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This paper is divided into three parts. First, we analyze data from the 2016-2020 American Community Survey conducted by the U.S. Census Bureau to assess the demographic structure of Florida families. We find differences between Florida and other parts of the United States. These differences are the result of trends and patterns in migration to, from and within the state. Second, we examine the role that disasters in general and hurricanes in particular play in the family life of Floridians. Third, we review the literature to assess how responses to the COVID-19 pandemic influenced family life and the migration of families into, out of, and within Florida. This paper highlights the dramatic changes that have occurred in family life in Florida. The implications of these trends are discussed. [ABSTRACT FROM AUTHOR]

Since 2002, public school teachers in Florida have been permitted to choose between a defined benefit (DB) and a defined contribution (DC) retirement plan. We exploit this unique policy environment to study new teachers' revealed preferences over pension plan structures. Roughly 30 percent of teachers hired between 2003 and 2008 selected the DC plan, despite the fact that teachers not actively deciding within six months were defaulted into the DB plan. The share choosing the DC plan was higher among teachers with advanced degrees, math and science teachers, and teachers in charter schools. It was lower among special education teachers and especially among black and Hispanic teachers. There was only a slight relationship between plan choice and teacher value added to student achievement, with teachers in the bottom value-added quartile roughly 2 percentage points less likely to choose the DC option.

School districts are a focus of education reform efforts in the United States, but there is very little existing research about how important they are to student achievement. We fill this gap in the literature using 10 years of student-level, statewide data on fourth- and fifth-grade students in Florida and North Carolina. A variance decomposition analysis based on hierarchical linear models indicates that districts account for only a small share (1 to 2 percent) of the total variation in student achievement. Nevertheless, the differences between lower- and higher-performing districts are large enough to be of practical and policy significance, with a one standard deviation difference in district effectiveness corresponding to about 0.11 standard deviations in student achievement (about nine weeks of schooling). District performance is generally stable over time, but there are examples of districts that have shown significant increases or decreases in performance.

Class-size reduction (CSR) mandates presuppose that resources provided to reduce class size will have a larger impact on student outcomes than resources that districts can spend as they see fit. I estimate the impact of Florida's statewide CSR policy by comparing the deviations from prior achievement trends in districts that were required to reduce class size to deviations from prior trends in districts that received equivalent resources but were not required to reduce class size. I use the same comparative interrupted time series design to compare schools that were differentially affected by the policy (in terms of whether they had to reduce class size) but that did not receive equal additional resources. The results from both the district- and school-level analyses indicate that mandated CSR in Florida had little, if any, effect on student achievement. (Contains 16 tables and 2 figures.)

We examine earnings records for more than 130,000 classroom teachers employed by Florida public schools between the 2001-2 and 2006-7 school years, roughly 35,000 of whom left the classroom during that time. A majority of those leaving the classroom remained employed by public school districts. Among teachers in grades 4-8 leaving for other industries, a 1 standard deviation increase in estimated value added to student math and reading achievement is associated with 6-8 percent higher earnings outside teaching. The relationship between effectiveness and earnings is stronger in other industries than it is for the same groups of teachers while in the classroom, suggesting that current teacher compensation systems do not fully account for the higher opportunity wages of effective teachers.

We use a unique administrative database from the state of Florida to provide the first evidence that promotion and other job reassignments within school districts are systematically related to differences in teacher effectiveness in raising student achievement. We follow the career paths of a cohort of almost 25,000 classroom teachers during the 2001-2002 school year for seven subsequent years. Our results confirm that effective teachers are more likely to become assistant principals or principals and less likely to be reassigned to a low-stakes teaching position. The tendency of highly effective teachers to continue teaching in high-stakes grades and subjects is strongest in schools receiving low ratings from the state's school accountability system. Teachers entering the principal track experience a large increase in annual earnings, but the share of teachers promoted in this way is small enough that future compensation remains largely unrelated to effectiveness for teachers as a whole.

Neither holding a college major in education nor acquiring a master's degree is correlated with elementary and middle school teaching effectiveness, regardless of the university at which the degree was earned. Teachers generally do become more effective with a few years of teaching experience, but we also find evidence that teachers may become less effective with experience, particularly later in their careers. These and other findings with respect to the correlates of teacher effectiveness are obtained from estimations using value-added models that control for student characteristics as well as school and (where appropriate teacher) fixed effects in order to measure teacher effectiveness in reading and math for Florida students in fourth through eighth grades for eight school years, 2001-2002 through 2008-2009.

BACKGROUND: In single-institution studies, overtriaging low-risk postoperative patients to ICUs has been associated with a low value of care; undertriaging high-risk postoperative patients to general wards has been associated with increased mortality and morbidity. This study tested the reproducibility of an automated postoperative triage classification system to generating an actionable, explainable decision support system. STUDY DESIGN: This longitudinal cohort study included adults undergoing inpatient surgery at two university hospitals. Triage classifications were generated by an explainable deep learning model using preoperative and intraoperative electronic health record features. Nearest neighbor algorithms identified risk-matched controls. Primary outcomes were mortality, morbidity, and value of care (inverted risk-adjusted mortality/total direct costs). RESULTS: Among 4,669 ICU admissions, 237 (5.1%) were overtriaged. Compared with 1,021 control ward admissions, overtriaged admissions had similar outcomes but higher costs ($15.9K [interquartile range $9.8K to $22.3K] vs $10.7K [$7.0K to $17.6K], p < 0.001) and lower value of care (0.2 [0.1 to 0.3] vs 1.5 [0.9 to 2.2], p < 0.001). Among 8,594 ward admissions, 1,029 (12.0%) were undertriaged. Compared with 2,498 control ICU admissions, undertriaged admissions had longer hospital length-of-stays (6.4 [3.4 to 12.4] vs 5.4 [2.6 to 10.4] days, p < 0.001); greater incidence of hospital mortality (1.7% vs 0.7%, p = 0.03), cardiac arrest (1.4% vs 0.5%, p = 0.04), and persistent acute kidney injury without renal recovery (5.2% vs 2.8%, p = 0.002); similar costs ($21.8K [$13.3K to $34.9K] vs $21.9K [$13.1K to $36.3K]); and lower value of care (0.8 [0.5 to 1.3] vs 1.2 [0.7 to 2.0], p < 0.001). CONCLUSIONs: Overtriage was associated with low value of care; undertriage was associated with both low value of care and increased mortality and morbidity. The proposed framework for generating automated postoperative triage classifications is reproducible. In this longitudinal cohort study, overtriage was associated with low value of care; undertriage was associated with increased mortality and morbidity and low value of care. These findings suggest that a postoperative triage classification system using automated electronic health record data is reproducible. [ABSTRACT FROM AUTHOR]

