RESUMO
This consensus statement emerges from collaborative efforts among leading figures in critical care cardiology throughout the United States, who met to share their collective expertise on issues faced by those active in or pursuing contemporary critical care cardiology education. The panel applied fundamentals of adult education and curriculum design, reviewed requisite training necessary to provide high-quality care to critically ill patients with cardiac pathology, and devoted attention to a purposeful approach emphasizing diversity, equity, and inclusion in developing this nascent field. The resulting paper offers a comprehensive guide for current trainees, with insights about the present landscape of critical care cardiology while highlighting issues that need to be addressed for continued advancement. By delineating future directions with careful consideration and intentionality, this Expert Panel aims to facilitate the continued growth and maturation of critical care cardiology education and practice.
Assuntos
Cardiologia , Cuidados Críticos , Cardiologia/educação , Humanos , Cuidados Críticos/normas , Estados Unidos , Currículo , Minnesota , Educação de Pós-Graduação em Medicina/métodosRESUMO
Importance: Disparities in COVID-19 vaccination rates by race and ethnicity are well documented. Less is known about primary language and COVID-19 vaccine uptake. Objective: To describe the time to COVID-19 primary series vaccination and booster doses by primary language and country of origin. Design, Setting, and Participants: This retrospective cohort study included patients aged 6 months or older with at least 1 health encounter from July 1, 2019, to June 30, 2023, at a single health care system serving patients across Minnesota and western Wisconsin. Exposure: Primary language and country of origin documented in the electronic health record. Main Outcomes and Measures: Three COVID-19 vaccine coverage outcomes were evaluated: (1) primary series (1 Ad26.COV.S vaccine or 2 mRNA COVID-19 vaccines), (2) first-generation booster (primary series Ad26.COV.S vaccine plus 1 Ad26.COV.S or mRNA COVID-19 vaccine at least 2 months after the second dose or primary series mRNA vaccine plus 1 mRNA vaccine at least 5 months after the second dose), and (3) bivalent booster. Vaccine coverage was described by patient characteristics. Associations of primary language, race and ethnicity, and other patient characteristics with COVID-19 vaccine uptake were evaluated using time-to-event analysis in multivariable Cox proportional hazards regression models, and adjusted hazard ratios (AHRs) with 95% CIs were reported. Results: There were 1â¯001â¯235 patients included (53.7% female). Most patients reported English as a primary language (94.1%) and were born in the US (91.8%). Primary series coverage was 63.7%; first-generation booster coverage, 64.4%; and bivalent booster coverage, 39.5%. Coverage for all outcomes was lower among those with a non-English primary language compared with English as the primary language (56.9% vs 64.1% for primary series; 47.5% vs 65.3% for first-generation booster; 26.2% vs 40.3% for bivalent booster). Those with a non-English primary language had lower COVID-19 vaccine uptake for the primary series (AHR, 0.85; 95% CI, 0.84-0.86), first-generation booster (AHR, 0.74; 95% CI, 0.73-0.75), and bivalent booster (AHR, 0.65; 95% CI, 0.64-0.67) compared with patients with English as their primary language. Non-US-born patients had higher primary series uptake compared with US-born patients (AHR, 1.19; 95% CI, 1.18-1.20) but similar first-generation booster (AHR, 1.01; 95% CI, 0.99-1.02) and bivalent booster (AHR, 1.00; 95% CI, 0.98-1.02) uptake. Conclusions and Relevance: In this retrospective cohort study, patients with a non-English primary language had both lower coverage and delays in receiving COVID-19 vaccines compared with those with English as their primary language. Reporting on language may identify health disparities that can be addressed with language-specific interventions.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Idioma , SARS-CoV-2 , Humanos , Feminino , COVID-19/prevenção & controle , Masculino , Estudos Retrospectivos , Vacinas contra COVID-19/uso terapêutico , Pessoa de Meia-Idade , Adulto , SARS-CoV-2/imunologia , Minnesota , Adolescente , Idoso , Wisconsin , Vacinação/estatística & dados numéricos , Criança , Adulto Jovem , Pré-Escolar , Cobertura Vacinal/estatística & dados numéricos , Lactente , Imunização Secundária/estatística & dados numéricosRESUMO
