia , Ageusia/virologia , COVID-19/prevenção & controle , Tosse , Estudos Transversais/métodos , Dispneia , Estudos Epidemiológicos , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , SARS-CoV-2/metabolismo , SARS-CoV-2/patogenicidade , Síndrome
9.
BMC Emerg Med ; 21(1): 36, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761876

RESUMO

BACKGROUND: While COVID-19 has had far-reaching consequences on society and health care providers, there is a paucity of research exploring frontline emergency medicine (EM) provider wellness over the course of a pandemic. The objective of this study was to assess the well-being, resilience, burnout, and wellness factors and needs of EM physicians and advanced practice providers (e.g., nurse practitioners and physician assistants; APPs) during the initial phase of the COVID-19 pandemic. METHODS: A descriptive, prospective, cohort survey study of EM physicians and APPs was performed across ten emergency departments in a single state, including academic and community settings. Participants were recruited via email to complete four weekly, voluntary, anonymous questionnaires comprised of customized and validated tools for assessing wellness (Well Being Index), burnout (Physician Work Life Study item), and resilience (Brief Resilience Scale) during the initial acceleration phase of COVID-19. Univariate and multivariate analysis with Chi-squared, Fisher's Exact, and logistic regression was performed. RESULTS: Of 213 eligible participants, response rates ranged from 31 to 53% over four weeks. Women comprised 54 to 60% of responses. Nonrespondent characteristics were similar to respondents. Concern for personal safety decreased from 85 to 61% (p < 0.001). Impact on basic self-care declined from 66 to 32% (p < 0.001). Symptoms of stress, anxiety, or fear was initially 83% and reduced to 66% (p = 0.009). Reported strain on relationships and feelings of isolation affected > 50% of respondents initially without significant change (p = 0.05 and p = 0.30 respectively). Women were nearly twice as likely to report feelings of isolation as men (OR 1.95; 95% CI 1.82-5.88). Working part-time carried twice the risk of burnout (OR, 2.45; 95% CI, 1.10-5.47). Baseline resilience was normal to high. Provider well-being improved over the four weeks (30 to 14%; p = 0.01), but burnout did not significantly change (30 to 22%; p = 0.39). CONCLUSION: This survey of frontline EM providers, including physicians and APPs, during the initial surge of COVID-19 found that despite being a resilient group, the majority experienced stress, anxiety, fear, and concerns about personal safety due to COVID-19, putting many at risk for burnout. The sustained impact of the pandemic on EM provider wellness deserves further investigation to guide targeted interventions.


Assuntos
Esgotamento Profissional/epidemiologia , COVID-19/epidemiologia , Serviço Hospitalar de Emergência , Centros Médicos Acadêmicos , Adulto , Feminino , Hospitais Comunitários , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , SARS-CoV-2 , Inquéritos e Questionários
10.
J Environ Manage ; 286: 112161, 2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-33691237

RESUMO

Invasive forest plants are a growing concern because of their perceived and actual negative ecological, economic, and social impacts. To effectively manage invasive plants in forest ecosystems, it is paramount to understand the management decisions made by family forest owners (FFOs), who collectively own 36% of forestlands in the United States. We contribute to the growing literature on invasive plant management and the factors that influence FFOs' likelihood to manage invasive plants on their property by incorporating protection motivation theory (PMT; Rogers 1975). Protection Motivation Theory argues that the degree to which individuals protect themselves from a perceived threat varies as a function of the perceived severity of the threat, their vulnerability to the threat, their perceptions of self-efficacy to effectively mitigate the threat, and the degree to which they believe they have access to the resources needed to effectively respond to the threat. We surveyed a random sample of 2,600 FFOs in Indiana about their knowledge, perceptions, experience, and plans regarding invasive plants on their wooded lands. Consistent with PMT, we constructed a hierarchical binary logistic model and found that FFOs reported greater intentions to manage invasive plants when they perceived the problem to be more severe and also when they felt a stronger sense of self-efficacy to address the problem. Although perceived vulnerability was not significant in our final model, our results also show that FFOs who had previous invasive plant management experience, had a Bachelor's degree or higher level of education, owned woodlands for recreational purposes, and were more subject to normative social influence also tended to report greater intentions to manage invasive plants. Together, these results suggest that components of PMT (perceived severity and self-efficacy) may be used to inform potential strategies, programs, and outreach for engaging family forest owners in invasive plant management.