Sharpnose sharks (genus Rhizoprionodon) experience extensive fishing pressure throughout their ranges in the Atlantic Ocean. As such, it is important to understand the degree to which intraspecific populations interact across a spatial gradient. The Atlantic sharpnose shark (Rhizoprionodon terraenovae) and Caribbean sharpnose shark (Rhizoprionodon porosus) share a similar appearance and spatial presence within the Gulf of Mexico, though until recently only R. terraenovae was observed north of the Bahamas. We assessed the population structure of R. terraenovae using the mitochondrial control region (650 bp). Our results indicate significant genetic structure (FST = 0.049, P < 0.001; ΦST = 0.017, P = 0.008) between the Gulf of Mexico and the rest of the Atlantic. In addition, we observed R. porosus outside their known range, in South Carolina, Virginia, and northern Florida. Given the overlapping range with R. terraenovae, we assessed the potential for congeneric hybridization with the addition of the nuclear ribosomal internal transcribed spacer 2 gene (1260 bp). Results designate these specimens to be true R. porosus specimens, indicating the need for reevaluation of this species' range. [ABSTRACT FROM AUTHOR]

Water samples were collected on three dates at 24 sites influenced by effluent from Georgia-Pacific's Palatka Pulp and Paper Mill Operation, a bleached and unbleached kraft mill near Palatka, Florida, USA. The sampling sites were located within the mill retention ponds, Rice Creek, and the St. John's River. Samples were analyzed by gas chromatography--mass spectrometry for abietic, dehydroabietic, and isopimaric acids, all of which are potentially toxic by-products of pulp production. Isopimaric acid concentrations greater than 12 mg/L were measured at the mill's effluent outfall but were less than 20 µg/L at the end of Rice Creek. This result indicates that the waters of Rice Creek provide dilution or conditions conducive for degradation or sorption of these compounds. Large differences in resin acid concentrations were observed between sampling events. In two sampling events, the maximum observed concentrations were less than 2 mg/L for each analyte. In a third sampling event, all of the compounds were detected at concentrations greater than 10 mg/L. Data from the three sample dates showed that resin acid concentrations were below 20 µg/L before the confluence of Rice Creek and the St. John's River in all cases. [ABSTRACT FROM AUTHOR]

Simple Summary: Citrus greening is devastating the citrus industry in Florida, and conventional synthetic pesticide applications are rapidly becoming unsustainable for the control of the vector, the Asian citrus psyllid (AsCP), Diaphorina citri. Laboratory experiments indicate that the entomopathogenic fungus Cordyceps javanica, alone and in combination with horticultural oils, may offer a more sustainable strategy to manage AsCP. The field study in this paper indicated that C. javanica alone, C. javanica mixed with white oil, and spinetoram (the chemical standard) mixed with white oil significantly suppressed AsCP populations by 60–90% and 61–83% 7 and 14 days after treatment, respectively, in 2018, compared to white oil only and the untreated control treatments. Only spinetoram + oil suppressed AsCP 100% up to 7 days after treatment in 2019. AsCP's natural enemies, mostly lady beetles, were observed on fungal-treated citrus trees and the untreated control. Overall, C. javanica was as effective in suppressing AsCP adults as spinetoram for up to 14 days in field conditions and was compatible with the psyllids' natural enemies. The use of C. javanica in citrus-integrated pest management is suggested. Citrus greening disease is devastating the citrus industry in Florida, and the conventional synthetic pesticide applications used to control the vector, the Asian citrus psyllid (AsCP), Diaphorina citri, are rapidly becoming unsustainable. Various laboratory experiments indicate that the entomopathogenic fungus Cordyceps javanica, alone and in combination with horticultural oils, may offer a more sustainable strategy for the management of AsCP. Field studies conducted in 2018 and 2019 in mature citrus indicated that C. javanica alone, C. javanica mixed with white oil, and the chemical standard spinetoram mixed with white oil significantly suppressed AsCP adult populations by 61–83% up to 14 days after treatment in 2018, although colony-forming units of C. javanica were still present on the leaves 21 days after treatment (DAT). Only spinetoram + oil significantly suppressed AsCP, by 100%, up to 7 DAT in 2019. Natural enemies of AsCP, including lady beetles, lacewing larvae and the parasitoid Tamarixia radiata, were observed in the fungal treatments and the untreated control. The AsCP suppression by C. javanica and its compatibility with beneficial organisms suggest the potential use of this entomopathogenic fungus in citrus-integrated pest management. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Seventeen states do not provide Medicaid coverage for neonatal male circumcision, despite American Academy of Pediatrics recommendations supporting access for families that choose it. Our study objectives were to (1) compare state-specific trends in neonatal circumcision to previously established estimates and (2) assess the impact of changes in Medicaid coverage of the procedure. METHODS: The State Inpatient Databases were used to determine rates of neonatal male circumcision in 4 states (CO, FL, MI, and NY) at 4 time points (2001, 2006, 2011, 2016). Neonatal circumcision was defunded by Medicaid in Florida (2003) and Colorado (2011). A multivariable logistic regression model was created to assess associations between patient and state characteristics and odds of neonatal circumcision. RESULTS: Overall, 54.5% of neonates underwent circumcision. States where Medicaid defunded neonatal circumcision revealed a decrease in circumcision rates in subsequent years (47.4% to 37.5% in FL; 61.9% to 52.0% in CO). Neonates with private insurance had higher odds of circumcision compared with those with public insurance (adjusted odds ratio [aOR] 2.23; 95% confidence interval [CI] 2.21-2.25). When Medicaid coverage was available, Black neonates had higher odds of circumcision compared with white neonates (aOR 1.44; 95% CI 1.42-1.46). When Medicaid coverage was not available, Black neonates had lower odds compared with white neonates (aOR 0.40; 95% CI 0.39-0.41). CONCLUSIONS: State-specific data reveal trends in neonatal circumcision similar to previous national estimates. Colorado and Florida revealed 20.9% and 16.0% reductions in neonatal circumcision rates, respectively, after defunding. Black neonates appeared to be disproportionately affected by changes in Medicaid coverage. [ABSTRACT FROM AUTHOR]

