Assessing the Potential Effects of Fungicides on Nontarget Gut Fungi (Trichomycetes) and Their Associated Larval Black Fly Hosts

Fungicides are moderately hydrophobic and have been detected in water and sediment, particularly in agricultural watersheds, but typically are not included in routine water quality monitoring efforts. This is despite their widespread use and frequent application to combat fungal pathogens. Although the efficacy of these compounds on fungal pathogens is well documented, little is known about their effects on nontarget fungi. This pilot study, a field survey in southwestern Idaho from April to December 2010 on four streams with varying pesticide inputs (two agricultural and two reference sites), was conducted to assess nontarget impact of fungicides on gut fungi, or trichomycetes. Tissues of larval black flies (Diptera: Simuliidae), hosts of gut fungi, were analyzed for pesticide accumulation. Fungicides were detected in hosts from streams within agricultural watersheds but were not detected in hosts from reference streams. Gut fungi from agricultural sites exhibited decreased percent infestation, density and sporulation within the gut, and black fly tissues had elevated pesticide concentrations. Differences observed between the sites demonstrate a potential effect on this symbiotic system. Future research is needed to parse out the details of the complex biotic and abiotic relationships; however, these preliminary results indicate that impacts to nontarget organisms could have far-reaching consequences within aquatic ecosystems

Increased Level of Myeloid-Derived Suppressor Cells, Programmed Death Receptor Ligand 1/Programmed Death Receptor 1, and Soluble CD25 in Sokal High Risk Chronic Myeloid Leukemia

Peer reviewe

Identifying Disproportionate Burden Through the Spatial Covariance of Two Acute Deaths of Despair: Firearm Suicide and Opioid Overdose

Thesis (Master's)--University of Washington, 2020Objectives: To evaluate the spatial covariance in two acute deaths of despair outcomes, firearm suicides and opioid overdoses, to better understand how these two public health crises intersect across US counties. The identification of communities which share similar risk for both outcomes as well as those with a disproportionate burden of one outcome compared to the other will allow for more effective resource allocation and targeted intervention strategies. Methods: CDC NVSS county-level detailed mortality data from 2013-2017 was used to classify deaths due to firearm suicide and opioid overdose. Local county standardized mortality ratios were smoothed using a Bayesian BYM model to reduce the influence of extreme, variable rates due to small numbers. The smoothed standardized mortality ratios for these two acute deaths of despair within each county were intersected to classify counties by their shared and distinct cause-specific burden of death compared to the US average risk. Results: There is significant heterogeneity in the incidence of firearm suicide and opioid overdose deaths at the county-level compared to the US average risk of death (3.48 firearm suicide deaths per 10,000 people and 7.66 opioid overdose deaths per 10,000 people). The burden of mortality from these preventable causes reveals a distinct spatial pattern of intersection and avoidance, creating a uneven landscape of risk across the United States. Conclusions: Spatial Bayesian smoothing techniques are crucial tools for making valid inferences regarding risk in small areas. Recognizing the shared or disproportionate burden of these two acute deaths of despair in a community can guide the development and refinement of programs designed to prevent them. To intervene to reduce deaths, a welfare geography approach should be used to equitably allocate shared resources to address the specific mediating pathways from despair to firearm suicide or opioid overdose deaths

Trajectories of Suicide Mortality in US Counties from 2000-2017 and the Influence of Selective Migration

