Increasing Actual and Perceived Burden of Tick-Borne Disease in Maine

Introduction: The burden of tick-borne disease (TBD) in Maine has steadily increased since the first case of Lyme disease was reported in the late 1980s. The emergence of five different agents of TBD in Maine has been challenging and confusing for clinicians and the public. Methods: We reviewed the ecology of emerging of tick -borne disease, then reviewed risk factors for tick bites and tick-borne disease in Maine. We then compared the burden of TBD versus community-acquired comparison infections in terms of hospitalizations, deaths, and media attention. Results and Discussion: In Maine, risk of exposure to bites from the vector blacklegged or “deer tick”, Ixodes scapularis, is a reality in most of the state. In New England, resurgence of white-tailed deer attending reforestation and suburbanization of the landscape and climate change have contributed to geographic expansion of the deer tick from relict populations in southern New England. TBDs have emerged as a significant health burden in Maine, but compared with other infections of public health importance, receive disproportionately high media attention. Measures of tick-borne disease severity provide a necessary context for individual and public health decision making. Mass media reports and social networking inform much public debate regarding TBDs, but in many instances, do not accurately reflect their actual prevalence or expected outcome. Conclusion: Reducing actual and perceived risks associated with TBD will require well-supported information paired with an appreciation for how interpersonal communication and social media drive community perceptions and responses to the emergence of TBDs

The Impact of Reforming the Medical Student Admissions Training Process on Medical Student Interviewers.

• Title: The Impact of Reforming the Medical Student Admissions’ Training Process on Medical Student Interviewers. • Authors: Sean McCarthy1, Iyanna Peppers1, Kevin Sprague, M.D.1, Abhinav Krishnan, PhD1 1.Wayne State University School of Medicine • Purpose: The Medical Student Admissions Interview Committee (MSAIC) at Wayne State University School of Medicine (WSUSOM) conducts over 1500 interviews per year. Medical student interviews are a core component of the admissions process, along with faculty/alumni interviews and multiple-mini-interviews. The continuous quality improvement (CQI) subcommittee of MSAIC aids in identifying, improving, and managing compliance. Following suggestions provided by a CQI survey about perceptions of the training process, the training procedure was refined. This study\u27s objective was to identify student perceptions on med-student interviewer training and evaluate the effectiveness of the different training methods. • Approach/Methods: This retrospective study reviewed two years of interviewer cohorts. In 2021 cohort, new students (n=15) were selected and participated in an orientation followed by a minimum of 3 shadowing and training sessions. Beginning with 2022 cohort, a new training schema was introduced that focused on early interactive training; new students (n=20) were selected and participated in an interactive training session and an orientation followed by a minimum of 2 shadowing and training sessions. Following each cohort year, surveys were collected and analyzed after the final interview day. • Results/Outcomes: For both cohort years, there was a response rate of 35.6% (2021) and 32.7% (2022). When analyzing the effect of training modification in 2022: There was an increase in the overall experience as a student interviewer rated as “highly positive” from 19% (2021) to 33% (2022). An increase in the number of students reporting that they did not need more training from 13% (2021) to 28% (2022). However, from 2021 to 2022, there was a decrease in preference for virtual interviews from 46% to 29%, respectively. • Discussion: The alteration and improvement of the Interviewer training has allowed for a streamlined approach during the beginning portion of the academic cycle with onboarding of new M1 interviewers. The MSAIC has adapted to better suit the needs of today\u27s learners by providing hands-on learning and the perceptions of the process over the study years have shown a net positive outcome in terms of the experience and training. The alteration to training has had an overall net benefit to the student cohorts within the MSAIC and has shortened the time required to be trained while also improving the experiences of those on the committee

The spatial and temporal characterisation of flooding within the floodplain wetland of the Nyl River, Limpopo Province, South Africa

The inundated area of a wetland is characterised by annual and interannual variability. This paper presents remotely-sensed imagery in order to better understand the spatial and temporal patterns of flooding within the floodplain wetland of the Nyl River, Limpopo Province. A detailed understanding of the hydrological characteristics of these flood events is essential in order to develop sustainable ecological and hydrological management plans for the area. From the results, flooding is shown to occur in 2 distinct phases. The initial phase is characterised by water ponding on the floodplain. The later phase is characterised by the input of water from tributaries to the north (e.g. Andriesspruit and Tobiasspriut) and southwest (e.g. Klein Nyl and Groot Nyl). This distinction may relate to the increasingly widespread practice of agricultural irrigation within adjacent tributary catchments. The methodology described in this study could yield valuable results when applied to other wetland systems in southern Africa.Keywords: Landsat, remote sensing, flood dynamics, floodplain wetlands, Nyl Rive

The Rise of the Social Business in Emerging Economies: A New Paradigm of Development

Social business has emerged as a sustainable and innovative means to solve emerging social problems. Although it is gaining momentum, there is a paucity of studies on the drivers of social business models and its key success factors. Drawing on a systematic literature review and an in-depth analysis of 31 social businesses in Bangladesh, the study presents eight key drivers and four success factors for a sustainable social business model. The findings show eight key drivers for social business models including customer centricity, quality, social needs, latent demands, incidental gains, innovation through partnerships, inspirations from initiatives and collaborative eco-systems. The findings also report four critical success factors including social goals, collaboration, simplicity and start from home. Overall, this study discusses the scope of developing and sustaining social business models for empowerment, quality of life and economic growth in emerging economies

Redesigning Primary Care Processes to Improve the Offering of Mammography. The use of Clinic Protocols by Nonphysicians.

