The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State.

PURPOSE: The Maine Cancer Genomics Initiative (MCGI) aimed to overcome patient- and provider-level barriers to using genomic tumor testing (GTT) in rural practices by providing genomic tumor boards (GTBs), clinician education, and access to comprehensive large-panel next-generation sequencing to all patients with cancer in Maine. This paper describes the successful implementation of the initiative and three key services made operative between 2016 and 2020. METHODS: A community-inclusive, hub-and-spoke approach was taken to implement the three program components: (1) a centralized GTB program; (2) a modular online education program, designed using an iterative approach with broad clinical stakeholders; and (3) GTT free of charge to clinicians and patients. Implementation timelines, participation metrics, and survey data were used to describe the rollout. RESULTS: The MCGI was launched over an 18-month period at all 19 oncology practices in the State. Seventy-nine physicians (66 medical oncologists, 5 gynecologic oncologists, 1 neuro-oncologist, and 7 pediatric oncologists) enrolled on the study, representing 100% of all practicing oncologists in Maine. Between July 2017 and September 2020, 1610 patients were enrolled. A total of 515 cases were discussed by 47 (73%) clinicians in 196 GTBs. Clinicians who participated in the GTBs enrolled significantly more patients on the study, stayed in Maine, and reported less time spent in clinical patient care. CONCLUSION: The MCGI was able to engage geographically and culturally disparate cancer care practices in a precision oncology program using a hub-and-spoke model. By facilitating access to GTT, structured education, and GTBs, we narrowed the gap in the implementation of precision oncology in one of the most rural states in the country.

Risk and Protective Factors for Vaping and Smoking Among High School Students in Maine.

INTRODUCTION: Vaping rates are rising among adolescents across the country, and smoking rates remain high. Understanding risk and protective factors associated with vaping and smoking can guide public health interventions. This study examined risk and protective factors associated with vaping and smoking among high school students in Maine. METHODS: We used 2019 Maine Integrated Youth Health Survey (MIYHS) data to examine risk and protective factors for vaping and smoking among Maine high school students. Our analytic sample consisted of 17,651 Maine high school students. In addition to bivariate analyses, we used unadjusted and adjusted logistic regression models to assess risk and protective factors. RESULTS: Factors with the greatest effect on students' likelihood to vape, smoke, or do both were parental attitude toward adolescent smoking and depressive symptoms. Students who reported their parents feel it is a little wrong or not wrong at all if they smoked had 4.9 times higher adjusted odds of smoking and 4.6 times higher adjusted odds of vaping and smoking compared with students who said their parents feel it would be wrong or very wrong if they smoked. Students who reported depressive symptoms had 2.1 times higher adjusted odds of vaping, 2.7 times higher adjusted odds of smoking, and 3.0 times higher adjusted odds of vaping and smoking compared with students who did not report depressive symptoms. CONCLUSION: Understanding risk and protective factors for smoking and vaping among high school students can help tailor adolescent-focused vaping and smoking public health interventions to increase effectiveness.

Modeling Opioid Abuse: A Case Study of the Opioid Crisis in New England.

For the past two decades, the USA has been embroiled in a growing prescription drug epidemic. The ripples of this epidemic have been especially apparent in the state of Maine, which has fought hard to mitigate the damage caused by addiction to pharmaceutical and illicit opioids. In this study, we construct a mathematical model of the opioid epidemic incorporating novel features important to better understanding opioid abuse dynamics. These features include demographic differences in population susceptibility, general transmission expressions, and combined consideration of pharmaceutical opioid and heroin abuse. We demonstrate the usefulness of this model by calibrating it with data for the state of Maine. Model calibration is accompanied by sensitivity and uncertainty analysis to quantify potential error in parameter estimates and forecasts. The model is analyzed to determine the mechanisms most influential to the number of opioid abusers and to find effective ways of controlling opioid abuse prevalence. We found that the mechanisms most influential to the overall number of abusers in Maine are those involved in illicit pharmaceutical opioid abuse transmission. Consequently, preventative strategies that controlled for illicit transmission were more effective over alternative approaches, such as treatment. These results are presented with the hope of helping to inform public policy as to the most effective means of intervention.

