Predictors of willingness to receive updated 2023-2024 COVID-19 booster vaccines among a convenience sample in Minnesota.

OBJECTIVES: To determine factors associated with intention to receive recommended COVID-19 booster vaccines in 2023-2024. METHODS: A cross-sectional study of 1,256 individuals at Minnesota State and County fairs was conducted to assess their intention to receive a COVID-19 booster vaccine in the coming year if recommended. The association between booster intention and multiple factors believed to influence willingness to receive the vaccine, including perceived vaccine safety, perceived risk of COVID-19, public health knowledge, fear of future pandemics, and political affiliation, were analyzed using ordinal logistic regression and adjusted odds ratios (aOR). RESULTS: Intention to receive a COVID-19 booster vaccine was high among our participants with 56% reporting they were extremely likely to receive the vaccine this year and another 15% reporting that they were likely to do the same. A strong association with getting a booster vaccine was found between perceived vaccine safety (aOR: 15.3, 95% CI: 10.6-22.2), perceived COVID-19 risk (aOR: 3.5, 95% CI: 2.4-5.1), pandemic fear (aOR: 3.4, 95% CI: 2.4-4.8), public health knowledge (aOR: 1.3, 95% CI: 0.9-1.8), and democrat political affiliation (aOR: 2.8, 95%CI: 1.8-4.4). CONCLUSIONS: Our study emphasizes the importance of perceived vaccine safety as a predictor of intention to accept COVID-19 vaccines and highlights the continued need to effectively communicate with the public about the safety of vaccines.

Four Models of Wastewater-Based Surveillance for SARS-CoV-2 in Jail Settings: How Monitoring Wastewater Complements Individual Screening.

Objective: To describe four unique models of implementing Wastewater Based Surveillance (WBS) for SARS-CoV-2 in jails of graduated sizes and differing architectural designs. Methods: This study summarizes how jails of Cook County (Illinois, average daily population [ADP] 6000), Fulton County (Georgia, ADP 3000, Washington DC (ADP 1600) and Middlesex County (Massachusetts, ADP 875) initiated WBS between 2020 and 2023. Results: Positive signal for SARS-CoV-2 via WBS can herald new onset of infection in a previously uninfected housing unit of a jail. Challenges in implementing WBS included political will and realized value, funding, understanding of the building architecture, and the need for granularity in the findings. Conclusions: WBS has been effective for detecting outbreaks of SARS-CoV-2 in differing sized jails, both those with dorm-based and cell-based architectural design. Policy implications: Given its effectiveness in monitoring SARS-CoV-2, WBS provides a model for population-based surveillance in carceral facilities for future infectious disease outbreaks.

Pilot study of women's perspectives when abnormal uterine bleeding occurs during perimenopause.

OBJECTIVE: We gained insights into women's experiences and knowledge about the occurrence of vaginal bleeding during perimenopause requiring evaluation. METHODS: Qualitative inquiry was chosen to explore topics in greater depth to understand individuals' experiences. Interviews with individuals were chosen due to the sensitive nature of gynecologic symptoms and management. Interviews were completed following gynecologic care to explore individuals' experiences with the evaluation and management of vaginal bleeding during perimenopause. RESULTS: Twelve individuals were interviewed between December 2019 and March 2020. Patient uncertainty about the medical significance of developing vaginal bleeding during perimenopause was associated with self-appraisal and gathering information from multiple sources. This experience of seeking evaluation and treatment resulted in varying degrees of trust concerning information received within or outside the clinic. Regarding new technologies that could replace the current invasive tests performed for diagnosis (i.e. ultrasound, hysteroscopy and biopsy), most women preferred the smartphone app and tampon home collection option. CONCLUSIONS: The experience of irregular or heavy vaginal bleeding during perimenopause is fraught with ambiguity, feelings of uncertainty about how to make sense of symptoms and inevitably begins with a period of self-appraisal.

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival.

