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Background The COVID-19 pandemic has continued despite large-scale public health measures. Some people are still hesitant to receive the COVID vaccine. The San Antonio Food Bank (SAFB) is an organization that wants to gather opinions of clientele regarding vaccinations. A prior study at the SAFB captured reasons for influenza vaccine hesitancy. Objectives Identify reasons for COVID vaccine hesitancy. Compare reasons for COVID vaccine hesitancy from this study to reasons for influenza vaccine hesitancy from a prior study. Methods Student pharmacists partnered with SAFB leaders to create and administer English and Spanish surveys regarding client demographics, COVID vaccination status, and COVID vaccine hesitancy in those who had not yet received the COVID vaccine. Investigators completed paper surveys with clients during verbal interviews. Information from this COVID vaccine hesitancy study was compared to previous information from a 2019-2020 influenza vaccine hesitancy study also conducted at the SAFB. Outcomes COVID vaccination rates in this study were higher than influenza vaccination rates observed in a prior study at the SAFB. When comparing the reasons for hesitancy, several differences were identified regarding what clients said about the COVID and influenza vaccines: too expensive, not knowing where to get it, and afraid of getting sick. Conclusion This study indicates that reasons for vaccine hesitancy differ between COVID and influenza vaccines, suggesting a need to provide accurate information about each vaccine. Healthcare providers can make an impact by educating the community regarding COVID vaccine misconceptions and helping them navigate where and how to receive influenza vaccines.

Anticoagulant rodenticides (ARs) are increasingly recognized as a threat to non-target species including native wildlife. Fishers (Pekania pennanti) are generally considered deep forest inhabitants that are not expected to have high exposure to ARs. To evaluate the distribution and levels of ARs in fishers, we analyzed liver samples from fisher carcasses (N = 45) opportunistically trapped across Vermont and New Hampshire between 2018 and 2019. Liquid chromatography-mass spectrometry was used to detect and quantify 11 different ARs in the liver tissue of each fisher at the time of trapping. All but one sample analyzed were positive for exposure to ARs, and 84% were positive for more than one type of AR. The most prevalent ARs detected were diphacinone (96%) and brodifacoum (80%). No samples had detectable levels of coumachlor, coumafuryl, difenacoum, pinodone, or warfarin. These results are mostly consistent with findings for fishers in the Pacific Northwest as well as with a variety of rodent specializing avifauna throughout the Northeastern USA, but show a higher prevalence of exposure and a different distribution of AR types than other studies. These results help establish current baseline exposure to ARs in fishers in the Northeast USA and suggest that ARs could pose a threat to wild mesocarnivore species in this region.

Metropolitan cities can serve as laboratories of sustainable development by experimenting with innovative sustainability programs while leveraging the advantages of metropolitan areas. With the importance of cities’ sustainability efforts, scholars have increasingly explored what factors motivate local governments to implement voluntary sustainability programs by focusing on internal government and community characteristics. However, what is missing in the previous discussion is whether city governments respond to sustainability efforts by other government entities, especially neighboring local governments. Drawing on institutional and policy diffusion theories, we analyzed the sustainability programs of 251 suburban cities in 66 metropolitan areas. We find that suburban cities are likely to consider sustainability efforts of central cities in the same metropolitan area when determining the extent to which they implement their sustainability programs. However, they are not necessarily responsive to sustainability efforts of nearby suburban cities. Our research sheds light on how local governments’ sustainability policy decisions are affected by their relationships with other local governments. It also provides policy implications for the important role of central cities in facilitating collective sustainability efforts in metropolitan areas.

The purpose of this review is to compare the effectiveness of different peripheral nerve blocks and general anesthesia (GA) in controlling postoperative pain after arthroscopic rotator cuff repair (ARCR).A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted for the period of January 1, 2005, to February 16, 2021, by searching the following databases: PubMed, Cochrane, Embase, and Arthroscopyjournal.org. The primary outcomes of interest included 1-hour, 24-hour, and 48-hour pain scores on a numeric rating scale or visual analog scale (VAS). Inclusion criteria were English language studies reporting on adults (≥18 years) undergoing ARCR with peripheral nerve blockade. To synthesize subjective pain score data at each evaluation time point across studies, we performed random-effects network meta-regression analyses accounting for baseline pain score as a covariate.A total of 14 randomized controlled trials with 851 patients were included in the meta-analysis. Data from six different nerve block interventions, single-shot interscalene brachial plexus nerve block (s-ISB; 37.8% [322/851]), single-shot suprascapular nerve block (s-SSNB; 9.9% [84/851]), continuous ISB (c-ISB; 17.5% [149/851]), continuous SSNB (c-SSNB; 6.9% [59/851]), s-ISB combined with SSNB (s-ISB+SSNB; 5.8% [49/851]), s-SSNB combined with axillary nerve block (s-SSNB+ANB; 4.8% [41/851]), as well as GA (17.3% [147/851]) were included. Our meta-analysis demonstrated that c-ISB block had a significant reduction in pain score relative to GA at 1-hour postoperation (mean difference [MD]: -1.8; 95% credible interval [CrI] = -3.4, -.08). There were no significant differences in VAS pain scores relative to GA at 24 and 48 hours postoperatively. However, s-ISB+SSNB had a significant reduction in 48-hour pain score compared to s-ISB (MD = -1.07; 95% CrI = -1.92, -.22).It remains unclear which peripheral nerve block strategy is optimal for ARCR. However, peripheral nerve blocks are highly effective at attenuating postoperative ARCR pain and should be more widely considered as an alternative over general anesthesia alone.Level II Systematic review and meta-analysis of Level I and II studies.