Assuntos
Ecossistema , Motivação , Florestas , Humanos , Indiana , Autoeficácia
12.
Am J Physiol Renal Physiol ; 320(5): F671-F682, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33682441

RESUMO

The Indiana O'Brien Center for Advanced Microscopic Analysis is a National Institutes of Health (NIH) P30-funded research center dedicated to the development and dissemination of advanced methods of optical microscopy to support renal researchers throughout the world. The Indiana O'Brien Center was founded in 2002 as an NIH P-50 project with the original goal of helping researchers realize the potential of intravital multiphoton microscopy as a tool for understanding renal physiology and pathophysiology. The center has since expanded into the development and implementation of large-scale, high-content tissue cytometry. The advanced imaging capabilities of the center are made available to renal researchers worldwide via collaborations and a unique fellowship program. Center outreach is accomplished through an enrichment core that oversees a seminar series, an informational website, and a biennial workshop featuring hands-on training from members of the Indiana O'Brien Center and imaging experts from around the world.


Assuntos
Academias e Institutos , Pesquisa Biomédica , Microscopia Intravital , Nefropatias/patologia , Rim/patologia , Microscopia de Fluorescência por Excitação Multifotônica , Nefrologia , Animais , Difusão de Inovações , Humanos , Interpretação de Imagem Assistida por Computador , Indiana , Cooperação Internacional , Rim/fisiopatologia , Nefropatias/fisiopatologia , Comunicação Acadêmica
13.
J Environ Qual ; 50(3): 667-679, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33788277

RESUMO

The midwestern United States is a highly productive agricultural region, and extended crop-free periods in winter/spring can result in nitrogen (N) and phosphorus (P) losses to waterways that degrade downstream water quality. Planting winter cover crops can improve soil health while reducing nutrient leaching from farm fields during the fallow period. In this study, we used linear mixed effects models and multivariate statistics to determine the effect of cover crops on soil nutrients by comparing fields with cover crops (n = 9) versus those without (n = 6) in two Indiana agricultural watersheds: the Shatto Ditch Watershed, which had >60% of croppable acres in winter cover crops, and the Kirkpatrick Ditch Watershed, which had ∼20%. We found that cover crops decreased soil nitrate-N by >50% and that the magnitude of reduction was related to the amount of cover crop biomass. In contrast, cover crops had variable effects on water extractable P and Mehlich III soil test P. Finally, cover crop biomass significantly increased soil N mineralization and nitrification rates, demonstrating that cover crops have the potential to supply bioavailable N to cash crop after termination. Our study showed that widespread implementation of winter cover crops holds considerable promise for reducing nutrient loss and improving soil health. The degree to which these results are generalizable across other systems depends on factors such as climate, soil characteristics, and past and current agronomic practices.


Assuntos
Produtos Agrícolas , Solo , Agricultura , Indiana , Meio-Oeste dos Estados Unidos , Nitrogênio/análise , Nutrientes
14.
J Public Health Manag Pract ; 27(3): 246-250, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729203