Thesis (Master's)--University of Washington, 2020Objectives: To identify five distinct latent trajectory classes of suicide mortality among US Counties from 2000 to 2017 and to compare these trajectories to each county’s cumulative net migration over the study period to assess the influence of population change due to migration as a potential measure of economic opportunity. Methods: The annual county suicide mortality rates were prepped using a spatial Bayesian smoothing approach using Integrated Nested Laplace Approximations to reduce the influence of extreme high rates due to small numbers. Latent growth mixture modelling was employed to identify five linear mortality trajectories. The model allowed for random slopes and intercepts to allow individual county trajectories to vary around the class means. Each class was compared descriptively against three categories of cumulative net migration over the study period: persistent population loss due to migration, net even migration, and persistent population gain due to migration. Results: All five classes of latent trajectories displayed a positive slope indicating rising suicide mortality rates in all classes of counties from 2000 to 2017. While two classes exhibited greater slopes, the classes seemed to be more differentiated by their intercepts – the suicide mortality rate in 2000. The proportion of counties in each of the three migration categories differed between the five classes. However, the results of the Lo-Mendell-Rubin test failed to reject the null hypothesis that five classes were more appropriate than four classes, calling into question the validity of the individual county classifications. Conclusions: As the five-class trajectory model was not found to be statistically significant, further research should be done to explore different numbers of classes as well as higher order polynomial slopes to identify the best fit for the data. However, given the similarity in the five class slopes it may be possible that county suicide mortality rates exist on a continuum rather than clustered within distinct classes. Lastly, while the latent trajectories seemed to be marginally associated with cumulative net migration, it is possible that aggregating migration counts across the study period masked local temporal variation that should be explored in a more nuanced manner

Local Efforts to Expand the World’s Largest Trichomycete Collection

Trichomycetes (gut fungi) are obligate symbionts of various arthropods and have been found in marine, freshwater, and terrestrial habitats on every continent except Antarctica. Gut fungi associate commensally with their immature aquatic hosts (including black flies, mayflies, stoneflies, isopods, and others) attaching to the chitinous lining of the mid- or hindgut. Gut fungi are routinely isolated from the host’s digestive tract into axenic cultures, which provide a rich resource of genetic material for phylogenic analysis. Given the obligate endosymbiotic nature of the fungi, unique challenges are encountered upon culturing, thus only 30% of all trichomycetes have been successfully cultured. Our laboratory houses the world’s largest culture collection of trichomycetes. We have been endeavoring to expand the collection by formulating suitable media in which field collected trichomycete specimens can grow. This requires attention to variables such as competing bacterial growth, pH changes required for sporulation, agar density and proper nutrient balance within the media. The continued development and enhancement of culture media is intended to increase the number of isolates that previously were considered unculturable and offer more robust samples of genetic material for future analyses

The association of alcohol use and heavy drinking with subsequent handgun carrying among youth from rural areas.

PURPOSE: Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm-related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults. METHODS: We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past-month alcohol use on handgun carrying in the subsequent 12 months using population-average generalized estimating equations with logistic regression on multiply imputed data. FINDINGS: During adolescence (ages 12-18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19-26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence. CONCLUSIONS: Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm-related harm among young people in rural areas

Integration of extreme risk protection orders into the clinical workflow: Qualitative comparison of clinician perspectives.

Extreme risk protection orders (ERPO) seek to temporarily reduce access to firearms for individuals at imminent risk of harming themselves and/or others. Clinicians, including physicians, nurse practitioners, and social workers regularly assess circumstances related to patients' risk of firearm-related harm in the context of providing routine and acute clinical care. While clinicians cannot independently file ERPOs in most states, they can counsel patients or contact law enforcement about filing ERPOs. This study sought to understand clinicians' perspectives about integrating ERPO counseling and contacting law enforcement about ERPOs into their clinical workflow. We analyzed responses to open-ended questions from an online survey distributed May-July of 2021 to all licensed physicians (n = 23,051), nurse practitioners (n = 8,049), and social workers (n = 6,910) in Washington state. Of the 4,242 survey participants, 1,126 (26.5%) responded to at least one of ten open-ended questions. Two coders conducted content analysis. Clinicians identified barriers and facilitators to integrating ERPOs into the clinical workflow; these influenced their preferences on who should counsel or contact law enforcement about ERPOs. Barriers included perceptions of professional scope, knowledge gaps, institutional barriers, perceived ERPO effectiveness and constitutionality, concern for safety (clinician and patient), and potential for damaging provider-patient therapeutic relationship. Facilitators to address these barriers included trainings and resources, dedicated time for counseling and remuneration for time spent counseling, education on voluntary removal options, and ability to refer patients to another clinician. Participants who were hesitant to be the primary clinician to counsel patients or contact law enforcement about ERPOs requested the ability to refer patients to a specialist, such as social workers or a designated ERPO specialist. Results highlight the complex perspectives across clinician types regarding the integration of ERPO counseling into the clinical workflow. We highlight areas to be addressed for clinicians to engage with ERPOs

