Hospitalization Rates for Coronary Heart Disease in Relation to Residence Near Areas Contaminated with Persistent Organic Pollutants and Other Pollutants

Exposure to environmental pollutants may contribute to the development of coronary heart disease (CHD). We determined the ZIP codes containing or abutting each of the approximately 900 hazardous waste sites in New York and identified the major contaminants in each. Three categories of ZIP codes were then distinguished: those containing or abutting sites contaminated with persistent organic pollutants (POPs), those containing only other types of wastes (“other waste”), and those not containing any identified hazardous waste site (“clean”). Effects of residence in each of these ZIP codes on CHD and acute myocardial infarction (AMI) hospital discharge rates were assessed with a negative binomial model, adjusting for age, sex, race, income, and health insurance coverage. Patients living in ZIP codes contaminated with POPs had a statistically significant 15.0% elevation in CHD hospital discharge rates and a 20.0% elevation in AMI discharge rates compared with clean ZIP codes. In neither of the comparisons were rates in other-waste sites significantly greater than in clean sites. In a subset of POP ZIP codes along the Hudson River, where average income is higher and there is less smoking, better diet, and more exercise, the rate of hospitalization for CHD was 35.8% greater and for AMI 39.1% greater than in clean sites. Although the cross-sectional design of the study prevents definite conclusions on causal inference, the results indirectly support the hypothesis that living near a POP-contaminated site constitutes a risk of exposure and of development of CHD and AMI

Final (Year 2) Report to OHA on SOGI Demographic Standards for Minors

Executive Summary The report synthesizes thoughtful recommendations of the authors to the Oregon Health Authority (OHA) about routine data collection of SOGI† (sex, sexual orientation, and gender) demographic data in minors for clinical and reporting purposes. We see five primary motivations to routinely collect SOGI data, including to: create an inclusive practice in order to welcome and make space for people from historically excluded genders, sexes, and sexual orientations, promote health equity between minority and majority SOGI identities, direct group-specific services towards those who need them, represent the actual diversity of Oregon, and its communities, and shift normative expectations about who Oregonians are. Our approach These recommendations are informed by: interviews with Oregon service providers and advocates for sex, sexual, and gender minority (SSGM) young people, a literature review to identify existing data sources on Oregon minors, and methods, and recommendations for collecting these data, a focus group with SSGM teens, and a survey of US states’ SOGI data practices as reflected in major health surveys. Expertise gleaned from interviews with community advocates and service providers is incorporated throughout the recommendations below. Among considerations included in the report, we highlight the impact of parent/caregiver presence in data collection procedures, the need for cultural specificity in determining appropriate question and response options, individuals’ right to have control over their data, and the value of open vs. structured questions which is dependent on age. The literature review yielded alarmingly few evidence-based recommendations for routine SOGI data collection for minors and sparse existing data on SSGM minors. Summary of recommendations (detailed in full in the report) Recommendations for children based on age: Questions and the response options should differ depending on the age and understanding of the child: For young children (under age 8 or 9) we recommend only using broad, open-ended questions and not involving structured, check-box style questions at all. If structured questions are necessary, we recommend a question that categorizes children’s gendered experiences either in their own words or according to gender conformity or nonconformity. For children (ages 8 to 11) we still recommend focusing on open-ended questions, but these can be more specific, including questions about the body, attraction, and self-identifying. For adolescents (ages 12+) we recommend that the adult SOGI recommendations should be applied with special consideration given to ensuring that the adolescent understands the limits of confidentiality regarding this information. Recommendations to limit parental/caregiver report bias: To account for parent/caregiver bias in reporting minor demographic information, indicators can be used to identify who is disclosing the data about a minor, and who is present when data are collected. Recommendation to limit administrator report bias: Add an option to indicate the question was not asked (e.g., ‘□ Did not ask question’) in order to account for instances in which a survey administrator did not ask the question, and to avoid conflating these instances with passive non-response, or active non-responses such as Prefer not to answer or I don’t know what this question is asking. Such a question could be used to identify administrators routinely not asking SOGI questions, and could also be used as a flag for follow-up with a respondent. This question could also be added for REALD. Recommendation to provide expanded prompts and definitions: Provide generously detailed prompts (similarly to REALD’s prompts for open text responses) to all SOGI questions, and provide definitions for each of the categories in structured questions. Recommendations for labor equity and a centralized demographic repository: Due to the labor cost of reporting demographic data (let alone, for example, screening, treatment or symptom questionnaires), we recommend that people are asked to fill out demographic forms no more than once per year. This poses technical challenges. We recommend a central database or repository be created, which holds demographic information provided and managed by both children and adults. For example, a minor might change their preferred pronoun or gender identity using a web page to interface with the database. To offset the reporting burden, healthcare and other service providers as well as researchers would be required to undergo training for respectful and ethical use of the data prior to requesting permission to access their SOGI data from this repository. Individuals should be able to access their own data. A centralized demographic data database would dramatically reduce the burden of changing legal documentation of a person’s name, sex, gender, race, ethnicity, etc., which is frequently mentioned as a stressor or barrier to care for SSGM minors and their families (as well as SSGM adults). We recommend that SOGI demographic data be collected routinely among minors in Oregon in contexts where REALD data are collected. Recommendations about restricting access to SOGI data: We recommend that service providers who wish to access historical SOGI data (that is the history of changes to an individual’s demographic information, including REALD), and who have obtained patient consent to do so, be required to document the reason for accessing such information and that institutions are required to review the validity of these reasons. Requiring service providers to document reasons for accessing historical demographic data serves as a checkpoint to help ensure patient data is being used safely and ethically but is not dependent on a prescriptive list of what uses of data are legitimate. Because Oregon law (OR 109.650) does not guarantee minors a right to confidentiality, nor does it guarantee parents/caregivers a right to access their children’s information, where possible we recommend service providers guarantee that minors over age 12 must give permission for their information to be shared, even with parents/caregivers. When such a guarantee is not possible, we recommend that the collection of SOGI data include an acknowledgment that confidentiality is not guaranteed and that providers are trained to recognize situations when it is or isn’t appropriate to share this information. Recommendations about mandatory training For accessing current SOGI data: We recommend workers and institutions who interface with minors should not be able to access SOGI data unless they have been trained on using the data respectfully. We recommend OHA develop and disseminate brief training materials around SOGI data use. For accessing historical demographic data (including SOGI): We recommend OHA create and disseminate training materials for institutions and individuals who desire to access historical demographic data (i.e. across the life course of the individual). Conclusion Collecting inclusive SOGI data is a public health good and a moral necessity, and has the potential to benefit individuals as well as population health. OHA’s draft SOGI data tool is, in our judgement, the most inclusive of all U.S. states among the tools we considered, and could play an important role as a model of inclusive routine SOGI representation for minors nationally countering SSGM erasure and distortion in other states. See also: Preliminary (Year 1) Report to OHA on Pediatric SOGI: Executive Summary. Report to the Oregon Health Authority, Office of Equity and Inclusio

