Bayesian Spatiotemporal Pattern and Eco-climatological Drivers of Striped Skunk Rabies in the North Central Plains

Citation: Raghavan, R. K., Hanlon, C. A., Goodin, D. G., Davis, R., Moore, M., Moore, S., & Anderson, G. A. (2016). Bayesian Spatiotemporal Pattern and Eco-climatological Drivers of Striped Skunk Rabies in the North Central Plains. Plos Neglected Tropical Diseases, 10(4), 16. doi:10.1371/journal.pntd.0004632Striped skunks are one of the most important terrestrial reservoirs of rabies virus in North America, and yet the prevalence of rabies among this host is only passively monitored and the disease among this host remains largely unmanaged. Oral vaccination campaigns have not efficiently targeted striped skunks, while periodic spillovers of striped skunk variant viruses to other animals, including some domestic animals, are routinely recorded. In this study we evaluated the spatial and spatio-temporal patterns of infection status among striped skunk cases submitted for rabies testing in the North Central Plains of US in a Bayesian hierarchical framework, and also evaluated potential eco-climatological drivers of such patterns. Two Bayesian hierarchical models were fitted to point-referenced striped skunk rabies cases [n = 656 (negative), and n = 310 (positive)] received at a leading rabies diagnostic facility between the years 2007-2013. The first model included only spatial and temporal terms and a second covariate model included additional covariates representing eco-climatic conditions within a 4km(2) home-range area for striped skunks. The better performing covariate model indicated the presence of significant spatial and temporal trends in the dataset and identified higher amounts of land covered by low-intensity developed areas [Odds ratio (OR) = 3.41; 95% Bayesian Credible Intervals (CrI) = 2.08, 3.85], higher level of patch fragmentation (OR = 1.70; 95% CrI = 1.25, 2.89), and diurnal temperature range (OR = 0.54; 95% CrI = 0.27, 0.91) to be important drivers of striped skunk rabies incidence in the study area. Model validation statistics indicated satisfactory performance for both models; however, the covariate model fared better. The findings of this study are important in the context of rabies management among striped skunks in North America, and the relevance of physical and climatological factors as risk factors for skunk to human rabies transmission and the space-time patterns of striped skunk rabies are discussed

Attributable healthcare utilization and cost of pneumonia due to drug-resistant streptococcus pneumonia: a cost analysis

Background: The burden of disease due to S. pneumoniae (pneumococcus), particularly pneumonia, remains high despite the widespread use of vaccines. Drug resistant strains complicate clinical treatment and may increase costs. We estimated the annual burden and incremental costs attributable to antibiotic resistance in pneumococcal pneumonia. Methods: We derived estimates of healthcare utilization and cost (in 2012 dollars) attributable to penicillin, erythromycin and fluoroquinolone resistance by taking the estimate of disease burden from a previously described decision tree model of pneumococcal pneumonia in the U.S. We analyzed model outputs assuming only the existence of susceptible strains and calculating the resulting differences in cost and utilization. We modeled the cost of resistance from delayed resolution of illness and the resulting additional health services. Results: Our model estimated that non-susceptibility to penicillin, erythromycin and fluoroquinolones directly caused 32,398 additional outpatient visits and 19,336 hospitalizations for pneumococcal pneumonia. The incremental cost of antibiotic resistance was estimated to account for 4% ($91 million) of direct medical costs and 5$233 million) of total costs including work and productivity loss. Most of the incremental medical cost ($82 million) was related to hospitalizations resulting from erythromycin non-susceptibility. Among patients under age 18 years, erythromycin non-susceptibility was estimated to cause 17$38 million in costs, or 39% of pneumococcal pneumonia costs attributable to resistance. Conclusions: We estimate that antibiotic resistance in pneumococcal pneumonia leads to substantial healthcare utilization and cost, with more than one-third driven by macrolide resistance in children. With 5% of total pneumococcal costs directly attributable to resistance, strategies to reduce antibiotic resistance or improve antibiotic selection could lead to substantial savings

Development of Query Strategies to Identify a Histologic Lymphoma Subtype in a Large Linked Database System

Background: Large linked databases (LLDB) represent a novel resource for cancer outcomes research. However, accurate means of identifying a patient population of interest within these LLDBs can be challenging. Our research group developed a fully integrated platform that provides a means of combining independent legacy databases into a single cancer-focused LLDB system. We compared the sensitivity and specifi city of several SQL-based query strategies for identifying a histologic lymphoma subtype in this LLDB to determine the most accurate legacy data source for identifying a specifi c cancer patient population.Methods: Query strategies were developed to identify patients with follicular lymphoma from a LLDB of cancer registry data, electronic medical records (EMR), laboratory, administrative, pharmacy, and other clinical data. Queries were performed using common diagnostic codes (ICD-9), cancer registry histology codes (ICD-O), and text searches of EMRs. We reviewed medical records and pathology reports to confirm each diagnosis and calculated the sensitivity and specificity for each query strategy.Results: Together the queries identified 1538 potential cases of follicular lymphoma. Review of pathology and other medical reports confirmed 415 cases of follicular lymphoma, 300 pathology-verifi ed and 115 verified from other medical reports. The query using ICD-O codes was highly specific (96%). Queries using text strings varied in sensitivity (range 7–92%) and specifi city (range 86–99%). Queries using ICD-9 codes were both less sensitive (34–44%) and specific (35–87%).Conclusions: Queries of linked-cancer databases that include cancer registry data should utilize ICD-O codes or employ structured free-text searches to identify patient populations with a precise histologic diagnosis.Abbreviations: LLDB: Large Linked Database; SEER: Surveillance Epidemiology and End Results; EMR: Electronic Medical Record; ICD-9: International Classifi cation of Diseases (9th revision); ICD-O: International Classifi cation of Diseases for Oncology; AP: Anatomical Pathology; WHO: World Health Organization