Irrigation with reclaimed water alleviates water supply shortages, but excess application often results in impairment of contiguous waterbodies. This project investigated the potential use of iohexol, an iodinated contrast media used in medical imaging, together with its bio- and phototransformation products as unique reconnaissance markers of reclaimed water irrigation intrusion at three golf courses within the state of Florida. Inter-facility iohexol concentrations measured in reclaimed waters ranged over ~2 orders of magnitude while observed intra-facility seasonal differences were ≤1 order of magnitude. A ~50 % reduction in iohexol was observed post-disinfection for reclaimed water facilities utilizing UV light while none was observed with use of chlorine. Iohexol biotransformation products were observed to decline or shift to lower molecular weight compounds when exposed to UV light but not during disinfection using chlorine. Iohexol biotransformation products were observed in most of the samples but were more prevalent in samples collected during the dry season. Much fewer iohexol phototransformation products were observed in chlorinated reclaimed water, and they were only observed in UV light irradiated reclaimed water when the pre-disinfectant iohexol concentration was ≥5000 ng/L or from solar exposure of reclaimed water spiked with 10 μM of iohexol. For the Hillsborough golf course overlaying an aquifer, the groundwater did not contain iohexol or phototransformation products but did contain biotransformation products. It is not known if these biotransformation products are from active or historical intrusion. The additional presence of sucralose in the aquifer suggests that intrusion has occurred within the past 3 years. This study demonstrates three crucial points in attempting to utilize iohexol to denote reclaimed water intrusion from irrigation overapplication: (1) interpretable results are obtained when iohexol concentrations in the reclaimed water employed for irrigation are ≥1000 ng/L, with higher concentrations in the range of ≥5000 ng/L better able to meet analytical sensitivity requirements after further dilution or degradation in the environment; (2) it is beneficial to assess iohexol transformation products in tandem with iohexol monitoring to account for environmental transformations of iohexol during storage and transport to the receiving water of concern; and (3) inclusion of monitoring for sucralose, an artificial sweetener ubiquitous in wastewater sources that is comparatively stable in the environment, can aid in interpretating whether reclaimed water intrusion based on identification of iohexol and transformation products in the receiving water is attributable to historic or ongoing irrigation overapplications., Competing Interests: Declaration of competing interest The authors declare no competing or conflicting interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: The purpose of this study was to identify the most parsimonious combination of cognitive tests that accurately predicts the likelihood of passing an on-road driving evaluation in order to develop a screening measure that can be administered as an in-office test., Design: This was a psychometric study of the new test's diagnostic accuracy., Settings and Participants: The study was conducted at the Florida Atlantic University's Memory Center and Clinical Research Unit, both easily accessible to older drivers. Participants were older drivers who received a driving evaluation at the Memory Center and agreed to have their results included in the Driving Repository and community-based older drivers who volunteered to participate., Methods: Mini-Mental State Exam (MMSE), Trail Making Tests A and B, Clock Test, Hopkins Verbal Learning Test, and Driving Health Inventory results were compared with an on-road driving evaluation to identify those tests that best predict the ability to pass the on-road evaluation., Results: Altogether, 412 older drivers, 179 men and 233 women, were included in the analysis. Fifty-four percent of Driving Repository participants failed the on-road evaluation compared with 8% of the community sample. The highest correlation to the on-road evaluation was Trails B time in seconds r = -0.713 (P < .001). Variables with high multicollinearity and/or low correlation with the on-road evaluation were eliminated and sets of receiver operating characteristics curves were generated to assess the predictive accuracy of the remaining tests. A linear combination of Trails B in seconds and MMSE using the highest of the Serial 7s or WORLD spelled backward scores accounted for the highest area under the curve of 0.915. Finally, an algorithm was created to rapidly generate the prediction for an individual patient., Conclusions and Implications: The Fit2Drive algorithm demonstrated a strong 91.5% predictive accuracy. Usefulness in office-based patient consultations is promising but remains to be rigorously tested., (Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: We evaluate the public health surveillance program, Screen, Test, and Protect (STP) designed to control and prevent COVID-19 at a large academic university in the United States. Methods: STP was established at the University of Florida in May 2020. This report details STP's full-time workforce, centralized database, and testing and vaccination programs. We evaluate the program's success in controlling COVID-19 during the 2020-2021 academic school year. Results:  COVID-19 cases rose among the campus community in the first few weeks of campus reopening in Fall 2020. Test positivity levels returned to prefall semester levels within one month, however. A few additional, yet smaller, waves occurred during the 2020-2021 school year and were successfully controlled without any campus-wide closures. Conclusions: This program may serve as a framework for other institutions managing the ongoing COVID-19 crisis, in addition to setting the standard for programmatic management of future emerging infectious diseases at universities.

We evaluated low-dose computed tomography (LDCT) adherence among people with HIV (PWH) treated at University of Florida (UF). From the UF Health Integrated Data Repository, we identified PWH who underwent at least one LDCT procedure (January 1, 2012-October 31, 2021). Lung cancer screening adherence was defined as having a second LDCT within recommended observation window, based on the Lung Imaging Reporting and Data System (Lung-RADS ® ). We identified 73 PWH with a history of at least one LDCT. PWH were mostly male (66%), non-Hispanic Black (53%), and living in urban (86%), high poverty (45%) areas. Almost 1 in 10 of PWH were diagnosed with lung cancer after their first LDCT. Overall, 48% and 41% of PWH were diagnosed with Lung-RADS categories 1 and 2, respectively. We observed that 12% of PWH were adherent to LDCT. Only 25% of PWH diagnosed with category 4A were adherent. PWH may have poor adherence to lung cancer screening.