A direct examination of microbial specialized metabolites associated with ocean sediments from Baffin Bay and the Gulf of Maine.

Specialized metabolites produced by microorganisms found in ocean sediments display a wide range of clinically relevant bioactivities, including antimicrobial, anticancer, antiviral, and anti-inflammatory. Due to limitations in our ability to culture many benthic microorganisms under laboratory conditions, their potential to produce bioactive compounds remains underexplored. However, the advent of modern mass spectrometry technologies and data analysis methods for chemical structure prediction has aided in the discovery of such metabolites from complex mixtures. In this study, ocean sediments were collected from Baffin Bay (Canadian Arctic) and the Gulf of Maine for untargeted metabolomics using mass spectrometry. A direct examination of prepared organic extracts identified 1468 spectra, of which ∼45% could be annotated using in silico analysis methods. A comparable number of spectral features were detected in sediments collected from both locations, but 16S rRNA gene sequencing revealed a significantly more diverse bacterial community in samples from Baffin Bay. Based on spectral abundance, 12 specialized metabolites known to be associated with bacteria were selected for discussion. The application of metabolomics directly on marine sediments provides an avenue for culture-independent detection of metabolites produced under natural settings. The strategy can help prioritize samples for novel bioactive metabolite discovery using traditional workflows.

Driver, roadway, and weather factors on severity of lane departure crashes in Maine.

INTRODUCTION: In Maine, lane departure crashes account for over 70% of roadway fatalities. The majority of roadways in Maine are rural. Moreover, Maine has aging infrastructure, houses the oldest population in the United States, and experiences the third coldest weather in the United States. METHODS: This study analyzes the impact of roadway, driver, and weather factors on the severity of single-vehicle lane departure crashes occurring from 2017 to 2019 on rural roadways in Maine. Rather than using police reported weather, weather station data were utilized. Four facility types: Interstates, minor arterials, major collectors, and minor collectors were considered for analysis. The Multinomial Logistic Regression model was used for the analysis. The property damage only (PDO) outcome was considered as the reference (or base) category. RESULTS: The modeling results show that the odds of a crash leading to major injury or fatality (KA outcome) increases by 330%, 150%, 243%, and 266% for older drivers (65 or above) compared to young drivers (29 or less) on Interstates, minor arterials, major collectors, and minor collectors, respectively. During the winter period (October to April), the odds of KA severity outcome (with respect to the PDO) decreases by 65%, 65%, 65%, and 48% on Interstates, minor arterials, major collectors, and minor collectors, respectively, presumably due to reduced speeds during winter weather events. CONCLUSION: In Maine, factors such as older drivers, operating under the influence, speeding, precipitation, and not wearing a seatbelt showed higher odds of leading to injury. PRACTICAL APPLICATIONS: This study provides safety analysts and practitioners in Maine a comprehensive study of factors that influence the severity of crashes in Maine at different facilities to improve maintenance strategies, enhance safety using proper safety countermeasures, or increase awareness across the state.

The impact of ABO and RhD blood types on Babesia microti infection.