The COVID-19 pandemic has claimed over one million lives in the United States and has drastically changed how patients interact with the healthcare system. Emergency medical services (EMS) are essential for emergency response, disaster preparedness, and responding to everyday emergencies. We therefore examined differences in EMS utilization and call severity in 2020 compared to trends from 2015-2019 in a large, multi-state advanced life support EMS agency serving the U.S. Upper Midwest. Specifically, we analyzed all emergency calls made to Mayo Clinic Ambulance, the sole advanced life support EMS provider serving a large area in Minnesota and Wisconsin, and compared the number of emergency calls made in 2020 to the number of calls expected based on trends from 2015-2019. We similarly compared caller demographics, call severity, and proportions of calls made for overdose/intoxication, behavioral health, and motor vehicle accidents. Subgroup analyses were performed for rural vs. urban areas. We identified 262,232 emergent EMS calls during 2015-2019 and 53,909 calls in 2020, corresponding to a decrease of 28.7% in call volume during 2020. Caller demographics shifted slightly towards older patients (mean age 59.7 [SD, 23.0] vs. 59.1 [SD, 23.7] years; p<0.001) and to rural areas (20.4% vs. 20.0%; p = 0.007). Call severity increased, with 95.3% of calls requiring transport (vs. 93.8%; p<0.001) and 1.9% resulting in death (vs. 1.6%; p<0.001). The proportion of calls for overdose/intoxication increased from 4.8% to 5.5% (p<0.001), while the proportion of calls for motor vehicle collisions decreased from 3.9% to 3.0% (p<0.001). All changes were more pronounced in urban areas. These findings underscore the extent to which the COVID-19 pandemic impacted healthcare utilization, particularly in urban areas, and suggest that patients may have delayed calling EMS with potential implications on disease severity and risk of death.
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COVID-19 , Serviços Médicos de Emergência , Humanos , COVID-19/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , SARS-CoV-2 , Adolescente , Adulto Jovem , Minnesota/epidemiologia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Wisconsin/epidemiologiaRESUMO
Schools of Nursing across the country are encountering fiscal, programmatic and leadership challenges exacerbated by chaos and fragmentation in health care systems. This article focuses on the transformation journey of the School of Nursing at the University of Minnesota highlighting the complex context of higher education, challenges faced, and strategies executed that focused on significant and sustained culture change. Recommendations are offered to enable all schools to embark on their own transformative journeys.
Assuntos
Escolas de Enfermagem , Humanos , Escolas de Enfermagem/organização & administração , Minnesota , Liderança , Currículo , Competência Cultural , Bacharelado em EnfermagemRESUMO
The use of trait-based approaches to understand ecological communities has increased in the past two decades because of their promise to preserve more information about community structure than taxonomic methods and their potential to connect community responses to subsequent effects of ecosystem functioning. Though trait-based approaches are a powerful tool for describing ecological communities, many important properties of commonly-used trait metrics remain unexamined. Previous work with simulated communities and trait distributions shows sensitivity of functional diversity measures to the number and correlation of traits used to calculate them, but these relationships have yet to be studied in actual plant communities with a realistic distribution of trait values, ecologically meaningful covariation of traits, and a realistic number of traits available for analysis. To address this gap, we used data from six grassland plant communities in Minnesota and New Mexico, USA to test how the number of traits and the correlation between traits used in the calculation of eight functional diversity indices impact the magnitude of functional diversity metrics in real plant communities. We found that most metrics were sensitive to the number of traits used to calculate them, but functional dispersion (FDis), kernel density estimation dispersion (KDE dispersion), and Rao's quadratic entropy (Rao's Q) maintained consistent rankings of communities across the range of trait numbers. Despite sensitivity of metrics to trait correlation, there was no consistent pattern between communities as to how metrics were affected by the correlation of traits used to calculate them. We recommend that future use of evenness metrics include sensitivity analyses to ensure results are robust to the number of traits used to calculate them. In addition, we recommend use of FDis, KDE dispersion, and Rao's Q when ecologically applicable due to their ability to produce consistent rankings among communities across a range of the numbers of traits used to calculate them.
