scholarly journals Protective Effectiveness of Long-Lasting Permethrin Impregnated Clothing Against Tick Bites in an Endemic Lyme Disease Setting: A Randomized Control Trial Among Outdoor Workers

2020 ◽  
Vol 57 (5) ◽  
pp. 1532-1538
Author(s):  
Cedar Mitchell ◽  
Megan Dyer ◽  
Feng-Chang Lin ◽  
Natalie Bowman ◽  
Thomas Mather ◽  
...  
Keyword(s):  
United States ◽  
Rhode Island ◽  
The United States ◽  
Amblyomma Americanum ◽  
Adverse Outcomes ◽  
Control Group ◽  
Tick Bites ◽  
Outdoor Workers ◽  
Significant Difference ◽  
Protective Effectiveness

Abstract Tick-borne diseases are a growing threat to public health in the United States, especially among outdoor workers who experience high occupational exposure to ticks. Long-lasting permethrin-impregnated clothing has demonstrated high initial protection against bites from blacklegged ticks, Ixodes scapularis Say (Acari: Ixodidae), in laboratory settings, and sustained protection against bites from the lone star tick, Amblyomma americanum (L.) (Acari: Ixodidae), in field tests. However, long-lasting permethrin impregnation of clothing has not been field tested among outdoor workers who are frequently exposed to blacklegged ticks. We conducted a 2-yr randomized, placebo-controlled, double-blinded trial among 82 outdoor workers in Rhode Island and southern Massachusetts. Participants in the treatment arm wore factory-impregnated permethrin clothing, and the control group wore sham-treated clothing. Outdoor working hours, tick encounters, and bites were recorded weekly to assess protective effectiveness of long-lasting permethrin-impregnated garments. Factory-impregnated clothing significantly reduced tick bites by 65% in the first study year and by 50% in the second year for a 2-yr protective effect of 58%. No significant difference in other tick bite prevention method utilization occurred between treatment and control groups, and no treatment-related adverse outcomes were reported. Factory permethrin impregnation of clothing is safe and effective for the prevention of tick bites among outdoor workers whose primary exposure is to blacklegged ticks in the northeastern United States.

scholarly journals THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Haley E. Smith ◽  
Madeline M. Lyons ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
National Database ◽  
Control Group ◽  
Meniscal Allograft Transplantation ◽  
Children's Hospitals ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

scholarly journals 1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S720-S720
Author(s):  
Amy M Beeson ◽  
Grace E Marx ◽  
Amy M Schwartz ◽  
Alison F Hinckley
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Standard Treatment ◽  
Age Distribution ◽  
Public Health Problem ◽  
The United States ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p&lt; 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p&lt; 0.0001) and during non-summer months (OR 2.2, p&lt; 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences

2021 ◽  
Author(s):  
Carrie Riestenberg ◽  
Anika Jagasia ◽  
Daniela Markovic ◽  
Richard P Buyalos ◽  
Ricardo Azziz
Keyword(s):  
United States ◽  
Polycystic Ovary Syndrome ◽  
Economic Burden ◽  
Polycystic Ovary ◽  
The United States ◽  
Reproductive Age ◽  
Cochrane Library ◽  
Control Group ◽  
Ovary Syndrome

Abstract Context Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting approximately 5-20% of women of reproductive age. A previous estimate noted that the economic burden of PCOS approximates $3.7 billion annually in 2020 USD when considering only the costs of the initial diagnosis and of reproductive endocrine morbidities, not considering the costs of pregnancy-related and long-term morbidities. Objective To estimate the excess prevalence and economic burden of pregnancy-related and long-term health morbidities attributable to PCOS. Data Sources PubMed, EmBase and Cochrane Library. Study Selection Studies in which the diagnosis of PCOS was consistent with the Rotterdam, National Institutes of Health (NIH), or Androgen Excess & PCOS (AE-PCOS) Society criteria, or that used electronic medical record diagnosis codes, or diagnosis based on histopathologic sampling were eligible for inclusion. Studies that included an outcome of interest and a control group of non-PCOS patients who were matched or controlled for body mass index (BMI) were included. Data Extraction Two investigators working independently extracted data on study characteristics and outcomes. Data Synthesis Data was pooled using random-effects meta-analysis. The I 2statistic was used to assess inter-study heterogeneity. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. Results The additional total healthcare-related economic burden due to pregnancy-related and long-term morbidities associated with PCOS in the United States is estimated to be $4.3 billion annually in 2020 USD. Conclusions Together with our prior analysis, the economic burden of PCOS is estimated at $8 billion annually in 2020 USD.