Purpose: The purpose of this study was to present the successful management and outcomes in a series of 6 cases of culture-positive nontuberculous mycobacterial keratitis after clear corneal incision phacoemulsification surgery., Methods: This is a case series of 6 consecutive eyes that presented at the Cornea Division at an academic institution, diagnosed with culture-positive nontuberculous mycobacterial keratitis after phacoemulsification surgery., Results: Six eyes of 5 patients were included. The mean interval from cataract surgery to presentation was 7.7 weeks. All cases presented with intrastromal abscesses adjacent to corneal incisions, and 2 had scleral extension of the infection. Isolated organisms were Mycobacterium abscessus (n = 4), Mycobacterium chelonae (n = 1), and Mycobacterium mucogenicum (n = 1). All cases were treated with topical amikacin 8 mg/mL for 10.5 weeks on average. All cases received either oral clarithromycin at 500 mg twice-daily dosage or oral azithromycin at 500 mg daily. Two patients with scleral abscesses underwent surgical debridement with amniotic membrane grafts. All 6 eyes achieved infection resolution and good visual recovery, with the final visual acuity ranging from 20/20 to 20/60. None of the patients experienced recurrence of infection., Conclusions: Prompt medical treatment with combined topical and oral therapy can lead to infection resolution and favorable visual recovery. Early surgical intervention can ensure good outcomes in cases of scleral extension., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Migrant and seasonal farmworkers face enormous barriers to health and have been a particularly vulnerable population during the COVID-19 pandemic, but their pandemic experiences and potential inequities have not been well studied., Objectives: We aimed to assess the impact of COVID-19 in Immokalee, Florida, a community with a significant population of migrant and seasonal farmworkers. We evaluated for differences in pandemic experience by language, a known barrier to healthcare, to inform and strengthen future public health efforts., Methods: First, to estimate the burden of COVID in the area, we conducted a descriptive analysis of data on COVID-19 deaths for Collier County from May-August 2020. We then surveyed a cross-sectional, randomized representative sample of 318 adults living in Immokalee from March-November 2020 to assess socio-demographics, workplace conditions, sources of information, ability to follow guidelines, and experiences with testing and contact tracing programs. Results were compared across language groups., Findings: Average excess mortality in Collier County was 108%. The majority surveyed in Immokalee had socio-demographic factors associated with higher COVID risk. Non-English speakers had higher workplace risk due to less ability to work from home. Haitian Creole speakers were less likely to be tested, though all participants were willing to get symptomatic testing and quarantine. Those participants who tested positive or had COVID-19 exposures had low engagement with the contact tracing program, and Spanish-speakers reported lower quality of contact tracing than English speakers., Conclusions: The community of Immokalee, FL is a vulnerable population that suffered disproportionate deaths from COVID-19. This study reveals language inequities in COVID testing and contact tracing that should be targeted in future pandemic response in Immokalee and other migrant farmworker communities., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Introduction: Drysuits use flexible neck and wrist seals to maintain water-tight seals. However, if the seals exert too much pressure adverse physiological effects are possible, including dizziness, lightheadedness, syncope, and paresthesias in the hands. We aimed to quantify the seal pressures of neck and wrist seals in non-immersed divers., Methods: We recruited 33 diving volunteers at two dive facilities in High Springs, Florida. After a history and physical exam, we measured vital signs as well as wrist and neck seal pressures using a manometer system., Results: The mean (SD) seal pressure of the right wrist seals was found to be 38.8 (14.9) mmHg, while that of the left wrist seals was 37.6 (14.9) mmHg. The average neck seal pressure was 23.7 (9.4) mmHg. Subgroup analysis of seal material demonstrated higher mean sealing pressure with latex seals compared to silicone; however, this difference was not statistically significant., Conclusions: Drysuit seal pressures are high enough to have vascular implications and even potentially cause peripheral nerve injury at the wrist. Divers should trim their seals appropriately and be vigilant regarding symptoms of excessive seal pressures. Further research may elucidate if seal material influences magnitude of seal pressure., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Background: Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse poststroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels., Objectives: The aim of this study was to determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels., Methods: We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7- and 30-day all-cause readmissions for Black and White ischemic stroke patients., Results: Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black patients, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30- and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (less than three patients per nurse), Black and White stroke patients' disparities were no longer significant., Discussion: Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Central line-associated bloodstream infections (CLABSI) are costly and can be lifethreatening. Many efforts have been taken to minimize the rates of infection, including sterile technique, pre-packaged sterile kits, site selection, and replacing infected or potentially infected lines. This study aims to identify the incidence of CLABSI following catheter placement in the ED, and to compare rates of CLABSI among ED and ICU placed catheters., Methods: This retrospective chart review was conducted at a Level 1 Trauma Center. Eligibility criteria included patients who had CVC placed in the ED or ICU from January 1st, 2018, through July 31st, 2019 who were 18 years or older., Results: Among 1810 patients with central lines, 1254 met eligibility criteria. There was no significant difference in infection rates when comparing lines placed in the ED (2.5 per 1000 catheter days, 95% confidence interval [CI] 0.8 to 5.8) compared to those placed in the ICU (4.6 per 1000 catheter days, 95% CI 3.0 to 6.8). The odds of CLABSI was not associated with age, sex, indication, site, location nor which type of health care professional (HCP) placed the line., Conclusions: In this study, the incidence of infection was no different between lines placed in the ED compared to the ICU., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Importance: Undertriaging patients who are at increased risk for postoperative complications after surgical procedures to low-acuity hospital wards (ie, floors) rather than highly vigilant intensive care units (ICUs) may be associated with risk of unrecognized decompensation and worse patient outcomes, but evidence for these associations is lacking., Objective: To test the hypothesis that postoperative undertriage is associated with increased mortality and morbidity compared with risk-matched ICU admission., Design, Setting, and Participants: This longitudinal cross-sectional study was conducted using data from the University of Florida Integrated Data Repository on admissions to a university hospital. Included patients were individuals aged 18 years or older who were admitted after a surgical procedure from June 1, 2014, to August 20, 2020. Data were analyzed from April through August 2021., Exposures: Ward admissions were considered undertriaged if their estimated risk for hospital mortality or prolonged ICU stay (ie, ≥48 hours) was in the top quartile among all inpatient surgical procedures according to a validated machine-learning model using preoperative and intraoperative electronic health record features available at surgical procedure end time. A nearest neighbors algorithm was used to identify a risk-matched control group of ICU admissions., Main Outcomes and Measures: The primary outcomes of hospital mortality and morbidity were compared among appropriately triaged ward admissions, undertriaged wards admissions, and a risk-matched control group of ICU admissions., Results: Among 12 348 postoperative ward admissions, 11 042 admissions (89.4%) were appropriately triaged (5927 [53.7%] women; median [IQR] age, 59 [44-70] years) and 1306 admissions (10.6%) were undertriaged and matched with a control group of 2452 ICU admissions. The undertriaged group, compared with the control group, had increased median [IQR] age (64 [54-74] years vs 62 [50-73] years; P = .001) and increased proportions of women (649 [49.7%] women vs 1080 [44.0%] women; P < .001) and admitted patients with do not resuscitate orders before first surgical procedure (53 admissions [4.1%] vs 27 admissions [1.1%]); P < .001); 207 admissions that were undertriaged (15.8%) had subsequent ICU admission. In the validation cohort, hospital mortality and prolonged ICU stay estimations had areas under the receiver operating characteristic curve of 0.92 (95% CI, 0.91-0.93) and 0.92 (95% CI, 0.92-0.92), respectively. The undertriaged group, compared with the control group, had similar incidence of prolonged mechanical ventilation (32 admissions [2.5%] vs 53 admissions [2.2%]; P = .60), decreased median (IQR) total costs for admission ($26 900 [$18 400-$42 300] vs $32 700 [$22 700-$48 500]; P < .001), increased median (IQR) hospital length of stay (8.1 [5.1-13.6] days vs 6.0 [3.3-9.3] days, P < .001), and increased incidence of hospital mortality (19 admissions [1.5%] vs 17 admissions [0.7%]; P = .04), discharge to hospice (23 admissions [1.8%] vs 14 admissions [0.6%]; P < .001), unplanned intubation (45 admissions [3.4%] vs 49 admissions [2.0%]; P = .01), and acute kidney injury (341 admissions [26.1%] vs 477 admissions [19.5%]; P < .001)., Conclusions and Relevance: This study found that admitted patients at increased risk for postoperative complications who were undertriaged to hospital wards had increased mortality and morbidity compared with a risk-matched control group of admissions to ICUs. Postoperative undertriage was identifiable using automated preoperative and intraoperative data as features in real-time machine-learning models.

