Understanding COVID-19 infection among people with intellectual and developmental disabilities using machine learning.

BACKGROUND: People with intellectual and developmental disabilities (IDD) were disproportionately affected by the COVID-19 pandemic. Predicting COVID-19 infection has been difficult. OBJECTIVE: We sought to address two research questions in this study: 1) to assess the overall utility of a machine learning model to predict COVID-19 diagnosis for people with IDD, and 2) to determine the primary predictors of COVID-19 diagnosis in a random sample of Home and Community Based Services users in one state. METHODS: We merged three major IDD-specific datasets (National Core Indicators, Supports Intensity Scale, Medicaid HCBS expenditures) from one state to create one combined dataset for analyses that included more than 700 variables. We then built a random forest machine learning algorithm to predict COVID-19 diagnosis and to explore the top predictors of such a diagnosis, when present. RESULTS: Our algorithm predicted COVID-19 diagnosis in a random sample of HCBS users with IDD with 62.5% accuracy. The top predictors of having a documented case of COVID-19 among our sample were higher age, having high overall, medical, or behavioral support needs, living in a lower-income neighborhood, total Medicaid expenditure, and higher body mass index. CONCLUSIONS: Results largely followed trends in the general population, and were largely suggestive that increased contact with other people may have exposed a person with IDD to greater COVID-19 risk.

Co-Occurring Mental Illness and Behavioral Support Needs in Adults with Intellectual and Developmental Disabilities.

People with intellectual and developmental disabilities (IDD) have higher incidences of mental health conditions and behavioral support needs than people without IDD but may not receive needed care from community providers. We examined rates of co-occurring conditions in a representative sample of adults with IDD who use state funded services in Virginia. Using data from two datasets, we identified four categories of mental health and behavioral conditions. We used these categories to examine differences in individual- and system-level factors in people with and without co-occurring conditions. We found high rates of co-occurring conditions in our sample. We found important disability factors and system-level characteristics that were associated with having a diagnosed mental health condition or behavioral support needs. Differing patterns of diagnosis and treatment for co-occurring conditions suggests more work needs to be done to support people with IDD and co-occurring mental health conditions living in the community.

An Examination of Support Needs, Supports, and Outcomes for People With Intellectual and Developmental Disabilities.

Researchers used a merged dataset to examine if more resources were expended on those with greater support needs and if support needs impacted personal outcomes when controlling for relevant personal and contextual factors. Results indicated that the amount of support a person receives had a direct relationship to their needs. However, we also found that people with the greatest needs had weaker personal outcomes suggesting that distribution of resources based on need may not result in equivalent outcomes. The authors suggest strategies at an individual and systems level to address the outcomes gap for people with the greatest support needs.

Comparing employment, employment services, and employment goals in propensity-matched samples of people with intellectual and developmental disabilities with and without autism.

Background: People with intellectual and developmental disabilities (IDD) tend to have poor employment outcomes relative to the general population, as do people with autism. Research is unclear, however, about how people with IDD with and without autism compare on a variety of employment-related indicators, including desire to work, having work as a goal in their service plans, and being employed. Objectives: To understand how people with IDD with and without autism compare on important employment related outcomes, based on a matched random sample. Methods: Using merged administrative datasets, we used propensity score matching to construct statistically proximate samples of Medicaid waiver users in a single state with IDD both with and without autism, and then tested differences between the two groups on important employment-related indicators. Results: People with IDD and autism were less likely than people with IDD alone to have a goal for employment in their individualized service plans and to hold employment in group community settings. There was no statistical difference between the two groups in terms of desire to have a job or employment in individual community settings. Conclusions: Results reinforce the importance of planning for employment if holding employment is a person's aim, regardless of the presence of autism.

Promising Practices in the Frontiers of Quality Outcome Measurement for Intellectual and Developmental Disability Services.

Medicaid Home and Community-Based Services (HCBS) for people with intellectual and developmental disabilities (IDD) are vital for supporting people with IDD to live well in their communities, but there are not set standards for monitoring quality outcomes related to HCBS. In this paper, we propose promising practices for improving the quality of HCBS outcome measurement, based both in the literature and our own experience conducting an extensive U.S. state-level study. Specifically, we discuss: (1) using merged administrative datasets, (2) developing high-quality psychometrics that attend to ecological issues in measurement, (3) using advanced statistical analyses, and (4) creating immersive, user-friendly translational dissemination products. We conclude by suggesting what we see as important new frontiers for researchers to consider in order to enhance the quality of HCBS outcome measurement for people with IDD in the future.

Hepatitis A Virus Infections Among Men Who Have Sex with Men - Eight U.S. States, 2017-2018.