Assuntos
Biodiversidade , Ecossistema , Pradaria , Minnesota , New Mexico , Plantas/classificaçãoRESUMO
ABSTRACT: Sarcocystis infections were found for the first time in the muscles of 3 of 3 gray wolves (Canis lupus) from Minnesota. Two kinds (thin-walled and thick-walled) of sarcocysts were detected, based on the appearance of the sarcocyst wall. In wolf 1, sarcocysts were thin-walled (<0.5 µm), and without any visible protrusions. Ultrastructurally, the sarcocyst wall was type 1a and identical to Sarcocystis svanai of the domestic dog (Canis familiaris). The second kind of sarcocyst, with a relatively thicker (>1 µm) sarcocyst wall, was detected in wolves 2 and 3. Ultrastructurally, the sarcocyst wall had undulating, pleomorphic villar protrusion of type 9c; these sarcocysts were identical to Sarcocystis caninum from the domestic dog. Molecularly, the 2 Sarcocystis species were characterized using 18S, 28S, COI, ITS-1, and rpoB genetic markers. All these markers showed 100% identity to either of the 2 species previously described from the domestic dog. The thick-walled sarococyst corresponded to Sarcocystis caninum, whereas the thin-walled sarcocyst corresponded to Sarcocystis svanai.
Assuntos
DNA de Protozoário , Reservatórios de Doenças , Doenças do Cão , Sarcocystis , Sarcocistose , Lobos , Animais , Sarcocistose/veterinária , Sarcocistose/parasitologia , Lobos/parasitologia , Sarcocystis/genética , Sarcocystis/classificação , Sarcocystis/isolamento & purificação , Sarcocystis/ultraestrutura , Cães , Minnesota , Doenças do Cão/parasitologia , Reservatórios de Doenças/veterinária , Reservatórios de Doenças/parasitologia , DNA de Protozoário/isolamento & purificação , DNA de Protozoário/química , Filogenia , Feminino , Masculino , Músculo Esquelético/parasitologia , Microscopia Eletrônica de Transmissão/veterinária , RNA Ribossômico 18S/genética , Dados de Sequência MolecularRESUMO
In the United States, frontal lobe lesioning procedures have been uniformly linked to the neurologist Walter Freeman, although the prefrontal lobotomy was investigated in other institutions in the United States, the United Kingdom, Europe, Russia, Japan, and China, mostly in patients with psychosis, obsessive-compulsive disorder, and/or intractable pain syndromes. These procedures were based on earlier reports of improvement of psychiatric symptoms after surgical resection of frontal lobe tumors and led many to infer a causal relationship between frontal lobe dysfunction and abnormal behavior. Freeman first visited Rochester, MN, as a medical student in a gastrointestinal laboratory at the Mayo Clinic. Freeman visited Rochester again many years later, a visit that was received with trepidation but ultimately led to the adoption of his lobotomy method. Freeman's grandfather, W.W. Keen, was a highly respected surgeon credited with the first successful surgical resection of a benign brain tumor in the United States, a connection that may have contributed to Freeman's subsequent interest in performing lobotomies. Keen maintained a close relationship with the Mayo brothers and also advocated for Freeman's initial visit to the Mayo Clinic. In this article, we present a brief historical review of Freeman and the early reports of the prefrontal lobotomy procedure performed by consultants affiliated with the Mayo Clinic and Rochester State Hospital.