Objectives: Because the population in Florida is 25.6% Hispanic, it is possible to evaluate the influence of race and ethnicity within clinically relevant subgroups of women with epithelial ovarian cancer (EOC), including histology and tumor grade. This study explores racial/ethnic disparities in the incidence of EOC in Florida by histology and tumor grade., Methods: This study is an analysis of the Florida Cancer Database System. All incidence EOC cases from 2001 through 2015 were identified. Age-adjusted incidences were calculated and trends modeled by race/ethnicity and histology using Joinpoint and Poisson regression., Results: In total, 80% of the 21,731 women with EOC were White, followed by Hispanic (13.1%) and non-Hispanic Black (7.9%). All races/ethnicities had statistically significant declines in incidence, with non-Hispanic White and non-Hispanic Black women having the steepest declines (annual percentage change -2.5, 95% confidence interval [CI] -5.9 to -2.1 and annual percentage change -2.8, 95% CI -4.8 to -1.5, respectively). A decreased incidence trend across the time period was seen for all subgroups (relative risk 0.97 [95% CI 0.96-0.98], 0.96 [95% CI 0.96-0.99], and 0.98 [95% CI 0.96-0.99] for non-Hispanic White, non-Hispanic Black, and Hispanic). High-grade EOC incidence for all groups did not change with time., Conclusions: We found significant declines in the incidence of EOC for all races/ethnicities, but not for high-grade EOC. The observed incidence decline in Hispanic women differs from previous research. More research is needed to understand women the causes of overall racial/ethnic differences and the decline in EOC.

Background and Purpose: This article describes the clinical and educational impact resulting from interprofessional (IP) collaboration between fourth-year advanced pharmacy practice experience (APPE) pharmacy students and community paramedics within a community paramedicine (CP) program., Educational Activity and Setting: The Manatee County, Florida CP program partnered with Lake Erie College of Osteopathic Medicine School of Pharmacy faculty to reduce 911 calls, emergency room visits, and hospital readmissions for underserved populations. The CP-pharmacist partnership optimized medication therapy, chronic disease management, and access to care through scheduled in-home visits with an IP team. With guidance from the pharmacist, APPE student responsibilities included comprehensive medication review, medication action plan development, communication with providers, and patient counseling to resolve medication issues., Findings: Survey data demonstrated this approach to APPEs increased student confidence in optimizing care plans (100%), assessing vitals (76%), identifying medical emergencies (84%), and communicating with patients (96%). Student incorporation into a CP program augmented the pharmacist's ability to successfully correct medication use errors and improve nonadherence through patient counseling. Medication interventions were successful in 693 of 799 scenarios, for a success rate of 86.7%., Summary: Results from this analysis reinforced prior research indicating pharmacy students can be successfully incorporated into a CP program, with resulting improvement in student clinical skills, communication strategies, and successful medication intervention outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Common bottlenose dolphins (Tursiops truncatus truncatus) inhabiting the Indian River Lagoon (IRL) estuarine system along the east coast of Florida are impacted by anthropogenic activities and have had multiple unexplained mortality events. Given this, managers need precise estimates of demographic and abundance parameters. Mark-recapture photo-identification boat-based surveys following a Robust Design were used to estimate abundance, adult survival, and temporary emigration for the IRL estuarine system stock of bottlenose dolphins. Models allowed for temporary emigration and included a parameter (time since first capture) to assess evidence for transient individuals. Surveys (n = 135) were conducted along predetermined contour and transect lines throughout the entire IRL (2016-2017). The best fitting model allowed survival to differ for residents and transients and to vary by primary period, detection to vary by secondary session, and did not include temporary emigration. Dolphin abundance was estimated from 981 (95% CI: 882-1,090) in winter to 1,078 (95% CI: 968-1,201) in summer with a mean of 1,032 (95% CI: 969-1,098). Model averaged seasonal survival rate for marked residents was 0.85-1.00. Capture probability was 0.20 to 0.42 during secondary sessions and the transient rate was estimated as 0.06 to 0.07. This study is the first Robust Design mark-recapture survey to estimate abundance for IRL dolphins and provides population estimates to improve future survey design, as well as an example of data simulation to validate and optimize sampling design. Transients likely included individuals with home ranges extending north of the IRL requiring further assessment of stock delineation. Results were similar to prior abundance estimates from line-transect aerial surveys suggesting population stability over the last decade. These results will enable managers to evaluate the impact of fisheries-related takes and provide baseline demographic parameters for the IRL dolphin population which contends with anthropogenic impacts and repeated mortality events., Competing Interests: We note that one or more of the authors are currently employed by a commercial company: GeoSan Services LLC, Centersoft Technologies, and Dolphin Census, Inc. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Racial disparities in survival among patients who had an in-hospital cardiac arrest (IHCA) have been linked to hospital-level factors., Objectives: To determine whether nurse staffing is associated with survival disparities after IHCA., Research Design: Cross-sectional data from (1) the American Heart Association's Get With the Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and Patient Safety Survey; and (3) The American Hospital Association annual survey. Risk-adjusted logistic regression models, which took account of the hospital and patient characteristics, were used to determine the association of nurse staffing and survival to discharge for black and white patients., Subjects: A total of 14,132 adult patients aged 18 and older between 2004 and 2010 in 75 hospitals in 4 states., Results: In models that accounted for hospital and patient characteristics, the odds of survival to discharge was lower for black patients than white patients [odds ratio (OR)=0.70; 95% confidence interval (CI), 0.61-0.82]. A significant interaction was found between race and medical-surgical nurse staffing for survival to discharge, such that each additional patient per nurse lowered the odds of survival for black patients (OR=0.92; 95% CI, 0.87-0.97) more than white patients (OR=0.97; 95% CI, 0.93-1.00)., Conclusions: Our findings suggest that disparities in IHCA survival between black and white patients may be linked to the level of medical-surgical nurse staffing in the hospitals in which they receive care and that the benefit of being admitted to hospitals with better staffing may be especially pronounced for black patients., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.)