Expert interpretation of bar and line graphs: The role of graphicacy in reducing the effect of graph format.

The distinction between informational and computational equivalence of representations, first articulated by Larkin and Simon (1987) has been a fundamental principle in the analysis of diagrammatic reasoning which has been supported empirically on numerous occasions. We present an experiment that investigates this principle in relation to the performance of expert graph users of 2 × 2 'interaction' bar and line graphs. The study sought to determine whether expert interpretation is affected by graph format in the same way that novice interpretations are. The findings revealed that, unlike novices—and contrary to the assumptions of several graph comprehension models—experts' performance was the same for both graph formats, with their interpretation of bar graphs being no worse than that for line graphs. We discuss the implications of the study for guidelines for presenting such data and for models of expert graph comprehension

Advantage of precision metagenomics for urinary tract infection diagnostics

Background: Urinary tract infections (UTIs) remain a diagnostic challenge and often promote antibiotic overuse. Despite urine culture being the gold standard for UTI diagnosis, some uropathogens may lead to false-negative or inconclusive results. Although PCR testing is fast and highly sensitive, its diagnostic yield is limited to targeted microorganisms. Metagenomic next-generation sequencing (mNGS) is a hypothesis-free approach with potential of deciphering the urobiome. However, clinically relevant information is often buried in the enormous amount of sequencing data. Methods: Precision metagenomics (PM) is a hybridization capture-based method with potential of enhanced discovery power and better diagnostic yield without diluting clinically relevant information. We collected 47 urine samples of clinically suspected UTI and in parallel tested each sample by microbial culture, PCR, and PM; then, we comparatively analyzed the results. Next, we phenotypically classified the cumulative microbial population using the Explify® data analysis platform for potential pathogenicity. Results: Results revealed 100% positive predictive agreement (PPA) with culture results, which identified only 13 different microorganisms, compared to 19 and 62 organisms identified by PCR and PM, respectively. All identified organisms were classified into phenotypic groups (0–3) with increasing pathogenic potential and clinical relevance. This PM can simultaneously quantify and phenotypically classify the organisms readily through bioinformatic platforms like Explify®, essentially providing dissected and quantitative results for timely and accurate empiric UTI treatment. Conclusion: PM offers potential for building effective diagnostic models beyond usual care testing in complex UTI diseases. Future studies should assess the impact of PM-guided UTI management on clinical outcomes