Assuntos
Hospitais Estaduais , Humanos , História do Século XX , História do Século XIX , Córtex Pré-Frontal/cirurgia , Minnesota , Procedimentos Neurocirúrgicos/métodos , Masculino , Psicocirurgia/métodos , Psicocirurgia/história , Lobo Frontal/cirurgiaRESUMO
OBJECTIVES: Continuous, therapeutic anticoagulation is the standard of care for patients on extracorporeal membrane oxygenation (ECMO). The risks of hemorrhage exacerbated by anticoagulation must be weighed with the thrombotic risks associated with ECMO. We hypothesized increased thrombotic events in patients who had interrupted (vs. continuous) anticoagulation during venovenous ECMO. DESIGN: This is a retrospective, observational study. SETTING: Enrollment of individuals took place at three adult ECMO centers in Minnesota from 2013 to 2022. PATIENTS: This study consists of 346 patients supported with venovenous ECMO. INTERVENTIONS: Anticoagulation administration was collected from electronic health records, including frequency and duration of anticoagulation interruptions (IAs) and timing and type of thrombotic events, and data were analyzed using descriptive statistics. MEASUREMENTS AND MAIN RESULTS: A total of 156 patients had IA during their ECMO run and 190 had continuous anticoagulation. Risk adjusted logistic regression demonstrated that individuals in the IA group were not statistically more likely to experience a thrombotic complication (odds ratio [OR], 0.69; 95% CI, 0.27-1.70) or require ECMO circuit change (OR, 1.36; 95% CI, 0.52-3.49). Subgroup analysis demonstrated greater frequency of overall thrombotic events with increasing frequency and duration of anticoagulation being interrupted (p = 0.001). CONCLUSIONS: Our multicenter analysis found a similar frequency of thrombotic events in patients on ECMO when anticoagulation was interrupted vs. administered continuously. Further investigation into the impact of the frequency and duration of these interruptions is warranted.
Assuntos
Anticoagulantes , Oxigenação por Membrana Extracorpórea , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Estudos Retrospectivos , Masculino , Anticoagulantes/efeitos adversos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Feminino , Pessoa de Meia-Idade , Adulto , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/epidemiologia , Minnesota/epidemiologia , IdosoRESUMO
The bigmouth buffalo Ictiobus cyprinellus (Catostomidae) is a freshwater fish native to North America that is known for its longevity. During the 1970s, the bigmouth buffalo was recorded as declining in Canada, Minnesota, and North Dakota and became a protected species in Canada. In the USA, population declines are exacerbated by wasteful recreational bowfishing, lack of fisheries management, and overall lack of knowledge. However, recent studies have revealed the exceptional lifespan of bigmouth buffalo, their negligible senescence, slow growth, delayed maturity, and episodic recruitment. Yet little is known about the spawning phenology of bigmouth buffalo, nor their age demographics in east central Minnesota. In this 2021-2023 study of bigmouth buffalo from Rice Lake National Wildlife Refuge we found that 99.7% (389 of 390) of the extant population hatched prior to 1972 despite annual spawning in Rice Lake. Moreover, recruitment success declined significantly since water control measures were established (1953). We found males arrive to spawning grounds with females but depart later, that both the midpoint and duration of spawn significantly vary across years, and that more massive females of the same age range invest disproportionately more in ovaries. Extensive post-spawn seining revealed bigmouth buffalo young-of-the-year in low numbers, but by mid-to-late summer they were no longer evident having likely succumbed to predation. Overall, these findings thoroughly reveal one of the oldest populations of vertebrate currently known (median age of 79 years as of 2024) and expose the stark vulnerability of a bigmouth buffalo population for which substantial recruitment has not occurred for more than six decades. Multiple lines of evidence indicate that the long-lived bigmouth buffalo is vulnerable, that a precautionary approach is immediately needed, and that the unlimited and unregulated kill-fishery be closed.
