Journal articles: 'Forms and Records Control – methods – United States'

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Skinner, Mark W., Gillian Hanson, Tao Xu, Richard Ofori-Asenso, Richard H. Ko, Emily Cibelli, Francis Nissen, Michelle Witkop, Fabian Sanabria, and Amy D. Shapiro. "A Novel Methodology for Building Longitudinal, Patient-Centric Real World Datasets in Hemophilia A." Blood 138, Supplement 1 (November 5, 2021): 594. http://dx.doi.org/10.1182/blood-2021-146160.

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Abstract Background: There are limited real-world data (RWD) available on the unmet needs of people with mild or moderate hemophilia A (PwHA). This population accounts for 40-52% of all PwHA, including nearly all women with hemophilia A (HA), and is under-represented in scientific literature (Michele, et al. Haemophilia 2014; Benson, et al. Blood Transfus 2018; Peyvandi, et al. Haemophilia 2019). Available claims data from payer databases are confined to billing codes, and lack key information on outcomes and disease characterization (e.g. severity, treatment response.) (Tyree, et al. Am J Med Qual 2006). Registry datasets can require resource-intensive data entry and potentially miss key information about care received at outside facilities, at home, or after patients switch providers (Gliklich, et al. Registries for Evaluating Patient Outcomes: A User's Guide. 2014). To address these data gaps, we developed a novel, patient-centered approach to create a longitudinal healthcare database from individuals with mild and moderate HA in the United States. This study assessed the feasibility of this approach, which integrates medical record data collected during routine clinical care along with patient-reported outcomes (PROs) to provide needed insights into this under-represented population. Methods: Recruitment began in June 2020 via a broad strategy of social media outreach, healthcare provider partnerships, and patient advocacy groups. Eligibility was confined to mild or moderate PwHA, confirmed via physician report within provider notes in combination with baseline factor VIII levels (>5-50% mild, 1-5% moderate.) This study received research ethics board approval and abides by the guiding principles of the Declaration of Helsinki. PwHA enrolled via an online record management platform, PicnicHealth. After signing authorization forms for collection of their electronic health records (EHR) and informed consent to share their de-identified data for research, participants were prompted to enter information on their care providers. Records were gathered from all providers, across any facility, retrospectively as records were available. (Figure 1) All records obtained were made available to the participants via a medical timeline. Records were translated to text via optical character recognition with human review. Data elements from structured text as well as disease-specific elements from narrative text were captured using natural language processing and supervised machine learning. All elements, including visit metadata, conditions, measurements, drugs, and procedures were mapped to standardized medical ontologies and reviewed by a team of nurses. (Table 1) Quality control was assessed via inter-abstractor agreement on outputs with physician review. Patient-reported bleed, treatment, and pain data were collected via online questionnaire for a subset of PwHA, with participants prompted to enter data every 2 weeks. Abstracted EHR data was linked to PRO responses in a de-identified dataset. Cohort and abstraction characteristics were summarized descriptively. Results: From June 1, 2020 to June 30, 2021, 104 PwHA met eligibility criteria for enrollment (65 [62.5%] mild; 39 [37.5%] moderate). Participants saw providers across 34 states in the US, 22.1% (23/104) were female, and 20.6% (14/68) of those with known race/ethnicity status were from minority groups. Records were gathered from a median of six care sites and 16 providers per participant. A median of 50 (IQR [21-93]) clinical documents from 11 years were processed for each PwHA. (Table 2) Inter-abstractor agreement to assess abstraction quality averaged 95.9% for condition, 99.5% for drug name, and 95.4% for drug start date. As of June 2021, the average PRO response rate was 90.3% (150/166 of all requests) and continues prospectively. Conclusions: The patient-centric data collection methods implemented in this study provide a novel approach to build longitudinal real-world data sets. Technology-enabled data abstraction showed consistent high quality when processing the heterogeneous clinical records across disparate providers and care sites, and direct engagement with patients complements potential gaps in the clinical record. Additionally, this approach provides needed data on groups under-represented in RWD and traditional PwHA cohorts, including those with mild and moderate disease and women with HA. Figure 1 Figure 1. Disclosures Skinner: ICER: Membership on an entity's Board of Directors or advisory committees; Spark (DMC): Honoraria; Sanofi: Honoraria; F. Hoffmann-La Roche Ltd/Genentech, Inc.: Honoraria; Pfizer (DMC): Honoraria; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees; uniQure: Research Funding; Takeda: Honoraria, Research Funding; F. Hoffmann-La Roche Ltd: Research Funding; Freeline: Research Funding; BioMarin: Honoraria, Research Funding; IPA Ltd.: Current holder of individual stocks in a privately-held company; National Hemophilia Foundation: Consultancy; Institute for Policy Advancement Ltd: Current Employment; WFH USA: Membership on an entity's Board of Directors or advisory committees; BCBS MAP: Membership on an entity's Board of Directors or advisory committees. Hanson: PicnicHealth: Current Employment, Current holder of stock options in a privately-held company. Xu: F. Hoffmann-La Roche AG: Current Employment. Ofori-Asenso: F. Hoffmann-La Roche Ltd: Current Employment. Ko: Genentech, Inc.: Current Employment; Genentech, Inc.-Roche: Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Cibelli: PicnicHealth: Current Employment. Nissen: Novartis: Consultancy; Actelion: Consultancy; F. Hoffmann-La Roche Ltd: Current Employment, Current holder of stock options in a privately-held company. Witkop: Roche Advisory Panel: Consultancy; National Hemophilia Foundation: Current Employment. Sanabria: F. Hoffmann-La Roche Ltd: Current Employment, Current holder of individual stocks in a privately-held company. Shapiro: Novartis: Research Funding; Novo Nordisk: Other: Advisory board fees, Research Funding, Speakers Bureau; Octapharma: Research Funding; Pfizer: Research Funding; OPKO: Research Funding; Prometric BioTherapeutics: Research Funding; Sangamo: Other: Advisory board fees, Research Funding; Sigilon Therapeutics: Other: Advisory board fees, Research Funding; Takeda: Research Funding; Kedrion Biopharma: Research Funding; Glover Blood Therapeutics: Research Funding; Genentech: Other: Advisory board fees, Research Funding, Speakers Bureau; Daiichi Sankyo: Research Funding; Bioverativ (a Sanofi company): Other: Advisory board fees, Research Funding; BioMarin: Research Funding; Agios: Research Funding.

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Afzali, A., S. Kakehi, K. Lapensee, R. Lukanova, F. Hennessy, H. Knight, and K. Singh. "P539 Unmet needs in advanced therapy-naïve (ATN) and advanced therapy-experienced (ATE) moderate-to-severe (mod-sev) ulcerative colitis (UC) patients in the United States (US)." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S510—S511. http://dx.doi.org/10.1093/ecco-jcc/jjab076.660.

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Abstract Background About a third of patients with mod-sev UC receiving advanced therapy (AT, i.e. biologics and tofacitinib) do not respond initially and another third lose response. We examined reasons for treatment choice and outcomes in ATN and ATE mod-sev UC patients. Methods A point-in-time survey of US gastroenterologists and their respective consulting UC patients was conducted from Jan 2020–Feb 2021 (ongoing) using the Adelphi Disease Specific Programme™ for Inflammatory Bowel Disease. Physicians completed patient record forms for UC patients with a history of mod-sev disease covering treatment history and clinical status. Patients were classified as ATN and ATE based on treatment. Response to treatment status was identified by factor and cluster analyses using flare, remission and change in symptoms. Descriptive and comparative statistics were calculated for reasons for initiating/switching therapy and patient-reported outcomes (satisfaction, pain/fatigue, and quality of life via the EuroQol-5 dimension questionnaire [EQ-5D]). Results Based on the interim sample, 66 physicians and 394 mod-sev UC patients were analysed. Of patients who were ATN (n=82) and ATE (n=312), 29% and 32% were classified as non-responders respectively. Comparing ATN vs ATE patients, mean age was directionally lower (38.4 vs 40.7 years), proportion of males was directionally higher (65% vs 55%), and mean time since diagnosis was similar (3.9 vs 3.8 years). In general, non-responders experienced gastrointestinal-related (90% vs 41%), anorectal (38% vs 6%), and fatigue-related symptoms (66% vs 23%) more frequently than responders. ATN patients eligible to receive AT (n=26) reported dislike of injections/infusions (46%) or unwillingness to go to infusion centres (31%) as reasons for not receiving AT. Most common reasons for switching therapy in ATN patients were disease progression (40%) and lack of tolerability (27%), and in ATE patients were loss of response over time (43%) and disease progression (35%). In the ATE group, patient and physician satisfaction rates were higher in responders vs non-responders (>93% vs <79%), pain and fatigue scores were lower (0.8 vs 2.3 and 1.1 vs 2.3, p<0.0001), and EQ-5D scores higher (0.93 vs 0.81, p=0.005). In the ATN group, comparisons were not conducted due to small sample sizes. Conclusion In this point-in-time survey study with data collected during the COVID-19 pandemic period, about a third of mod-sev UC patients did not respond to current therapy. These results suggest an opportunity for new therapies that increase response rates, provide long-term disease control, provide alternatives to parenteral routes of administration, and enhance patient satisfaction.

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Kelly, Emily A., Jose I. Echeverri Alegre, Katherine Promer, Jesica Hayon, Roumen Iordanov, Jerry J. Zhang, Zian Fang, et al. "742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S469. http://dx.doi.org/10.1093/ofid/ofab466.939.

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Abstract Background Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas. Methods Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site. Results We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site. Conclusion These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US. Disclosures Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)

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Eskalen, A., A. Gonzalez, D. H. Wang, M. Twizeyimana, J. S. Mayorquin, and S. C. Lynch. "First Report of a Fusarium sp. and Its Vector Tea Shot Hole Borer (Euwallacea fornicatus) Causing Fusarium Dieback on Avocado in California." Plant Disease 96, no. 7 (July 2012): 1070. http://dx.doi.org/10.1094/pdis-03-12-0276-pdn.

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Per capita consumption of avocado in the United States has nearly doubled between 2000 and 2010. The California avocado industry supplies almost 40% of U.S. demand and the remaining 60% is supplied by imports from Latin America and New Zealand. The Tea Shot Hole Borer (TSHB) is an ambrosia beetle from Asia that forms a symbiosis with a new, yet undescribed Fusarium sp. and is a serious problem for the Israeli avocado industry (3). The beetle also causes severe damage on the branches of tea (Camelia sinensis) in Sri Lanka and India (1). In California, TSHB was first reported on black locust (Robinia pseudoacacia) in 2003, but there are no records of fungal damage (4). In 2012, nine backyard avocado trees (cvs. Hass, Bacon, Fuerte, and Nabal) exhibiting branch dieback were observed throughout the residential neighborhoods of South Gate, Downey, and Pico Rivera in Los Angeles County. Upon inspection, symptoms of white powdery exudate, either dry or surrounded by wet discoloration of the outer bark in association with a single beetle exit hole, were found on the trunk and main branches of the tree. Examination of the cortex and wood under the exit hole revealed brown discolored necrosis. The TSHB was also found within galleries that were 1 to 4 cm long going against the grain. Symptomatic cortex and sapwood tissues were plated onto potato dextrose agar amended with 0.01% tetracycline (PDA-tet). The TSHB was dissected and plated onto PDA-tet after surface disinfestation following methods described by Kajimura and Hijii (2). After 5 days of incubation at room temperature, regular fungal colonies with aerial mycelia and reddish brown margins were produced. Single spore isolations were used to establish pure culture of the fungus. Fifty conidia were hyaline, clavate with a rounded apex, and initially aseptate (4.1 to 12.0 × 2.4 to 4.1 μm) becoming one- to three-septate (7.6 to 15.1 × 2.8 to 4.5 μm, 9.2 to 17.2 × 3.4 to 4.8 μm, and 13.5 to 17.6 × 4.3 to 4.7 μm, respectively). Identity of the fungal isolates was determined by amplification of the rDNA genes with primers ITS4/5 and EF1/2, respectively. Sequences were deposited into GenBank under Accession Nos. JQ723753, JQ723760, JQ723756, and JQ723763. A BLASTn search revealed 100% similarity to Fusarium sp. (Accession Nos. JQ038020 and JQ038013). Detached green shoots of healthy 1-year-old avocado were wounded to a depth of 1 to 2 mm and 5-mm mycelial plugs from 5-day-old cultures (UCR 1781 and UCR 1837) were placed mycelial side down onto the freshly wounded surfaces and then wrapped with Parafilm. Control shoots were inoculated with sterile agar plugs and five replicates per treatment were used. Shoots were incubated at 25 ± 1°C in moist chambers for 3 weeks. Lesions were observed on all inoculated shoots except for the control. Mean lesion lengths were 10.7 and 12.8 cm for UCR1781 and UCR1837, respectively, and were significantly different (P ≤ 0.05) from the control. Both isolates were reisolated from 100% of symptomatic tissues of inoculated shoots to complete Koch's postulates. This experiment was conducted twice and similar results were obtained. To our knowledge, this is the first report of Fusarium sp. and its vector E. fornicatus causing Fusarium dieback on Avocado in California. References: (1) W. Danthanarayana. Tea Quarterly 39:61, 1968. (2) H. Kajimura and N. Hijii. Ecol. Res. 7:107, 1992; (3) Mendel et al., Phytoparasitica, DOI 10.1007/s12600-012-0223-7, 2012. (4) R. J. Rabaglia. Annals Entomol. Soc. Amer. 99:1034, 2006.