RESUMO

CONTEXT: Existing hospitalization ratios for COVID-19 typically use case counts in the denominator, which problematically underestimates total infections because asymptomatic and mildly infected persons rarely get tested. As a result, surge models that rely on case counts to forecast hospital demand may be inaccurately influencing policy and decision-maker action. OBJECTIVE: Based on SARS-CoV-2 prevalence data derived from a statewide random sample (as opposed to relying on reported case counts), we determine the infection-hospitalization ratio (IHR), defined as the percentage of infected individuals who are hospitalized, for various demographic groups in Indiana. Furthermore, for comparison, we show the extent to which case-based hospitalization ratios, compared with the IHR, overestimate the probability of hospitalization by demographic group. DESIGN: Secondary analysis of statewide prevalence data from Indiana, COVID-19 hospitalization data extracted from a statewide health information exchange, and all reported COVID-19 cases to the state health department. SETTING: State of Indiana as of April 30, 2020. MAIN OUTCOME MEASURES: Demographic-stratified IHRs and case-hospitalization ratios. RESULTS: The overall IHR was 2.1% and varied more by age than by race or sex. Infection-hospitalization ratio estimates ranged from 0.4% for those younger than 40 years to 9.2% for those older than 60 years. Hospitalization rates based on case counts overestimated the IHR by a factor of 10, but this overestimation differed by demographic groups, especially age. CONCLUSIONS: In this first study of the IHR based on population prevalence, our results can improve forecasting models of hospital demand-especially in preparation for the upcoming winter period when an increase in SARS CoV-2 infections is expected.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Defesa Civil/organização & administração , Defesa Civil/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , SARS-CoV-2 , Adulto Jovem
15.
Subst Use Misuse ; 56(7): 988-996, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33749520

RESUMO

BACKGROUND: Individuals with prior opioid-related overdose events have an increased risk for opioid-related mortality. Buprenorphine is a partial agonist that has shown to be an effective medication for opioid use disorder (MOUD). Yet, few studies have investigated whether buprenorphine reduces the risk of opioid-related mortality following a nonfatal opioid-related overdose. METHODS: A retrospective study was conducted on all overdose cases in Indiana between January 1, 2017 and December 31, 2017. Data were linked from multiple administrative sources. Cases were linked to vital records to assess mortality. Bivariate analyses were conducted to assess group differences between survivors and decedents. A series of multiple logistic regression models were used to determine main and interaction effects of opioid-related mortality. RESULTS: Among the 10,195 nonfatal overdoses, 2.4% (247) resulted in a subsequent fatal overdose. Overdose decedents were on average 36.4 years-old, 66.8% male, 91.1% White, and 83.8% did not receive a buprenorphine dispensation. Incremental increases in the number of buprenorphine dispensations decreased the likelihood of fatal overdose by 94% (95% CI = 0.88-0.98, p = .001). Incremental increases in arrest encounters were found to significantly increase the likelihood of a fatal overdose (AOR = 2.16; 95% CI = 1.13-3.55). Arrest encounters were a significant moderator of the relationship between buprenorphine uptake effectiveness and drug-related mortality. CONCLUSIONS: Analysis of linked data provided details of risk and protective factors of fatal overdose. Buprenorphine reduced the risk of death; however, criminal justice involvement remains an area of attention for diversion and overdose death prevention interventions.


Assuntos
Buprenorfina , Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Adulto , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Feminino , Humanos , Indiana , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Retrospectivos
16.
J Contin Educ Nurs ; 52(3): 109-111, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33631018

RESUMO

This article describes how a health care organization optimized staffing during the COVID-19 crisis by capitalizing on the expertise of nursing professional development practitioners to create a rapid deployment onboarding plan. The rapid onboarding training plan provided Riley Hospital for Children at Indiana University Health with a sense of stability in an uncertain time. Designing a plan that easily could be modified allowed the organization to be prepared during the pandemic and at a point where staffing needs must meet surge capacity. [J Contin Educ Nurs. 2021;52(3):109-111.].


Assuntos
COVID-19/enfermagem , Capacitação em Serviço , Recursos Humanos de Enfermagem no Hospital/organização & administração , Enfermagem Pediátrica , Admissão e Escalonamento de Pessoal , Algoritmos , COVID-19/epidemiologia , Competência Clínica , Hospitais Pediátricos , Humanos , Indiana/epidemiologia , Recursos Humanos de Enfermagem no Hospital/educação , Pandemias , Enfermagem Pediátrica/educação , SARS-CoV-2 , Capacidade de Resposta ante Emergências
17.
Cochrane Database Syst Rev ; 2: CD013457, 2021 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-33583058