Constraints on star formation theories from the Serpens molecular cloud and protocluster

We have mapped the large-scale structure of the Serpens cloud core using moderately optically thick (13CO(1--0) and CS(2--1)) and optically thin tracers (C18O(1--0), C34S(2--1), and N2H+(1--0)), using the 16-element focal plane array operating at a wavelength of 3mm at the Five College Radio Astronomy Observatory. Our main goal was to study the large-scale distribution of the molecular gas in the Serpens region and to understand its relation with the denser gas in the cloud cores, previously studied at high angular resolution. All our molecular tracers show two main gas condensations, or sub-clumps, roughly corresponding to the North-West and South-East clusters of submillimeter continuum sources. We also carried out a kinematical study of the Serpens cloud. The 13CO and C18O(1--0) maps of the centroid velocity show an increasing, smooth gradient in velocity from East to West, which we think may be caused by a global rotation of the Serpens molecular cloud whose rotation axis is roughly aligned in the SN direction. Although it appears that the cloud angular momentum is not sufficient for being dynamically important in the global evolution of the cluster, the fact that the observed molecular outflows are roughly aligned with it may suggest a link between the large-scale angular momentum and the circumstellar disks around individual protostars in the cluster. We also used the normalized centroid velocity difference as an infall indicator. We find two large regions of the map, approximately coincident with the SE and NW sub-clumps, which are undergoing an infalling motion. Although our evidence is not conclusive, our data appear to be in qualitative agreement with the expectation of a slow contraction followed by a rapid and highly efficient star formation phase in localized high density regions.Comment: 17 pages, A&A in press, full resolution figures available at http://www.arcetri.astro.it/~lt/preprints/preprints.htm

Optimization of the Illumina COVIDSeq™ protocol for decentralized, cost-effective genomic surveillance

A decentralized surveillance system to identify local outbreaks and monitor SARS-CoV-2 Variants of Concern is one of the primary strategies for the pandemic’s containment. Although nextgeneration sequencing (NGS) is a gold standard for genomic surveillance and variant discovery, the technology is still cost-prohibitive for decentralized sequencing, particularly in small independent labs with limited resources. We have optimized the Illumina COVIDSeq™ protocol for the Illumina MiniSeq instrument to reduce cost without compromising accuracy. We slashed the library preparation cost by half by using 50% of recommended reagents at each step and normalizing the libraries before pooling to achieve uniform coverage. Reagent-only cost (~ $43.27/sample) for SARS-CoV-2 variant analysis with this normalized input protocol on MiniSeq instruments is comparable to what is achieved on high throughput instruments such as NextSeq and NovaSeq. Using this modified protocol, we tested 153 clinical samples, and 90% of genomic coverage was achieved for 142/153 samples analyzed in this study. The lineage was correctly assigned to all samples (152/153) except for one. This modified protocol can help laboratories with constrained resources to contribute in decentralized COVID-19 surveillance in the postvaccination era

Deciphering microbiota of acute upper respiratory infections: A comparative analysis of PCR and mNGS methods for lower respiratory trafficking potential

Although it is clinically important for acute respiratory tract (co)infections to have a rapid and accurate diagnosis, it is critical that respiratory medicine understands the advantages of current laboratory methods. In this study, we tested nasopharyngeal samples (n = 29) with a commercially available PCR assay and compared the results with those of a hybridization-capture-based mNGS workflow. Detection criteria for positive PCR samples was Ct \u3c 35 and for mNGS samples it was \u3e40% target coverage, median depth of 1X and RPKM \u3e 10. A high degree of concordance (98.33% PPA and 100% NPA) was recorded. However, mNGS yielded positively 29 additional microorganisms (23 bacteria, 4 viruses, and 2 fungi) beyond PCR. We then characterized the microorganisms of each method into three phenotypic categories using the IDbyDNA Explify® Platform (Illumina® Inc, San Diego, CA, USA) for consideration of infectivity and trafficking potential to the lower respiratory region. The findings are significant for providing a comprehensive yet clinically relevant microbiology profile of acute upper respiratory infection, especially important in immunocompromised or immunocompetent with comorbidity respiratory cases or where traditional syndromic approaches fail to identify pathogenicity. Accordingly, this technology can be used to supplement current syndrome-based tests, and data can quickly and effectively be phenotypically characterized for trafficking potential, clinical (co)infection, and comorbid consideration—with promise to reduce morbidity and mortality

Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students

Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP’s and used for this purpose with participating students on their ambulatory care APPE. Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students’ baseline knowledge regarding MRP’s, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline. Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP’s. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students’ knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students’ knowledge occurred on one specific question, which tested their ability to classify MRP’s (p = 0.029). Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP’s to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning