Within 8 months, 3 children from 1 family in northern Vietnam died from melioidosis. Burkholderia pseudomallei of the same sequence type, 541, was isolated from clinical samples, borehole water, and ...garden and rice field soil. Boreholes should be properly constructed and maintained to avoid B. pseudomallei contamination.
Isolation of the soil bacterium Burkholderia pseudomallei from tropical environments is important to generate a global risk map for man and animals to acquire the infectious disease melioidosis. ...There is increasing evidence, that the currently recommended soil culture protocol using threonine-basal salt solution with colistin (TBSS-C50) for enrichment of B. pseudomallei and Ashdown agar for subsequent subculture lacks sensitivity. We therefore investigated, if the otherwise rarely encountered erythritol catabolism of B. pseudomallei might be exploited to improve isolation of this bacterium from soil.
Based on TBSS-C50, we designed a new colistin-containing medium with erythritol as the single carbon source (EM). This medium was validated in various culture protocols by analyzing 80 soil samples from 16 different rice fields in Vietnam. B. pseudomallei enrichment was determined in all culture supernatants by a specific quantitative PCR (qPCR) targeting the type three secretion system 1. 51 out of 80 (63.8%) soil samples gave a positive qPCR signal in at least one of the culture conditions. We observed a significantly higher enrichment shown by lower median cycle threshold values for B. pseudomallei in a two-step culture with TBSS-C50 for 48 h followed by EM for 96h compared to single cultures in TBSS-C50 for either 48h or 144h (p<0.0001, respectively). Accordingly, B. pseudomallei could be isolated on Ashdown agar in 58.8% (30/51) of samples after subcultures from our novel two-step enrichment culture compared to only 9.8% (5/51) after standard enrichment with TBSS-C50 for 48h (p<0.0001) or 25.5% (13/51; p<0.01) after TBSS-C50 for 144h.
In the present study, we show that specific exploitation of B. pseudomallei metabolic capabilities in enrichment protocols leads to a significantly improved isolation rate of this pathogen from soil compared to established standard procedures. Our new culture method might help to facilitate the creation of environmental risk maps for melioidosis in the future.
We compared the use of sexual and reproductive health (SRH) services for Medicaid-enrolled women of reproductive age (WRA) living in Oregon by urban/rural status and examined the effect of the ...Affordable Care Act (ACA) Medicaid expansion on the use of SRH services for these women.
We linked Oregon Medicaid enrollment files and claims for the years 2008-2016 to identify 392,111 WRA. Outcome measures included receipt of five key SRH services. The main independent variables were urban/rural status (urban, large rural cities, and small rural towns) and an indicator for the post-Medicaid expansion time period (2014-2016). We performed (conditional) fixed-effects logistic regression and multiple-group interrupted time-series analyses.
Women living in small rural towns were less likely than women living in urban areas to receive well-woman visits (odds ratio OR = 0.87; 95% confidence interval 95% CI 0.80-0.94), sexually transmitted infection (STI) screening (OR = 0.81; 95% CI 0.72-0.90), and pap tests (OR = 0.91; 95% CI 0.84-0.99). Women living in large rural cities were less likely than women living in urban areas to receive STI screening (OR = 0.91; 95% CI 0.84-0.98). Following the implementation of ACA Medicaid expansion, the average number of all five SRH services increased for all women. With the exception of contraceptive services, the average number of SRH services examined increased more for urban women than for women living in small rural towns.
Although Medicaid expansion contributed to increased use of SRH services for all WRA, the policy was unsuccessful in reducing disparities in access to SRH services for WRA living in rural areas compared with urban areas.
The soil bacterium
causes melioidosis, a potentially fatal and greatly underdiagnosed tropical disease. Detection of
in the environment is important to trace the source of infections, define risk ...areas for melioidosis and increase the clinical awareness. Although
polymerase chain reaction (PCR)-based environmental detection provides important information, the culture of the pathogen remains essential but is still a methodological challenge.
can catabolize erythritol, a metabolic pathway, which is otherwise rarely encountered among bacteria. We recently demonstrated that replacing threonine with erythritol as a single carbon source in the pH-neutral threonine-basal salt solution (TBSS-C50) historically used improved the isolation of
from rice paddy soils. However, further culture medium parameters for an optimized recovery of
strains from soils are still ill-defined. We, therefore, aimed to design a new erythritol-based medium by systematically optimizing parameters such as pH, buffer capacity, salt and nutrient composition. A key finding of our study is the enhanced erythritol-based growth of
under acidic medium conditions. Our experiments with
strains from different geographical origin led to the development of a phosphate-buffered acidic erythritol (ACER) medium with a pH of 6.3, higher erythritol concentration of 1.2%, supplemented vitamins and nitrate. This highly selective medium composition shortened the lag phase of
cultures and greatly increased growth densities compared to TBSS-C50 and TBSS-C50-based erythritol medium. The ACER medium led to the highest enrichments of
as determined from culture supernatants by quantitative PCR in a comparative validation with soil samples from the central part of Vietnam. Consequently, the median recovery of
colony forming units on Ashdown's agar from ACER subcultures was 5.4 times higher compared to TBSS-C50-based erythritol medium (
= 0.005) and 30.7 times higher than TBSS-C50 (
< 0.001). In conclusion, our newly developed ACER medium significantly improves the isolation of viable
from soils and, thereby, has the potential to reduce the rate of false-negative environmental cultures in melioidosis risk areas.
The aim was to examine the impact of receipt of mental health services on health care expenditures for U.S. adults with major chronic physical conditions.
Medical Expenditure Panel Survey data for ...2004-2014 were analyzed for adults ages ≥18 with at least one of six chronic physical conditions (cardiovascular diseases, cancer, diabetes, emphysema, asthma, and arthritis) who were followed up for 2 years (N=33,419). Outcomes included overall health care spending and expenditure by service type (inpatient services, outpatient services, emergency department visits, office-based physician visits, and prescribed medication). A difference-in-differences model compared a change in health care costs in the subsequent year for those who did and did not receive mental health services in the preceding year.
On average, the increase in overall health care expenditure in the subsequent year among adults receiving mental health services in the preceding year was smaller by 12.6 percentage points (p<0.05) than for those who did not receive such services. The difference was equivalent to $1,146 in 2014 constant U.S. dollars (p=0.05). Medication treatment alone did not have a meaningful effect on overall costs. The combination of psychotherapy and medication was associated with a per-capita reduction in overall health care expenditure of 21.7 percentage points, or $2,690 (p<0.01). The combination was also associated with reduced costs for office-based visits (p<0.05) and medication (p<0.05).
Receipt of mental health services was associated with a reduction in overall health care costs, particularly for office-based visits and prescribed medication, among adults with chronic physical conditions.
To identify hospital capabilities associated with behavioral health (BH) processes in emergency departments (EDs).
Six hundred two hospital responses to the 2017/2018 National Survey of Healthcare ...Organizations and Systems were linked to 2017 American Hospital Association Annual Survey data. Separate multivariable regressions estimated how hospital capabilities (the use of quality improvement methods, approaches to disseminate best patient-care practices, barriers to using care delivery innovations, and inpatient beds for psychiatric or substance use) were associated with each of 4 ED-based BH processes: mental health and substance use disorder screening, team-based approaches to BH, telepsychiatry, and direct referrals to community-based BH clinicians. Models controlled for hospital structural characteristics and area-level socioeconomic factors.
Most hospitals screened for BH conditions and provided direct referrals to community-based BH clinicians. Approximately half of the hospitals used a team approach to BH. A minority had implemented telepsychiatry. Each additional process used to disseminate best patient-care practices was associated with more screening for BH conditions (an increase of 4.07 points on the screening index, P <0.01) and greater likelihood of using a team approach to BH 4.41 percentage point ( P <0.01) increase. Hospitals reporting more barriers to the use of care delivery innovations reported less screening and use of a team approach a decrease of 0.15 points on the screening index ( P <0.01) and 0.28 percentage points reduction in likelihood of team approach use ( P <0.001) for 1-point increase in the barrier index.
Research and interventions focused on removing innovation barriers or adding processes to disseminate best practices offer a path to accelerate BH integration in hospital EDs.
The rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal ...women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.
Data from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.
Thirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.
The risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.
This work aims to synthesize akaganeite nanoparticles (AKNPs) by using microwave and use them to adsorb Congo red dye (CR) from the aqueous solution. The AKNPs with an average particle size of about ...50 nm in width and 100 nm in length could be fabricated in 20 min. The effects of pH, CR initial concentration, adsorption time, and adsorbent dosage on the adsorption process were investigated and the artificial neural network (ANN) was used to analyze the adsorption data. The various ANN structures were examined in training the data to find the optimal model. The structure with training function, TRAINLM; adaptation learning function, LARNGDM; transfer function, LOGSIG (in hidden layer) and PURELIN (in output layer); and 10 neutrons in hidden layer having the highest correlation (
R
2
= 0.996) and the lowest MSE (4.405) is the optimal ANN structure. The consistency between the experimental data and the data predicted by the ANN model showed that the behavior of the adsorption process of CR onto AKNPs under different conditions can be estimated by the ANN model. The adsorption kinetics was studied by fitting the data into pseudo-first-order, pseudo-second-order, Elovich, and intraparticle diffusion models. The results showed that the adsorption kinetics obeyed the pseudo-second-order model and governed by several steps. The adsorption isotherms at the different temperatures were studied by fitting the data to Langmuir, Freundlich, and Temkin isotherm models. The
R
2
obtained from the Langmuir model was above 0.9 and the highest value in three of four temperatures, suggesting that the adsorption isotherms were the best fit to the Langmuir model and the maximum adsorption capacity was estimated to be more than 150 mg/g. Thermodynamic studies suggested that the adsorption of CR onto AKNPs was a spontaneous and endothermic process and physicochemical adsorption. The obtained results indicated the potential application of microwave-synthesize AKNPs for removing organic dyes from aqueous solutions.
Objective
To examine the impact of Oregon's Coordinated Care Organizations (CCOs), an accountable care model for Oregon Medicaid enrollees implemented in 2012, on neonatal and infant mortality.
Data ...Sources
Oregon birth certificates linked with death certificates, and Medicaid/CCO enrollment files for years 2008‐2016.
Study Design
The sample consisted of the pre‐CCO birth cohort of 135 753 infants (August 2008‐July 2011) and the post‐CCO birth cohort of 148 650 infants (August 2012‐December 2015). We used a difference‐in‐differences probit model to estimate the difference in mortality between infants enrolled in Medicaid and infants who were not enrolled. We examined heterogeneous effects of CCOs for preterm and full‐term infants and the impact of CCOs over the implementation timeline. All models were adjusted for maternal and infant characteristics and secular time trends.
Principal Findings
The CCO model was associated with a 56 percent reduction in infant mortality compared to the pre‐CCO level (−0.20 percentage points 95% CI: −0.35; −0.05), and also with a greater reduction in infant mortality among preterm infants compared to full‐term infants. The impact on mortality grew in magnitude over the postimplementation timeline.
Conclusions
The CCO model contributed to a reduction in mortality within the first year of birth among infants enrolled in Medicaid.
Cervical cancer can be prevented and highly curable if detected early. Current guidelines recommend women to receive cervical cancer screening starting at age 21. Our study aims to investigate how ...improving continuity of care (COC) may influence guideline concordance of cervical cancer screening. Using the eligibility and claims data, we created a person-month panel data set for women who were enrolled in Oregon Medicaid for at least 80% of the period from 2008 to 2015. We then selected our study cohort following the cervical cancer screening guidelines. Our dependent variable is whether a woman received cervical cancer screening concordant with guidelines in a given month, when she did not receive Pap test in the past 36 months and did not receive co-testing of HPV test plus Pap test in the past 60 months. We used both population-averaged logit model and conditional fixed-effect logit model to estimate the association between the guideline concordance and the COC index, after controlling for high risk, pregnancy, age, race, and ethnicity. A total of 466,526 person-month observations were included in our main models. A 0.1 unit increase of the COC score was significantly associated with a decrease in the odds of receiving guideline-concordant cervical cancer screening (population-averaged logit model: OR = 0.988,
p
< .001; conditional fixed-effect logit model: OR = 0.966,
p
< .001). Our findings remain robust to a series of sensitivity analyses. A better COC may not be necessarily beneficial to improving cervical cancer prevention. Educations for both physicians and patients should be supplemented to assure quality of preventive care.
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