RESUMO

BACKGROUND: Symptoms of autism spectrum disorder (ASD) have been associated, in part, with the dysfunction of N-methyl-D-aspartate (NMDA) glutamate receptors at excitatory synapses and glutamate abnormalities. Medications related to glutamatergic neurotransmission, such as D-cycloserine - which is a partial agonist of the NMDA glutamate receptor - are potential treatment options for the core features of ASD. However, the potential effect of D-cycloserine on the social and communication skills deficits of individuals with ASD has not been thoroughly explored and no systematic reviews of the evidence have been conducted. OBJECTIVES: To assess the efficacy and adverse effects of D-cycloserine compared with placebo for social and communication skills in individuals with ASD. SEARCH METHODS: In November 2020, we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers. We also searched the reference lists of relevant publications and contacted the authors of the included study, Minshawi 2016, to identify any additional studies. In addition, we contacted pharmaceutical companies, searched manufacturers' websites and sources of reports of adverse events.  SELECTION CRITERIA: All randomised controlled trials (RCTs) of any duration and dose of D-cycloserine, with or without adjunct treatment, compared to placebo in individuals with ASD. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted relevant data, assessed the risk of bias, graded the certainty of the evidence using the GRADE approach, and analysed and evaluated the data. We provide a narrative report of the findings as only one study is included in this review. MAIN RESULTS: We included a single RCT (Minshawi 2016) funded by the United States Department of Defense. It was conducted at two sites in the USA: Indiana University School of Medicine and Cincinnati Children's Hospital Medical Centre. In the included study, 67 children with ASD aged between 5 and 11 years were randomised to receive either 10 weeks (10 doses) of (50 mg) D-cycloserine plus social skills training, or placebo plus social skills training. Randomisation was carried out 1:1 between D-cycloserine and placebo arms, and outcome measures were recorded at one-week post-treatment. The 'risk of bias' assessment for the included study was low for five domains and unclear for two domains. The study (67 participants) reported low certainty evidence of little to no difference between the two groups for all outcomes measured at one week post-treatment: social interaction impairment (mean difference (MD) 3.61 (assessed with the Social Responsiveness Scale), 95% confidence interval (CI) -5.60 to 12.82); social communication impairment (MD -1.08 (measured using the inappropriate speech subscale of the Aberrant Behavior Checklist (ABC)), 95% CI -2.34 to 0.18); restricted, repetitive, stereotyped patterns of behaviour (MD 0.12 (measured by the ABC stereotypy subscale), 95% CI -1.71 to 1.95); serious adverse events (risk ratio (RR) 1.11, 95% CI 0.94 to 1.31); non-core symptoms of ASD (RR 0.97 (measured by the Clinical Global Impression-Improvement scale), 95% CI 0.49 to 1.93); and tolerability of D-cycloserine (RR 0.32 (assessed by the number of dropouts), 95% CI 0.01 to 7.68).  AUTHORS' CONCLUSIONS: We are unable to conclude with certainty whether D-cycloserine is effective for individuals with ASD. This review included low certainty data from only one study with methodological issues and imprecision. The added value of this review compared to the included study is we assessed the risk of bias and evaluated the certainty of evidence using the GRADE approach. Moreover, if we find new trials in future updates of this review, we could potentially pool the data, which may either strengthen or decrease the evidence for our findings.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Comunicação , Ciclosserina/uso terapêutico , Habilidades Sociais , Criança , Pré-Escolar , Ciclosserina/efeitos adversos , Feminino , Humanos , Indiana , Masculino , Estudos Multicêntricos como Assunto , Ohio , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Estereotipado/efeitos dos fármacos
18.
J Med Virol ; 93(5): 2883-2889, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33448423