During 1995-2011, the overall incidence of hepatitis A decreased by 95% in the United States from 12 cases per 100,000 population during 1995 to 0.4 cases per 100,000 population during 2011, and then plateaued during 2012─2015. The incidence increased by 294% during 2016-2018 compared with the incidence during 2013-2015, with most cases occurring among populations at high risk for hepatitis A infection, including persons who use illicit drugs (injection and noninjection), persons who experience homelessness, and men who have sex with men (MSM) (1-3). Previous outbreaks among persons who use illicit drugs and MSM led to recommendations issued in 1996 by the Advisory Committee on Immunization Practices (ACIP) for routine hepatitis A vaccination of persons in these populations (4). Despite these long-standing recommendations, vaccination coverage rates among MSM remain low (5). In 2017, the New York City Department of Health and Mental Hygiene contacted CDC after public health officials noted an increase in hepatitis A infections among MSM. Laboratory testing* of clinical specimens identified strains of the hepatitis A virus (HAV) that subsequently matched strains recovered from MSM in other states. During January 1, 2017-October 31, 2018, CDC received reports of 260 cases of hepatitis A among MSM from health departments in eight states, a substantial increase from the 16 cases reported from all 50 states during 2013-2015. Forty-eight percent (124 of 258) of MSM patients were hospitalized for a median of 3 days. No deaths were reported. In response to these cases, CDC supported state and local health departments with public health intervention efforts to decrease HAV transmission among MSM populations. These efforts included organizing multistate calls among health departments to share information, providing guidance on developing targeted outreach and managing supplies for vaccine campaigns, and conducting laboratory testing of clinical specimens. Targeted outreach for MSM to increase awareness about hepatitis A infection and improve access to vaccination services, such as providing convenient locations for vaccination, are needed to prevent outbreaks among MSM.

Tumor carcinoide primario de ovario. Reporte de caso / Primary ovarian carcinoid tumor. Case report / Primary ovarian carcinoid tumor. Case report

RESUMEN Los tumores neuroendocrinos primarios del ovario son raros y consisten en un grupo de neoplasias heterogéneas que expresan marcadores inmunohistoquímicos similares. Los tumores carcinoides son las neoplasias neuroendocrinas más comunes, la mayoría surgen en el tracto gastrointestinal y broncopulmonar. Los tumores carcinoides primarios del ovario son entidades raras que representan aproximadamente 0,3% de todos los tumores carcinoides y menos del 0,1% de todas las neoplasias ováricas, con buen pronóstico y generalmente limitados al parénquima ovárico. Estos tumores surgen del sistema de células neuroendocrinas del estroma, epitelio superficial y teratomas ováricos. Las manifestaciones clínicas, en la mayoría de los casos, están asociadas con liberación de sustancias vasoactivas que causan síntomas, como enrojecimiento cutáneo, diarrea y broncoespasmo. Para realizar el diagnóstico es necesario el uso de imágenes radiológicas multimodales y análisis bioquímicos de marcadores tumorales neuroendocrinos. El tratamiento de primera línea es la resección del tumor siempre que sea posible. El pronóstico es generalmente favorable, excepto en algunos casos con metástasis. Se presenta un caso de tumor carcinoide primario de ovario.

ABSTRACT Primary neuroendocrine tumors are rare. They belong to a group of heterogeneous neoplasms that express similar immunohistochemical markers. Carcinoid tumors are the most common neuroendocrine neoplasms. Most of them arise in the gastrointestinal and bronchopulmonary tract. Primary carcinoid tumors of the ovary are rare entities that represent approximately 0.3% of all carcinoid tumors and less than 0.1% of all ovarian neoplasms, with good prognosis and generally limited to the ovarian parenchyma. These tumors arise from the ovarian stromal neuroendocrine cell system, superficial epithelium, and teratomas. In most cases, clinical manifestations are associated with the release of vasoactive substances that cause symptoms such as skin redness, diarrhea, and bronchospasm. For diagnosis it is necessary to use multimodal radiological images and biochemical analysis of neuroendocrine tumor markers. First-line treatment is tumor resection whenever possible. Prognosis is generally favorable, except in some cases with metastases. A case of primary ovarian carcinoid tumor is presented.

Collaborative Public Health Investigation of Clenbuterol-Adulterated Heroin Outbreak-Richmond, Virginia, March-April 2015.