Acute mesenteric ischemia (AMI) remains a vascular emergency. Our aim was to explore readmission for AMI. We identified all patients admitted for AMI from the state of California through the Healthcare and Utilization Project from 2005 to 2011. Our primary end point was the rate and etiology for readmission. Our secondary end points were the length of hospitalization and in-hospital mortality. Cox proportional hazard regression was utilized to assess risk of 30-day readmission. There were 534 (9.9%) readmissions at 30 days. The mean age was 67 ± 17 years and 209 (39.1%) were male. The five most common etiologies for readmission were AMI (7.6%), cardiac events (5.3%), severe sepsis (1.2%), dehydration (1.1%), and acute kidney failure (1.1%). Once readmitted, these patients were most likely to experience cardiac catheterizations (25.4%), red blood cell transfusions (23.6%), intubation and mechanical ventilation (17.6%), biopsy of the large intestine (13.9%), reoperation for small bowel resection (10.9%), administration of total parenteral nutrition (10.5%), and transfusion of other blood products (6.9%). This hospitalization was 8.8 ± 12.7 days long. In-hospital mortality was 36 patients (6.7%). On multivariable Cox-regression analysis, severe (hazard ratio [HR]: 2.1 [1.4-3.2], p = 0.0005) and moderate (HR: 1.5 [1.03-2.13], p = 0.04) Elixhauser Comorbidity Group, complications (HR: 1.5 [1.2-1.9], p = 0.0007), and longer index hospitalization (HR: 1.02 [1.01-1.02], p < 0.0001) were predictors of readmission. Conclusion AMI remains a vascular emergency. Readmissions have a significant rate of morbid invasive procedures and can lead to an in-hospital mortality of 6.7%. The adoption of guidelines similar to the European Society for Trauma and Emergency Surgery should be considered.

The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis.

INTRODUCTION: More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES: To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS: We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS: The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS: The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS: Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

Are US degree-granting institutions associated with better community health determinants and outcomes?

OBJECTIVES: The impact of individual education level on health outcomes is well-established, but the effect of degree-granting institutions on county health rankings (CHRs) is unknown. The objective of this study is to determine if there is an association between the presence of degree-granting institutions and CHRs. STUDY DESIGN: This is an ecologic study. METHODS: Data for 3062 counties were derived from the Robert Wood Johnson County Health Rankings and the Integrated Postsecondary Education Data System for year 2016. Ordinal logistic regression was utilized to determine the association between presence of a degree-granting institution and county rankings for health behaviors, health outcomes, clinical care, social and economic factors, and physical environment. All models were adjusted for potential confounding factors including age, sex, race/ethnicity, English language proficiency, and urban/rural location. RESULTS: The presence of a degree-granting institution was positively associated with CHRs for length of life (odds ratio [OR] = 1.28; 95% confidence interval [CI]: 1.05, 1.58), health behaviors (OR = 1.46; 95% CI: 1.19, 1.79), and clinical care (OR = 1.36; 95% CI: 1.11, 1.67). Counties with the highest rankings in one health category were more likely to score in the highest rankings for other health categories. CONCLUSIONS: These findings suggest that degree-granting institutions are associated with CHRs. Partnerships between public health agencies and degree-granting institutions are recommended to improve population health.

Improved Time to Notification of Impending Brain Death and Increased Organ Donation Using an Electronic Clinical Decision Support System.

Early referral of patients to an organ procurement organization (OPO) may positively affect donation outcomes. We implemented an electronic clinic decision support (CDS) system to automatically notify our OPO of children meeting clinical triggers indicating impending brain death. Medical records of all patients who died in a pediatric critical care unit or were referred for imminent death for 3 years prior to installation of the initial CDS (pre-CDS) and for 1 year after implementation of the final CDS (post-CDS) were reviewed. Mean time to OPO notification decreased from 30.2 h pre-CDS to 1.7 h post-CDS (p = 0.015). Notification within 1 h of meeting criteria increased from 36% pre-CDS to 70% post-CDS (p = 0.003). Although an increase in donor conversion from 50% pre-CDS to 90% post-CDS did not reach statistical significance (p = 0.0743), there were more organ donors post-CDS (11 of 24 deaths) than pre-CDS (seven of 57 deaths; p = 0.002). Positive outcomes were achieved with the use of a fully automated CDS system while simultaneously realizing few false-positive notifications, low costs, and minimal workflow interruption. Use of an electronic CDS system in a pediatric hospital setting improved timely OPO notification and was associated with increased organ donation.

Engineering a soluble high-affinity receptor domain that neutralizes staphylococcal enterotoxin C in rabbit models of disease.

Superantigens (SAgs) are a class of immunostimulatory exotoxins that activate large numbers of T cells, leading to overproduction of cytokines and subsequent inflammatory reactions and systemic toxicity. Staphylococcal enterotoxin C (SEC), a SAg secreted by Staphylococcus aureus, has been implicated in various illnesses including non-menstrual toxic shock syndrome (TSS) and necrotizing pneumonia. SEC has been shown to cause TSS illness in rabbits and the toxin contributes to lethality associated with methicillin-resistant S.aureus (MRSA) in a rabbit model of pneumonia. With the goal of reducing morbidity and mortality associated with SEC, a high-affinity variant of the extracellular variable domain of the T-cell receptor beta-chain for SEC (~14 kDa) was generated by directed evolution using yeast display. This protein was characterized biochemically and shown to cross-react with the homologous (65% identical) SAg staphylococcal enterotoxin B (SEB). The soluble, high-affinity T-cell receptor protein neutralized SEC and SEB in vitro and also significantly reduced the bacterial burden of an SEC-positive strain of MRSA (USA400 MW2) in an infective endocarditis model. The neutralizing agent also prevented lethality due to MW2 in a necrotizing pneumonia rabbit model. These studies characterize a soluble high-affinity neutralizing agent against SEC, which is cross-reactive with SEB, and that has potential to be used intravenously with antibiotics to manage staphylococcal diseases that involve these SAgs.