Assuntos
Conservação dos Recursos Naturais , Reprodução , Animais , Feminino , Masculino , Minnesota , Reprodução/fisiologia , Estações do AnoRESUMO
Poleward and uphill range shifts are a common-but variable-response to climate change. We lack understanding regarding this interspecific variation; for example, functional traits show weak or mixed ability to predict range shifts. Characteristics of species' ranges may enhance prediction of range shifts. However, the explanatory power of many range characteristics-especially within-range abundance patterns-remains untested. Here, we introduce a hypothesis framework for predicting range-limit population trends and range shifts from the internal structure of the geographic range, specifically range edge hardness, defined as abundance within range edges relative to the whole range. The inertia hypothesis predicts that high edge abundance facilitates expansions along the leading range edge but creates inertia (either more individuals must disperse or perish) at the trailing range edge such that the trailing edge recedes slowly. In contrast, the limitation hypothesis suggests that hard range edges are the signature of strong limits (e.g. biotic interactions) that force faster contraction of the trailing edge but block expansions at the leading edge of the range. Using a long-term avian monitoring dataset from northern Minnesota, USA, we estimated population trends for 35 trailing-edge species and 18 leading-edge species and modelled their population trends as a function of range edge hardness derived from eBird data. We found limited evidence of associations between range edge hardness and range-limit population trends. Trailing-edge species with harder range edges were slightly more likely to be declining, demonstrating weak support for the limitation hypothesis. In contrast, leading-edge species with harder range edges were slightly more likely to be increasing, demonstrating weak support for the inertia hypothesis. These opposing results for the leading and trailing range edges might suggest that different mechanisms underpin range expansions and contractions, respectively. As data and state-of-the-art modelling efforts continue to proliferate, we will be ever better equipped to map abundance patterns within species' ranges, offering opportunities to anticipate range shifts through the lens of the geographic range.
Assuntos
Distribuição Animal , Aves , Mudança Climática , Animais , Aves/fisiologia , Minnesota , Modelos Biológicos , Dinâmica Populacional , EcossistemaRESUMO
BACKGROUND: Differences in the MS course between White and Black populations is well accepted. The existence of a large Somali immigrant population in Minnesota facilitates a study of MS characteristics in this immigrant native African population. The objective of this study was to compare Somali American (SA), African American (AA), and White American (WA) persons with MS (pwMS) regarding clinical features and disease modifying therapy (DMT) use. METHODS: This single center (Mayo Clinic) geographically-restricted retrospective cohort study (residing within 250 miles of Rochester, MN, USA) included participants seen before May 2023. Age at immigration to the USA; age at MS onset; DMT use/type; MS phase/phenotype; age at progressive MS (PMS) onset; and proportion with severe MS (expanded disability status scale-EDSS ≥6) were examined. RESULTS: 18 SApwMS, 92 AApwMS, and 94 WApwMS were included. Of the 15 SApwMS not born in USA, 3/15 immigrated pre-puberty, 3/15 peripuberty, 8/15 post-puberty, and 1/15 at an unknown date. SApwMS were younger at MS onset (median years, interquartile range (IQR)=25, 22-33 vs. AApwMS: 31, 25-38; p = 0.049 vs. WApwMS: 35, 27-41; p = 0.022). DMT use frequencies were 13/19 SApwMS, 69/92 AApwMS, 80/94 WApwMS (p > 0.05). SApwMS were treated with DMT earlier than AApwMS (HR 2.16, p = 0.012) and WApwMS (HR 1.86, p = 0.041). SApwMS were less commonly treated with natalizumab (SApwMS 0 %, AApwMS 13 %, WApwMS 25 %; p = 0.035) and anti-CD20 therapies (SApwMS 23 %, AApwMS 23 %, WApwMS 48 %; p = 0.005). PMS occurred in 3/19 SApwMS, 28/92 AApwMS and 29/94 WApwMS (p > 0.05). Age of PMS onset in SApwMS (47 years, 34-57) was similar to WApwMS (47 years, 31-71; p > 0.05) but older than AApwMS (41 years, 18-7; p = 0.008). CONCLUSIONS: SApwMS that recently immigrated to the USA have similar disease course to WApwMS, and better than AApwMS from the same geographical region.