BACKGROUND: Babesiosis is an emerging infectious disease caused by intraerythrocytic Babesia parasites that can cause severe disease and death. While blood type is known to affect the mortality of Plasmodium falciparum malaria patients, associations between red blood cell (RBC) antigens and Babesia microti infection and disease severity are lacking. METHODS: We evaluated RhD and ABO blood types of Babesia-infected (18S rRNA reactive) blood donors in 10 endemic states in the Northeastern and northern Midwestern United States. We also assessed possible associations between RhD and ABO blood types and disease severity among hospitalized babesiosis patients in Connecticut. RESULTS: A total of 768 Babesia-infected blood donors were analyzed, of which 750 (97.7%) had detectable B. microti-specific antibodies. B. microti-infected blood donors were more likely to be RhD- (OR of 1.22, p-value 0.024) than RhD+ donors. Hospitalized RhD- babesiosis patients were more likely than RhD+ patients to have high peak parasitemia (p-value 0.017), which is a marker for disease severity. No differences in RhD+ blood type were noted between residents of the Northeast (OR of 0.82, p-value 0.033) and the Midwest (OR of 0.74, p-value 0.23). Overall, ABO blood type was not associated with blood donor B. microti infection, however, B. microti-infected donors in Maine and New Jersey were more likely to be blood type B compared to non-type B (OR 2.49 [p = 0.008] and 2.07 [p = 0.009], respectively), while infected donors from Pennsylvania were less likely to be type B compared to non-type B (OR 0.32 [p = 0.02]). CONCLUSIONS: People expressing RhD antigen may have a decreased risk of B. microti infection and babesiosis severity. The association of B antigen with B. microti infection is less clear because the antigen appeared to be less prevalent in infected Pennsylvania blood donors but more prevalent in Maine and New Jersey infected donors. Future studies should quantify associations between B. microti genotypes, RBC antigens, and the frequency and severity of B. microti infection to increase our understanding of human Babesia pathogenesis and improve antibody, vaccine, and RBC exchange transfusion strategies.

Implementation of Universal School Meals during COVID-19 and beyond: Challenges and Benefits for School Meals Programs in Maine.

School meals play a major role in supporting children's diets and food security, and policies for universal school meals (USM) have the potential to contribute to positive child health outcomes. During the COVID-19 pandemic, schools provided free school meals to all students in the United States, but this national USM policy ended in school year (SY) 2022-2023; however, a few states have adopted policies to continue USM statewide for SY 2022-2023. Research examining the challenges and strategies for successful continuation of USM is essential, along with studying pandemic-related challenges that are likely to persist in schools. Therefore, we conducted a study in Maine (with a USM policy) to evaluate the impact of COVID-19 and the concurrent implementation of USM, as well as examine differences in implementation by school characteristics, throughout the state. A total of n = 43 school food authorities (SFAs) throughout Maine completed surveys. SFAs reported multiple benefits of USM including increased school meal participation; reductions in the perceived stigma for students from lower-income households and their families; and no longer experiencing unpaid meal charges and debt. SFAs also experienced challenges due to the COVID-19 pandemic, particularly regarding costs. When considering future challenges, most respondents were concerned with obtaining income information from families, product and ingredient availability, and the costs/financial sustainability of the school meal programs. Overall, USM may have multiple important benefits for students and schools, and other states should consider implementation of a USM policy.

Degree and direction of overlap between social vulnerability and community resilience measurements.

An ongoing debate in academic and practitioner communities, centers on the measurement similarities and differences between social vulnerability and community resilience. More specifically, many see social vulnerability and community resilience measurements as conceptually and empirically the same. Only through a critical and comparative assessment can we ascertain the extent to which these measurement schemas empirically relate to one another. This paper uses two well-known indices-the social vulnerability index (SoVI) and the Baseline Resilience Indicators for Communities (BRIC) to address the topic. The paper employs spatio-temporal correlations to test for differences or divergence (negative associations) and similarities or convergence (positive associations), and the degree of overlap. These tests use continental U.S. counties, two timeframes (2010 and 2015), and two case study sub-regions (to identify changes in measurement associations going from national to regional scales given the place-based nature of each index). Geospatial analytics indicate a divergence with little overlap between SoVI and BRIC measurements, based on low negative correlation coefficients (around 30%) for both time periods. There is some spatial variability in measurement overlap, but less than 2% of counties show hot spot clustering of correlations of more than 50% in either year. The strongest overlap and divergence in both years occurs in few counties in California, Arizona, and Maine. The degree of overlap in measurements at the regional scale is greater in the Gulf Region (39%) than in the Southeast Atlantic region (21% in 2010; 28% in 2015) suggesting more homogeneity in Gulf Coast counties based on population and place characteristics. However, in both study areas SoVI and BRIC measurements are negatively associated. Given their inclusion in the National Risk Index, both social vulnerability and resilience metrics are needed to interpret the local community capacities in natural hazards risk planning, as a vulnerable community could be highly resilient or vice versa.

Environmental DNA detects Spawning Habitat of an ephemeral migrant fish (Anadromous Rainbow Smelt: Osmerus mordax).

BACKGROUND: Anadromous rainbow smelt (Osmerus mordax) have experienced a large range reduction in recent decades and the status of remnant spawning populations is poorly known in Maine, where these fish have significant ecological, cultural, and commercial relevance. Defining the remnant range of anadromous smelt is more difficult than for many declining fish species because adults are only ephemerally present while spawning in small coastal streams at night during spring runoff periods when traditional assessments can be unreliable or even hazardous. We hypothesized that eDNA might facilitate improved survey efforts to define smelt spawning habitat, but that detection could also face challenges from adult eDNA quickly flushing out of these small stream systems. We combined daytime eDNA sampling with nighttime fyke netting to ascertain a potential window of eDNA detection before conducting eDNA surveys in four streams of varying abundance. Hierarchical occupancy modeling was in turn employed to estimate eDNA encounter probabilities relative to numbers of sampling events (date), samples within events, and qPCR replicates within samples. RESULTS: Results from the combined eDNA and fyke net study indicated eDNA was detectable over an extended period, culminating approximately 8-13 days following peak spawning, suggesting developing smelt larvae might be the primary source of eDNA. Subsequently, smelt eDNA was readily detected in eDNA surveys of four streams, particularly following remediation of PCR inhibitors. Hierarchical occupancy modeling confirmed our surveys had high empirical detection for most sites, and that future surveys employing at least three sampling events, three samples per event, and six qPCR replicates can afford greater than 90% combined detection capability in low abundance systems. CONCLUSIONS: These results demonstrate that relatively modest eDNA sampling effort has high capacity to detect this ephemerally present species of concern at low to moderate abundances. As such, smelt eDNA detection could improve range mapping by providing longer survey windows, safer sampling conditions, and lower field effort in low density systems, than afforded by existing visual and netting approaches.

Maine's Overdose Prevention Through Intensive Outreach, Naloxone and Safety (OPTIONS) Initiative.

This article outlines the successes, barriers, and lessons learned in implementing the Overdose Prevention Through Intensive Outreach, Naloxone and Safety (OPTIONS) initiative in Maine during its first year. With leadership from the Governor's Office, the Department of Health and Human Services, and the Department of Public Safety, the Office of Behavioral Health contracted with behavioral health organizations to hire and provide supervision for 16 clinicians. These behavioral health clinicians, known as OPTIONS liaisons, were each assigned to provide services for one county in the state and were embedded within a public safety agency. A technical assistance team was also assembled to assist in guiding implementation and improving this public health and public safety partnership.

Jamestown Canyon Virus in Collected Mosquitoes, Maine, United States, 2017-2019.

Jamestown Canyon virus (JCV) is a mosquito-borne arbovirus that circulates in North America. We detected JCV in 4 pools of mosquitoes collected from midcoastal Maine, USA, during 2017-2019. Phylogenetic analysis of a JCV sequence obtained from Aedes cantator mosquitoes clustered within clade A, which also circulates in Connecticut, USA.

Modeling the impact of the COVID-19 pandemic on speeding at rural roadway facilities in Maine using short-term speed and traffic count data.

The COVID-19 pandemic caused a significant change in traffic operations and safety. For instance, various U.S. states reported an increase in the rate of fatal and severe injury crashes over this duration. In April and May of 2020, comprehensive stay-at-home orders were issued across the country, including in Maine. These orders resulted in drastic reductions in traffic volume. Additionally, there is anecdotal evidence that speed enforcement had been reduced during pandemic. Drivers responded to these changes by increasing their speed. More importantly, data show that speeding continues to occur, even one year after the onset of the pandemic. This study develops statistical models to quantify the impact of the pandemic on speeding in Maine. We developed models for three rural facility types (i.e., major collectors, minor arterials, and principal arterials) using a mixed effect Binomial regression model and short duration speed and traffic count data collected at continuous count stations in Maine. Our results show that the odds of speeding by more than 15 mph increased by 34% for rural major collectors, 32% for rural minor arterials, and 51% for rural principal arterials (non-Interstates) during the stay-at-home order in April and May of 2020 compared to the same months in 2019. In addition, the odds of speeding by more than 15 mph, in April and May of 2021, one year after the order, were still 27% higher on rural major collectors and 17% higher on rural principal arterials compared to the same months in 2019.