The spiny lobster, Panulirus argus, is an ecologically relevant species in shallow water coral reefs and a target of the most lucrative fishery in the greater Caribbean region. This study reports, for the first time, the heart + hemolymph transcriptome of the Caribbean spiny lobster Panulirus argus assembled from short Illumina 150bp PE raw reads. A total of 80,152,094 raw reads were assembled using the Oyster River Protocol pipeline. The assembly resulted in a total of 254,773 transcripts. Functional gene annotation was conducted using the software package 'dammit'. Lastly, gene enrichment analyses were conducted using the Gene Ontology (GO) and KEGG pathway (Kaas) databases. This resource will be of utmost importance in future research aiming at exploring the effect of local and regional anthropogenic disturbances, as well as global climate change on the molecular physiology of this overexploited species., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Public opinion researchers often find changing attitudes about pressing public health issues to be a difficult task and even when attitudes do change, behaviors often do not. However, salient real-world events have the ability to bring public health crises to the fore in unique ways. To assess the impact of localized public health events on individuals' self-reported behavior, this paper examines Floridians' intentions to take preventative measures against the Zika virus before and after the first locally transmit- ted case of Zika emerged in Florida. We find that local and national media coverage of Zika increased significantly following its first transmission in the U.S. Critically, we also find that Floridians surveyed after this increase in media coverage were more likely to pay attention to Zika-related news, and self-report intentions to take protective action against the virus. These results suggest that behavioral intentions can shift as health threats become more proximate.

Objective: Pain and disability among surgeons can lead to practice restrictions, early retirement, and physician burnout. This project sought to address the physical well-being of surgical residents by teaching ergonomic principles, a "microbreaks" model, and stretching exercises aimed at targeting the four anatomical areas identified as most problematic for surgeons., Design: Three modules, led by physical therapists, were presented to surgical residents over the course of the 2018-2019 academic year. These modules targeted specific problem areas for surgeons according to current literature. A perioperative micro-break model was also presented. Pre- and post-lecture surveys were administered to document pain, applicability of lecture content and effectiveness for use in the operating room (OR), and were reviewed retrospectively., Setting: Jackson Memorial Hospital, DeWitt Daughtry Family Department of Surgery, Division of General Surgery, Miami, Florida RESULTS: A large number of participants reported pain in one or more body part (87%) prior to beginning this ergonomic training and 39% indicated that this pain was performance-limiting. The majority of residents (93%) who attended Module #3 reported that learning the targeted exercises and microbreaks model would help them physically perform better in the OR and, in fact, after practicing these exercises during this Module, 85% of residents reported decreased pain, especially in the areas of the cervical and lumbar spine., Conclusions: Preliminary data indicate that this novel curriculum was perceived as valuable by surgical residents and that practicing these targeted exercises reduced pain, particularly in the neck and lower back. Further research is needed to determine the longitudinal effects of this ergonomics curriculum on surgical resident well-being and whether these exercises will be effective in reducing pain and enhancing performance in the OR setting., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: To the authors' knowledge, the etiology of survival disparities in patients with epithelial ovarian cancer (EOC) is not fully understood. Residential segregation, both economic and racial, remains a problem within the United States. The objective of the current study was to analyze the effect of residential segregation as measured by the Index of Concentration at the Extremes (ICE) on EOC survival in Florida by race and/or ethnicity., Methods: All malignant EOC cases were identified from 2001 through 2015 using the Florida Cancer Data System (FCDS). Census-defined places were used as proxies for neighborhoods. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed: economic (high vs low), race and/or ethnicity (non-Hispanic white [NHW] vs non-Hispanic black [NHB] and NHW vs Hispanic), and racialized economic segregation (low-income NHB vs high-income NHW and low-income Hispanic vs high-income NHW). Random effects frailty models were conducted., Results: A total of 16,431 malignant EOC cases were diagnosed in Florida among women living in an assigned census-defined place within the time period. The authors found that economic and racialized economic residential segregations influenced EOC survival more than race and/or ethnic segregation alone in both NHB and Hispanic women. NHB women continued to have an increased hazard of death compared with NHW women after controlling for multiple covariates, whereas Hispanic women were found to have either a similar or decreased hazard of death compared with NHW women in multivariable Cox models., Conclusions: The results of the current study indicated that racial and economic residential segregation influences survival among patients with EOC. Research is needed to develop more robust segregation measures that capture the complexities of neighborhoods to fully understand the survival disparities in EOC., (© 2020 American Cancer Society.)

In summer of 2017 in Charlottesville, Virginia, white nationalists clashed with counterprotestors, ultimately leading to the death of three people and leaving 34 more injured. Soon after, the same group was granted permission to speak on the campus of the University of Florida in Gainesville, Florida. Despite our college town having limited resources and personnel, the comprehensive and extensive preparation preceding the event ensured a peaceful resolution for such a large and potentially volatile situation. The preparatory steps required joint efforts from local and state partners in law enforcement, emergency medical services, and emergency departments. We describe here the situation we faced, the pre-event preparations, the response in the field and in our emergency department, and the outcomes from an emergency and tactical medicine perspective. We hope our successful experience will impart knowledge for similar events., (2020.)

Background: Skeletal muscle wasting, or sarcopenia, affects a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). However, its influence on post-TAVR recovery and 1-year health-related quality of life (HR-QOL) remains unknown. We examined the relationship between skeletal muscle index (SMI), post-TAVR length of hospital stay (LOS), and 1-year QOL., Methods: The study sample consisted of 300 consecutive patients undergoing TAVR from 2012 to 2018 who had pre-TAVR computed tomographic scans suitable for analysis of body composition. Skeletal muscle mass was quantified as cm 2 of skeletal mass per m 2 of body surface area from the cross-sectional computed tomographic image at the third lumbar vertebra. Sarcopenia was defined using established sex-specific cutoffs (women: SMI < 39 cm 2 /m 2 ; men: < 55 cm 2 /m 2 ). Multivariable linear regression analysis was used to determine the relationship between SMI, LOS, and HR-QOL using the Kansas City Cardiomyopathy Questionnaire., Results: Sarcopenia was present in most (59%) patients and associated with older age (82 vs 76 years; P < .001) and lower body mass index (27 vs 33 kg/m 2 ; P < .001). There were no other differences in baseline clinical or echocardiographic characteristics among the 4 quartiles of SMI. SMI was positively correlated with LOS and 1-year QOL. After adjusting for age, gender, race, and body mass index, SMI remained a significant predictor of both LOS (P = .01) and 1-year QOL (P = .012). For every 10 cm 2 /m 2 higher SMI, there was an 8-point increase in Kansas City Cardiomyopathy Questionnaire score, a difference that is clinically meaningful., Conclusions: Sarcopenia is prevalent in TAVR patients. Higher SMI is associated with shorter LOS and better 1-year HR-QOL. To achieve optimal TAVR benefits, further study into how body composition influences post-TAVR recovery and durable improvement in QOL is warranted., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Significant population declines in Acropora cervicornis and A. palmata began in the 1970s and now exceed over 90%. The losses were caused by a combination of coral disease and bleaching, with possible contributions from other stressors, including pollution and predation. Reproduction in the wild by fragment regeneration and sexual recruitment is inadequate to offset population declines. Starting in 2007, the Coral Restoration Foundation™ evaluated the feasibility of outplanting A. cervicornis colonies to reefs in the Florida Keys to restore populations at sites where the species was previously abundant. Reported here are the results of 20 coral outplanting projects with each project defined as a cohort of colonies outplanted at the same time and location. Photogrammetric analysis and in situ monitoring (2007 to 2015) measured survivorship, growth, and condition of 2419 colonies. Survivorship was initially high but generally decreased after two years. Survivorship among projects based on colony counts ranged from 4% to 89% for seven cohorts monitored at least five years. Weibull survival models were used to estimate survivorship beyond the duration of the projects and ranged from approximately 0% to over 35% after five years and 0% to 10% after seven years. Growth rate averaged 10 cm/year during the first two years then plateaued in subsequent years. After four years, approximately one-third of surviving colonies were ≥ 50 cm in maximum diameter. Projects used three to sixteen different genotypes and significant differences did not occur in survivorship, condition, or growth. Restoration times for three reefs were calculated based on NOAA Recovery Plan (NRP) metrics (colony abundance and size) and the findings from projects reported here. Results support NRP conclusions that reducing stressors is required before significant population growth and recovery will occur. Until then, outplanting protects against local extinction and helps to maintain genetic diversity in the wild., Competing Interests: We have read the journal's policy and Steven Miller may have a competing interest: He is on the board of the Coral Restoration Foundation.