Recency, range expansion, and unsorted lineages: implications for interpreting neutral genetic variation in the sharp-tailed grouse (Tympanuchus phasianellus).

Both current and historical patterns of variation are relevant to understanding and managing ecological diversity. Recently derived species present a challenge to the reconstruction of historical patterns because neutral molecular data for these taxa are more likely to exhibit effects of recent and ongoing demographic processes. We studied geographical patterns of neutral molecular variation in a species thought to be of relatively recent origin, Tympanuchus phasianellus (sharp-tailed grouse), using mitochondrial control region sequences (CR-I), amplified fragment length polymorphisms (AFLP), and microsatellites. For historical context, we also analysed CR-I in all species of Tympanuchus. Within T. phasianellus, we found evidence for restricted gene flow between eastern and western portions of the species range, generally corresponding with the range boundary of T. p. columbianus and T. p. jamesi. The mismatch distribution and molecular clock estimates from the CR-I data suggested that all Tympanuchus underwent a range expansion prior to sorting of mitotypes among the species, and that sorting may have been delayed as a result of mutation-drift disequilibrium. This study illustrates the challenge of using genetic data to detect historical divergence in groups that are of relatively recent origin, or that have a history dominated by nonequilibrium conditions. We suggest that in such cases, morphological, ecological, and behavioural data may be particularly important adjuncts to molecular data for the recognition of historically or adaptively divergent groups.

Predicting the potential of engulfment using an on-farm grain storage hazard assessment tool.

The goal of this research was to address the problem of engulfment in flowing grain in on-farm metal grain storage bins. This was accomplished using a systems approach to identify contributing factors to engulfment, which were then used to develop a 28-question Farm Grain Hazard Assessment Tool (FGHAT). A numerically weighted high- and low-risk response accompanied each question, the sum of which resulted in a potential-risk-of-engulfment score for a given on-farm grain handling and storage system. The assessment tool was pilot tested on a sample of 47 farms. The difference between the mean scores of farms with a history of engulfment (n = 14) and the mean scores of farms with no prior reported engulfment incident (n = 33) was significant (p < or = 0.001). This finding suggests that it is possible, using the hazard assessment tool, to predict the increased likelihood of an engulfment in a specific on-farm grain storage and handling system. It was also found that the management of grain during storage and an individual's perception of risk and willingness to avoid flowing grain hazards had the most significant impact on reducing the potential for an engulfment. In contrast, a history of grain plugging problems was not found to make a considerable difference in scores between the two groups of farms. The presence of stirring devices in bins, accommodation for lockout devices on electrical controls, and using grain storage bins smaller than 20, 000 bu capacity also had little impact on the difference in scores. Based upon the level of significance of each of the 28 questions'ability to predict an increased risk of engulfment, it was concluded that a valid response could be obtained with as few as eight questions. Recommendations concerning continued study and application of the tool were formulated, including the effectiveness of the tool in changing the farmers' behavior, and the findings also contributed to the revision of a potential engineering standard for on-farm grain storage structures.

Iris cyst simulating melanoma.

Congenital cysts of the iris stroma are extremely uncommon and only a few cases have been reported. The vast majority of reported cases have been found in infants or children as a unilateral, translucent mass in the middle or peripheral third of the iris. 1-3 Although these cysts may remain dormant for years, they have a tendency to enlarge, causing corneal decompensation, secondary glaucoma, and eye pain. 2 Occasionally, they have been mistaken for iris melanomas leading to enucleation. 4,5 We describe a 14-year-old girl with a congenital cyst of the iris stroma, which over a period of 8 years enlarged, became opaque resembling melanoma, and required surgical excision.

Psyllid endosymbionts exhibit patterns of co-speciation with hosts and destabilizing substitutions in ribosomal RNA.

Eubacterial 16S rDNAs were sequenced from endosymbionts of seven psyllids (Psylloidea) and one whitefly (Aleyrodoidea), to investigate the evolution of endosymbionts and their hosts. Primary endosymbionts from all psyllids formed a highly supported clade, tentatively placed as the sister to whitefly primary endosymbionts, and showing several points of congruence with the host morphological phylogeny. Almost all host taxa yielded an additional eubacterial sequence, related either to known psyllid secondary endosymbionts or to other insect endosymbionts or parasites. The relationships of some secondary endosymbionts also suggested cospeciation with psyllid hosts, or ancient horizontal transfers. All primary endosymbionts, and some secondary endosymbionts, exhibited molecular genetic effects of a long-term, intracellular existence in their biased nucleotide content and decreased stability of rRNA secondary structure.