Emerging Areas of Nursing Science and PhD Education for The 21\u3csup\u3est\u3c/sup\u3e Century: Response to Commentaries

We respond to commentaries from the American Academy of Nursing, the American Association of Colleges of Nursing, and the National Institute of Nursing Research on our thoughts about integrating emerging areas of science into nursing PhD programs. We identify areas of agreement and focus our response on cross-cutting issues arising from cautions about the unique focus of nursing science and how best to proceed with incorporation of emerging areas of science into nursing PhD programs

Health Literacy: Cancer Prevention Strategies for Early Adults.

Health literacy, the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make health decisions, is an essential element for early adults (aged 18-44 years) to make informed decisions about cancer. Low health literacy is one of the social determinants of health associated with cancer-related disparities. Over the past several years, a nonprofit organization, a university, and a cancer center in a major urban environment have developed and implemented health literacy programs within healthcare systems and in the community. Health system personnel received extensive health literacy training to reduce medical jargon and improve their patient education using plain language easy-to-understand written materials and teach-back, and also designed plain language written materials including visuals to provide more culturally and linguistically appropriate health education and enhance web-based information. Several sustainable health system policy changes occurred over time. At the community level, organizational assessments and peer leader training on health literacy have occurred to reduce communication barriers between consumers and providers. Some of these programs have been cancer specific, including consumer education in such areas as cervical cancer, skin cancer, and breast cancer that are targeted to early adults across the cancer spectrum from prevention to treatment to survivorship. An example of consumer-driven health education that was tested for health literacy using a comic book-style photonovel on breast cancer with an intergenerational family approach for Chinese Americans is provided. Key lessons learned from the health literacy initiatives and overall conclusions of the health literacy initiatives are also summarized

Rebuttal to published article “A review of ghost gear entanglement amongst marine mammals, reptiles and elasmobranchs” by M. Stelfox, J. Hudgins, and M. Sweet

Author Posting. © The Author(s), 2016. This is the author's version of the work. It is posted here under a nonexclusive, irrevocable, paid-up, worldwide license granted to WHOI. It is made available for personal use, not for redistribution. The definitive version was published in Marine Pollution Bulletin 117 (2017): 554-555, doi:10.1016/j.marpolbul.2016.11.052.We reviewed the findings of the recently published article by Stelfox et al. (2016): “A review of ghost gear entanglement amongst marine mammals, reptiles and elasmobranchs” published in this journal (Volume 111, pp 6–17) and found that they are both flawed and misleading as they do not accurately reflect the prevalence of “ghost gear” cases reported in the literature. While we commend the authors for recognizing the importance of attempting to quantify the threat and for recommending more comprehensive databases, the methods, results and conclusions of this review have not advanced the understanding of the issue. As authors of the papers on whale entanglements in the North Atlantic that were reviewed by Stelfox et al. (2016) and others who are knowledgeable about the topic, we provide specific comments regarding misrepresentations of both the source of entanglement (e.g., actively fished gear versus “ghost gear”) and the number of reported entanglements for whale species included in the North Atlantic

Don’t assume it’s ghost gear : accurate gear characterization is critical for entanglement mitigation [poster]

Presented at the Society for Marine Mammology 22nd Biennial Marine Mammal Conference, Halifax, Nova Scotia, October 23-27, 2017Entanglement is a significant conservation and welfare issue which is limiting the recovery of a number of marine species, including marine mammals. It is therefore important to reliably identify the causes of these events, including the nature of the entangling gear in order to reduce or prevent them in the future. A recently published review of marine debris assessed 76 publications and attributed a total of 1805 cases of cetacean entanglements in “ghost gear”, of which 78% (n=1413) were extracted from 13 peer reviewed publications. We examined the 13 publications cited in the review and found that the specific gear type or status of gear involved in the reported events was rarely mentioned beyond the fact that it was fishing related. This is likely due to the fact that determinations of debris as the entangling material are very difficult. In fact, in reviewing 10 years of large whale entanglement records for the U.S., the authors of another study reported that Hawaii was the only region in which any entangling gear was positively identified as ghost gear. The assumption that entangling gear is marine debris unless otherwise stated is dangerous because it could impact efforts to modify or restrict risk-prone fishing in key marine mammal habitats. Entanglement in actively fished gear poses a very real threat, and claims that only lost or abandoned fishing gear is responsible for entanglements can undermine conservation efforts.2017-10-2

Diagnosing the influence of diabatic processes on the explosive deepening of extratropical cyclones

A novel version of the classical surface pressure tendency equation (PTE) is applied to ERA-Interim reanalysis data to quantitatively assess the contribution of diabatic processes to the deepening of extratropical cyclones relative to effects of temperature advection and vertical motions. The five cyclone cases selected, Lothar and Martin in December 1999, Kyrill in January 2007, Klaus in January 2009, and Xynthia in February 2010, all showed explosive deepening and brought considerable damage to parts of Europe. For Xynthia, Klaus and Lothar diabatic processes contribute more to the observed surface pressure fall than horizontal temperature advection during their respective explosive deepening phases, while Kyrill and Martin appear to be more baroclinically driven storms. The powerful new diagnostic tool presented here can easily be applied to large numbers of cyclones and will help to better understand the role of diabatic processes in future changes in extratropical storminess