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Kelson, Jennifer. "Clinical Informatics Consult Service Positively Affects Some Clinical Decisions in the ICU." Evidence Based Library and Information Practice 4, no. 2 (June 14, 2009): 174. http://dx.doi.org/10.18438/b8m91t.

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A Review of: Mulvaney, Shelagh A., Leonard Bickman, Nunzia B. Giuse, Warren E. Lambert, Nila A. Sathe, and Rebecca N. Jerome." A Randomized Effectiveness Trial of a Clinical Informatics Consult Service: Impact on Evidence-based Decision-making and Knowledge Implementation." Journal of the American Medical Informatics Association 15.2 (2008): 203-11. Objective – To determine whether the provision of synthesized research evidence provided by the Clinical Informatics Consult Service (CICS) affects the clinical decision-making of clinicians working in intensive care units (ICUs). Design – Non-blinded randomized control effectiveness trial. Setting – ICUs in United States-based 658 bed university hospital providing tertiary care for adults and children. Subjects – Clinical staff working within one of four ICUs who submitted a request for clinical information during the study period. Methods – Valid requests submitted by clinical staff from the four clinical ICUs (medical, paediatric, trauma, or neonatal) were randomly allocated to receive information from the CICS (CICS provided) or no information (no CICS provided). Pre-consult forms, completed at the time of the request, examined reasons for the request and the clinical actions clinicians thought might be influenced by the search results. Requestors could opt out of the no CICS provided group either before or after the randomization of their request. Responses to requests, supplied within 0.5 to 7 days as agreed with the requestor, included a search strategy and bibliographic references, a targeted list of full-text articles, and a written synthesis and critique of the relevant research. Clinicians within both groups were free to conduct their own searches and reviews. An online evaluation form, emailed to recipients, was used to assess the impact of the information supplied. The evaluation form asked clinicians to record the time spent on their own searches, sources of information consulted including colleagues, the immediate and future impact of the information provided (either from the CICS or their own searches), what influence the information had on their clinical actions, whether there were any barriers to using the information, and quality and overall satisfaction with the results provided by the CICS. Data was analyzed according to the randomized group assignment using standard intention-to-treat analysis for the main outcomes between the two groups. Statistical adjustments were made to control for possible clustering of responses or multiple ratings from individual clinicians. The data was also analyzed on an efficacy basis depending on who provided the search results. The groups were Clinician only, CICS librarian-only, or Both Clinician and CICS librarian. Results from the Clinician only search group were used as a comparison to the remaining groups. This assessment did not take account of the randomization and therefore constitutes a cohort analysis. Results were analysed by one of two methods using statistical software SAS Proc Mixed (v9) for multi-level quantitative data analysis, e.g., analysis of variance, and SPSS (v14) for all other quantitative data analysis, including descriptive statistics. Main Results – The study period was conducted over 19 months: August 2004 to March 2006. During this time, 299 valid requests were received and 226 post consult evaluation forms were returned giving a response rate of 76%. Post consult forms were returned for 108/146 of the CICS provided group and 118/153 of the no CICS provided group. The 24% of requests that had no post consult evaluation were excluded from further analysis. Statistical tests, conducted to check for potential bias relating to missing data, suggested that the missing data had little impact on the findings. Medical and neonatal ICUs accounted for the majority of completed forms (40.3% and 38.1% respectively). The majority of opt-outs (10.2% overall) were from the medical ICU. No significant difference in outcome variables was found between opt-out and other requests when tested using analysis of variance (ANOVA). Evaluation forms were completed by 89 unique clinicians and over half (49) submitted more than one request. The average requests per clinician was 2.96, SD 3.17, range 1-15, and the average number of requests per clinician who submitted more than one request was 4.57, SD 3.55, range 2-15. Total number of responses, mean, standard deviation, and Cohen’s d effect size were reported for the outcome variables based on intention to treat analysis. Results showed no significant difference between the groups on the immediate impact of the information provided, the number of articles read or the frequency with which clinicians consulted colleagues, either formally or informally. The potential future impact of the information was rated higher in the CICS group (p=

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Shapiro, Amy, Ateefa Chaudhury, Nisha Jain, Elisa Tsao, Chris Barnowski, Jing Feng, and Doris Quon. "Real-World Data on the Use of rFIXFc in Subjects With Hemophilia B for Up to 3.7 Years Demonstrates Improved Bleed Control and Adherence With Reduced Treatment Burden." Blood 132, Supplement 1 (November 29, 2018): 2493. http://dx.doi.org/10.1182/blood-2018-99-116909.

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Abstract Introduction: Recombinant factor IX Fc fusion protein (rFIXFc) was the first extended half-life FIX product approved in the United States to treat children and adults with hemophilia B. Long-term data from clinical trials have demonstrated the safety and efficacy of rFIXFc as well as an extended dosing interval (once weekly or every 10‒14 days based on individual needs); however, real-world data are limited (Wang et al. Haemophilia, 2018; Buckley et al. AMCP NEXUS, 2015). We therefore performed a retrospective chart review to further understand the clinical experience and outcomes associated with real-world treatment of hemophilia B with rFIXFc. Methods: This retrospective chart review is being conducted at 6 sites across different regions of the United States and aims to include 70 patient charts. Data entry for 43 patient charts has been completed to date (cutoff: June 29, 2018). Data collection is ongoing. Inclusion criteria were diagnosis of hemophilia B and receipt of rFIXFc for ≥6 months. Subjects with other coagulation disorders or any record of positive FIX inhibitor titers were excluded. De-identified subject-level data were transcribed onto anonymous electronic case report forms. Endpoints included changes in FIX therapy dosing interval, factor consumption, bleed control, and patient adherence before and after rFIXFc initiation. Descriptive statistics were used to summarize the results. Results: For the 43 charts available for analysis, the duration of follow-up receiving rFIXFc ranged from 0.5 to 3.7 years. Of these, 58% of subjects (25/43) were >18 years of age, 77% (33/43) were of white race, and 51% (22/43) had severe hemophilia B (Table 1). The most common genotype was missense, occurring in 63% of subjects (27/43). Among subjects with comorbidity, 37% reported hemophilic arthropathy (16/43) and 28% had hepatitis C (12/43). All 22 subjects with severe hemophilia B were treated with rFIXFc prophylactically compared with 9/15 moderate and 3/6 mild cases. From the data collected thus far, 94% of prophylaxis subjects were on a dosing interval of weekly or longer (every 7 days, n=20; every 10 days, n=3; and every 14 days, n=9). The total weekly dose before and after switching to rFIXFc prophylaxis were available for 20 subjects. Of the 12 adults (9 severe, 2 moderate, and 1 mild), the median weekly factor consumption decreased from 111 IU/kg to 52.5 IU/kg. A similar pattern was observed for subjects who were 12-18 years of age (n=4). For subjects <12 years of age (n=4), 2 had reduced weekly consumption after switching to rFIXFc, whereas 2 (on plasma-derived product pre-rFIXFc) had an increase in weekly consumption. The annualized bleeding rates (ABRs), annualized spontaneous bleeding rates (AsBRs), and annualized joint bleeding rates (AjBRs) were available for 17 subjects treated with prophylaxis regimens pre- and post-rFIXFc (Table 2). Of these subjects, 11 had severe, 5 had moderate, and 1 had mild hemophilia B. Among 11 subjects with severe hemophilia B, median (interquartile range) ABRs decreased from 8.2 (4.4‒11.5) to 2.3 (0.6‒10.2), AsBR from 1.2 (0‒9.7) to 0.3 (0‒8.7), and AjBR from 2.3 (1.4‒8.2) to 0.7 (0‒6.9) before and after rFIXFc treatment. Subjects with moderate disease had a similar pattern (Table 2). The most common reason for switching to rFIXFc was to reduce the burden associated with therapy (21/43, 49%). No rationale for switching was documented in 40% (17/43) of subjects, and 7% (3/43) switched due to lack of efficacy with previous treatment. The other reasons, including difficult venous access, lack of adherence, and failure to reach desired trough were mentioned by <5% of subjects. No subject reported adherence issues while on rFIXFc. Conclusions: This real-world study of rFIXFc demonstrates improved bleed control, reduced overall consumption, and reduced frequency of injection for subjects with moderate and severe hemophilia B. The data also show that rFIXFc provides an opportunity to tailor dosing and improve adherence. These results echo the findings of the pivotal trials and add to the pool of evidence supporting rFIXFc in the treatment of hemophilia B. These data also reflect the use of rFIXFc for mild hemophilia patients in the real-world setting. Disclosures Shapiro: Kedrion Biopharma: Consultancy, Research Funding; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bioverativ, a Sanofi Company: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Prometic Life Sciences: Consultancy, Research Funding; Shire: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Genetech: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bayer Healthcare: Other: International Network of Pediatric Hemophilia; BioMarin: Research Funding; Bio Products Laboratory: Consultancy; Octapharma: Research Funding; OPKO: Research Funding; Sangamo Biosciences: Consultancy; Daiichi Sankyo: Research Funding. Chaudhury:Bioverativ, a Sanofi Company: Consultancy, Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees. Jain:Bioverativ: Employment. Tsao:Bioverativ: Employment. Barnowski:Bioverativ, a Sanofi Company: Employment. Feng:Bioverativ: Employment. Quon:Shire: Speakers Bureau; Genetech: Consultancy, Speakers Bureau; NovoNordisk: Consultancy, Speakers Bureau; Bayer: Consultancy; Octapharma: Consultancy; Bioverativ, a Sanofi Company: Speakers Bureau.

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Ravi Kumar Gali and Ramesh Kumar V. "Corrosion studies of various salt solutions on metals and alloys." Global Journal of Engineering and Technology Advances 16, no. 3 (September 30, 2023): 007–18. http://dx.doi.org/10.30574/gjeta.2023.16.3.0174.

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corrosion refers to a chemical (dry corrosion) or electrochemical (wet corrosion) reaction of and the surrounding environment due to erosion of steel and its alloys or atmospheric gases causing substances used to break down or lose component atoms. Section Corrosion is also defined as an electrochemical process in which oxidation and reduction of metal occur simultaneously in the presence of an oxidizing agent such as oxygen. Section Dry corrosion and wet corrosion are two types. Oxidation of waste to form metal oxides; It is a good example of electrochemical dry corrosion, commonly known as rust. The loss of corrosion products often produces oxides or salts of the old metal. Corrosion cannot be prevented, but losses from corrosion can be minimized. Almost all materials, such as ceramics (concrete rusts) or polymers, corrode in one way or another, but in this case the word "degrades" is often used with . Section Corrosion is also defined as the loss of valuable properties. materials due to the attack of atmospheric gases. Surface corrosion of metals and their alloys due to atmospheric gases (wind and moisture), chemical or electrochemical reactions that cause corrosion (loss) of metals Atmospheric gases affect different metal alloys. Many processes alloys, moisture content, nature of disease, flow rate, etc. will corrode heavily, while others will corrode slightly. Corrosion rates can be greatly affected by exposure of to certain elements in the atmosphere. Corrosion occurs in many forms. Section Corrosion Similar to the diffusion control process as corrosion occurs in most materials and alloy . Main battery design is another cause of corrosion. The formation of primary cells in the body should be avoided as much as possible. Galvanic cells are created because when two dissimilar metals come into contact with each other, the formation of Section galvanic cells occurs, which causes galvanic corrosion. In galvanic cells, more reactive metals with hydrogen greater than in the EMF series will corrode at a high rate (anode), while noble metals with hydrogen less than in the EMF series will corrode at a slower rate (cathode). However, when they are separated, no galvanic cells are formed and each metal corrodes independently. The choice of metals and alloys used in industry prevents the Galvanic cell design from occurring, which can be done with the help of many galvanic cells. For example, zinc is often used as a sacrificial anode to protect steel and its alloys, to provide protection to steel structures. Galvanic Cell Corrosion Different factors affect the corrosion rate, such as the relative position of the anode, the type of metal , and physical conditions such as temperature, humidity, and salinity. The area between the anode and the cathode is also an important factor affecting the corrosion rate. Corrosion rate of records. Section Among the different factors affecting the corrosion rate, water in the air is the most important Section. Any metal electrode immersed in a standard ventilated environment such as steam Hot sea water in the house will be faster than the next Inert. . Chapter or more Chapter is being bullied as much as its position in the EMF series is different from When two dissimilar metals are in electrical contact with each other placed in the same electrolyte, and sharing the same electrons, there is competition between the two free electrons of the two materials. Item Electrolyte acts as a host for ions to flow in the same direction and eventually gains noble metal and takes electrons from active ions. The current generation can be scaled to increase or decrease data in the center of interest. There is a basic requirement that the metal be clean to reduce corrosion. Generally, corrosion products can be removed by chemical/physical means to obtain a clean surface , but one or another type of corrosion such as pitting corrosion may still occur. To reduce the corrosion of , different anti-corrosion agents should be used in the body; For example, phosphoric acid, usually in the form of dark blue glue, is used to surface ferrous equipment to remove rust. Different materials have different corrosion properties. For example, EMF and Galvanic series. Different types and alloys of series or reactive series metals can be prepared in different environments. Section will certainly help you understand the nature and type of rust. Among the different corrosion protection methods, the various methods for protecting carbon steel from corrosion include painting, hot dip galvanizing, anodic protection, altruistic protection, and a combination of methods.. More procedures can be used if more sensitive data is used. It is used to protect and components from damage during manufacture, transportation and storage. Section The most corrosion resistant materials are those that are thermodynamically unsuitable for corrosion. Any corrosion of gold or platinum will spontaneously convert to pure metal; therefore these elements can be found in the world in metallic form and are part of their true value. Article The more "base" metal can be preserved with longer use. Chapter Normal metals have slow reaction kinetics, but their corrosion is thermodynamically favored. These include metals such as zinc, magnesium and cadmium. The corrosion of these metals continues, but occurs at a lower rate. Section A 2002 study by the Federal Highway Administration entitled "Costs and Prevention in the United States" Section shows the direct costs associated with metal corrosion in virtually every industry in the United States. It showed that the estimated annual direct cost of corrosion in the United States in 1998 was .The United States is approximately $276 billion, of which is approximately 3.2% of US GDP. However, the cost directly related to the corrosion of steel is heavier. Failure is due to the loss of mechanical strength of the concrete structure due to corrosion. Corrosion limits the life of the concrete structure. As corrosion cannot be avoided, engineers will determine the service life of the model. Rust is one of the most common causes of bridge accidents. Article Harassment Corrosion was the main cause of the Milans River Bridge collapse in 1983 when internal corrosion at the bearings caused the angle of the road plate to come off its support. Meanwhile, three people driving on the road died when the stone slabs fell into the river below. NTSB research revealed that engineers blocked the drain in the road while renovating, but forgot to unclog it later, allowing water to seep into the hangers. Article It is also difficult for mechanics to find bearings by inspection. Section When rust builds up and the support is removed, it eventually causes serious damage to Section .There are many instances where rust was responsible for the tragic events of . Rust was a factor in the 1967 Silver Bridge disaster in West Virginia at ,when the steel suspension bridge collapsed in less than a minute, killing 46 drivers and passengers. Carbon and Mild Steel are the most common steels used in many industries as well as everyday life for the design and manufacture of in a variety of applications. Carbon steel and low carbon will corrode severely when exposed to corrosive medium, ie corrosive medium. is an acid, but their use is still mostly due to their low cost and good quality. Corrosion can cause loss of metals and their strength which can lead to serious accidents and loss of work, work and people. Scientists have always wanted to understand the corrosion process and ways to control it. Chapter A number of corrosion inhibitors have been reported to control the corrosion of steel and its alloys in different corrosion systems. Every step towards finding a new Corrosion Inhibitor for a corrosion remediation project will not only result in significant savings, but will also help engineers keep plants and machinery running smoothly as Corrosion occurs. Carbon Steel, Stainless Steel, and Mild Steel are the most common materials used in the design and manufacture of the Chloride ions can corrode steel, stainless steel, and mild steel and are found in plumbing, electrical equipment, boilers, condensing units, etc. can cause problems. The sea is also abundant in chloride , which is used for injection into water in oil for cooling, such as in desalination plants. Chemical corrosion inhibitors are generally used in manufacturing and processing. The challenge, however, is to develop a new corrosion inhibitor that will protect material and make it a good friend in many situations. Surfactants are environmentally acceptable as corrosion inhibitors and is very economical and readily available. The purpose of this article is to determine the ability of surfactants to prevent corrosion of on carbon, stainless and mild steel surfaces. Chapter The various uses and properties of various surfactants are also discussed. The effect of surfactant concentration, temperature and corrosion inhibition mechanisms, and type of adsorption are also discussed in this book. In this study, we try to study in detail surfactants as corrosion inhibitors to control corrosion of carbon steel, stainless steel and small iron in acidic environment. Chapter Experiments were performed using both gravitational and electrochemical polarization methods, and the results of all studied surfactants used in this study are discussed in detail.

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Yang, Guobin. "Internet Activism & the Party-State in China." Daedalus 143, no. 2 (April 2014): 110–23. http://dx.doi.org/10.1162/daed_a_00276.

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The history of Internet activism and Internet control in China is one of mutual adaptation between citizen activists and party authorities. The party-state initially reacted to Internet activism with alarm, but has since built a comprehensive approach combining repressive policing with gentler methods of social management. This approach has evolved in response to the diverse forms of and participants in Internet activism. But the adaptability of the Chinese Internet control regime does not mean that it will root out Internet activism. On the contrary, Internet activism will continue to grow and will itself adapt to the changing forms of control. Comparisons with Russia and the United States highlight how political economy, history, and everyday practice shape the forms of Internet activism and control.

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Des Jarlais, Don C., Jonathan Feelemyer, Paul LaKosky, Kathryn Szymanowski, and Kamyar Arasteh. "Expansion of Syringe Service Programs in the United States, 2015–2018." American Journal of Public Health 110, no. 4 (April 2020): 517–19. http://dx.doi.org/10.2105/ajph.2019.305515.

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Objectives. To report on the expansion of syringe service programs (SSPs) in the United States from 2015 to 2018. Methods. We obtained data from records of the Buyers’ Club of the Dave Purchase Project/North American Syringe Exchange Network (NASEN), including the number of US SSPs and the numbers of sterile syringes purchased by programs. We conducted a subset analysis of states with high numbers of counties defined as “vulnerable” by the Centers for Disease Control and Prevention. Results. SSP participation in the Buyers’ Club increased from 141 in 2015 to 292 in 2018, with an increase in syringes purchased from 42 million to 88 million. In addition to these large increases in numbers of programs and in syringes purchased, there were also indications of instability among new programs in vulnerable states. Conclusions. There have been substantial increases in the number of programs established and the number of syringes distributed in response to the opioid epidemic. Ensuring high-quality services in these new programs will be critical to successfully addressing the current epidemic.

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Crist, Matthew B., John R. McQuiston, Maroya Spalding Walters, Elizabeth Soda, Heather Moulton-Meissner, Ainsley Nicholson, and Kiran Perkins. "868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S472. http://dx.doi.org/10.1093/ofid/ofaa439.1057.

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Abstract Background Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks. Methods CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures. Results We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic. Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates. Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks. Conclusion EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients. Disclosures All Authors: No reported disclosures

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Savage, Philip, Sarah Mahmoud, Yogin Patel, and Hagop Kantarjian. "Cancer Drugs: An International Comparison of Postlicensing Price Inflation." Journal of Oncology Practice 13, no. 6 (June 2017): e538-e542. http://dx.doi.org/10.1200/jop.2016.014431.

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Purpose: The cost of cancer drugs forms a rising proportion of health care budgets worldwide. A number of studies have examined international comparisons of initial cost, but there is little work on postlicensing price increases. To examine this, we compared cancer drug prices at initial sale and subsequent price inflation in the United States and United Kingdom and also reviewed relevant price control mechanisms. Methods: The 10 top-selling cancer drugs were selected, and their prices at initial launch and in 2015 were compared. Standard nondiscounted prices were obtained from the relevant annual copies of the RED BOOK and the British National Formulary. Results: At initial marketing, prices were on average 42% higher in the United States than in the United Kingdom. After licensing in the United States, all 10 drugs had price rises averaging an overall annual 8.8% (range, 1.4% to 24.1%) increase. In comparison, in the United Kingdom, six drugs had unchanged prices, two had decreased prices, and two had modest price increases. The overall annual increase in the United Kingdom was 0.24%. Conclusion: Cancer drug prices are rising substantially, both at their initial marketing price and, in the United States, at postlicensing prices. In the United Kingdom, the Pharmaceutical Price Regulation Scheme, an agreement between the government and the pharmaceutical industry, controls health care costs while allowing a return on investment and funds for research. The increasing costs of cancer drugs are approaching the limits of sustainability, and a similar government-industry agreement may allow stability for both health care provision and the pharmaceutical industry in the United States.

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Nabatov, Sergei. "Comparative characteristics of future theater art specialists’ professional training in Ukraine and the USA." ScienceRise: Pedagogical Education, no. 3(42) (May 31, 2021): 37–45. http://dx.doi.org/10.15587/2519-4984.2021.233903.

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The article provides a comparative analysis of the training of future theater professionals at universities in Ukraine and the United States. The author reviews modern scientific works on the problem of professional training in general and optimal approaches to the selection of criteria for comparative research. On the basis of a comparative comparison, common and different aspects of professional training of future theater professionals at universities in Ukraine and the United States were clarified. The author determined that the peculiarities of the methodological principles are that in the United States they are presented more widely and more thoroughly in legislative documents; the concept of professional training of future specialists in theater art, approaches and principles in general determine the vector of further development of the system of professional training in the research area; standards in the United States are also comprehensive and specific, which provides better control over the quality of higher education in the theater; qualification requirements in the United States and Ukraine largely coincide (qualifications, features of vocational education - terms and institutions where it is possible to get a profession); content structure and list of disciplines is characterized by flexibility, diversity and differentiation in the US, which provides a wider range of individual trajectory of vocational education, while in Ukraine the list of disciplines and their content is much narrower); forms, methods and tools that are also component components of organizational and methodological principles in the system of university education in the United States and Ukraine are characterized by variability and generally provide quality training for future theater professionals in both countries

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Trombatt, William D., Pamela H. Koerner, Zoie N. Craft, Richard T. Miller, and Khalid M. Kamal. "Retrospective Analysis of the Medication Utilization and Clinical Outcomes of Patients Treated with Various Regimens for Hepatitis C Infection." Journal of Pharmacy Practice 30, no. 2 (July 9, 2016): 154–61. http://dx.doi.org/10.1177/0897190015626008.

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Background: The hepatitis C virus (HCV) is the most common chronic blood-borne infection and the leading cause of liver transplantation in the United States. There are approximately 3.2 million people currently infected with HCV in the United States. In late 2013, the introduction of sofosbuvir and simeprevir represented a critical advancement in the treatment of HCV by improving sustained virologic response (SVR) rates. Purpose: The purpose of this study was to evaluate medication utilization and clinical outcomes of patients with HCV who were treated with any Food and Drug Administration-approved combination of ribavirin, peginterferon products, simeprevir, and sofosbuvir. Methods: Prescription records and clinical assessment forms of patients who started HCV therapy and were eligible for SVR between January 1, 2014, and December 31, 2014, were retrospectively reviewed. Data collection included patient demographics, genotype, SVR, patient-reported adverse events, discontinuations, and adherence markers. Results: A total of 367 eligible patients were identified who had initiated treatment during the study period. Genotype 1 was the most common genotype, and an overall SVR rate of 86.9% was observed. Results were similar to those seen in phase III clinical trials. In addition, adverse events of these medications were more tolerable, and discontinuation rates were lower than with previous therapies.

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Young-Xu, Yinong, Jeremy Smith, Salaheddin M. Mahmud, Robertus Van Aalst, Edward W. Thommes, Nabin Neupane, Jason K. H. Lee, and Ayman Chit. "Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans." PLOS ONE 15, no. 12 (December 11, 2020): e0243248. http://dx.doi.org/10.1371/journal.pone.0243248.

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Background Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies. Methods With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the “risk interval” as the first 7 days after specimen collection and the “control interval” as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality. Results We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16–12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99–22.10) and high platelet count (IR, 15.89; 95% CI: 3.59–70.41). Conclusion We confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism.

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Islam, Khandaker Reajul, Johayra Prithula, Jaya Kumar, Toh Leong Tan, Mamun Bin Ibne Reaz, Md Shaheenur Islam Sumon, and Muhammad E. H. Chowdhury. "Machine Learning-Based Early Prediction of Sepsis Using Electronic Health Records: A Systematic Review." Journal of Clinical Medicine 12, no. 17 (August 30, 2023): 5658. http://dx.doi.org/10.3390/jcm12175658.

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Background: Sepsis, a life-threatening infection-induced inflammatory condition, has significant global health impacts. Timely detection is crucial for improving patient outcomes as sepsis can rapidly progress to severe forms. The application of machine learning (ML) and deep learning (DL) to predict sepsis using electronic health records (EHRs) has gained considerable attention for timely intervention. Methods: PubMed, IEEE Xplore, Google Scholar, and Scopus were searched for relevant studies. All studies that used ML/DL to detect or early-predict the onset of sepsis in the adult population using EHRs were considered. Data were extracted and analyzed from all studies that met the criteria and were also evaluated for their quality. Results: This systematic review examined 1942 articles, selecting 42 studies while adhering to strict criteria. The chosen studies were predominantly retrospective (n = 38) and spanned diverse geographic settings, with a focus on the United States. Different datasets, sepsis definitions, and prevalence rates were employed, necessitating data augmentation. Heterogeneous parameter utilization, diverse model distribution, and varying quality assessments were observed. Longitudinal data enabled early sepsis prediction, and quality criteria fulfillment varied, with inconsistent funding–article quality correlation. Conclusions: This systematic review underscores the significance of ML/DL methods for sepsis detection and early prediction through EHR data.

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Kostrinsky-Thomas, Alexander L., Fuki M. Hisama, and Thomas H. Payne. "Searching the PDF Haystack: Automated Knowledge Discovery in Scanned EHR Documents." Applied Clinical Informatics 12, no. 02 (March 2021): 245–50. http://dx.doi.org/10.1055/s-0041-1726103.

