Disease Risk & Landscape Attributes of Tick-Borne Borrelia Pathogens in the San Francisco Bay Area, California

Habitat heterogeneity influences pathogen ecology by affecting vector abundance and the reservoir host communities. We investigated spatial patterns of disease risk for two human pathogens in the Borrelia genus–B. burgdorferi and B. miyamotoi–that are transmitted by the western black-legged tick, Ixodes pacificus. We collected ticks (349 nymphs, 273 adults) at 20 sites in the San Francisco Bay Area, California, USA. Tick abundance, pathogen prevalence and density of infected nymphs varied widely across sites and habitat type, though nymphal western black-legged ticks were more frequently found, and were more abundant in coast live oak forest and desert/semi-desert scrub (dominated by California sagebrush) habitats. We observed Borrelia infections in ticks at all sites where we able to collect >10 ticks. The recently recognized human pathogen, B. miyamotoi, was observed at a higher prevalence (13/349 nymphs = 3.7%, 95% CI = 2.0–6.3; 5/273 adults = 1.8%, 95% CI = 0.6–4.2) than recent studies from nearby locations (Alameda County, east of the San Francisco Bay), demonstrating that tick-borne disease risk and ecology can vary substantially at small geographic scales, with consequences for public health and disease diagnosis

Summary statistics of entomologic risk for <i>Ixodes pacificus</i> infected with <i>Borrelia</i> spp. in recreational areas of the San Francisco Bay Area.

<p>¹Betsy Crowder Trail is comprised of coast live oak woodland.</p><p>²Anniversary Trail is comprised of coastal scrub and moderate grassland.</p><p>³Meadow Trail is comprised of coast live oak woodland and Douglas fir forest.</p><p>Data are presented on density of nymphal (DON) <i>I</i>. <i>pacificus</i> (i.e., number of nymphs/100m² (calculated by (number of ticks collected/meters covered by transects) x100); density of infected nymphs (DIN) for <i>Borrelia</i> spp. (calculated by <i>Borrelia</i> prevalence x DON); and for <i>B</i>. <i>miyamotoi</i>, <i>B</i>. <i>burgdorferi</i> ss, and for <i>B</i>. <i>burgdorferi</i> sl.</p

Digital Story Map Learning for STEM Disciplines

Modern technological advances and trends require new pedagogy and delivery of mapping materials to prepare the future workforce in the disciplines of Science, Technology, Engineering, and Mathematics (STEM) for an increasingly technology-dominated society. The purpose of this study was to develop an Environmental Systems Research Institute (ESRI) Story Map &#8220;Soil Forming Factors: Climate&#8222; for multiple STEM disciplines based on the design guidelines from the Cognitive Theory of Multimedia Learning (CTML). The study incorporated a two-group post-test only design that utilized multiple methods of analysis, including a quality assessment of the ESRI Story Map using the five principles of effective storytelling, direct quantitative measures of learning (quiz), and surveys of participants&#8217; perceptions (PowerPoint presentation versus ESRI Story Map) using QualtricsTM. Survey results were summarized by gender, academic classification (year), and academic major program. The newly developed ESRI Story Map was an effective teaching tool as demonstrated by quiz scores and students&#8217; positive responses. Post-testing scores indicated that ESRI Story Maps were an effective way to learn and were viewed as effective as traditional teaching methods (e.g., PowerPoint). Additionally, students reported feeling comfortable using ESRI Story Maps. These positive responses were consistent by gender, major, and academic classification (year). This research indicates that adding audio may improve the use of this ESRI Story Map for educational concept delivery. Empirical studies such as this that include multifaceted quantitative and qualitative assessments are critical to understanding the benefits of new types of multimedia learning in an educational setting

Recreational areas in the San Francisco Bay area (left) sampled for western black-legged ticks, with a close-up (right) of recreational areas sampled in San Mateo and Santa Clara Counties.

<p>Recreational areas in the San Francisco Bay area (left) sampled for western black-legged ticks, with a close-up (right) of recreational areas sampled in San Mateo and Santa Clara Counties.</p

Study area showing independent variables: soil type (top left), elevation (top right), vegetation type (bottom left) and distance to roads (bottom right).

<p>Purple dots represent tick- drag transects in Santa Clara and San Mateo counties.</p

Prevalence data for <i>Borrelia</i> in <i>I</i>. <i>pacificus</i> ticks from previous studies in California.

<p>¹Number positive/number tested (percentage positive, 95% CI).</p><p>Prevalence data for <i>Borrelia</i> in <i>I</i>. <i>pacificus</i> ticks from previous studies in California.</p

Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities

Introduction: The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina.Methods: We conducted this retrospective study at the largest non-profit healthcare system in South Carolina, using electronic health record (EHR) data of patients who had an ED or UC visit between February 2, 2016–July 31, 2018. Key variables including International Classification of Diseases, 10th Revision codes, laboratory test results, family history, medication, and demographic characteristics were used to classify the patients as healthy, having prediabetes, having diabetes, being at-risk for prediabetes, or being at-risk for diabetes. Patients who were known to have diabetes were classified further as having controlled diabetes, management challenged, or uncontrolled diabetes. Population analysis was stratified by the patient’s annual number of ED/UC visits.Results: The risk stratification revealed 4.58% unique patients with unrecognized diabetes and 10.34% of the known patients with diabetes considered to be suboptimally controlled. Patients identified as diabetes management challenged had more ED/UC visits. Of note, 33.95% of the patients had unrecognized prediabetes/diabetes risk factors identified during their ED/UC with 87.95% having some form of healthcare insurance.Conclusion: This study supports the idea that a single ED/UC unscheduled visit can identify individuals with unrecognized diabetes and an at-risk prediabetes population using EHR data. A patient’s ED/UC visit, regardless of their primary reason for seeking care, may be an opportunity to provide early identification and diabetes disease management enrollment to augment the medical care of our community