Outcomes of critically ill solid organ transplant patients with COVID‐19 in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163464/2/ajt16280.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163464/1/ajt16280_am.pd

Perceptions of Community Risk and Travel During Pregnancy in an Area of Zika Transmission

Introduction Between June 2016 and August 2016, the first cases of the Zika transmission were reported in Miami, FL, US. Since then, travel advisories have been issued by the Centers for Disease Control and Prevention (CDC) to avoid travel to Florida. Women that are of childbearing age or pregnant are the populations most vulnerable to Zika infection because birth defects can occur in infants born to infected mothers. Till date, there are no studies assessing the perception of the community risk of Zika in pregnant women residing in an affected region such as Miami. Methods A cross-sectional design was utilized for this study. The survey included questions assessing community risk and travel perceptions. Surveys were distributed in the antenatal clinics at the University of Miami Hospital and the Jackson Memorial Hospital. Results A total of 85 women were surveyed between January 27, 2016 and March 3, 2017. Of the surveyed women, 92.6 percent believed Zika is an important issue in their community, 85.9 percent reported a change in behavior because of Zika, 26.9 percent believed they can get Zika at their location, and 13.9 percent considered moving away from Florida because of Zika.  Conclusion Despite the majority of women believing Zika is an important issue in their community, only one-fourth believed they could get Zika in Miami. Efforts to educate pregnant women in affected areas about preventive measures against the Zika infection should be undertaken. Further studies comparing the perceptions of community risks and travel behaviors in other affected areas are warranted.

Chapter 12 - Allogeneic versus Autologous Source: Comparative Effects

Mesenchymal stem cells (MSCs) are a safe and promising biologic therapeutic for promoting tissue repair in ischemic and non-ischemic heart disease. The mechanisms underlying the salutary effects of MSCs include multilineage differentiation potential, immunomodulatory effect, anti-fibrotic effect, and stimulation of neovascularization and endogenous progenitor cell proliferation and differentiation. The immune-evasive properties of MSCs permit their use in allogeneic therapy, which offers the benefit of immediate availability and the appropriate number of cells. A growing number of clinical trials support the notion that both autologous and allogeneic MSC therapy is safe and has the capacity for repair of the myocardium. Studies are underway to determine the best tissue source of MSCs and the optimal number of cells, route(s) of delivery, and timing of the intervention. In addition, combination stem cell therapy is emerging as a strategy to improve the therapeutic potential of MSCs

Socioeconomic Disparities in Knowledge and Behaviors of Zika virus in Pregnant Women [6J]

INTRODUCTION:Gaps in knowledge and prevention of Zika have been established in pregnant women, though it is unclear whether these gaps are further pronounced in disadvantaged populations. In this study, we aim to identify disparities in knowledge and behaviors of Zika during pregnancy. METHODS:A cross-sectional design was utilized. Surveys were distributed to pregnant women in the antenatal clinics of University of Miami Hospital and Jackson Health Systems. Women were divided into two groups based on socioeconomic status(SES):low(income less than $25,000 or education less than high school) and middle/high(income greater than$25,001 or education greater than high school). Data was then recorded onto REDcap and analyzed using SAS studio. Categorical variables were compared using Pearson’s chi-square or Fisher’s exact test. RESULTS:The study was carried out between January 17th,2017-May 3rd,2017, and a total of 224 women were surveyed. Low SES group consisted of 107 women, and middle/high SES group consisted of 117 women. Both groups were similar in trimester and parity and differed in age, race, ethnicity, employment status, and number of children. Women in middle/high SES group answered more questions correctly about Zika symptomology and prevention compared to the lower SES group. Women in lower SES group were more likely to answer that they feel doctors should talk to their patients about risks and protection from Zika at every visit compared to women in middle/higher SES group. CONCLUSION:There are disparities in knowledge and behaviors regarding Zika in women of lower SES compared to women of middle/higher SES. Interventions to further educate disadvantaged women on Zika

Individual Knowledge, Attitudes, and Practices Regarding Zika Virus During Pregnancy in Miami [19I]