Impact of community-level socioeconomic disparities on quality of life after burn injury: A Burn Model Systems Database study

INTRODUCTION: Individual-level socioeconomic disparities impact burn-related incidence, severity and outcomes. However, the impact of community-level socioeconomic disparities on recovery after burn injury is poorly understood. As a result, we are not yet able to develop individual- and community-specific strategies to optimize recovery. Therefore, we aimed to characterize the association between community-level socioeconomic disparities and long-term, health-related quality of life after burn injury. METHODS: We queried the Burn Model System National Longitudinal Database for participants who were \u3e 14 years with a zip code and who had completed a health-related quality of life (HRQOL) questionnaire (VR-12) 6 months after injury. BMS data were deterministically linked by zip code to the Distressed Communities Index (DCI), which combines seven census-derived metrics into a single indicator of economic well-being, education, housing and opportunity at the zip code level. Hierarchical linear models were used to estimate the association between community deprivation and HRQOL 6 months after burn injury, as measured by mental (MCS) and physical (PCS) component summary scores of the SF12/VR12. RESULTS: 342 participants met inclusion criteria. Participants were mostly male (n = 239, 69 %) and had a median age of 48 years (IQR 33-57 years). Median %TBSA was 10 (IQR 3-28). More than one-third of participants (n = 117, 34 %) lived in a community within the highest two distress quintiles. After adjusting for age, race/ethnicity, number of trips to the operating room (OR) and pre-injury PCS, neighbourhood distress was negatively associated with 6-month PCS (ß-0.05, 95 % CI [-0.09,-0.01]). Increasing age and lower pre-injury PCS were also negatively associated with 6-month PCS. There was no observed association between neighbourhood distress and 6-month MCS after adjustment for age, participant race/ethnicity, number of trips to the OR and pre-injury MCS. Higher pre-injury MCS was associated with 6-month MCS (ß0.54, 95 % CI [-0.41,0.67]). CONCLUSIONS: Community distress is associated with lower PCS at 6 months after burn injury but no association with MCS was identified. Pre-injury HRQOL is associated with both PCS and MCS after injury. Further study of the factors underlying the relationship between community distress and physical functional recovery (e.g., access to rehabilitation services, availability of adaptations) is required to identify potential interventions

Racial and ethnic differences in the association between depressive symptoms and cognitive outcomes in older adults: Findings from KHANDLE and STAR

IntroductionDepressive symptoms are associated with higher risk of dementia, but how they impact cognition in diverse populations is unclear.MethodsAsian, Black, Latino, or White participants (n = 2227) in the Kaiser Healthy Aging and Diverse Life Experiences (age 65+) and the Study of Healthy Aging in African Americans (age 50+) underwent up to three waves of cognitive assessments over 4 years. Multilevel models stratified by race/ethnicity were used to examine whether depressive symptoms were associated with cognition or cognitive decline and whether associations differed by race/ethnicity.ResultsHigher depressive symptoms were associated with lower baseline verbal episodic memory scores (-0.06, 95% CI: -0.12, -0.01; -0.15, 95% CI: -0.25, -0.04), and faster decline annually in semantic memory (-0.04, 95% CI: -0.07, -0.01; -0.10, 95% CI: -0.15, -0.05) for Black and Latino participants. Depressive symptoms were associated with lower baseline but not decline in executive function.DiscussionDepressive symptoms were associated with worse cognitive outcomes, with some evidence of heterogeneity across racial/ethnic groups.HighlightsWe examined whether baseline depressive symptoms were differentially associated with domain-specific cognition or cognitive decline by race/ethnicity. Depressive symptoms were associated with worse cognitive scores for all racial/ethnic groups across different domains examined. Higher depressive symptoms were associated with faster cognitive decline for semantic memory for Black and Latino participants. The results suggest a particularly harmful association between depressive symptoms and cognition in certain racial/ethnic groups