Associations of Community Water Lead Concentrations with Hemoglobin Concentrations and Erythropoietin-Stimulating Agent Use among Patients with Advanced CKD

2021 ◽  
pp. ASN.2020091281
Author(s):  
John Danziger ◽  
Kenneth J. Mukamal ◽  
Eric Weinhandl
Keyword(s):  
United States ◽  
Drinking Water ◽  
Kidney Disease ◽  
The United States ◽  
Water Systems ◽  
Adverse Outcomes ◽  
Content Type ◽  
Community Water Systems ◽  
Community Water ◽  
Lead Levels

BackgroundAlthough patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known.MethodsTo investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90th percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System.ResultsAmong 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90th percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients.ConclusionsThis first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

Differences of US-FNA BSRTC class, postoperative pathology, and mutation landscape of thyroid nodules between China and other countries.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3055-3055
Author(s):  
Yuntao Song ◽  
Jie Liu ◽  
Weiran Wang ◽  
Tonghui Ma
Keyword(s):  
United States ◽  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Malignant Tumors ◽  
The United States ◽  
Braf V600e ◽  
Class V ◽  
Ras Mutation ◽  
First Choice ◽  
Significant Difference

3055 Background: Ultrasound and ultrasound-guided fine needle aspiration (US-FNA) are the first choice for judging benign and malignant thyroid nodules. This study will report on the differences of US-FNA BSRTC class, postoperative pathology and mutation landscape of thyroid nodules between China and other countries. Methods: We conducted a prospective study containing 383 FNA samples of thyroid nodules. For most of these FNA samples, genomic DNA and RNA were extracted and sequenced with FSZ-Thyroid NGS Panel V1, and postoperative pathology were followed up. Moreover, we also compared results of this study with those of West China Hospital in China, Yamashita Thyroid Hospital in Japan, and Cleveland Clinic in the United States. Results: Among the 383 FNA samples, the proportions of BSRTC class I to VI were 10.7%, 6.3%, 18.8%, 3.7%, 12.3%, and 48.3% respectively. Compared with study in other countries, the proportion of class II was significantly lower than that in Japan and the United States. Meanwhile, the proportion of class V and VI were significantly higher than the above two countries. Subsequently, 232 thyroid nodules were surgically removed. Postoperative pathology showed that the proportion of malignant tumors (85.3%) was also significantly higher than reported in Japan and the United States. But compared with other studies in China, there was no significant difference. Most of the malignant tumors were papillary thyroid cancer (PTC, 96%), accompanied with 2 follicular thyroid cancer (FTC), 3 medullary cancer (MTC) and 3 anaplastic thyroid cancer (ATC). Compared with study in the United States, the proportion of PTC and FTC were elevated (96% vs. 85.3%) and reduced (1% vs. 9.3%) respectively. At last, we also analysis the mutation landscape of 180 malignant tumors. Compared with TCGA study, the frequency of BRAF V600E in PTC in our study was significantly higher than that of TCGA (73.3% vs. 58%), and the frequency of RAS mutation was significantly lower (1.2% vs. 12.6%). And compared with an institutional experience of ThyroSeq v3 for Bethesda III and IV at the University of Pittsburgh Medical Center, the frequency of BRAF V600E and RAS mutation in Bethesda III-IV malignant tumors was also significantly higher (45.8% vs. 1.4%) and lower (8.3% vs. 47.1%). Conclusions: There were significant differences in BSRTC class and postoperative pathology between China and other countries, such as Japan and the United States. The possible reasons included that the indications for FNA in China were different. For example, most of patients who underwent FNA in this study had suspicious clinical/ultrasound features. So the proportion of BSRTC class V and VI as well as the malignant rate were elevated. On the other hand, more BRAF V600E and less RAS mutations were detected in malignant tumors in this study which might result from racial differentiation and discrepancy in proportion of PTC and FTC.

Are You Experienced? US Ambassadors and International Crises, 1946–2014

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Paul K MacDonald
Keyword(s):  
United States ◽  
International Politics ◽  
The United States ◽  
International Crises ◽  
Systematic Analysis ◽  
Militarized Disputes ◽  
Political Appointees ◽  
Significant Difference ◽  
The Military ◽  
Sizable Number

Abstract How important are ambassadors in international politics? While a growing body of research stresses the importance of diplomacy in international politics, it remains unclear if individual ambassadors make a significant difference or what attributes make for an effective ambassador. This paper explores these questions through a systematic analysis of 2,730 US ambassadors between 1946 and 2014. The United States is distinctive in that it sends a sizable number of noncareer political appointees to serve as ambassadors. This provides a unique opportunity to examine how an ambassador's experience shapes where they are placed and how they perform. Using various techniques to address selection effects, including matching, I find that the United States is less likely to experience a militarized dispute with a host nation when it is represented by a political ambassador. Moreover, political ambassadors with professional experience in politics or the military, those who are close to the president, and those who are appointed in permissive congressional environments are less likely to experience militarized disputes during their tenure. Individual ambassadors matter, but diplomatic experience alone is not the only attribute that makes for an effective ambassador.

First Hemispheric Report of Invasive Tick Species Haemaphysalis Punctata Canestrini Et Fanzago, 1878, First State Report of Haemaphysalis Longicornis Neumann, and Range Expansion of Native Tick Species in Rhode Island, USA

2021 ◽  
Author(s):  
Danielle M Tufts ◽  
Maria A Diuk-Wasser
Keyword(s):  
United States ◽  
Rhode Island ◽  
Range Expansion ◽  
Tick Species ◽  
The United States ◽  
Western Hemisphere ◽  
Avian Host ◽  
Haemaphysalis Longicornis ◽  
New Locations ◽  
Block Island

Abstract Invasive arthropod vectors and the range expansions of native vectors can lead to public and veterinary health concerns, as these vectors may introduce novel pathogens or spread endemic pathogens to new locations. Recent tick invasions and range expansion in the United States has been attributed to climate and land use change, an increase in global travel, and importations of exotic animals. A 10 year surveillance study was conducted on Block Island, Rhode Island from 2010–2020 including sampling ticks from small mammal and avian hosts. We report the discovery and establishment of the red sheep tick for the first time in the western hemisphere and in the United States. This invasive species was first collected in 2010 on Block Island, was collected continuously throughout the study, and was collected from an avian host. We document the first report of the invasive Asian longhorned tick in the state of Rhode Island, first observed at our sites in 2018. Finally, we present data on the range expansion and establishment of two native tick species, the lone star tick and the rabbit tick on Block Island. This study emphasized the importance of long-term surveillance to detect changes in tick host communities, including invasive and expanding native vectors of potential significance to humans and wildlife.

scholarly journals Prevalence of advanced directives in the geriatric population with in long-term care facilities in the United States

2021 ◽  
Vol 12 (2) ◽  
pp. 173-178
Author(s):  
Ateequr Rahman ◽  
Druti Shukla ◽  
Lejla Cukovic ◽  
Kirstin Krzyzewski ◽  
Noopur Walia ◽  
...  
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Living Wills ◽  
Term Care ◽  
Advanced Directive ◽  
Advanced Directives ◽  
Significant Difference ◽  
Care Facilities

Advanced directives, such as Living Wills and Do Not Resuscitate (DNR) orders, provide the ability to identify, respect, and implement an individual's wishes for medical care during serious illness or end-of-life care. The aim of this study was to evaluate the prevalence of advanced directives amongst the residents of long-term care facilities in the United States. A total of 527 cases were extracted from 2018 National Study of Long-Term Care Providers, which was collected by the National Center for Health Statistics through the surveys of residential care communities and adult day services centers. Advanced directive rates were higher in patients 90 years of age and above as compared to other age groups. Nursing home residents were more likely to have advanced directives than other long term care facilities. There was no significant difference among males and females in the rate of advanced directives. Nursing home and Hospice residents had more advanced directives compared to other facilities. The Black population had the highest rate of advanced directive preparedness. Overall, the finding of this study revealed that there was a significant difference in the preparedness of DNR orders and Living Wills by patient demographics and the type of long-term care facility. Offering advanced directive services at public health/social services facilities can enhance the rate of advanced directive preparedness. Advanced directives ease the stress and anxiety of patients, family, and friends during difficult times.

scholarly journals First Report of Seedborne Fusarium thapsinum and its Pathogenicity on Soybean (Glycine max) in the United States

Plant Disease ◽  
2014 ◽  
Vol 98 (12) ◽  
pp. 1745-1745 ◽  
Author(s):  
R. Pedrozo ◽  
C. R. Little
Keyword(s):  
United States ◽  
The United States ◽  
Soybean Plant ◽  
Sodium Hypochlorite Solution ◽  
Distilled Water ◽  
Seedling Mortality ◽  
Beta Tubulin ◽  
First Report ◽  
Significant Difference ◽  
Germinated Seeds

A three-year survey from 2010 to 2012 was conducted in Kansas to investigate the identity and diversity of seedborne Fusarium spp. in soybean. A total of 408 soybean seed samples from 10 counties were tested. One hundred arbitrarily selected seeds from each sample were surface-sterilized for 10 min in a 1% sodium hypochlorite solution to avoid contaminants and promote the isolation of internal fusaria. Seeds were rinsed with sterile distilled water and dried overnight at room temperature (RT). Surface-sterilized seeds were plated on modified Nash-Snyder medium and incubated at 23 ± 2°C for 7 days. Fusarium isolates were single-spored and identified by morphological characteristics on carnation leaf agar (CLA) and potato dextrose agar (PDA) (3). From 276 seedborne Fusarium isolates, six were identified as F. thapsinum (2). On CLA, F. thapsinum isolates produced abundant mycelium and numerous chains of non-septate microconidia produced from monophialides. Microconidia were club-shaped and some were napiform. No chlamysdospores were found. On PDA, three of the isolates presented characteristic dark yellow pigmentation and three were light violet. Confirmation of the isolates to species was based on sequencing of an elongation factor gene (EF1-α) segment using primers EF1 and EF2 and the beta-tubulin gene using primers Beta1 and Beta2 (1). Sequence results (~680 bp, EF primers; ~600 bp, beta-tubulin primers) were confirmed by using the FUSARIUM-ID database (1). All isolates matched F. thapsinum for both genes sequenced (Accession No. FD01177) at 99% identity. Koch's postulates were completed for two isolates of F. thapsinum under greenhouse conditions. Soybean seeds (Asgrow AG3039) were imbibed with 2.5 × 105 conidia ml−1 for 48 h. After inoculation, seeds were dried for 48 h at RT. One isolate each of F. equiseti and F. oxysporum were used as the non-pathogenic and pathogenic inoculation controls, respectively. In addition, non-inoculated seeds and seeds imbibed in sterile distilled water (mock) were also used. Twenty-five seeds from each treatment were planted in pots (500 ml) with autoclaved soil and vermiculite (1:1). The experiment was a completely randomized design with three replicates (pots) per isolate. The entire experiment was repeated three times. After 21 days, aggressiveness of both F. thapsinum isolates was assessed using initial stand (%), final stand (%), and seed mortality (% of non-germinated seeds). Both seedborne F. thapsinum isolates caused reduced emergence and final stand, and increased seedling mortality when compared to the non-inoculated and F. equiseti controls (P< 0.0001). No significant difference was observed between F. thapsinum isolates and F. oxysporum. F. thapsinum isolates were re-isolated from wilted seedlings and non-germinated seeds, but not from the control treatments. Typically, F. thapsinum is considered a pathogen of sorghum, but it has also been recovered from bananas, peanuts, maize, and native grasses (3). However, its presence on soybean plant tissues and its pathogenicity has never been reported. To our knowledge, this is the first report of seedborne F. thapsinum and its pathogenicity on soybean in the United States. References: (1) D. M. Geiser et al. Eur. J. Plant Pathol. 110:473, 2004. (2) C. J. R. Klittich et al. Mycologia 89:644, 1997. (3) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual. Blackwell Publishing, Oxford, UK, 2006.

scholarly journals Methadone Distribution Trends from 2017-2019 in the United States

2020 ◽  
Author(s):  
John A. Furst ◽  
Nicholas J. Mynarski ◽  
Kenneth L. McCall ◽  
Brian J. Piper
Keyword(s):  
United States ◽  
Rhode Island ◽  
Distribution Patterns ◽  
The United States ◽  
Opioid Use Disorder ◽  
Primary Objective ◽  
Treatment Programs ◽  
Opioid Use ◽  
Drug Enforcement ◽  
The Us

AbstractObjectiveMethadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends.MethodsThe Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally.ResultsBetween 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming.ConclusionAlthough methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.

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