INTRODUCTION:On July 2016, the first case of United States based Zika virus infection was identified in Miami, FL. Till date, there are no studies assessing knowledge and behaviors of Zika virus in Miami, FL. In this study, we aimed to assess knowledge, attitudes, and practices of Zika virus amongst pregnant women residing in Miami, FL. METHODS:A cross-sectional design was utilized for this study and a survey was distributed to the antenatal clinics at University of Miami to pregnant women. Completed surveys were entered onto Redcap and analyzed using SAS studio (SAS Institute Inc. Cary, NC, USA). Pearsonʼs chi-square or Fisherʼs exact test were used to compare categorical variables and multivariate logistic regression was utilized to adjust for confounding variables. RESULTS:A total of 224 women were surveyed from January 2017-May 2017. Seventy-five percent of women answered questions about Zika virus transmission, prevention, and vulnerable population. On prevention, 61.4% of wore long-sleeved clothing, 87.8% used mosquito repellant, and 54.9% used condoms during intercourse. On multivariate regression, employment was associated with answering six knowledge questions correctly. First trimester was associated with wearing long-sleeved clothing [OR:2.538(1.260-5.114), p=0.0091] and perception of changed behavior due to Zika virus [2.458(1.128-5.356), p=0.0236]. CONCLUSION:Knowledge, attitudes, and practices regarding Zika virus amongst pregnant women residing in Miami are adequate. The role of employment and workplace environment in promoting health education on Zika virus should be further evaluated

Group-Based Differences in Anti-Aging Bias Among Medical Students

Medical students (MS) may develop ageist attitudes early in their training that may predict their future avoidance of caring for the elderly. This study sought to determine MS' patterns of explicit and implicit anti-aging bias, intent to practice with older people and using the quad model, the role of gender, race, and motivation-based differences. One hundred and three MS completed an online survey that included explicit and implicit measures. Explicit measures revealed a moderately positive perception of older people. Female medical students and those high in internal motivation showed lower anti-aging bias, and both were more likely to intend to practice with older people. Although the implicit measure revealed more negativity toward the elderly than the explicit measures, there were no group differences. However, using the quad model the authors identified gender, race, and motivation-based differences in controlled and automatic processes involved in anti-aging bias

Endogenous Endophthalmitis Heralding Central Nervous System Involvement by Nocardia Farcinica

Nocardiosis is an uncommon opportunistic infection caused by aerobic, gram-positive, weakly acid-fast, filamentous bacteria of the genus Nocardia that presents as a suppurative disease in immunocompromised hosts. Herein the authors describe the case of an elderly male with granulomatosis with polyangiitis (GPA) on chronic immunosuppressive therapy that presented initially with visual symptoms and developed focal neurological deficits. Nocardia should be considered as a potential pathogen in any immunosuppressed patient presenting with endogenous endophthalmitis and new-onset focal neurological deficits. Early recognition and treatment may prevent irrevocable neurological compromise stemming from misdiagnosis

How Did the Zika Virus Outbreak Impact Residency and Fellowship Recruitment in Miami, FL?

Abstract Background In July 2016 South Florida experienced a Zika Virus (ZIKV) outbreak as part of the introduction of the flavivirus in the Americas. At the same time, the National Residency recruiting season was held. The affected area was a mile away from the residency/fellowship training programs of Jackson Memorial Hospital (JMH) and University of Miami Miller School of Medicine (UM). The population at risk for severe ZIKV complications include pregnant women. Many of the applicants were women at reproductive age. The factors influencing residency applicants’ choice of training program have been reported. However, no study has analyzed how a local outbreak with proximity to the area of training affects applicants’ choice of programs. Methods Following the Match 2017, an electronic survey was sent to 2,256 applicants to 19 JMH/UM graduate medical education (GME) programs (15 residency, 4 fellowship programs). We used quantitative and qualitative analyses to explore factors influencing candidates’ decisions, including the ZIKV outbreak. Results Survey response rate was 15% (331/2256). The quantitative analysis identified factors that were Òvery important to applicantsÓ rated 4–5/5 (current resident satisfaction; relationship between faculty and residents; collegiality of current residents; location; quantity and quality of faculty content/mentoring; faculty teaching expertise; diversity of patients; diversity of types of procedures), consistent with prior research In contrast, the presence of ZIKV in MDC was Ònot importantÓ; average score of 1.46/5. 10 respondents said that the presence of ZIKV was ÒVery ImportantÓ; 4 were female, 6 were male; 3/10 said ZIKV made the applicant less likely to accept the interview offer; all ultimately accepted the interview. 100% of respondents were aware that ZIKV was in Miami-Dade county. However, only 6 % (19) of respondents were provided information about ZIKV by their interviewed Program. Conclusion ZIKV outbreak was not a significant independent variable affecting likelihood to match at JMH/UM in Miami-Dade County. These results have important implications for the role of local disease outbreaks in affecting recruitment of medical trainees for residency and fellowship programs. Disclosures All authors: No reported disclosures