"We Really Help, Taking Care of Each Other": Older Homeless Adults as Caregivers.

Objectives:Many older homeless adults maintain contact with family. We conducted a qualitative study examining the role of family caregiving for older homeless adults. Method:We conducted semi-structured qualitative interviews with a sample of 46 homeless participants who reported spending at least one night with a housed family member in the prior 6 months. Results:A total of 13 of 46 older adult participants provided caregiving. Themes included (a) the death of the care recipient led to the participant's homelessness; (b) feeling a duty to act as caregivers; (c) providing care in exchange for housing; (d) caregivers' ability to stay was tenuous; (e) providing care conflicted with the caregiver's needs; and (f) resentment when family was ungrateful. Discussion:In a sample of older homeless adults in contact with family, many provided caregiving for housed family. For some, caregiving precipitated homelessness; for others, caregiving provided temporary respite from homelessness, and for others, caregiving continued during homelessness

Approaches Initiated to Gain Insight into Respiratory Disease in Montana’s Bighorn Sheep Herds

Respiratory disease is a major limiting factor in the restoration, conservation, and management of bighorn sheep in Montana and throughout western North America. Despite many decades of research there is a limited understanding of the disease process, with proactive management to minimize disease primarily limited to establishing policies to minimize exposure of bighorn sheep to domestic sheep. In the past decade, however, there have been significant advances in understanding the pathogens involved in bighorn sheep pneumonia that have resulted in the development of new sampling and testing methodologies that promise to advance our understanding of the disease.  This presentation will review the general ideas regarding the pathogens and the disease process advanced by leading researchers of bighorn sheep pneumonia and describe how these ideas are being combined with recent sampling and testing advances and incorporated into Montana’s state-wide bighorn sheep research program. We will also describe the collaborations developed between our research team and other research teams addressing the same questions in neighboring states. These collaborations are an attempt to build a regional initiative that combines the resources, expertise, and unique management histories of bighorn herds in other states. We think such open communication and coordination of research activities will help us advance our understanding of bighorn sheep pneumonia and develop management strategies that can enhance restoration of the species

Assessing Brucellosis Seroprevalence and Transmission Risk in a Free-Ranging Elk Population: The Targetted Brucellosis Surveillance Project in Montana

Brucellosis is a bacterial disease that affects elk, bison and domestic cattle.  Recently the seroprevalence of brucellosis in free-ranging elk populations of Montana has increased and its’ range has expanded, resulting in increased pressure on Montana Fish, Wildlife and Parks (MFWP) to manage the disease in elk.  In 2010 MFWP and the Montana Department of Livestock initiated a targeted surveillance program to delineate the current geographic distribution of brucellosis, document spatio-temporal habitat selection and movement patterns, and to quantify potential transmission risk from elk to cattle.  Since 2010, we have targeted 11 different winter ranges from 9 hunt districts, both within and outside of the Designated Surveillance Area used to manage cattle.  During each capture operation we tested approximately 100 adult female elk for exposure to brucellosis.  We deployed GPS radiocollars on a subsample of adult female elk on each winter range.  An epidemiological summary of the first five years, including seroprevalence, movement and implications for transmission vectors will be presented. Current brucellosis exposure in domestic herds, future surveillance areas, evaluation of various management actions on transmission risk, and the creation of a spatio-temporal risk model are discussed

Elk Movements and Brucellosis Transmission Risk in Southwest Montana

The presence of Brucella abortus within free-ranging elk populations is an important conservation and management issue because of the risk of brucellosis transmission to livestock. Understanding elk distributions is necessary to forecast elk and livestock spatial overlap and the potential for brucellosis transmission. As part of a 5-yr brucellosis surveillance project, 30 adult female elk were captured and fitted with GPS collars in each of the winters of 2010, 2011 and 2012 in three southwest Montana study areas. We used elk location information to assess elk movements, and spatial overlap with livestock and adjacent elk herds. The elk movement results were further augmented with data from Wyoming and Idaho elk herds. The elk movement data shows interchange of females between elk herds during the transmission risk period. Resource selection models predicting elk distribution and spatial overlap with livestock during the transmission risk period were developed and extrapolated across the designated brucellosis surveillance area of Montana. We used the elk location data collected in this study to validate and refine models predicting elk distributions and spatial overlap with livestock during the risk period. Predictive models may be used as a tool for focusing management actions aimed at minimizing elk and livestock spatial overlap during the transmission risk period

Autism Spectrum Disorder Prevalence Rates in the United States: Methodologies, Challenges, and Implications for Individual States

Many different studies have been conducted to determine the prevalence rates of Autism Spectrum Disorder (ASD) in the United States. The methodologies of these studies have varied, resulting in a multitude of publications with differing prevalence rates. Because there is such a wide range in the results of prevalence studies, it may be difficult for individual states to determine their rates. Accurate prevalence rates are important to obtain for many different reasons including increasing advocacy and awareness, increasing funding, and proper allocation of services for individuals with ASD and their families. Additionally, prevalence studies can be used to assess which groups are more at risk for ASD based off location and environmental factors. This paper describes different methodologies that can be utilized to determine ASD prevalence rates, the strengths and weaknesses of each method, and the challenges to determining accurate rates. This paper also includes the results from a study conducted in Nebraska to determine prevalence rates of ASD in the state. Implications for future prevalence studies are addressed and recommendations are provided

2103. Emergency Department (ED) Stewardship: Stratifying ED Sepsis Order Sets by Penicillin (PCN) Allergy Severity

Background: The Surviving Sepsis Campaign Guidelines recommends administration of broad-spectrum antibiotics within 1 hour of sepsis diagnosis; electronic order sets drive antibiotic selection with pre-populated regimens based on the suspected infectious indication. Given the low rate of cephalosporin cross-reactivity in patients with a PCN allergy, we modified our ED sepsis order set (Images 1 and 2) to include cephalosporin options in patients with reported mild-to-moderate PCN reaction histories. This was a single-center, retrospective analysis evaluating the impact of this change on antibiotic prescribing and associated outcomes. Methods: An electronic medical record (EMR) report identified patients ≥18 years of age with a documented PCN allergy that received antibiotics via the ED sepsis order set from December 30, 2012 to September 28, 2013 (pre-intervention) and January 3, 2014 to July 18, 2015 (post-intervention). The primary objective was to compare antibiotic days of therapy (DOT) and length of therapy (LOT) between the pre- and post-groups. The secondary objectives included 30-day readmission and mortality, hospital length of stay (LOS), incidence of C. difficile within 6 months and documented hypersensitivity reactions. Bivariate analyses, with chi-square, Mann–Whitney U, and Poisson means test, were used. Results: A total of 180 patients (90 pre- and 90 post-intervention) were included. Demographics were similar between groups, with the exception of congestive heart failure (CHF) which was more prevalent in the post-intervention group (P = 0.039). Aztreonam, vancomycin, aminoglycoside, and fluoroquinolone DOTs were significantly reduced (P \u3c 0.001) while cephalosporin DOTs significantly increased (P \u3c 0.001) in the post-intervention group. There were no statistical differences in antibiotic LOT, 30-day readmission and mortality, hospital LOS, or incidence of C. difficile infection. For those patients that received cephalosporin antibiotics, there were no hypersensitivity reactions documented in the EMR. Conclusion: Stratifying ED sepsis order sets by PCN allergy history severity is a safe and effective intervention that reduces second-line antibiotics in PCN allergic patients presenting to the ED with suspected sepsis