CONTEXT: In March 2015, the Virginia Department of Health (VDH) was alerted by the Virginia Poison Center of a 6-patient cluster treated for severe clinical presentations after using heroin. Patients' symptoms were atypical for heroin use, and concern existed that patients were exposed to heroin that had been adulterated with or replaced by another substance. OBJECTIVE: To understand the extent and characterization of the outbreak and implement response measures to prevent further cases. The purpose of this report is to highlight the collaborative nature of a public health investigation among a diverse group of stakeholders. DESIGN: Active surveillance and retrospective case finding. SETTING: Richmond metro area community and hospitals. PARTICIPANTS: Regional poison centers, the Division of Consolidated Laboratory Services, the Department of Behavioral Health and Developmental Services, community partners, local law enforcement, and multiple VDH divisions. INTERVENTION: Outbreak investigation, communication to public health professionals, clinicians, and the community, and liaising with the local law enforcement. MAIN OUTCOME MEASURES: Outbreak control. RESULTS: Laboratory confirmation of clenbuterol in clinical specimens implicated it as the heroin adulterant. Thirteen patients met clinical and epidemiologic criteria for exposure to clenbuterol-adulterated heroin. All patients were associated with a localized area within Richmond, and patient interviews elucidated heroin supplier information. VDH collaborated with local law enforcement agents who investigated and arrested the supplier, leading to cessation of the outbreak. CONCLUSION: This outbreak highlights the value of policies and practices that support an integrated outbreak response among public health practitioners, poison center staff, laboratorians, clinicians, law enforcement agents, community groups, and other agencies. Collaboration enabled implementation of effective control measures-including those outside the purview of the health department-and should be standard practice in future outbreaks involving illicit substances.

Caring for those who die at home: the use and validation of 'Care Of the Dying Evaluation' (CODE) with bereaved relatives.

BACKGROUND: As well as facilitating patients' wish to die at home, evaluating quality of care in this setting is essential. Postbereavement surveys with family members represent one assessment method. 'Care Of the Dying Evaluation' (CODE) is a 40-item self-completion postbereavement questionnaire, based on the key components of best practice for care of the dying. AIM: To assess the validity and reliability of CODE by conducting: cognitive 'think aloud' interviews; test-retest analysis; and assessing internal consistency and construct validity of three key composite scales. DESIGN: Postbereavement survey to next-of-kin (NOK). SETTING/PARTICIPANTS: 291 NOK to patients who died at home in Northwest England from an advanced incurable illness were invited to complete the CODE questionnaire. Additionally, potential participants were asked to undertake a cognitive interview and/or complete CODE for a second time a month later. RESULTS: 72 bereaved relatives (24.7% response rate) returned the completed CODE questionnaire, and 25 completed CODE for a second time. 15 cognitive interviews were undertaken. All interviewees found CODE sensitively worded and easy to understand. Minor revisions were suggested to provide additional clarity. Test-retest analysis showed all except one question had moderate or good stability. Although the ENVIRONMENT scale was not as relevant within the home setting, all three key composite scales showed good internal consistency and construct validity. CONCLUSIONS: 'CODE' represents a user-friendly, comprehensive outcome measure for care of the dying and has been found to be valid and reliable. CODE could potentially be used to benchmark individual organisations and identify areas for improvement.

Quality of end-of-life care for those who die at home: views and experiences of bereaved relatives and carers.

Little is known about the quality of the end-of-life care patients receive at home. This paper reports findings from a study that explored bereaved relatives' and carers' experiences of end-of-life care at home using the Care of the Dying Evaluation (CODE) questionnaire. Narrative data from questionnaires completed by 72 carers of patients who had died at home in the North West of England underwent qualitative analysis. In general good quality care was provided, but there were times when adequate support was not evident in relation to pain control and what to expect when death was imminent. The study provides useful information for those who provide end-of-life care at home.

On-field management of the acute anterior glenohumeral dislocation.

BACKGROUND: Glenohumeral dislocations are prevalent injuries in an athletic population, and proper, acute on-field management remains a topic of debate among health care professionals. OBJECTIVE: Firstly, to provide a systematic approach to the on-field management of acute anterior glenohumeral dislocations for on-field health care professionals. Secondly, to present current methods of reduction, including a description of the safest and most efficacious methods. METHODS: Based on the current literature, an overview of the relevant anatomy, mechanisms of injury, and associated injuries is provided. In addition, systematic guidelines for on-field management of acute glenohumeral dislocations are provided. RESULTS: The glenohumeral joint remains the most commonly dislocated joint in the body. Anterior dislocations comprise 90% to 98% of all glenohumeral dislocations. Despite a variety of described methods of reduction, there remains a lack of high-level evidence reporting the efficacy of each. To date, there is no position statement or consensus regarding the acute management of glenohumeral dislocations, creating discontinuity among health care professionals. CONCLUSION: A systematic approach in management of the acute anterior glenohumeral dislocation is paramount. Method of reduction and position of immobilization should be dependent on physician and patient comfort, respectively. Reduction is safest in patients aged < 40 years with no neurovascular compromise, and when minimal attempts are performed.

Assessing adolescent mindfulness: validation of an adapted Mindful Attention Awareness Scale in adolescent normative and psychiatric populations.