And Then There Were Three: The Decimation of the Affordable Care Act (ACA) CO-OPs.

The Consumer Operated and Oriented Plans (CO-OPs), the subject of Section 1322 of the Affordable Care Act (ACA), were to constitute "qualified nonprofit health insurance issuers." Designed with an eye toward increasing competition with the extant commercial and nonprofit insurance sector, the CO-OPs were to enhance consumer choice as well as hold down prices on the state and federal exchanges. To achieve these ends, the consumer-governed state-licensed CO-OPs were to target the individual and small-group markets. At least one qualified CO-OP was to be established in each and every state. By the fall of 2013, however, coincident with the first open enrollment period of the ACA, only 23 CO-OPs were on tap. At the time of this writing, only three of these CO-OPs remain operational in the states of Maine, Montana, and Wisconsin. Viewed in hindsight, the thorough dissolution of the CO-OPs was the product of incremental financial privation effectuated by congressional opponents of the ACA. In this Commentary, we revisit the ontogeny of the CO-OP construct, review its partisan dismantling, and explore the potential resurrection thereof.

Convergence of Service Providers and Managers' Perspectives on Strengths, Gaps, and Priorities for Rural Health System Redesign: A Whole-Systems Qualitative Study in Washington County, Maine.

INTRODUCTION: Both rural residents and state government leaders describe a need to redesign rural health care systems. Community members should be at the center of this effort. METHODS: We conducted 46 in-depth interviews of direct service providers between September and November 2020 in Washington County, Maine. Data were analyzed using a thematic analysis approach. RESULTS: Existing strengths included collaboration between government and health systems, and community-based services. Gaps included insufficient workforce, restricted scope of licensing and poor reimbursement, lack of coordination between health systems, and limited paramedicine capacity. Strategies for health system redesign included addressing maldistribution of services and resource optimization, changing federal and state legislation around insurance and scope of practice, and moving toward value-based purchasing models. CONCLUSIONS: Participants provided pragmatic recommendations based on their deep understanding of the community context. Lessons learned are likely to be salient in areas with similar profiles regarding rurality and poverty.

Spatiotemporal Trends of Legacy and Alternative Flame Retardants in Harbor Seals from the Coasts of California, the Gulf of Maine, and Sweden.

Temporal trends of polybrominated diphenyl ethers (PBDEs) have been extensively studied in various environmental compartments globally. However, despite the increasing use of alternative flame retardants following PBDE bans, the spatiotemporal trends of these replacements have rarely been studied, and the available results are often inconsistent. In the present study, we retrospectively investigated the spatiotemporal trends of PBDEs and a suite of alternative brominated FRs (aBFRs) and chlorinated FRs (i.e., dechloranes or DECs) in three harbor seal (Phoca vitulina) populations from the coasts of California, the Gulf of Maine, and southern Sweden during 1999-2016. We observed significantly decreasing trends of ΣPBDEs in all the three populations at an annual rate of 9-11%, which were predominantly driven by the declining concentrations of tetra- and penta-BDEs. The levels of ΣaBFRs decreased significantly in seals from California (mainly 1,3,5-tribromobenzene) and Sweden (mainly hexabromobenzene), while no trend was observed for those from Maine. By contrast, DECs (dominated by DEC 602) did not decrease significantly in any population. Compared with the consistent PBDE congener profiles across regions, aBFRs and DECs exhibited varying compositional profiles between regions, likely indicating region-specific sources of these alternative FR mixtures. Spatial analysis also revealed regional differences in the concentrations of PBDEs, aBFRs, and DECs in harbor seals. Our reconstructed spatiotemporal trends suggest the effective regulation of commercial penta-BDE mix in these regions and warrant further monitoring of the higher brominated BDEs and alternative FRs.

The Impact of COVID-19 on Northeast and Appalachian Loggers.