Many studies have focused on white and black disparities in epithelial ovarian cancer (EOC) but fewer include Hispanics. Florida presents a unique opportunity to study racial/ethnic disparities. This study examined racial/ethnic disparities in the overall survival of women with EOC in Florida by histology. All EOC cases from 2001 through 2015 were identified in the Florida Cancer Database System (FCDS). Survival curves by race/ethnicity and histology were generated by Kaplan-Meier methods. Cox regression evaluated the associations between race/ethnicity, histology, and survival. Eligible EOC cases (n = 21,721) identified in the 2001-2015 FCDS were included in the study. The median survival for non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics was 31, 21, and 35 months, respectively (p < 0.001). NHB had an increased [AHR 1.23 (95% CI 1.15, 1.30)] and Hispanics a nonsignificant decreased hazard [AHR 0.96 (95% CI 0.91, 1.02)] of death compared to NHW after controlling for other demographic, treatment, and tumor characteristics. Relative to NHWs, NBH had worse survival while Hispanics had equivalent survival. Future research should consider evaluating genetic and epigenetic modifications, and prevalence of cancer syndromes to further elucidate the etiologies of disease in these disparate populations.

Background: Orthopaedic trauma patients frequently experience mobility impairment, fear-related issues, self-care difficulties, and work-related disability []. Recovery from trauma-related injuries is dependent upon injury severity as well as psychosocial factors []. However, traditional treatments do not integrate psychosocial and early mobilization to promote improved function, and they fail to provide a satisfying patient experience., Questions/purposes: We sought to determine (1) whether an early psychosocial intervention (integrative care with movement) among patients with orthopaedic trauma improved objective physical function outcomes during recovery compared with usual care, and (2) whether an integrative care approach with orthopaedic trauma patients improved patient-reported physical function outcomes during recovery compared with usual care., Methods: Between November 2015 and February 2017, 1133 patients were admitted to one hospital as orthopaedic trauma alerts to the care of the three orthopaedic trauma surgeons involved in the study. Patients with severe or multiple orthopaedic trauma requiring one or more surgical procedures were identified by our orthopaedic trauma surgeons and approached by study staff for enrollment in the study. Patients were between 18 years and 85 years of age. We excluded individuals outside of the age range; those with diagnosis of a traumatic brain injury []; those who were unable to communicate effectively (for example, at a level where self-report measures could not be answered completely); patients currently using psychotropic medications; or those who had psychotic, suicidal, or homicidal ideations at time of study enrollment. A total of 112 orthopaedic trauma patients were randomized to treatment groups (integrative and usual care), with 13 withdrawn (n = 99; 58% men; mean age 44 years ± 17 years). Data was collected at the following time points: baseline (acute hospitalization), 6 weeks, 3 months, 6 months, and at 1 year. By 1-year follow-up, we had a 75% loss to follow-up. Because our data showed no difference in the trajectories of these outcomes during the first few months of recovery, it is highly unlikely that any differences would appear months after 6 months. Therefore, analyses are presented for the 6-month follow-up time window. Integrative care consisted of usual trauma care plus additional resources, connections to services, as well as psychosocial and movement strategies to help patients recover. Physical function was measured objectively (handgrip strength, active joint ROM, and Lower Extremity Gain Scale) and subjectively (Patient-Reported Outcomes Measurement Information System-Physical Function [PROMIS®-PF] and Tampa Scale of Kinesiophobia). Higher values for hand grip, Lower Extremity Gain Scale (score range 0-27), and PROMIS®-PF (population norm = 50) are indicative of higher functional ability. Lower Tampa Scale of Kinesiophobia (score range 11-44) scores indicate less fear of movement. Trajectories of these measures were determined across time points., Results: We found no differences at 6 months follow-up between usual care and integrative care in terms of handgrip strength (right handgrip strength β = -0.0792 [95% confidence interval -0.292 to 0.133]; p = 0.46; left handgrip strength β = -0.133 [95% CI -0.384 to 0.119]; p = 0.30), or Lower Extremity Gain Scale score (β = -0.0303 [95% CI -0.191 to 0.131]; p = 0.71). The only differences between usual care and integrative care in active ROM achieved by final follow-up within the involved extremity was noted in elbow flexion, with usual care group 20° ± 10° less than integrative care (t [27] = -2.06; p = 0.05). Patients treated with usual care and integrative care showed the same Tampa Scale of Kinesiophobia score trajectories (β = 0.0155 [95% CI -0.123 to 0.154]; p = 0.83)., Conclusion: Our early psychosocial intervention did not change the trajectory of physical function recovery compared with usual care. Although this specific intervention did not alter recovery trajectories, these interventions should not be abandoned because the greatest gains in function occur early in recovery after trauma, which is the key time in transition to home. More work is needed to identify ways to capitalize on improvements earlier within the recovery process to facilitate functional gains and combat psychosocial barriers to recovery., Level of Evidence: Level II, therapeutic study.