OBJECTIVE: To develop, within the framework of continuous quality improvement, new processes for offering mammography and determine whether protocols executed completely by nonphysicians would increase mammography utilization. DESIGN: A prospective follow-up study with patients from an intervention clinic and two control clinics. SETTING: Three general internal medicine clinics in a large, urban teaching hospital in Detroit, Michigan. PATIENTS/PARTICIPANTS: A total of 5,934 women, aged 40 through 75 years, making 16,546 visits to one of the clinics during the study period (September 1, 1992, through November 31, 1993). INTERVENTION: Medical assistants and licensed practical nurses in the intervention clinic were trained to identify women due for screening mammography, and to directly offer and order a mammogram if patients agreed. MEASUREMENTS AND MAIN RESULTS: Patients were considered up-to-date with screening if they had a mammogram within 1 year (if age 50-75) or 2 years (if age 40-49) prior to the visit or a mammogram within 60 days after the visit. The proportion of visits each month in which a woman was up-to-date with mammography was calculated using computerized billing records. Prior to the intervention, the proportion of visits in which women were up-to-date was 68% (95% confidence interval [CI] 63%, 73%) in the intervention clinic and 66% (95% CI 61%, 71%) in each of the control clinics. At the end of the evaluation, there was an absolute increase of 9% (95% CI 2%, 16%) in the intervention clinic, and a difference of 1% (95% CI -5%, 7%) in one of the control clinics and -2% (95% CI -3%, 5%) in the other. In the intervention clinic, the proportion of visits in which women were up-to-date with mammography increased over time and was consistent with a linear trend (p = .004). CONCLUSIONS: Redesigning clinic processes to make offering of mammography by medical assistants and licensed practical nurses a routine part of the clinic encounter can lead to mammography rates that are superior to those seen in physicians\u27 usual practice, even when screening levels are already fairly high. Physicians need not be considered the sole, or even the primary, member of the health care team who can effectively deliver some preventive health measures

Removing Barriers to Tecovirimat for Mpox-infected Individuals via Novel Models of Care Delivery

Problem Statement During the 2022 mpox outbreak, the CDC’s expanded access Investigational New Drug (IND) protocol created a practical barrier to the outpatient provision of tecovirimat. We rapidly implemented a tecovirimat prescription program for individuals infected with mpox to improves access to care. Project AIM Primary aim: describe how we rapidly implemented a program for increasing tecovirimat distribution in a metropolitan area. Secondary aims: describe the patient population who received tecovirimat as treatment for mpox at our clinic and analyze several clinically relevant time intervals along the continuum of care delivery.https://jdc.jefferson.edu/didemposters/1004/thumbnail.jp

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

Abstract Background Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains. Questions/Purposes We addressed two questions: (1) Does the LLRS AIM Index show construct validity by correlating with rankings of case complexity? (2) Does the LLRS AIM Index show sufficient interrater and intrarater reliabilities? Methods We had eight surgeons evaluate 10 fictionalized patients with various lower limb deformities. First, they ranked the cases from simplest to most complex, and then they rated the cases using the LLRS AIM Index. Two or more weeks later, they rated the cases again. We assessed reliability using the Kendall's W test. Results Raters were consistent in their rankings of case complexity (W = 0.33). Patient rankings also correlated with both sets of LLRS AIM ratings (r 2 = 0.25; r 2 = 0.23). The LLRS AIM Index showed interrater reliability with an intraclass correlation (ICC) of 0.97 for Trial 1 and 0.98 for Trial 2 and intrarater reliability with an ICC of 0.94. The LLRS AIM Index ratings also were highly consistent between the attending surgeons and surgeons-in-training (ICC = 0.91). Conclusions Our preliminarily observations suggest that the LLRS AIM Index reliably classifies the complexity of lower limb deformities in and between observers

Influence of Glutathione S-Transferase Polymorphisms on Cognitive Functioning Effects Induced by p,p′-DDT among Preschoolers

5 pages, 4 tables.-- PMID: 19057715 [PubMed].-- PMCID: PMC2592282.-- Printed version published Nov 2008.Background Early-life exposure to p,p′-DDT [2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane] is associated with a decrease in cognitive skills among preschoolers at 4 years of age. We hypothesized that genetic variability in glutathione S-transferase (GST) genes (GSTP1, GSTM1, and GSTT1) could influence the effects of prenatal exposure to p,p′-DDT.Methods We used data from 326 children assessed in a prospective population-based birth cohort at the age of 4 years. In that study, the McCarthy Scales of Children’s Abilities were administrated by psychologists, organochlorine compounds were measured in cord serum, and genotyping was conducted for the coding variant Ile105Val from GSTP1 and for null alleles from GSTM1 and GSTT1. We used linear regression models to measure the association between organochlorines and neurodevelopmental scores by GST polymorphisms.Results p,p′-DDT cord serum concentration was inversely associated with general cognitive, memory, quantitative, and verbal skills, as well as executive function and working memory, in children who had any GSTP1 Val-105 allele. GSTP1 polymorphisms and prenatal p,p′-DDT exposure showed a statistically significant interaction for general cognitive skills (p = 0.05), quantitative skills (p = 0.02), executive function (p = 0.01), and working memory (p = 0.02). There were no significant associations between p,p′-DDT and cognitive functioning at 4 years of age according to GSTM1 and GSTT1 polymorphisms.Conclusions Results indicate that children with GSTP1 Val-105 allele were at higher risk of the adverse cognitive functioning effects of prenatal p,p′-DDT exposure.This study was funded by grants from the Spanish Ministry of Health (FIS-PI041436, FIS-PI041705, FIS-PI051187), Instituto de Salud Carlos III (Red INMA G03/176 and CB06/02/0041), and Ciber en Epidemiología y Salud Pública, the Generalitat de Catalunya-CIRIT (Consejo Interdepartmental de Investigación e Innovación de Cataluña) (1999SGR 00241), and Genome Spain.Peer reviewe