OBJECTIVE: The Northeast Center for Occupational Health and Safety conducted a survey in December 2020 to understand the impact of the coronavirus disease 2019 (COVID-19) and the Androscoggin Mill explosion among loggers in six states: Maine, New Hampshire, Vermont, New York, Pennsylvania, and West Virginia. METHODS: Logger mailing addresses were aggregated with the assistance of state logging organizations. A paper survey, including a self-addressed return envelope was mailed to the loggers in December 2020. RESULTS: The mailed survey had a response rate of 13.3% and captured data on 484 loggers. The majority knew someone (including themselves) who tested positive for COVID-19 (71.9%). Less than half (43%) received employer training about COVID-19 prevention measures, though 73% received some form of COVID-19 personal protective equipment from their employers. The health department, Centers for Disease Control and Prevention (CDC), and health care providers were the most trusted sources of health information. Nearly half acknowledged significant change in their home lives and work responsibilities due to the pandemic. The explosion of the Androscoggin Mill affected the business of 80% of Maine loggers, and 18% of loggers that resided outside Maine. CONCLUSION: The lessons learned can be used to enhance trust in public health institutions and future public health response to this unique occupational group.

Not Quite Out of the Woods: Overall Health and Chronic Disease Risk Factors among Maine Logging Workers.

OBJECTIVE: This research reports on the health status, including chronic disease risk factors, among Maine loggers. METHODS: Loggers completed a survey and health screenings were held across Maine, collecting data on a variety of health endpoints. RESULTS: Seventy-five loggers participated. The majority were men (97.1%) with a median age of 46, and a mean BMI of 30.6 kg/m2 (SD 4.9). Nearly half of those screened (45.9%) had blood pressure at the level of stage II hypertension. Loggers with at least a single joint abnormality were 38.4%. The health screening cohort was similar to the non-health screening cohort for many attributes. CONCLUSIONS: Future research should focus on tailored interventions to improve cardiovascular and musculoskeletal risk factors among loggers.

Relationship Analysis of Injured Workers' Average Weekly Wages and Workers' Compensation Indemnity Claims in Maine, US: 1998 to 2017.

OBJECTIVE: Explore the relationship between injured workers' average weekly wages (AWW) and their workers' compensation (WC) claims outcomes in Maine, US. METHODS: A total of 29,668 indemnity (lost-time) claims categorized into three wage-based percentile groups from a 20-year period (5-year intervals) were analyzed. WC outcomes included medical costs, number of indemnity checks, claim's duration, and claim settlements. RESULTS: Generally, claims within the lower percentile group were less likely to have high medical costs, but were more likely to have an elevated number of indemnity checks when compared to those in the middle percentile group. An inverse relationship was observed for those claims within the higher percentile group. CONCLUSIONS: Generalizations about low wage earners' claims being longer-lasting and more expensive or early return to work always reducing the medical cost of claims should be avoided.

Umbrella effect of monitoring protocols for mammals in the Northeast US.

Developing cost-effective monitoring protocols is a priority for wildlife conservation agencies worldwide. In particular, developing protocols that cover a wide range of species is highly desirable. Here we applied the 'umbrella species' concept to the context of ecological monitoring; specifically testing the hypothesis that protocols developed for the American marten would contextually allow detecting occupancy trends for 13 other mammalian species (i.e., an umbrella effect). We conducted a large-scale four-year camera trapping survey across a gradient of forest disturbance in Maine, USA. We sampled 197 sites using a total of 591 cameras and collected over 800,000 photographs to generate detection histories for the most common terrestrial species. By combining multi-season occupancy modelling and power analyses, we estimated the required sampling effort to detect 10%, 25% and 50% declines in the fourteen species. By conducting a spatially explicit comparison of sampling effort, we found evidence that monitoring protocols for American marten would provide an umbrella effect for up to 11 other mammal species. The capacity of the umbrella effect varied among species, with fisher, snowshoe hare, red squirrel, and black bear consistently covered under several scenarios. Our results support the application of the umbrella species concept to monitoring (here defined as 'umbrella monitoring species'), providing empirical evidence for its use by management agencies.