Background Patients with Eisenmenger syndrome are known to have a high incidence of sudden cardiac death (SCD), yet the underlying causes are not well understood. We sought to define the predictors of SCD in this population. Methods and Results A retrospective analysis of all patients with Eisenmenger syndrome from 2 large tertiary referral centers was performed. ECGs, prolonged ambulatory recordings, echocardiograms, and clinical histories were reviewed; and the cause of death was identified. A total of 246 patients (85 [34.6%] men) with a mean age of 37.3 (±14.2) years were followed up for a median of 7 years. Over the study period, 136 patients died, with 40 experiencing SCD and 74 experiencing cardiac death (sudden and nonsudden). Age, atrial fibrillation, prolonged QRS duration, complete heart block, right atrial enlargement, right bundle branch block, increased right atrial pressure, impaired biventricular function, and the presence of a pacemaker were associated with increased risk of SCD, whereas advanced pulmonary hypertension therapies were protective. Atrial fibrillation (11.45-fold increased risk; P <0.001) and QRS duration ≥120 ms (2.06-fold increased risk; P =0.034) remained significant predictors of SCD in the multivariate analysis, whereas advanced pulmonary hypertension therapies were strongly protective against SCD ( P <0.001). Conclusions Atrial arrhythmias, impaired ventricular function, and conduction system disease were associated with increased risk of SCD in this cohort of patients with Eisenmenger syndrome, providing an opportunity for early risk stratification and potential intervention. Clinical heart failure symptoms (New York Heart Association class ≥II) were predictive of increased mortality but not of SCD, suggesting a potential arrhythmic cause behind SCD.

Objectives/hypothesis: To evaluate the trend and factors associated with surgical management of orbital cellulitis., Study Design: Retrospective database study., Methods: Study using the State Inpatient Databases (SIDs) from 2008 to 2015. Patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for orbital cellulitis were identified in the SIDs for the following states: Arkansas, Florida, Iowa, Maryland, Nebraska, New York, and Wisconsin. Surgery was defined as an ICD-9-CM procedure code for orbitotomy and/or functional endoscopic sinus surgery. The trend of surgery over time was evaluated using the Cochran-Armitage test. Multivariable logistic regression models were used to identify patient- and hospital-level factors associated with surgery., Results: From 2008 to 2013, the number of hospitalizations for orbital cellulitis ranged from 1,349 to 1,574, but declined to 865 in 2014. From 2008 to 2015, the number of surgeries ranged from 103 to 154. For children (n = 3,041), age, ophthalmologic comorbidity, and conjunctival edema were significantly associated with surgery, whereas for adults (n = 7,961), male gender, private insurance, optic neuritis, and cranial nerves III/VI/VI palsy were associated with surgery., Conclusions: Although the number of inpatient hospitalizations for orbital cellulitis has markedly declined, the number of surgeries for orbital cellulitis has remained fairly stable, leading to an observed higher proportion of hospitalized patients undergoing surgery. Future directions include extending the time frame to the present day to assess current rates of hospitalization and surgery. Knowledge of surgical trends and patient- and hospital-level characteristics associated with surgery may help improve management guidelines for and understanding of this vision-threatening disease., Level of Evidence: NA Laryngoscope, 130:567-574, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Injury of the spleen may result in significant morbidity and mortality, often related to blood loss. Splenic injuries may be missed on the initial Emergency Department (ED) presentation. This study was undertaken to describe cases of delayed diagnosis, and to identify factors associated with delayed diagnosis, treatment, and outcomes., Methods: This retrospective study examined eligible participants with injury to the spleen who were admitted between July 2015-December 2017. Eligible participants included patients age 16 and over with injury to the spleen, with two or more ED presentations prior to admission and inpatient management. Data collected included age, gender, ethnicity, trauma triage category, vital signs, mechanism of injury, CT diagnosis, time from injury to diagnosis, toxicologic test results, inpatient management, outcome, and days of hospitalization., Results: Among 210 patients with splenic injury, the mean age was 36. Most participants were male (N = 132; 63%) and White (N = 165; 79%). A small percentage (6%) was not diagnosed with splenic injury during the initial ED encounter. Missed diagnosis on the initial ED visit was not associated with age, gender, ethnicity, mechanism of injury, vital signs, grade of injury, intervention, or days of hospitalization. Most patients were discharged home (N = 9); a minority died (N = 1) or were discharged to a rehabilitation facility (N = 1)., Conclusions: In this study, 6% of patients with splenic injury were not diagnosed during the initial ED encounter. These patients with delayed diagnosis had similar grade of injury, need for intervention, days of hospitalization, and outcome., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Rapid and significant range expansion of both Zika virus (ZIKV) and its Aedes vector species has resulted in ZIKV being declared a global health threat. Mean temperatures are projected to increase globally, likely resulting in alterations of the transmission potential of mosquito-borne pathogens. To understand the effect of diurnal temperature range on the vectorial capacity of Ae. aegypti and Ae. albopictus for ZIKV, longevity, blood-feeding and vector competence were assessed at two temperature regimes following feeding on infectious blood meals. Higher temperatures resulted in decreased longevity of Ae. aegypti [Log-rank test, χ2, df 35.66, 5, P < 0.001] and a decrease in blood-feeding rates of Ae. albopictus [Fisher's exact test, P < 0.001]. Temperature had a population and species-specific impact on ZIKV infection rates. Overall, Ae. albopictus reared at the lowest temperature regime demonstrated the highest vectorial capacity (0.53) and the highest transmission efficiency (57%). Increased temperature decreased vectorial capacity across groups yet more significant effects were measured with Ae. aegypti relative to Ae. albopictus . The results of this study suggest that future increases in temperature in the Americas could significantly impact vector competence, blood-feeding and longevity, and potentially decrease the overall vectorial capacity of Aedes mosquitoes in the Americas.

Background: Lesbian, gay, bisexual, and transgender (LGBT) cancer patients experience substantial health disparities, including poorer overall health and lower satisfaction with their cancer care than their heterosexual and cisgender counterparts, which may be due in part to a lack of culturally competent providers. To address these disparities, a web-based LGBT cultural competency training tailored to oncologists was developed by an interdisciplinary team of scientists, LGBT cancer survivors, cultural competency experts, oncologists, a web designer, and an instructional designer., Methods: Oncologists (n = 44) were recruited from 3 academic cancer centers in Florida. Participants were administered the LGBT cultural competency training Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS) and completed pre- and posttraining measures regarding LGBT-related knowledge, attitudes (including general negative attitudes and health care-related attitudes), and clinical practices. After the training, participants completed training acceptability measures., Results: Of the 44 participants, 33 (75%) completed the COLORS training. Participants were 55% non-Hispanic white, 63% male, and had a mean age of 47 years. Participants demonstrated significant improvements in LGBT-related knowledge (t = -4.9, P < .001), attitudes (Z = -3.0, P = .002; t = -2.5, P = .019), and clinical practices (Z = -3.5, P < .001) after completing the COLORS training (Wilcoxon signed rank tests were used for nonnormally distributed variables). Moreover, training acceptability was high, with 82% of participants rating the training as high quality, and 97% being willing to recommend the training to a colleague., Conclusion: The COLORS training is both feasible to administer and acceptable for use with oncologists, and may improve oncologists' LGBT-related knowledge, attitudes, and clinical practices. Larger trials are needed to examine the training's effectiveness in reducing LGBT cancer disparities, as well as its applicability to other types of care providers., (© 2019 American Cancer Society.)