Interest in mindfulness-based interventions for children and adolescents is burgeoning, bringing with it the need for validated instruments to assess mindfulness in youths. The present studies were designed to validate among adolescents a measure of mindfulness previously validated for adults (e.g., Brown & Ryan, 2003), which we herein call the Mindful Attention Awareness Scale-Adolescent (MAAS-A). In 2 large samples of healthy 14- to 18-year-olds (N = 595), Study 1 supported a single-factor MAAS-A structure, along with acceptably high internal consistency, test-retest reliability, and both concurrent and incremental validity. In Study 2, with a sample of 102 psychiatric outpatient adolescents age 14-18 years, participants randomized to a mindfulness-based stress reduction intervention showed significant increases in MAAS-A scores from baseline to 3-month follow-up, relative to nonsignificant score changes among treatment-as-usual participants. Increases in MAAS-A scores among mindfulness-based stress reduction participants were significantly related to beneficial changes in numerous mental health indicators. The findings support the reliability and validity of the MAAS-A in normative and mixed psychiatric adolescent populations and suggest that the MAAS-A has utility in mindfulness intervention research.

Influence of hydration status on pacing during trail running in the heat.

The purpose of this study was to determine the influence of hydration status on pacing of trail runners in the heat (wet bulb globe temperature = 26.2 +/- 1.8 degrees C). A randomized, crossover design was used and the participation occurred within a 2-week period. Seventeen competitive, well-trained distance runners (9 men, 8 women, age 27 +/- 7 years, height 171 +/- 9 cm, weight 64.2 +/- 9.0 kg, body fat 14.6 +/- 5.5%) completed the study. Subjects started maximum effort trials that were either hydrated (HYR) and dehydrated (DHR). Each trial subjects ran three 4-km loops with a 4-minute rest between loops. Significance was set at p < or = 0.05. The DHR had a significantly greater body mass loss at the pre- and posttrial time points (-2.05 +/- 1.25 and -4.3 +/- 1.25%, respectively) vs. HYR (-0.79 +/- 0.95 and -2.05 +/- 1.09%, respectively). Subjects ran the 12 km faster (p < 0.001) in HYR (3,191 +/- 366 seconds) vs. DHR (3,339 +/- 450 seconds). Differences between fastest and slowest loops during HYR (54 +/- 40 seconds) were significantly smaller than DHR (111 +/- 93 seconds; p = 0.041). Additionally, loop times were slower for loop 1 (HYR 1,039 +/- 116 seconds vs. DHR 1,071 +/- 123 seconds; p = 0.028), loop 2 (HYR 1,066 +/- 123 seconds vs. DHR 1,105 +/- 148 seconds; p = 0.01) and loop 3 (HYR 1,081 +/- 132 seconds vs. DHR 1,168 +/- 189 seconds; p = 0.003) when dehydrated. Percent of the race completed by loop as calculated by finishing time was significantly different at loop 2 between HYR (33.6 +/- 0.36%) and DHR (33.1 +/- 0.35%, p = 0.002) and loop 3 (33.8 +/- 0.75% vs. 34.9 +/- 1.35%, respectively, p = 0.01). Total variation from the mean pace for the duration of the HYR compared to the DHR approached significance (p = 0.064). Average percent of variance approached significance between trials (p = 0.057). Differences between the fastest and slowest loops between trials demonstrated an increased ability for hydrated individuals to evenly pace themselves. While total variation from the mean pace was not significantly different, it could have practical applicability. These findings reveal that dehydration is associated with decreases in a runners' ability to evenly pace themselves during a competitive situation.

Biological monitoring of uranium exposure in south central Virginia.

In May 2004, two groundwater wells in Dinwiddie County, Virginia were found to have natural uranium levels either at or above the EPA recommended limit of 30 microg/l. As a result, a stop drinking water advisory was issued until a water treatment system could be installed to remove the uranium. In response to residents' concerns, and uncertainty of exposures, affected individuals were asked to participate in a voluntary epidemiological investigation of uranium uptake and 1-year uranium retention study. This study had two primary objectives: quantification of the uranium load on the participants, as expressed by their urine uranium concentration, and retention after 1 year of no exposure. A first-morning void urine specimen, along with survey information, was collected from 156 participants in May 2004, with a second collection occurring 12 months later of 91 participants. The samples were analyzed for uranium by ICP/MS, pH, creatinine by the Jaffe method, and RBP by LIA after both collections. A reduction of one order of magnitude for the geometric mean urine uranium concentration was observed, from 0.100 microg/g creatinine to 0.011 microg/g creatinine in 1 year. Comparatively, NHANES has reported that the geometric mean for all participants, ages 6 years and older, is 0.008 microg/g creatinine, with the 95th percentile being 0.040 microg/g creatinine. None of the second round specimens showed a urine uranium concentration higher than baseline for an individual.