Case of complex craniofacial anomalies, bilateral nasal proboscides, palatal pituitary, upper limbs reduction, and amnion rupture sequence: disorganization phenotype?

We report a case of a dizygotic twin with complex abnormalities of head, body, and limbs. The anomalies include the following: lateral and midline cleft upper lip, ectopic palatal pituitary, natal teeth, bilateral nasal proboscides with an absent nose, left microphthalmia with conjunctival-lined cyst, right ocular dysgenesis, bilateral retinal dysplasia, platybasia with skull asymmetry, hydrocephalus secondary to aqueductal atresia, brain hemispheric asymmetry with a parietal-occipital cortical flap, agenesis of posterior corpus callosum, absence of the olfactory nerves and left anterior cerebral artery, leptomeningeal and intraventricular heterotopias, right radial longitudinal terminal meromelia with constriction rings of fingers, partial syndactyly of the third and fourth left fingers, dorsiflexed great toes and pes equinovarus bilaterally, and multiple skin tags with a sacral appendage. Additionally, this twin's placental disc and extraplacental membranes were devoid of amnion. We regard these anomalies as a possible expression of the human homologue of the disorganization phenotype or another gene mutation. Nevertheless, an abnormality of blastogenesis with early damage to organizing tissues of the frontonasal region and limbs, or a vascular disruption, cannot be excluded. Early amnion rupture sequence (possible extraamniotic pregnancy with amniotic bands, limb reduction defects with Streeter bands, and multiple skin tags tapering into amniotic bands) was also present in this case, and may have acted as a contributing factor.

Hepatitis B vaccination practices in state and federal prisons.

OBJECTIVE: Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings. METHOD: The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000. RESULTS: Thirty-five states and the federal system responded (response rate = 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates. CONCLUSIONS: Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections.

Risk factors for syphilis among incarcerated women in Rhode Island.

Syphilis remains a significant problem in the United States. The prison environment is an ideal location to identify and treat syphilis. We undertook this study to describe the correlates and risk factors for syphilis among incarcerated women in Rhode Island. The study design was a review of all cases of syphilis identified through routine screening in the state prison and a case control study. Between 1992 and 1998, among 6,249 incarcerated women, 86 were found to have syphilis; of these, 29 were primary and secondary cases representing 49% of infectious cases of syphilis in women in the state. The prison environment offers a unique opportunity for the diagnosis and treatment of syphilis.

Atypical presentation of a dacryolith.

PURPOSE: To describe the clinical features and management of a patient with an extralacrimal dacryolith. METHODS: Case report. RESULTS: A 43-year-old woman remarked at a routine eye examination that a small, firm mass located for several years on the right side of her nose had recently become slightly larger. The mass had remained firm and nontender during this enlargement. She explicitly denied having any past or current lacrimal outflow problems. Surgical excision disclosed a mass external to the lacrimal sac and duct, adherent to its lateral wall. The histopathologic features were consistent with a dacryolith surrounded by a chronic inflammatory reaction and no epithelial lining. CONCLUSION: We presume that the dacryolith must have formed within the lacrimal sac and then migrated laterally into the surrounding soft tissue.

Comprehensive medical care among HIV-positive incarcerated women: the Rhode Island experience.

Our objective was to characterize the clinical presentation of human immunodeficiency virus (HIV) infection among incarcerated women in a program that provides HIV testing and primary care to all state prisoners in Rhode Island. A retrospective medical chart review on all HIV-seropositive women who were incarcerated between 1989 and 1994 and had at least two medical visits with an HIV medical care provider was used. At the Rhode Island Adult Correctional Institution (ACI), under mandatory testing laws between 1989 and 1994, 28% (172 of 623) of all women were identified with HIV infection. Of the 172 women who tested seropositive in prison, 110 were included in the study. Of the 110 women followed, 84% reported injection drug use (IDU) as their primary risk factor, and 30% reported both IDU and sex work. The median CD4 count was 596/mm3, with 60% having a CD4 count >500 cells/mm3. The most common medical conditions were vaginal candidiasis, oral candidiasis, and bronchitis. Antiretroviral therapy was well accepted and followed community standards. Continuity of medical care after release was facilitated by the same physician caring for the patient in the community setting, with 83% of women following up for HIV care after release. The medical conditions noted reflect that these women are early in the course of their HIV disease when they are initially diagnosed. This comprehensive program in Rhode Island's state prison plays a central role in the diagnosis of HIV-seropositive women and provides counseling, primary medical and gynecological care, and linkage to community resources after release.