Assuntos
Negro ou Afro-Americano , Emigrantes e Imigrantes , Esclerose Múltipla , Humanos , Adulto , Feminino , Masculino , Esclerose Múltipla/etnologia , Esclerose Múltipla/tratamento farmacológico , Estudos Retrospectivos , Minnesota/epidemiologia , Somália/etnologia , População Branca , Pessoa de Meia-Idade , Idade de Início , Adulto Jovem , Fatores Imunológicos/uso terapêuticoRESUMO
OBJECTIVES: To quantify infant mortality rates (IMR) using expanded racial categories, and to examine associations between infant formula exposure, housing instability and postneonatal mortality among Minnesota WIC Participants. METHODS: Births in Minnesota from 2014 through 2019 (n = 404,102) and associated infant death records (n = 2034) were used to calculate neonatal and postneonatal rates using expanded racial categories. Those births that participated in the WIC program (n = 170,011) and their linked death records (n = 853) were analyzed using logistic regression to examine associations between formula exposure, housing instability, and postneonatal death. RESULTS: Postneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28 days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2-4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364 days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4). CONCLUSIONS FOR PRACTICE: Disaggregating Black mortality rates revealed inequities in infant mortality among Black families of varied backgrounds. Formula exposure and housing instability are modifiable risk factors associated with postneonatal mortality. Appropriate interventions to reduce barriers to breastfeeding and provide housing stability for vulnerable families could reduce disparities in postneonatal mortality.
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Assistência Alimentar , Fórmulas Infantis , Mortalidade Infantil , Humanos , Mortalidade Infantil/tendências , Mortalidade Infantil/etnologia , Lactente , Feminino , Fórmulas Infantis/estatística & dados numéricos , Recém-Nascido , Assistência Alimentar/estatística & dados numéricos , Minnesota/epidemiologia , Masculino , Habitação/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/estatística & dados numéricosRESUMO
Importance: Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking. Objective: To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D. Design, Setting, and Participants: This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023. Intervention: The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials. Main Outcomes and Measures: The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires. Results: There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high. Conclusions and Relevance: In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults. Trial Registration: ClinicalTrials.gov Identifier: NCT03766438.
Assuntos
Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Hispânico ou Latino , Narração , Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Feminino , Masculino , Hispânico ou Latino/psicologia , Pessoa de Meia-Idade , Hemoglobinas Glicadas/análise , Minnesota , Adulto , Idoso , Arizona , Autogestão/métodos , Autogestão/educaçãoRESUMO
BACKGROUND: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities. METHODS: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities. RESULTS: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White. CONCLUSIONS: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
Assuntos
Disparidades em Assistência à Saúde , Atenção Primária à Saúde , Humanos , Doença Crônica/terapia , Atenção Primária à Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Minnesota , Gerenciamento Clínico , Análise de Classes Latentes , FemininoRESUMO
Cannabis use among individuals with cancer is best understood using survey self-report. As cannabis remains federally illegal, surveys could be subject to nonresponse and measurement issues impacting data quality. We surveyed individuals using medical cannabis for a cancer-related condition in the Minnesota Medical Cannabis Program (MCP). Although survey responders are older, there are no differences by race and ethnicity, gender, or receipt of reduced cannabis registry enrollment fee. Responders made a more recent purchase and more recently completed an independent symptom assessment for the registry than nonresponders, suggesting some opportunity for nonresponse error. Among responders, self-report and MCP administrative data with respect to age, race, gender, registry certification, and cannabis purchase history were similar. Responders were less likely to report receipt of Medicaid than would be expected based on registry low-income enrollment eligibility. Although attention should be paid to potential for nonresponse error, surveys are a reliable tool to ascertain cannabis behavior patterns in this population.