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Abstract Background Clinicians express concern that they may be unaware of important information contained in voluminous scanned and other outside documents contained in electronic health records (EHRs). An example is “unrecognized EHR risk factor information,” defined as risk factors for heritable cancer that exist within a patient's EHR but are not known by current treating providers. In a related study using manual EHR chart review, we found that half of the women whose EHR contained risk factor information meet criteria for further genetic risk evaluation for heritable forms of breast and ovarian cancer. They were not referred for genetic counseling. Objectives The purpose of this study was to compare the use of automated methods (optical character recognition with natural language processing) versus human review in their ability to identify risk factors for heritable breast and ovarian cancer within EHR scanned documents. Methods We evaluated the accuracy of the chart review by comparing our criterion standard (physician chart review) versus an automated method involving Amazon's Textract service (Amazon.com, Seattle, Washington, United States), a clinical language annotation modeling and processing toolkit (CLAMP) (Center for Computational Biomedicine at The University of Texas Health Science, Houston, Texas, United States), and a custom-written Java application. Results We found that automated methods identified most cancer risk factor information that would otherwise require clinician manual review and therefore is at risk of being missed. Conclusion The use of automated methods for identification of heritable risk factors within EHRs may provide an accurate yet rapid review of patients' past medical histories. These methods could be further strengthened via improved analysis of handwritten notes, tables, and colloquial phrases.

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Trofymenko, Anastasiia, and Dmytro Lubinets. "The main lobbying development trends in the United States of America." Історико-політичні проблеми сучасного світу, no. 39 (June 16, 2019): 156–63. http://dx.doi.org/10.31861/mhpi2019.39.156-163.

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The relevance of the issue of decreasing corruption in Ukraine causes the scientific interest in the study of such a political institution as lobbyism. An analysis of the global lobbying experience allows us to distinguish the lessons Ukraine can apply in this field. The article presents an analysis of the American lobbying model, since the United States was the first country to acknowledge and determine lobbying, as well as to develop the most advanced lobbying methods and technologies on the legislative level. The authors specify the main trends in the establishment and functioning of lobbying in the United States of America through studying the requirements of legislation in this field, imposed both on lobbyists and officials, considering ethical norms that lobbyists should be guided by in their work, subject-object determination of American lobbyism, and prevailing forms thereof in the state. As a result of the study carried out, it was found out that the legal framework for lobbying in the United States is based on the following: the principles of compulsory accountability and reporting of lobbyists and their clients, foreign clients, in particular; ethical standards of conduct for employees; restriction of lobbying for former civil servants; lobbying in all the branches of power; lobbying supervision and control by government agencies (these functions are entrusted to the Secretary of the Senate and Secretary of the House of Representatives) and the public, by lobbyists as well through establishing a Code of Lobbying Ethics, mediation between the client and the authorities. Keywords: lobbyism, lobbying, American model, Association of Government Relations Professionals, Code of Lobbying Ethics, lobby register.

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Douglass, Matthew J., LuAnn Wandsnider, and Simon J. Holdaway. "Surface Artifact Scatters, Data Collection, and Significance." Advances in Archaeological Practice 11, no. 1 (February 2023): 29–41. http://dx.doi.org/10.1017/aap.2022.37.

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ABSTRACTThe three authors research surface archaeological records dominated by low-density scatters and isolated artifacts, archaeological phenomena frequently encountered during cultural resource management (CRM) projects in areas of the United States and Australia. We each began researching surface artifact scatters for different reasons but converged on approaches that emphasize the formation of these forms of archaeological deposits. Through a variety of projects, we asked a common set of questions about the processes that both buried and exposed these materials, the methods needed to obtain a chronology in different regions, and the ways we might interpret artifacts found together in different densities. Answering these questions led to the collection and analyses of datasets in innovative ways and the questioning of a number of archaeological categories often thought of as fundamental for archaeological research. Here, we review examples of our respective research and consider the implications for CRM projects dealing with surface lithics.

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C. Stanley, Okoro, Lopez Alexander, and Unuriode O. Austine. "Proactive Wildfire Detection and Management using AI, ML, and 5G Technology in the United States." International Journal of Data Mining & Knowledge Management Process 14, no. 1/2 (March 29, 2024): 01–15. http://dx.doi.org/10.5121/ijdkp.2023.14201.

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Over the past few years, wildfires have become a worldwide environmental emergency, resulting in substantial harm to natural habitats and playing a part in the acceleration of climate change. Wildfire management methods involve prevention, response, and recovery efforts. Despite improvements in detection techniques, the rising occurrence of wildfires demands creative solutions for prompt identification and effective control. This research investigates proactive methods for detecting and handling wildfires in the United States, utilizing Artificial Intelligence (AI), Machine Learning (ML), and 5G technology. The specific objective of this research covers proactive detection and prevention of wildfires using advanced technology; Active monitoring and mapping with remote sensing and signaling leveraging on 5G technology; and Advanced response mechanisms to wildfire using drones and IOT devices. This study was based on secondary data collected from government databases and analyzed using descriptive statistics. In addition, past publications were reviewed through content analysis, and narrative synthesis was used to present the observations from various studies. The results showed that developing new technology presents an opportunity to detect and manage wildfires proactively. Utilizing advanced technology could save lives and prevent significant economic losses caused by wildfires. Various methods, such as AI-enabled remote sensing and 5G-based active monitoring, can enhance proactive wildfire detection and management. In addition, super intelligent drones and IOT devices can be used for safer responses to wildfires. This forms the core of the recommendation to the fire Management Agencies and the government.

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Lopez Pineda, Arturo, Josue Abinadi Garrido-Sanchez, Gilberto Gonzalez-Arroyo, and Cleto Alvarez-Aguilar. "A binational cancer registry analysis of Hispanic patients in Mexico and the United States." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e22513-e22513. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e22513.

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e22513 Background: A marked disparity in cancer burden exists between regions of the world. This global picture can only be obtained because of data obtained from population-based cancer registries, which allow estimates for different geographic areas. We investigate the data differences, clinical characteristics, tumor information, and patient outcomes of Hispanic patients in North America. Methods: We used data from Mexico’s National Cancer Registry and the United States Surveillance, Epidemiology, and End Results Program (SEER) program with four years of follow-up on each registry. of Mexican registry, we excluded outliers and records with more than 80% missing variable; of the United States registry, only patients identified as hispanic or latino were included. On the Mexican registry we re-coded all variables and the United States registry data on secondary neoplasm was excluded to match boths registry. Baseline characteristics and a geographical information system was constructed to map cancer registries and their relative frequencies. A survival analysis was done to understand the correlation between covariates. Lastly, we build machine learning models to predict 3-year overall survival. Results: The Hispanic cancer database (HCB) consists of 291,178 patients (19,904 from Mexico, and 271,274 from the United States). The top three most frequent cancer types were breast, prostate and hematological. The age of diagnosis was 55±17 years. Mexico has a slight skewness towards the earlier age of diagnosis of females. The registries with the highest burden of cancer were New Mexico (USA) and Baja California Sur (Mexico). Average survival months seem very stable across registries in the United States, but not in Mexico. Our linear regression model achieved a coefficient of determination (R-squared) of 0.49, while the logistic regression achieved an AUC of 0.82, with an F1-score of 0.88. Conclusions: Cancer registries are important tools for prevention and development of control programs. Hispanics are a traditionally neglected population in oncological clinical trials, with low enrollment of patients outside of the United States. Mexico enacted its National Cancer Registry Law in 2017, which alongside the Hispanic data on the SEER program in the United States offers enormous opportunities for continued collaboration and understanding of cancer. Both Mexico and the United States can strengthen their cancer prevention strategies and generate trans-border collaboration, research, and patient-support networks.

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Gold, Jeremy A. W., Jennifer DeCuir, Jayme P. Coyle, Lindsey M. Duca, Jennifer Adjemian, Kayla N. Anderson, Brittney N. Baack, et al. "COVID-19 Case Surveillance: Trends in Person-Level Case Data Completeness, United States, April 5–September 30, 2020." Public Health Reports 136, no. 4 (March 31, 2021): 466–74. http://dx.doi.org/10.1177/00333549211006973.

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Objectives To obtain timely and detailed data on COVID-19 cases in the United States, the Centers for Disease Control and Prevention (CDC) uses 2 data sources: (1) aggregate counts for daily situational awareness and (2) person-level data for each case (case surveillance). The objective of this study was to describe the sensitivity of case ascertainment and the completeness of person-level data received by CDC through national COVID-19 case surveillance. Methods We compared case and death counts from case surveillance data with aggregate counts received by CDC during April 5–September 30, 2020. We analyzed case surveillance data to describe geographic and temporal trends in data completeness for selected variables, including demographic characteristics, underlying medical conditions, and outcomes. Results As of November 18, 2020, national COVID-19 case surveillance data received by CDC during April 5–September 30, 2020, included 4 990 629 cases and 141 935 deaths, representing 72.7% of the volume of cases (n = 6 863 251) and 71.8% of the volume of deaths (n = 197 756) in aggregate counts. Nationally, completeness in case surveillance records was highest for age (99.9%) and sex (98.8%). Data on race/ethnicity were complete for 56.9% of cases; completeness varied by region. Data completeness for each underlying medical condition assessed was <25% and generally declined during the study period. About half of case records had complete data on hospitalization and death status. Conclusions Incompleteness in national COVID-19 case surveillance data might limit their usefulness. Streamlining and automating surveillance processes would decrease reporting burdens on jurisdictions and likely improve completeness of national COVID-19 case surveillance data.

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Agathis, N. T., R. Bhavaraju, V. Shah, L. Chen, C. A. Haley, N. D. Goswami, and A. Patrawalla. "Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database." Public Health Action 11, no. 3 (September 21, 2021): 162–66. http://dx.doi.org/10.5588/pha.21.0026.

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BACKGROUND: Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.METHODS: This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs’ medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.RESULTS: The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).CONCLUSION: Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.

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Owusu, Daniel, Melissa A. Rolfes, Carmen S. Arriola Velezmoro, Carrie Reed, Pam Daily Kirley, Nisha B. Alden, Evan J. Anderson, et al. "1504. Risk of Influenza-Associated Hospitalization Among Older Adults Living with Diabetes — United States, 2012–2017." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S754—S755. http://dx.doi.org/10.1093/ofid/ofaa439.1685.

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Abstract Background Older adults account for tens to hundreds of thousands of influenza-associated hospitalizations annually. Diabetes mellitus (DM) is common among patients hospitalized with influenza, yet data are limited on the impact of DM on influenza-associated hospitalizations. We compared influenza-associated hospitalization rates among older adults living with and without DM Methods We included adults ≥65 years hospitalized with influenza during 2012–13 through 2016–17 from the Influenza Hospitalization Surveillance Network (FluSurv-Net), a population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations conducted in defined catchment areas within 13 states. Influenza testing is clinician-directed, and surveillance officers identify cases through infection control logs, laboratory records and other disease reporting systems. Data on underlying conditions, including DM, were abstracted from medical records Population denominators were calculated using county-specific estimates of DM prevalence from the Centers for Medicare and Medicaid Services. We calculated hospitalization rates by state and season, and present pooled rates and rate ratios, with 95% confidence intervals (CI), using meta-analysis with state as a random effect. Results Of 31,934 patients included in the analysis, 34% had DM. DM prevalence in the FluSurv-Net source population aged ≥65 years was 25%. Accounting for variability by state, the average influenza-associated hospitalization rate per 100,000 person years from 2012-13 through 2016-17 was 276 (95% CI: 230–330/100,000) in those with DM and 181 (95% CI:150–217/100,000) in those without DM. Though the magnitude of the association varied by season, hospitalization rates among those with DM was consistently greater than those without DM (pooled rate ratio: 1.57; 95% CI: 1.43–1.72; P< .0001). Conclusion Older adults have high influenza-associated hospitalization rates, and those with DM have a 57% increased risk compared to those without DM. These findings reinforce the importance of annual influenza vaccination in adults ≥65 years of age, particularly those with DM. Disclosures Nisha B. Alden, MPH, CDC (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator) Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support)

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O'Neel, Shad, Christopher McNeil, Louis C. Sass, Caitlyn Florentine, Emily H. Baker, Erich Peitzsch, Daniel McGrath, Andrew G. Fountain, and Daniel Fagre. "Reanalysis of the US Geological Survey Benchmark Glaciers: long-term insight into climate forcing of glacier mass balance." Journal of Glaciology 65, no. 253 (September 5, 2019): 850–66. http://dx.doi.org/10.1017/jog.2019.66.

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AbstractMountain glaciers integrate climate processes to provide an unmatched signal of regional climate forcing. However, extracting the climate signal via intercomparison of regional glacier mass-balance records can be problematic when methods for extrapolating and calibrating direct glaciological measurements are mixed or inconsistent. To address this problem, we reanalyzed and compared long-term mass-balance records from the US Geological Survey Benchmark Glaciers. These five glaciers span maritime and continental climate regimes of the western United States and Alaska. Each glacier exhibits cumulative mass loss since the mid-20th century, with average rates ranging from −0.58 to −0.30 m w.e. a−1. We produced a set of solutions using different extrapolation and calibration methods to inform uncertainty estimates, which range from 0.22 to 0.44 m w.e. a−1. Mass losses are primarily driven by increasing summer warming. Continentality exerts a stronger control on mass loss than latitude. Similar to elevation, topographic shading, snow redistribution and glacier surface features often exert important mass-balance controls. The reanalysis underscores the value of geodetic calibration to resolve mass-balance magnitude, as well as the irreplaceable value of direct measurements in contributing to the process-based understanding of glacier mass balance.

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Benowitz, Isaac, Joseph Perz, and Julia Marders. "Detection of Possible Medical Product-Related Infection or Pathogen Transmission—United States, 2015–2019." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s30—s31. http://dx.doi.org/10.1017/ice.2020.508.

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Background: Medications, medical devices, biological products, and other medical products can cause healthcare-associated infections related to contamination in production or transportation (intrinsic contamination) or contamination at the point of use (extrinsic contamination). Rapid identification of contaminated medical products can lead to actions to decrease further patient harm. We sought to describe events that prompted public health investigations of contaminated medical products in healthcare facilities. Methods: We reviewed records of CDC consultations with health departments and healthcare facilities from January 2015 through August 2019 to identify public health investigations in which medical products were identified as a likely source of patient infection or pathogen transmission to at least 1 patient. We collected data on products, contamination type, pathogens, route of patient exposure, healthcare setting where exposure occurred, and resulting actions. Results: There were 34 investigations involving medications (n = 15, 44%), medical devices (n = 12, 35%), biological products (n = 3, 9%), and other medical products (n = 4, 12%). Intrinsic contamination was suspected in 15 investigations (44%), with 13 (87%) based on isolation of a pathogen from unopened products and 2 (13%) based on isolation of similar pathogens from patients in contact with a medical product at multiple facilities. Extrinsic contamination was suspected in 19 investigations (56%) based on evidence of pathogen transmission at a single healthcare facility and concurrent infection control gaps at that facility supporting a mechanism of contamination. The most common pathogens prompting investigation were nontuberculous mycobacteria (n = 9, 26%), Burkholderia spp (n = 7, 21%), Klebsiella spp (n = 3, 9%), Serratia spp (n = 2, 6%), and other environmental and commensal organisms. Patients were most commonly exposed in hospitals (n = 19, 56%) and outpatient settings (n = 9, 26%). The most common patient exposures that resulted in transmission of the pathogen were infusions and injections (n = 15, 44%), diagnostic and therapeutic procedures (n = 9, 26%), and surgery (n = 5, 15%). Patient were notified and offered testing in at least 6 investigations (18%) . Interventions included product removal, healthcare provider alerts, patient notification and testing, modification of injection safety practices and other general infection control practices, correction of improper storage and handling, and changes in product design, manufacturing processes, or instructions for use. Conclusions: Public health investigations identified intrinsic and extrinsic contamination of medications, devices, and other products as a cause of healthcare-associated infections. Healthcare facilities should consider contaminated products in investigations of healthcare-associated infections, take steps to identify local infection control concerns, and alert public health authorities to events that could suggest widespread contamination.Funding: NoneDisclosures: None

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Marquez, Edna, Eira Valeria Barrón-Palma, Katya Rodríguez, Jesus Savage, and Ana Laura Sanchez-Sandoval. "Supervised Machine Learning Methods for Seasonal Influenza Diagnosis." Diagnostics 13, no. 21 (October 31, 2023): 3352. http://dx.doi.org/10.3390/diagnostics13213352.

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Influenza has been a stationary disease in Mexico since 2009, and this causes a high cost for the national public health system, including its detection using RT-qPCR tests, treatments, and absenteeism in the workplace. Despite influenza’s relevance, the main clinical features to detect the disease defined by international institutions like the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC) do not follow the same pattern in all populations. The aim of this work is to find a machine learning method to facilitate decision making in the clinical differentiation between positive and negative influenza patients, based on their symptoms and demographic features. The research sample consisted of 15480 records, including clinical and demographic data of patients with a positive/negative RT-qPCR influenza tests, from 2010 to 2020 in the public healthcare institutions of Mexico City. The performance of the methods for classifying influenza cases were evaluated with indices like accuracy, specificity, sensitivity, precision, the f1-measure and the area under the curve (AUC). Results indicate that random forest and bagging classifiers were the best supervised methods; they showed promise in supporting clinical diagnosis, especially in places where performing molecular tests might be challenging or not feasible.

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Stewart, S. L., J. M. Wike, R. Cress, C. O’Malley, S. Neloms, A. R. Kahn, and M. J. Schymura. "Ovarian cancer treatment patterns and outcomes in the United States: A National Program of Cancer Registries (NPCR) study." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 15031. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.15031.

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15031 Background: Ovarian cancer (ovca) is the fifth leading cause of cancer death among women in the United States. In 2001, the NPCR program (administered by the Centers for Disease Control and Prevention) initiated a multi-year study to determine the first course of treatment for ovca patients in order to assess whether the ovca standard of care (as defined by the NIH Physician Data Query) was met. Methods: Population-based cancer registries in Maryland, New York, and Northern California were funded to collect patient, tumor, provider, and treatment data on patients diagnosed in these areas between 1997 and 2000. Information was collected through a retrospective medical record abstraction; all ovca records in Northern California and Maryland were included in the study, a simple random sample of ovca medical records in New York was included. Data on over 3000 patients from Northern California and New York were obtained (about 1500 patients each); data on about 1000 patients from Maryland was obtained. Patient vital status was followed through 2002. Results: Most patients were non-Hispanic white and between the ages of 50 and 79. About 30% of the tumors were papillary serous cystadenocarcinomas and almost 40% were poorly differentiated; about 66% of tumors were distant stage at diagnosis. The percentage of distant stage diagnoses increased with increasing age through age 79. Over half of patients were treated by gynecologic oncologists; obstetrician/gynecologists treated a little over 10% of patients. Overall, over 80% of patients underwent cancer directed surgery; about 50% were treated with carboplatin and about 55% were treated with paclitaxel. Patients ages 70 and older received cancer-directed surgery less often than younger patients. Overall, about 50% of patients were alive at the end of the follow-up period, with the percentage alive within age categories decreasing with increasing age. Conclusions: Age remains a negative factor in ovca presentation, treatment, and survival. Continued assessment of ovca patterns of care will enhance ovca knowledge and may aid clinicians in determining appropriate treatments for their ovca patients. No significant financial relationships to disclose.

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Friedman, Joseph, and Samir Akre. "COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the United States, January‒July 2020." American Journal of Public Health 111, no. 7 (July 2021): 1284–91. http://dx.doi.org/10.2105/ajph.2021.306256.

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Objectives. To determine the magnitude of increases in monthly drug-related overdose mortality during the COVID-19 pandemic in the United States. Methods. We leveraged provisional records from the Centers for Disease Control and Prevention provided as rolling 12-month sums, which are helpful for smoothing, yet may mask pandemic-related spikes in overdose mortality. We cross-referenced these rolling aggregates with previous monthly data to estimate monthly drug-related overdose mortality for January through July 2020. We quantified historical errors stemming from reporting delays and estimated empirically derived 95% prediction intervals (PIs). Results. We found that 9192 (95% PI = 8988, 9397) people died from drug overdose in May 2020—making it the deadliest month on record—representing a 57.7% (95% PI = 54.2%, 61.2%) increase over May 2019. Most states saw large-magnitude increases, with the highest in West Virginia, Kentucky, and Tennessee. We observed low concordance between rolling 12-month aggregates and monthly pandemic-related shocks. Conclusions. Unprecedented increases in overdose mortality occurred during the pandemic, highlighting the value of presenting monthly values alongside smoothed aggregates for detecting shocks. Public Health Implications. Drastic exacerbations of the US overdose crisis warrant renewed investments in overdose surveillance and prevention during the pandemic response and postpandemic recovery efforts.

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Malenko, Sergey, and Andrey Nekita. "VISUAL EXTREME, PERMEATED WITH THE SMELL OF FEAR AND “GUNPOWER”: BLOODY BATTLES OF THE ELITE AND THE MASS IN AMERICAN HORROR MOVIES." Experience industries Socio-Cultural Research Technologies, no. 4 (2023): 135–68. http://dx.doi.org/10.34680/eiscrt-2023-4(5)-135-168.

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Communication between the elite and the masses in the context of modern culture over time acquires a rather specific and atypical character. Instead of the usual system of coercion in its diverse forms, in modern institutional, socio-political discourse, visual methods of manipulating feelings, thoughts, moods and behavior of people are becoming increasingly popular. The continuous competition of fundamentally unconscious complexes of corporate economic and political interests becomes the leading reason for the active transformation of the modern management system under the influence ofdecisive biopolitical arguments, forcibly introduced by the authorities into the subordinate socio-cultural space. Being an archaic form of realizing power interests, war today is becoming widespread, replacing physical coercion with methods of media programming of the feelings, thoughts and behavior of individuals. The American horror film has successfully positioned itself as one of the most effective ideological tools for establishing effective biopolitical control both within and outside the United States; it acts as a modern, attractive and non-trivial way of aestheticization and visual propaganda of violence as natural forms of existence of civilization.

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Johnson, Desalyn Louise, Waldemar Carlo, Fazlur AKM Rahman, Rachel Tindal, and Colm Travers. "163 Private or Public Health Insurance and Infant Outcomes in the United States." Journal of Clinical and Translational Science 6, s1 (April 2022): 18. http://dx.doi.org/10.1017/cts.2022.71.

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OBJECTIVES/GOALS: Health insurance status is associated with differences in access to healthcare and health outcomes. The objective of this study was to test the hypothesis that among infants born in the United States, maternal private insurance compared with public Medicaid insurance would be associated with a lower infant mortality rate (IMR). METHODS/STUDY POPULATION: This ecological study used data from the Center for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database 2017-2018. We included hospital-born infants from 20 to 42 weeks of gestational age (wga) if the mother had either private or Medicaid insurance. We excluded infants with congenital anomalies and infants who died due to congenital anomalies. We used negative-binomial regression adjusted for race, sex, multiple birth, and any maternal pregnancy risk factors (as defined by the CDC) to determine the difference in IMR between private and Medicaid insurance. Chi-square or Fishers exact test was used to compare differences in categorical variables between groups. RESULTS/ANTICIPATED RESULTS: We included 6,901,328 infants; 53.6% had private insurance and 46.4% were insured by Medicaid. Privately insured infants had a lower IMR compared with Medicaid insured infants (2.84/1000 vs. 5.32/1000; adjusted relative risk (aRR) 0.71; 95% confidence intervals (CI) 0.62 to 0.81; p<.0001). The privately insured had higher rates of 1st trimester prenatal care compared to those with Medicaid (85.6% vs. 66.6%; p<.00001). Rates of infant morbidity and maternal morbidity (per CDC definitions) were lower among the privately insured compared to those with Medicaid (both p<.00001). The privately insured had lower rates of preterm (9.1% vs. 11.0%), extremely preterm (0.5% vs. 0.7%), low birth weight (7.1% vs. 9.6%), and extremely low birth weight (0.5% vs. 0.7%) births compared to those with Medicaid (all p<0.001). DISCUSSION/SIGNIFICANCE: Private insurance is associated with a lower IMR compared to Medicaid insurance. Privately insured pregnancies also have higher rates of early prenatal care, less morbidity, and less preterm and low birth weight births. There may be opportunities to improve access to care and pregnancy outcomes among Medicaid insured pregnancies in the United States.

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BAGLEY, JUSTIN C., CAL C. JOHNSON, STUART W. MCGREGOR, MARIA F. BREITMAN, JONATHAN W. ARMBRUSTER, PHILLIP M. HARRIS, and PATRICK E. O’NEIL. "Marine and freshwater fishes of Alabama: a revised checklist and discussion of taxonomic issues." Zootaxa 5357, no. 3 (October 19, 2023): 301–41. http://dx.doi.org/10.11646/zootaxa.5357.3.1.

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Checklists are fundamental and important tools for organizing information about biodiversity that provide a basis for conservation and additional scientific research. While Alabama is recognized as an aquatic biodiversity ‘hotspot’ with the highest native freshwater fish diversity in the contiguous United States, we currently lack an up-to-date list of the state’s fishes. In particular, much has changed over the past ~20 years regarding our knowledge of fishes from Alabama and the Mobile River Basin, rendering past comprehensive treatments by Mettee et al. (1996) and Boschung and Mayden (2004) out of date. Here, we provide a revised checklist of marine and freshwater fishes known from the coastal and inland waters of Alabama that includes 463 species (335 primarily freshwater fishes, and 128 marine or diadromous fishes) in 35 orders, 78 families, and 176 genera. Extant, extirpated, and extinct species are included, as are putative candidate species. The checklist is based on prior work, searches of the literature and online sources, as well as parsing a large compilation of >140,000 fish records for Alabama and the Mobile River Basin from 37 data providers in the global Fishnet2 database (www.fishnet2.net) and >4000 marine survey records from the SEAMAP database (https://www.gsmfc.org/seamap.php). After editing and quality control checks, the final combined database contained 144,215 collection records, ~95% of which were georeferenced. We discuss the species descriptions, nomenclatural changes, and updates to marine species that account for changes to the state list, and we close with a discussion of ~13 candidate species forms that remain undescribed, which represent outstanding taxonomic issues in need of further research attention.

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Kidd, Sarah, Adriana Lopez, W. Allan Nix, Gloria E. Anyalechi, Megumi Itoh, Eileen L. Yee, M. Steven Oberste, and Janell A. Routh. "48. Clinical Characteristics of Acute Flaccid Myelitis Cases Associated with Enteroviruses D68 and A71 — United States, 2018." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S154. http://dx.doi.org/10.1093/ofid/ofaa439.358.