RESUMO

INTRODUCTION: The rate of bacterial coinfection with SARS-CoV-2 is poorly defined. The decision to administer antibiotics early in the course of SARS-CoV-2 infection depends on the likelihood of bacterial coinfection. METHODS: We performed a retrospective chart review of all patients admitted through the emergency department with confirmed SARS-CoV-2 infection over a 6-week period in a large healthcare system in the United States. Blood and respiratory culture results were abstracted and adjudicated by multiple authors. The primary outcome was the rate of bacteremia. We secondarily looked to define clinical or laboratory features associated with bacteremia. RESULTS: There were 542 patients admitted with confirmed SARS-CoV-2 infection, with an average age of 62.8 years. Of these, 395 had blood cultures performed upon admission, with six true positive results (1.1% of the total population). An additional 14 patients had positive respiratory cultures treated as true pathogens in the first 72 h. Low blood pressure and elevated white blood cell count, neutrophil count, blood urea nitrogen, and lactate were statistically significantly associated with bacteremia. Clinical outcomes were not statistically significantly different between patients with and without bacteremia. CONCLUSIONS: We found a low rate of bacteremia in patients admitted with confirmed SARS-CoV-2 infection. In hemodynamically stable patients, routine antibiotics may not be warranted in this population.


Assuntos
Infecções Bacterianas/epidemiologia , COVID-19/epidemiologia , Coinfecção/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/terapia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , COVID-19/diagnóstico , COVID-19/terapia , Coinfecção/diagnóstico , Coinfecção/terapia , Feminino , Hospitalização , Hospitais , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento
19.
Proc Natl Acad Sci U S A ; 118(5)2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33441450

RESUMO

From 25 to 29 April 2020, the state of Indiana undertook testing of 3,658 randomly chosen state residents for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, the agent causing COVID-19 disease. This was the first statewide randomized study of COVID-19 testing in the United States. Both PCR and serological tests were administered to all study participants. This paper describes statistical methods used to address nonresponse among various demographic groups and to adjust for testing errors to reduce bias in the estimates of the overall disease prevalence in Indiana. These adjustments were implemented through Bayesian methods, which incorporated all available information on disease prevalence and test performance, along with external data obtained from census of the Indiana statewide population. Both adjustments appeared to have significant impact on the unadjusted estimates, mainly due to upweighting data in study participants of non-White races and Hispanic ethnicity and anticipated false-positive and false-negative test results among both the PCR and antibody tests utilized in the study.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , SARS-CoV-2/isolamento & purificação , Teorema de Bayes , COVID-19/etnologia , COVID-19/virologia , Teste para COVID-19/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Indiana/epidemiologia , Indiana/etnologia , Reação em Cadeia da Polimerase , Prevalência , SARS-CoV-2/genética
20.
MMWR Morb Mortal Wkly Rep ; 70(4): 118-122, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33507894

RESUMO

Institutions of higher education adopted different approaches for the fall semester 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. Approximately 45% of colleges and universities implemented online instruction, more than one fourth (27%) provided in-person instruction, and 21% used a hybrid model (1). Although CDC has published COVID-19 guidance for institutions of higher education (2-4), little has been published regarding the response to COVID-19 outbreaks on college and university campuses (5). In August 2020, an Indiana university with approximately 12,000 students (including 8,000 undergraduate students, 85% of whom lived on campus) implemented various public health measures to reduce transmission of SARS-CoV-2, the virus that causes COVID-19. Despite these measures, the university experienced an outbreak involving 371 cases during the first few weeks of the fall semester. The majority of cases occurred among undergraduate students living off campus, and several large off-campus gatherings were identified as common sources of exposure. Rather than sending students home, the university switched from in-person to online instruction for undergraduate students and instituted a series of campus restrictions for 2 weeks, during which testing, contact tracing, and isolation and quarantine programs were substantially enhanced, along with educational efforts highlighting the need for strict adherence to the mitigation measures. After 2 weeks, the university implemented a phased return to in-person instruction (with 85% of classes offered in person) and resumption of student life activities. This report describes the outbreak and the data-driven, targeted interventions and rapid escalation of testing, tracing, and isolation measures that enabled the medium-sized university to resume in-person instruction and campus activities. These strategies might prove useful to other colleges and universities responding to campus outbreaks.


Assuntos
COVID-19/prevenção & controle , Surtos de Doenças/prevenção & controle , Universidades/organização & administração , COVID-19/epidemiologia , Teste para COVID-19 , Busca de Comunicante , Humanos , Indiana/epidemiologia , Isolamento de Pacientes , Quarentena
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