Assuntos
Confiabilidade dos Dados , Maconha Medicinal , Neoplasias , Sistema de Registros , Humanos , Maconha Medicinal/uso terapêutico , Neoplasias/epidemiologia , Neoplasias/terapia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Inquéritos e Questionários , Estados Unidos/epidemiologia , Minnesota/epidemiologia , Autorrelato , IdosoRESUMO
PURPOSE: To create a succession plan for clinical nurse specialist positions across multiple clinical settings. DESCRIPTION OF THE PROJECT: Mayo Clinic (Rochester, Minnesota) had multiple clinical nurse specialist position vacancies. However, standard recruitment methods and a collaboration between human resources and nursing managers to expand the applicant pool yielded few applicants. A work group was subsequently commissioned to identify innovative ways to fill the vacant clinical nurse specialist positions. Guiding principles for hiring and implementing the role were developed. OUTCOME: During the 4-year project period (2016 through 2019), the time to fill positions decreased from 174 days to 83 days. Nurse managers and clinical nurse specialists reported an increased number of registered nurses seeking information about the profession. Twenty-eight clinical nurse specialist interns, titled clinical resource nurses, were hired, and 14 completed their graduate degree, obtained state licensure, and transitioned to clinical nurse specialist roles. Twelve clinical resource nurses were on schedule to transition to clinical nurse specialist positions, and 2 left their positions. CONCLUSION: A succession plan that used clinical nurse specialists to mentor clinical resource nurses to fill gaps in practice priorities while completing graduate education was a successful strategy to fill vacant clinical nurse specialist positions.
Assuntos
Liderança , Enfermeiros Clínicos , Enfermeiros Clínicos/educação , Humanos , Seleção de Pessoal , MinnesotaAssuntos
Infecções por Citomegalovirus , Triagem Neonatal , Humanos , Recém-Nascido , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/epidemiologia , Minnesota/epidemiologia , Vigilância da População , Citomegalovirus/isolamento & purificaçãoRESUMO
We surveyed (September 9-17, 2021) students, staff, and faculty at the University of Minnesota, a large, highly vaccinated university, to evaluate whether the COVID-19 vaccine mandate increased self-reported vaccine uptake. Vaccine mandates have the potential to improve public health but should consider the context of implementation and costs associated with infringements on personal choice. Policymakers need to be equipped with data to inform decisions about vaccine mandates in light of contextual factors and potential backlash affecting public health interventions. (Am J Public Health. 2024;114(11):1222-1227. https://doi.org/10.2105/AJPH.2024.307804).
Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Vacinas contra COVID-19/administração & dosagem , Universidades , COVID-19/prevenção & controle , Masculino , Programas Obrigatórios , Minnesota , Feminino , Estudantes/estatística & dados numéricos , Vacinação , Adulto , SARS-CoV-2 , Adulto Jovem , Docentes , Inquéritos e QuestionáriosRESUMO
The Soudan Underground Mine State Park, found in the Vermilion Iron Range in northern Minnesota, provides access to a ~ 2.7 billion-year-old banded iron formation. Exploratory boreholes drilled between 1958 and 1962 on the 27th level (713 m underground) of the mine intersect calcium and iron-rich brines that have recently been subject to metagenomic analysis and microbial enrichments. Using concentrated brine samples pumped from a borehole depth of up to 55 m, a novel Gram-positive bacterium was enriched under anaerobic, acetate-oxidizing, and Fe(III) citrate-reducing conditions. The isolated bacterium, designated strain MK1, is non-motile, rod-shaped, spore-forming, anaerobic, and mesophilic, with a growth range between 24°C and 30°C. The complete circular MK1 genome was found to be 3,720,236 bp and encodes 25 putative multiheme cytochromes, including homologs to inner membrane cytochromes in the Gram-negative bacterium Geobacter sulfurreducens and cytoplasmic membrane and periplasmic cytochromes in the Gram-positive bacterium Thermincola potens. However, MK1 does not encode homologs of the peptidoglycan (CwcA) and cell surface-associated (OcwA) multiheme cytochromes proposed to be required by T. potens to perform extracellular electron transfer. The 16S rRNA gene sequence of MK1 indicates that its closest related isolate is Desulfitibacter alkalitolerans strain sk.kt5 (91% sequence identity), which places MK1 in a novel genus within the Desulfitibacteraceae family and Moorellales order. Within the Moorellales order, only Calderihabitans maritimus strain KKC1 has been reported to reduce Fe(III), and only D. alkalitolerans can also grow in temperatures below 40°C. Thus, MK1 represents a novel species within a novel genus, for which we propose the name "Metallumcola ferriviriculae" strain MK1, and provides a unique opportunity to study a cytochrome-rich, mesophilic, Gram-positive, spore-forming Fe(III)-reducing bacterium.IMPORTANCEThe Soudan Underground Mine State Park gives access to understudied regions of the deep terrestrial subsurface that potentially predate the Great Oxidation Event. Studying organisms that have been relatively unperturbed by surface conditions for as long as 2.7 billion years may give us a window into ancient life before oxygen dominated the planet. Additionally, studying microbes from anoxic and iron-rich environments can help us better understand the requirements of life in analogous environments, such as on Mars. The isolation and characterization of "Metallumcola ferriviriculae" strain MK1 give us insights into a novel genus and species that is distinct both from its closest related isolates and from iron reducers characterized to date. "M. ferriviriculae" strain MK1 may also act as a model organism to study how the processes of sporulation and germination are affected by insoluble extracellular acceptors, as well as the impact of spores in the deep terrestrial biosphere.
Assuntos
Genoma Bacteriano , Oxirredução , Filogenia , Mineração , Ferro/metabolismo , RNA Ribossômico 16S/genética , Compostos Férricos/metabolismo , Minnesota , Bactérias Gram-Positivas/genética , Bactérias Gram-Positivas/classificação , Bactérias Gram-Positivas/metabolismo , Bactérias Gram-Positivas/isolamento & purificaçãoRESUMO
Regular cigarette smoking and cannabis consumption are strongly positively related to each other, yet few studies explore their underlying variation and covariation. We evaluated the genetic and environmental decomposition of variance and covariance of these two traits in twin data from three countries with different social norms and legislation. Data from the Netherlands Twin Register, FinnTwin12/16, and the Minnesota Center for Twin Family Research (total N = 21,617) were analyzed in bivariate threshold models of lifetime regular smoking initiation (RSI) and lifetime cannabis initiation (CI). We ran unstratified models and models stratified by sex and country. Prevalence of RSI was lowest in the Netherlands and prevalence of CI was highest in Minnesota. In the unstratified model, genetic (A) and common environmental factors (C) contributed substantially to the liabilities of RSI (A = 0.47, C = 0.34) and CI (A = 0.28, C = 0.51). The two liabilities were significantly phenotypically (rP = 0.56), genetically (rA = 0.74), and environmentally correlated in the unstratified model (rC = 0.47and rE = 0.48, representing correlations between common and unique environmental factors). The magnitude of phenotypic correlation between liabilities varied by country but not sex (Minnesota rP ~ 0.70, Netherlands rP ~ 0.59, Finland rP ~ 0.45). Comparisons of decomposed correlations could not be reliably tested in the stratified models. The prevalence and association of RSI and CI vary by sex and country. These two behaviors are correlated because there is genetic and environmental overlap between their underlying latent liabilities. There is heterogeneity in the genetic architecture of these traits across country.