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Abstract Background Acute flaccid myelitis (AFM) is an uncommon but serious condition that causes paralysis in previously healthy children. Multiple viruses can be associated with AFM. In 2018, enteroviruses D68 (EV-D68) and A71 (EV-A71) were the most common viruses detected among patients with confirmed AFM. We described and compared clinical characteristics of cases associated with EV-D68 and EV-A71. Methods Health departments report cases meeting AFM clinical criterion (acute onset of flaccid limb weakness) to the Centers for Disease Control and Prevention along with medical records. Confirmed AFM cases were patients who met clinical criterion and had magnetic resonance imaging (MRI) showing spinal cord lesions largely restricted to gray matter. We abstracted clinical data and laboratory results from records of confirmed case-patients with onset of limb weakness during 2018. EV-D68 and EV-A71 cases were compared using chi-square and Wilcoxan rank sum tests. Results Among 238 confirmed AFM cases, 34 had EV-D68 and 12 had EV-A71 detected in a respiratory, serum, stool, or cerebrospinal fluid specimen. Median age of EV-D68 and EV-A71 cases were 5.9 and 1.6 years, respectively (p< 0.01). EV-D68 cases came from 20 states, while 11/12 EV-A71 cases were from Colorado. Prodromal respiratory illness was more common among EV-D68 (97%) than EV-A71 cases (58%) (p< 0.01). Prodromal rash was more common among EV-A71 (58%) than EV-D68 cases (9%) (p< 0.01). At presentation, the most common symptoms accompanying limb weakness among EV-D68 cases were neck/back pain (59%), gait difficulty (56%), and fever (47%). Among EV-A71 cases, the most common symptoms were fever (67%), ataxia (67%), gait difficulty (50%), and altered consciousness (50%). EV-A71 cases were more likely to have ataxia, altered consciousness, and brainstem (92% vs. 45%) or cerebellar (75% vs. 9%) lesions on MRI (all p< 0.01). EV-D68 cases were more likely to require mechanical ventilation (44% vs. 8%, p 0.03). Conclusion These national data suggest that EV-D68 and EV-A71 are associated with overlapping but different clinical phenotypes. Differences in demographics, prodromal illness, symptoms, and brain MRI findings were identified. Additional research is needed to determine whether pathogenesis and optimal treatment also vary by virus type. Disclosures All Authors: No reported disclosures

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Cummings, K. Michael, Jonathan Gdanski, Nichole Veatch, and Ernesto Marcelo Sebrié. "Assumption of Risk and the Role of Health Warnings Labels in the United States." Nicotine & Tobacco Research 22, no. 6 (May 25, 2019): 975–83. http://dx.doi.org/10.1093/ntr/ntz089.

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Abstract Introduction This article provides historical context for understanding how the cigarette industry have manipulated language used in health warning labels (HWLs) to protect them in litigation. Methods Review of previously secret internal business records from 1964 discussing the role HWLs on cigarettes. Review of the legal challenges made by cigarette manufacturers surrounding HWLs as mandated in the 2009 Family Smoking Prevention and Tobacco Control Act and the language in corrective statements ordered by US Department of Justice. Results Within days after the Surgeon General’s Advisory Committee issued its 1964 Report the cigarette companies plotted how they could use HWLs on cigarettes as a defense in future litigation. Industry lawyers discussed drafting legislation that would preempt other government agencies from requiring HWLs on cigarette containers and in cigarette advertising with language mirroring the key findings of the Surgeon General’s Advisory Committee report. In July 1965, Congress did pass legislation which mandated a single watered-down cigarette pack HWL which excluded cigarette advertising, just as industry lawyers had recommended. Subsequent HWL laws passed by Congress in 1969 and 1984 along with the more recent history of manufacturers opposing updated graphic HWLs and corrective statements reflects a consistent and continuing effort by cigarette companies to insulate themselves from taking responsibility for harms caused by smoking. Conclusion Beginning in the mid-1960s and continuing even through today, lawyers working on behalf of cigarettes companies have worked to manipulate the language of consumer warnings to focus responsibility for the harms caused by smoking on smokers. Implications In tobacco litigation, juries should be informed about the industry’s coordinated effort to draft legislation and water down the original caution statements proposed on cigarette containers and in advertising even though Congress ultimately is responsible for the law that was enacted. In addition, even though the 1992 Supreme Court decision in the Cipollone case preempted post-1969 failure to warm claims against cigarette makers, this protection does not apply on pre-1969 warning claims where the evidence shows that cigarette companies understood they were selling a defective product that when used as intended would harm their customers. Thus, those initiating smoking before 1969 and subsequently harmed by cigarettes can hold cigarette makers responsible for their failure to warn them about health risks.

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Kortas, Kenneth J., and Laurie Quinn. "Diabetes Education: A Multidisciplinary Team Approach." Journal of Pharmacy Practice 5, no. 5 (October 1992): 238–53. http://dx.doi.org/10.1177/089719009200500503.

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Diabetes mellitus is one of the leading causes of mortality and morbidity in the United States, showing an incidence of over 14 million individuals, with the numbers increasing yearly. Current evidence suggests that maintaining normal blood glucose levels will result in preventing or lessening the degree of acute and chronic complications of diabetes. Therefore, because many of the complications of diabetes may be prevented or lessened by strict glycemic control, it is of the utmost importance that the individual with diabetes understand the roles of diet, exercise, and insulin/oral hypoglycemics in the management of his or her diabetes. This is an area in which diabetic education plays an important role. The properly educated individual with diabetes can learn to increase or decrease insulin, to change diet, or to modify exercise regimens based on results of home blood glucose-monitoring to achieve normoglycemia. This article discusses a multidisciplinary team approach to educating the diabetic patient. This involves using the skills of physicians, pharmacists, nurses, dieticians, and other health care professionals, as well as teaching tools such as diabetes patient assessment forms, diabetes education, and teaching documentation records. It should become clear from this discussion the active role that pharmacists can play as an important member of the diabetic education team.

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Richert-Boe, K. E., L. L. Humphrey, A. G. Glass, and N. S. Weiss. "Screening digital rectal examination and prostate cancer mortality: a case-control study." Journal of Medical Screening 5, no. 2 (June 1, 1998): 99–103. http://dx.doi.org/10.1136/jms.5.2.99.

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Background Prostate cancer is the second most common cause of death from cancer in men in the United States. Digital rectal examination is the oldest and most commonly used screening test for prostate cancer, but as yet there are no studies which demonstrate its effectiveness. Methods A case-control study was conducted among members of a large health maintenance organisation to estimate the effect of screening digital rectal examination on mortality from prostate cancer. 150 men, aged 40–84 when cancer was diagnosed, who developed fatal prostate cancer, and 299 male controls matched for age who did not die from prostate cancer were studied. A history of screening digital rectal examination during the 10 years before the date on which cancer was diagnosed was determined from medical records. Results A similar proportion of men who died from prostate cancer and controls had undergone at least one screening digital rectal examination during the 10 year interval (odds ratio = 0.84, 95% confidence interval 0.48 to 1.46). Similar results were obtained when a shorter interval (such as five years before diagnosis) during which screening histories were evaluated was considered, or in analyses in which men with a history of benign prostatic hypertrophy were excluded. Conclusions The data suggest that screening digital rectal examination does not reduce mortality from prostate cancer to any appreciable degree.

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Sanchez, Emily, Ryan Simpson, Lauren Sallade, Yutong Zhang, and Elena Naumova. "Foodborne Illness Outbreak Severity Across Geographic and Supply Chain Contamination Locations in the United States, 2009–2019." Current Developments in Nutrition 6, Supplement_1 (June 2022): 946. http://dx.doi.org/10.1093/cdn/nzac067.066.

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Abstract Objectives In 2009, the Centers for Disease Control and Prevention's National Outbreak Reporting System (NORS) began collecting supply chain contamination data as part of foodborne outbreak (FBO) traceback investigations. We created an integrated FBO severity score measure and examined differences in FBO severity by geographic and supply chain contamination locations. We used 9,407 NORS records between 2009–2019 to demonstrate the utility of the proposed methodology. Methods The severity scores were composed of 11 metrics based on outbreak intensity and duration characteristics and metrics’ completeness. Metrics were normalized (with natural log-transformation), calibrated (to 0–1 scale), and weighed (by completeness) across all recorded outbreaks. Individual outbreak scores ranged from 0 (lowest severity) to 1 (highest severity). We compared averages of severity scores across geographic (i.e., multistate and single state exposure outbreak) and supply chain contamination locations (i.e., suspected or confirmed before preparation, preparation, unknown and missing) using tobit-regression models. Results All FBOs reported the state of exposure; 5,500 (58.5%) reported supply chain contamination location. Multistate exposure FBOs had higher median severity scores than single state outbreaks (0.54 [0.44, 0.67] vs 0.28 [0.16, 0.41], P < 0.001). FBOs with reported point of contamination that occurred before preparation had higher median severity scores than all other stages (0.36 [0.27, 0.49] vs 0.26 [0.15, 0.41], 0.25 [0.13, 0.39], and 0.29 [0.16, 0.43], P < 0.001, for preparation, unknown and missing stages respectively). Conclusions Understanding an FBO's severity by geographic and supply chain contamination location helps to quantify supply chain vulnerability and improve monitoring of food safety. Identification of supply chain contamination at high level granularity and completeness is critical for developing foodborne outbreak (FBO) prediction analytics aimed to reduce both the volume and severity of outbreaks and illnesses. Funding Sources DoD, ODNI, NIFA, NSF, USIAD.

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Hauser, Ronald George, Douglas B. Quine, and Alex Ryder. "LabRS: A Rosetta stone for retrospective standardization of clinical laboratory test results." Journal of the American Medical Informatics Association 25, no. 2 (May 12, 2017): 121–26. http://dx.doi.org/10.1093/jamia/ocx046.

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Abstract Objective Clinical laboratories in the United States do not have an explicit result standard to report the 7 billion laboratory tests results they produce each year. The absence of standardized test results creates inefficiencies and ambiguities for secondary data users. We developed and tested a tool to standardize the results of laboratory tests in a large, multicenter clinical data warehouse. Methods Laboratory records, each of which consisted of a laboratory result and a test identifier, from 27 diverse facilities were captured from 2000 through 2015. Each record underwent a standardization process to convert the original result into a format amenable to secondary data analysis. The standardization process included the correction of typos, normalization of categorical results, separation of inequalities from numbers, and conversion of numbers represented by words (eg, “million”) to numerals. Quality control included expert review. Results We obtained 1.266 × 109 laboratory records and standardized 1.252 × 109 records (98.9%). Of the unique unstandardized records (78.887 × 103), most appeared <5 times (96%, eg, typos), did not have a test identifier (47%), or belonged to an esoteric test with <100 results (2%). Overall, these 3 reasons accounted for nearly all unstandardized results (98%). Conclusion Current results suggest that the tool is both scalable and generalizable among diverse clinical laboratories. Based on observed trends, the tool will require ongoing maintenance to stay current with new tests and result formats. Future work to develop and implement an explicit standard for test results would reduce the need to retrospectively standardize test results.

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Kim, Richard D., Cherrishe Brown-Bickerstaff, Angele Kotomale, Michael A. Rodriguez, Bruce A. Feinberg, Sarah Gordon, Kristin M. Zimmerman Savill, Haobo Ren, Michael Blecker, and Kim Saverno. "Real-world use of pemigatinib (pemi) for cholangiocarcinoma (CCA) among racial and ethnic minorities in the United States." Journal of Clinical Oncology 42, no. 3_suppl (January 20, 2024): 461. http://dx.doi.org/10.1200/jco.2024.42.3_suppl.461.

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461 Background: Pemi received accelerated approval by the FDA in 2020 for treatment of patients (pts) with unresectable locally advanced or metastatic CCA with a fibroblast growth factor receptor 2 ( FGFR2) fusion or other FGFR2 rearrangement. A recent real-world study (RWS; submitted to ASCO-GI 2024) assessing characteristics, FGFR2 testing patterns, treatment patterns, and outcomes of pts treated with pemi for locally advanced or metastatic CCA in the US as part of routine clinical care found substantial racial and ethnic diversity in pts treated with pemi. The purpose of this analysis is to describe the findings of the pemi RWS for CCA by race and ethnicity. Methods: This was a retrospective cohort study in which US-based participating physicians from Cardinal Health’s Oncology Provider Extended Network abstracted data from eligible pts’ medical records into electronic case report forms. Eligible pts were ≥18 years of age, initially prescribed pemi for unresectable locally advanced or metastatic CCA on or after 4/17/2020, and had ≥4 mo of follow-up (unless <4 mo due to death). Pts who did not receive pemi or had received pemi in a clinical trial or systemic therapy for another primary malignancy (except for cancer of unknown primary or hepatic cancer) were excluded. Results were summarized by race (White, Black/African American, “Other” [pts with mixed race or a race other than White, Black/African American, or Unknown]) and ethnicity (Non-Hispanic, Hispanic) using descriptive statistics. Results: 18 physicians abstracted data for 120 eligible pts. Median follow-up from initial pemi prescription was 6.5 mo, at which time 71 pts (59%) were alive and 60 (50%) were still receiving pemi. The racial makeup of the study population was 55% White, 21% Black, 18% Other, and 7% Unknown. Ethnic composition was 78% Non-Hispanic, 19% Hispanic, and 3% Unknown. Key results are presented in the Table. Conclusions: The diverse population in this RWS is reflective of the heterogeneous CCA pt population in the US. These real-world overall response rates support the clinical benefit of pemi across racial and ethnic groups and complement the results of the clinical trial. [Table: see text]

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Noharet-Koenig, Roxane, Katarzyna Lasota, Pascaline Faivre, and Edith Langevin. "Evolution of Pneumococcal Vaccine Recommendations and Criteria for Decision Making in 5 Western European Countries and the United States." MDM Policy & Practice 8, no. 1 (January 2023): 238146832311744. http://dx.doi.org/10.1177/23814683231174432.

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Objectives Pneumococcal vaccine recommendations have become increasingly complex. This study aims to understand how national immunization technical advisory groups (NITAGs) and health technology assessment (HTA) agencies of 5 European countries and the United States formed their pneumococcal vaccine recommendations, by providing reviewed evidence and key drivers for new recommendations. Methods Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, and National Health Authorities Web sites were screened to capture the evolution of pneumococcal recommendations. A narrative review was conducted on NITAGs and HTA bodies’ Web sites. Assessments of pneumococcal vaccines published from 2009 to 2022 were included. Results Thirty-four records were identified including 21 assessments for risk groups, 17 for elderly, and 12 for children. Burden of disease and vaccine characteristics were almost systematically reviewed during assessments. All 6 countries recommended the use of higher-valent pneumococcal vaccine (PCV; i.e., PCV10 and PCV13) in childhood vaccination programs, given their broader serotype coverage and their comparable profile to PCV7. PCV13 was progressively added to the vaccine schedule (in addition to polysaccharide vaccine) in at least the high-risk group, given the high burden in this population and expected additional benefits of PCV13. For the elderly, unlike the United States, European countries issued negative recommendation for PCV13 routine use because of substantial herd effects from childhood vaccination program making PCV13 likely not cost-effective. Conclusions This research provides an overview of decision-making processes for higher-valent PCVs recommendations and could be of interest to anticipate the place of next generation of PCVs in the vaccination landscape. Highlights By describing evidence-based criteria for decision making, this study emphasizes the framework analysis of NITAGs and HTA bodies when assessing pneumococcal vaccines and demonstrates that variation exists between countries and also according to population evaluated. While the burden of disease and immunogenicity/efficacy data were almost systematically reviewed by national stakeholders, economic assessments were reported to a lesser extent but played a major role in the limited use of PCV13 in the adult population.

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Singal, Amit G., Saurabh P. Nagar, Abigail Hitchens, and Shrividya Iyer. "Real-world effectiveness of lenvatinib monotherapy among previously treated unresectable hepatocellular carcinoma patients in United States clinical practices." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e16129-e16129. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e16129.

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e16129 Background: In the United States (U.S.), lenvatinib monotherapy was approved in August 2018 for first-line treatment of patients with unresectable hepatocellular carcinoma (uHCC) based on the pivotal trial, REFLECT. Treatment patterns in uHCC are evolving with recent approvals. The main objective of our real-world data (RWD) study was to assess treatment patterns and clinical effectiveness of lenvatinib among previously treated uHCC patients in U.S. clinical practices. Methods: A retrospective patient chart review study was conducted among U.S. adult patients (≥18 years) with uHCC and ECOG status of 0 or 1, who initiated lenvatinib monotherapy as second- or later-line systemic therapy between Aug 2018 and Sept 2019. Data were extracted from individual patients’ electronic health records and captured in electronic case report forms. Clinical outcomes assessed include provider-reported best response, progression-free survival (PFS) and overall survival (OS). PFS and OS were estimated using Kaplan-Meier methods. For PFS, patients were censored at end of treatment or end of follow-up in case of ongoing treatment, while censoring occurred at end of follow-up for OS. Results: Of 164 patients, median age was 62 years, majority were male (72%), and most were Caucasian (56%) followed by African American (23%). The most common liver disease etiologies were alcohol-related (32%), hepatitis C (26%), non-alcoholic steatohepatitis (21%) and hepatitis B (15%). Only one-third (31%) had Child Pugh A cirrhosis, with nearly half (49%) having Child Pugh B cirrhosis. Most patients had Barcelona Clinic Liver Cancer Stage B (24%) or C (38%) disease. Median body weight was 77 kg, and the median starting dose of lenvatinib was 12 mg daily. Median duration of lenvatinib treatment was 6.9 months, with 43% of patients remaining on lenvatinib at end of follow-up. RECIST v1.1 was reported as the criteria used to assess response in 60% of patients. Provider-reported best response was complete response (CR):9%, partial response (PR):45% and stable disease (SD): 26%. Median PFS and median OS were estimated to be 12.5 months and 14.0 months respectively. At 6 and 12 months, landmark PFS was 71% and 52%, respectively and landmark OS was 84% and 58%, respectively. PFS and OS estimates were consistent in subgroup analyses among those who had received lenvatinib in the second-line (81%, n=133) or treated with lenvatinib post immunotherapy (66%, n=109) (Table). Conclusions: Results from this retrospective real-world study affirm the clinical effectiveness of lenvatinib monotherapy among previously treated uHCC patients, including those with prior immunotherapy.[Table: see text]

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Patel, Bindiya, Suhong Luo, Tanya M. Wildes, and Kristen M. Sanfilippo. "Frailty in Older Adults with Multiple Myeloma: A Study of United States Veterans." Blood 134, Supplement_1 (November 13, 2019): 3478. http://dx.doi.org/10.1182/blood-2019-124971.

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Introduction: Multiple Myeloma (MM) predominantly affects older patients, and treatment in older patients is fraught with challenges due to the spectrum of aging-associated vulnerabilities present in older patients. Age-associated cumulative decline across physiological systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in retrospective data, including the electronic medical record, can allow for assessment of prognosis, provide input during treatment selection and facilitate control for confounding, as in comparative effectiveness research. A frailty index (FI) operationalizes frailty using an accumulation of health-related deficits (Rockwood 2007). The deficits accumulation approach to frailty is validated in many populations and settings, including in older patients with cancer receiving chemotherapy and older adults with myeloma. Routinely collected health information in the electronic medical record system may provide a standardized and feasible means of identifying cumulative deficits and generating a FI in older adults with myeloma. The objective of this study was to develop a claims-based FI in veterans with MM. Methods: From the Veterans Administration Central Cancer Registry (VACCR), we identified all patients aged 65 years and older diagnosed with MM between 1999 and 2014. For the construction of the FI using an accumulation of health-related deficits model, we followed the method described by Orkaby et al (Orkaby, J Gerontol A Biol Sci Med Sci, 2018). The FI is calculated by dividing the total number of deficits an individual has by the total number of possible variables, giving a score between 0 and 1. We included 31 deficits in a range of systems including comorbidity, functional status, cognition, mood, sensory loss, and other geriatric domains. We categorized the FI into five groups as recommended: non-frail (FI 0-0.1), pre-frail (0.11-0.20), mild frailty (0.21-0.30), moderate frailty (0.31-0.40), and severe frailty (>0.4). We used Kaplan-Meier curves to demonstrate the relationship between frailty status and mortality in patients with MM. Next, we used cox proportional hazards regression to control for the following factors in the mortality analyses: age, BMI, race, diagnosis year, MM treatment, bisphosphonate use, and statin use. Results: We identified 3807 patients aged 65 years and older diagnosed with MM. Prior to starting treatment for MM, 28.7% of the cohort was classified as non-frail, 41.3% as pre-frail, 21.6% as mildly frail, 6.6% as moderately frail, and 1.7% as severely frail. Increasing frailty status was associated with increased mortality (Figure 1). The median overall survival for non-frail veterans was 38 months, compared to those who were pre-frail (27 months), mildly frail (15 months), moderately frail (8 months), and severely frail (9 months). After controlling for the relevant variables, higher frailty score remained significantly associated with higher mortality (Table 1). Conclusions: In this study, we demonstrate a systematic method of calculating a FI using the readily available administrative and claims data from the Electronic Medical Record in veterans with MM. Frailty status was strongly associated with mortality, independent of age, race, BMI, MM treatment, and statin use. Assessment of frailty status using the readily available electronic medical records data in retrospective data allows for assessment of prognosis. Disclosures Sanfilippo: Bristol-Myers Squibb: Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Other: Travel Expenses; NHLBI: Research Funding.

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Singal, Amit G., Saurabh P. Nagar, Abigail Hitchens, and Shrividya Iyer. "Real-world effectiveness of lenvatinib monotherapy among unresectable hepatocellular carcinoma patients treated in United States clinical practices." Journal of Clinical Oncology 39, no. 3_suppl (January 20, 2021): 273. http://dx.doi.org/10.1200/jco.2021.39.3_suppl.273.

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273 Background: In the United States (U.S.), lenvatinib monotherapy was approved in August 2018 for first-line treatment of patients with unresectable hepatocellular carcinoma (uHCC) based on the pivotal trial, REFLECT. Real-world data are essential to assess if this efficacy translates into effectiveness in clinical practice. The main objective of our real-world data (RWD) study was to assess clinical characteristics and effectiveness of lenvatinib among patients treated in U.S. clinical practices. Methods: A retrospective patient chart review study was conducted among adult patients (≥18 years) in the U.S. initiating lenvatinib monotherapy as first-line (1L) systemic therapy for uHCC between Aug 2018 and Sept 2019 and with ECOG status of 0 or 1. Data were extracted from individual patients’ electronic health records and captured in electronic case report forms. Clinical outcomes assessed include provider-reported best response, progression-free survival (PFS) and overall survival (OS). PFS and OS were estimated using Kaplan-Meier methods. For PFS, patients were censored at end of treatment or end of follow-up in case of ongoing treatment, while censoring occurred at end of follow-up for OS. Results: Among 233 patients treated with 1L lenvatinib monotherapy, majority were male (68%) and most were Caucasian (52%) or African American (25%). Median age was 63 years and median body weight was 76 kg. The most common etiologies of liver disease were hepatitis C (36%), alcohol-related liver disease (28%), hepatitis B (16%) and non-alcoholic steatohepatitis (14%). Most patients had compensated cirrhosis, with 49% Child Pugh A and 43% Child Pugh B. All patients had uHCC, with most having Barcelona Clinic Liver Cancer stage B (29%) or C (44%) disease. Portal vein invasion was reported in 19%, of whom7% had main portal vein involvement. The median starting dose of lenvatinib was 12 mg daily. Over a median follow-up period of 9 months from HCC diagnosis, median PFS and OS were not reached. At 6 and 12 months landmark PFS was 85% and 65%, respectively and landmark OS was 92% and 73%, respectively. In the overall cohort, provider-reported best response was complete response (CR): 21%, partial response (PR):44% and stable disease (SD): 26%. Based on RECIST 1.1 (n = 125) CR:16%, PR:54%, SD:26% and mRECIST (n = 11) CR:73%, PR:0% and SD:18% were reported. Average duration of lenvatinib treatment was 7.4 months (median: 6.7 months) with 61% of patients remaining on lenvatinib at end of follow-up. Second-line (2L) treatment was initiated in 32 patients, with immunotherapy (50%), sorafenib (31%) and regorafenib (9%) being most common. Median time to 2L treatment from initiation of lenvatinib was about 8 months. Conclusions: Results from this retrospective real-world study in an U.S. population affirm the clinical effectiveness of 1L lenvatinib monotherapy among patients with uHCC.

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Rankin, Shelley C., and Stephen D. Cole. "An Outbreak of New Delhi Metallo--Lactamase-5 (blaNDM-5)–Producing Escherichia coli in Companion Animals in the United States." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s21. http://dx.doi.org/10.1017/ice.2020.496.

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Background: The emergence of carbapenem-resistant Enterobacteriaceae (CRE) in companion animals will be a game changer for infection prevention and control strategies in veterinary and human healthcare facilities. CRE have emerged as an important cause of human healthcare-associated infections and are a major clinical and public health problem. Although reports of CRE from animals are still very rare, they have been documented in China, Europe, and the United States. Methods: In April 2019, a passive veterinary surveillance system identified the blaNDM-5 gene in an E. coli isolated from a dog in Philadelphia in July 2018. CRE are reportable to the Philadelphia Department of Public Health (PDPH), and in May 2019, the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania (MJRVH) reported a cluster of carbapenem-resistant E. coli (CR-E. coli) isolated from 14 animals to the PDHP. This cluster of 17 isolates, that all contained a blaNDM-5 gene, was the first report of a CR-E. coli outbreak at a US veterinary facility. The first isolate, E. coli 24213-18, was sequenced on the Pacific Biosciences (PacBio) Sequel Sequencer and has been uploaded to GenBank. Whole genome sequencing was performed on all 17 isolates using the Illumina MiSeq platform. Antimicrobial resistance genes were identified from the National Center for Biotechnology Information Pathogen Detection Isolates Browser using AMRFinder. Results: PacBio sequencing confirmed E. coli ST167 and identified a circular IncFII plasmid of 139,547 bp that contained the blaNDM-5 gene, along with many additional resistance genes. In June 2019, a retrospective review of hospital records was completed and showed that, from July 2018, 17 CR- E. coli were isolated from 14 animals. Conclusions: Control of CRE infections in human healthcare settings is challenging because the organisms colonize the gastrointestinal tract and can go undetected. The same issue is to be expected with companion animals. Healthcare-associated spread of CRE E. coli in a veterinary facility emphasizes the importance of rapidly identifying and characterizing carbapenem-resistant isolates from animals. Methods to control the spread of CRE in veterinary medical settings have not yet been studied, and related investigations will be critically important to limit the transmission of these pathogens in animal populations. The risk of transmission of CRE from animals to people is currently poorly understood. CRE will be a major challenge across all health fields as these organisms become more prevalent in the community. It is likely that a ‘One Health’ approach to surveillance, infection prevention, and antimicrobial stewardship will be required to limit the spread and potential global dominance of CRE.Funding: NoneDisclosures: None

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Farrar, Mallory, Robert Farber, Ginny P. Sen, Charles Yonan, and Jean Lin Chan. "Real-World Evidence of Clinical Outcomes in Patients With Assumed Classic Congenital Adrenal Hyperplasia in the United States." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A93—A94. http://dx.doi.org/10.1210/jendso/bvab048.187.

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Abstract Background: Classic congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder, usually due to a deficiency in the 21-hydroxylase enzyme, that results in impaired cortisol synthesis and excess androgen production. Patients with classic CAH experience both disease-related features from excess androgens and treatment-related complications from the chronic, supraphysiologic use of glucocorticoids (GCs) often required for androgen control. This study was conducted to evaluate the demographics and clinical characteristics of adult and pediatric patients in the United States (US) with assumed classic CAH based on International Classification of Diseases (ICD) codes, GC prescriptions, and medical claims. Methods: Analyses were based on longitudinal patient-level data from the Decision Resources Group Real World Evidence repository, which links medical claims, prescription claims, and electronic health records from >300 million US patients. Data were analyzed for patients aged ≥18 years (adult) and <18 years (pediatric) with assumed classic CAH based on ICD 9/10 codes associated with “adrenogenital disorders” and whose proportion of days covered with a GC in 2018–2019 was >75%. These patients were matched 1:3 with a control cohort based on age, gender, geographic region, and insurance type. Both assumed CAH and control cohorts had continuous coverage with at least 1 medical claim and 1 pharmacy claim in each year, 2018–2019. Results: Of 1,111 patients with assumed classic CAH, 778 were ≥18 years old (65% female; mean age [±SD], 43±17 years) and 333 were <18 years old (51% female; mean age [±SD], 11±4.7 years). Both adult and pediatric patients with assumed classic CAH were more likely than matched controls (adult N=2334; pediatric N=999) to experience events that could be related to chronic GC use, including infection (adult: 49.9% vs 37.3% [control]; pediatric: 49.5% vs 40.0%), weight gain (adult: 5.9% vs 2.5%; pediatric: 9.0% vs 2.6%), and moon face (adult: 44.0% vs 0.1%; pediatric: 37.8% vs 0.1%); all P<0.01 vs control. Adult patients were more likely than matched controls to experience acne (6.0% vs 3.6%), hirsutism (8.1% [47/508] vs 5.5% [84/1524]), and infertility (1.7% vs 0.4%); all P<0.01. Pediatric patients were more likely to experience pubertal development issues (10.5% vs 1.8%), acne (8.4% vs 5.1%), and advanced bone age (1.2% vs 0.1%); all P<0.05. Conclusions: Compared to matched controls, both adult and pediatric patients with assumed classic CAH had significantly more disease-related comorbidities and potential GC treatment-related conditions, indicating the challenges with current GC treatments. This study was limited by the assumed nature of classic CAH due to lack of a specific ICD code, but the combination of chronic GC use (>75% days) with the diagnosis code most likely used in these patients (adrenogenital disorder) supports the validity of this analysis.

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O’Laughlin, Kevin, Jennifer R. Cope, and Zachary A. Marsh. "354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S246. http://dx.doi.org/10.1093/ofid/ofaa439.549.

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Abstract Background Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States. Methods CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies. Results We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively. Conclusion Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment. Disclosures All Authors: No reported disclosures

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Wagner, JoAnna, Ami Gandhi, Bill Johnson, Nicole Gualandi, Danae Bixler, Tonya Hayden, Po-Yi Ho, Sumathi Ramachandran, Priti Patel, and Jeanne Negley. "Hepatitis C Virus Transmission at a Long-Term Care Facility (LTCF) Providing Hemodialysis Services—Georgia, United States, 2019." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s248—s249. http://dx.doi.org/10.1017/ice.2020.808.

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Background: Hepatitis C virus (HCV) transmission at outpatient hemodialysis clinics is well documented, but little is known about HCV transmission risks in long-term care facilities (LTCFs) providing hemodialysis services. LTCFs can provide onsite hemodialysis for residents by contracting with a licensed hemodialysis clinic to either provide its staff to the LTCF or to train LTCF staff as caregivers. In August 2019, the Georgia Department of Public Health (DPH) was notified about an HCV seroconversion in patient A at a LTCF providing onsite hemodialysis. Methods: Three residents (including patient A) were receiving hemodialysis at the LTCF in August 2019; patients B and C had chronic HCV infection upon admission. Records were reviewed for medical history, behavioral risk factors, and healthcare exposures. We conducted onsite infection control assessments and interviewed staff. Serum specimens were collected for all 3 patients in August 2019 and HCV tested for genetic similarity using Global Hepatitis Outbreak Surveillance Technology (GHOST). Results: The facility reported initiating onsite hemodialysis in November 2018; facility staff were trained by a dialysis provider. Patient A, admitted in September 2018, was anti-HCV negative in June 2019 and both anti-HCV and HCV RNA positive in July 2019. Patient B was admitted in December 2018, discharged for 1 month in May 2019, and then readmitted. Patients A and B reported previous injection drug use, and they were not observed by staff to use during their stay and had limited mobility. Patient A was wheelchair confined and B was bed confined. Patient C was admitted in May 2019. HCV samples from patients A and B both had HCV genotype 1b and demonstrated 100% genetic relatedness, indicating that patient B was the likely source. Patient C had HCV genotype 1a. Hemodialysis was provided to residents simultaneously in a converted resident room with 4 hemodialysis stations, and the LTCF operated 2 shifts, 3 times per week. We observed multiple infection control gaps, such as preparation of IV medications and inadequate disinfection in the shared dialysis treatment area. Recommendations addressing gaps were issued, and a follow-up site visit was conducted to validate implementation. With the exception of May 2019, patients A and B received hemodialysis on the same shift and days from December 2018 to September 2019. Conclusions: Phylogenetic and epidemiological results indicate HCV transmission likely occurred during hemodialysis services provided by the LTCF. As the provision of dialysis expands to nontraditional settings such as LTCFs, it is essential that proper infection control procedures and oversight are in place.Funding: NoneDisclosures: None

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Elliott, Dabney O. "THE BEACH EROSION BOARD." Coastal Engineering Proceedings 1, no. 1 (May 12, 2010): 12. http://dx.doi.org/10.9753/icce.v1.12.

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The purpose of this paper is to describe the methods by which, and the extent to which the Federal Government participates with local agencies in the control of beach erosion. The Beach Erosion Board of the Corps of Engineers is the instrumentality through which this participation is affected. However, before describing this Board, it is necessary to sketch very briefly the background of the beach erosion problem as viewed from the national standpoint. The necessity for the control of beach erosion by one means or another has no doubt been recognized from the beginning of the practice of coastal engineering in the United States. The early technical records of the Corps of Engineers contain numerous references to the mutual effects which navigation structures and the adjacent shorelines exert upon each other. As an example, chosen at random, I may mention the construction in 1874 of twelve stone groins along the shore of the State of Connecticut between Welshs Point and Indian River, and of a stone jetty at the mouth of that river in the following year, to stabilize the shoreline and to prevent the movement of sand into the navigation channel of that river.

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Wilson, Dean. "Predictive Policing Management: A Brief History of Patrol Automation." New Formations 98, no. 98 (July 1, 2019): 139–55. http://dx.doi.org/10.3898/newf:98.09.2019.

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Predictive policing has attracted considerably scholarly attention. Extending the promise of being able to interdict crime prior to its commission, it seemingly promised forms of anticipatory policing that had previously existed only in the realms of science fiction. The aesthetic futurism that attended predictive policing did, however, obscure the important historical vectors from which it emerged. The adulation of technology as a tool for achieving efficiencies in policing was evident from the 1920s in the United States, reaching sustained momentum in the 1960s as the methods of Systems Analysis were applied to policing. Underpinning these efforts resided an imaginary of automated patrol facilitated by computerised command and control systems. The desire to automate police work has extended into the present, and is evident in an emergent platform policing – cloud-based technological architectures that increasingly enfold police work. Policing is consequently datafied, commodified and integrated into the circuits of contemporary digital capitalism.

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Goodloe, J. M., L. D. Vinson, M. L. Cox, and B. D. Burns. "P059: Paramedic compliance with a novel defibrillation strategy in a large, urban EMS system in the United States." CJEM 19, S1 (May 2017): S98. http://dx.doi.org/10.1017/cem.2017.261.

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Introduction: Emergency Medical Services (EMS) care confers distinct impact upon survivability from sudden cardiac arrest. Many studies have been conducted regarding EMS interventions for cardiac arrest, though fewer studies have been published detailing specific analysis of paramedic compliance with standing orders, particularly those involving a novel energy strategy in defibrillation. Methods: Adults in sudden cardiac arrest with resuscitation initiated, including at least one defibrillation, between July 1, 2016 and December 1, 2016 were enrolled. Education on a novel defibrillation strategy, involving weight-based joule settings and double sequential external defibrillation (DSED) was delivered in classroom and internet-accessed settings. Paramedics then performed hands-on practice in DSED. All resuscitations were reviewed from electronic medical records (EMRs) completed by treating paramedics, alongside telemetry and defibrillation events recorded, transmitted, and analyzed in proprietary software (CODE-STAT™, Physio-Control Corporation, Redmond, WA). All ECGs and defibrillation events were reviewed by an emergency physician to determine energy settings used by paramedics for determining the accuracy of compliance with protocol-based standing orders. Results: During the 5 month study period, the paramedics involved treated 133 adults in sudden cardiac arrest involving perceived ventricular fibrillation that was treated with at least one defibrillation. 76/90 (84.4%) with estimated weight <100 kg were treated with correct joule settings, though only 7/43 (16.3%) with estimated weight ≥100kg received all defibrillations at 360J as protocol-specified. 26/44 (59.1%) in refractory ventricular fibrillation, defined as requiring a fourth defibrillation, received DSED as protocol-specified. Conclusion: Paramedics, when specifically trained on a novel defibrillation strategy, involving both weight-based joule settings and use of DSED for refractory ventricular fibrillation, are inconsistently able to quickly and successfully incorporate that strategy in EMS resuscitation care. Further educational endeavours are warranted to achieve higher defibrillation strategy protocol compliance.

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Beets, Becca, Todd P. Newman, Emily L. Howell, Luye Bao, and Shiyu Yang. "Surveying Public Perceptions of Artificial Intelligence in Health Care in the United States: Systematic Review." Journal of Medical Internet Research 25 (April 4, 2023): e40337. http://dx.doi.org/10.2196/40337.

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Background This paper reviews nationally representative public opinion surveys on artificial intelligence (AI) in the United States, with a focus on areas related to health care. The potential health applications of AI continue to gain attention owing to their promise as well as challenges. For AI to fulfill its potential, it must not only be adopted by physicians and health providers but also by patients and other members of the public. Objective This study reviews the existing survey research on the United States’ public attitudes toward AI in health care and reveals the challenges and opportunities for more effective and inclusive engagement on the use of AI in health settings. Methods We conducted a systematic review of public opinion surveys, reports, and peer-reviewed journal articles published on Web of Science, PubMed, and Roper iPoll between January 2010 and January 2022. We include studies that are nationally representative US public opinion surveys and include at least one or more questions about attitudes toward AI in health care contexts. Two members of the research team independently screened the included studies. The reviewers screened study titles, abstracts, and methods for Web of Science and PubMed search results. For the Roper iPoll search results, individual survey items were assessed for relevance to the AI health focus, and survey details were screened to determine a nationally representative US sample. We reported the descriptive statistics available for the relevant survey questions. In addition, we performed secondary analyses on 4 data sets to further explore the findings on attitudes across different demographic groups. Results This review includes 11 nationally representative surveys. The search identified 175 records, 39 of which were assessed for inclusion. Surveys include questions related to familiarity and experience with AI; applications, benefits, and risks of AI in health care settings; the use of AI in disease diagnosis, treatment, and robotic caregiving; and related issues of data privacy and surveillance. Although most Americans have heard of AI, they are less aware of its specific health applications. Americans anticipate that medicine is likely to benefit from advances in AI; however, the anticipated benefits vary depending on the type of application. Specific application goals, such as disease prediction, diagnosis, and treatment, matter for the attitudes toward AI in health care among Americans. Most Americans reported wanting control over their personal health data. The willingness to share personal health information largely depends on the institutional actor collecting the data and the intended use. Conclusions Americans in general report seeing health care as an area in which AI applications could be particularly beneficial. However, they have substantial levels of concern regarding specific applications, especially those in which AI is involved in decision-making and regarding the privacy of health information.

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Journal articles on the topic 'Forms and Records Control – methods – United States'

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