Context: Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. Objective: To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. Data Sources: Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017. Study Selection: Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. Results: A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. Conclusion: Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.

We investigated habitat use of bobcats (Lynx rufus) across spatial scales in New Hampshire, USA, by integrating independent sources of information into one statewide model of habitat suitability. First, statewide distribution of bobcats (second-order selection) was estimated using observations of bobcats solicited from the public. Probability functions indicated that areas where bobcats were not detected (no sightings) were characterized by high elevations and deep snow during winter. That pattern was corrob-orated by camera traps that were distributed among high and low-elevation landscapes. Second, bobcats equipped with GPS collars in two study areas were used to determine habitat use within established home ranges (third-order selection). Resource-selection probability functions developed from locations of marked bobcats indicated they selected forests, shrub/scrub, and wetlands, and avoided developed areas, agricultural areas, and open water relative to availability. Bobcats also avoided areas with high road densities and selected areas close to forest edges, and preferred rugged south-facing slopes. Finally, these measures of bobcat distribution were combined to obtain fine-scale estimates of bobcat habitat suitability across New Hampshire. A comparison of models of habitat suitability to an index of bobcat abundance (effort-corrected detections of bobcats by hunter) indicated that the hierarchical model (second-order multiplied by third-order of selection) provided a better description of statewide bobcat habitat than either single-scale analyses. As a result, we recommend caution when extrapolating information on the distribution of a species obtained at a limited spatial scale.

Three fishers ( Martes pennanti), 2 gray foxes ( Urocyon cinereoargenteus), 1 mink ( Neovison vison), 1 skunk ( Mephitis mephitis), and 1 raccoon ( Procyon lotor), from Vermont and New Hampshire, had lesions on autopsy consistent with canine distemper virus (CDV) infections diagnosed in a 12-mo period in 2016–2017. Lesions of CDV infection were most commonly noted in the lungs (8 of 8 animals), urothelium (5 of 8), biliary tract (5 of 8), gastrointestinal tract (4 of 7), and brain (4 of 6). Splenic lesions were seen in 3 animals. The diagnosis was confirmed via immunohistochemistry and virus isolation. Viral genotyping indicated that all 8 animals were infected with a distinct clade of CDV that has only been reported in wildlife in New England, and this clade of viruses is distinct from vaccine strains. During the 12 mo when these cases occurred, no other CDV clade was identified in any other wildlife or domesticated animal submitted from the 2 states.

To understand large scale animal – habitat associations, biologists often rely on intensive home-range based studies, where a large number of locations are obtained from relatively few individuals equipped with radio transmitters and then extrapolate patterns of habitat use to much larger areas. Alternatively, extensive methods (e.g. incidental observations) that provide few observations per individual can be eff ectively used to sample large areas. Both methods have advantages, limitations, and potential sources of bias. We used these diff erent approaches in an eff ort to identify habitat features that may be important to expanding populations of bobcats Lynx rufus in New Hampshire, USA. Twelve adult bobcats with GPS-equipped transmitters provided detailed summaries of movement patterns within a 2300-km 2 study area. We also solicited incidental observations from citizens throughout the state (24 200 km 2 ). Using locations from both methods, we developed logistic models based on a comparison of home range composition to study area composition (second-order habitat selection). We also explored an approach to reduce potential bias associated with incidental observations (overrepresentation of human population centers) by applying a weighing factor. Th e telemetry and uncorrected observation-based models overlapped substantially with eight common covariates. Th e telemetry-based model indicated that bobcats preferred areas with few roads, limited human development, high stream densities, and steep topography. In contrast, the adjusted (to reduce bias) observation-based model indicated bobcats preferred areas with an abundance of roads and development with few streams and limited topographic variation. Because of these diff erences, we recommend caution when using sightings to model habitat associations unless biases associated with such information can be identifi ed and overcome. Although public sightings had limited application for describing bobcat habitat, they were useful in documenting a recent range expansion and revealing novel prey use by bobcats.

To describe time trends in total laryngectomy health services utilization across the United States, such as rates of surgery, cost, length of stay, and insurance payer, and to compare this to important milestones in recommendations for laryngeal cancer treatment.Population-based cohort study.Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) 1997-2008: stratified sample of all US hospital discharges.All patients with the principal procedure of complete laryngectomy. The unit of analysis was the discharge.Between 1997 and 2008, the number of laryngectomies done in the United States decreased by 48%. New cases of laryngeal cancer decreased 33% during the same time. The proportion of patients older than 65 years decreased from 48% to 43%. Mortality for the procedure was 1.4% in 1997 and 1.1% in 2008. Mean length of stay over the study period increased from 13 days to 14 days. Mean hospital charges rose from $58,000 in 1997 to $109,000 in 2008, consistent with the overall rise in US health care costs. Medicare was the dominant insurer throughout. Home health was ordered in 50% of 2008 discharges but only 32% in 1997.The rate of total laryngectomy has dropped more than the incidence of laryngeal cancer has dropped, consistent with the trend toward nonsurgical treatment. Lower surgical volumes and/or salvage laryngectomy surgeries are hypothesized to play a role in longer length of stay, stable mortality rates despite younger patient age, and increased need for home services after discharge.

Objectives: We describe the parotidectomy experience at a single rural institution over 17 years. Methods: We retrieved the records of all patients who underwent parotidectomy for any nontrauma indication (current procedural terminology codes 42410, 42415, 42420, 42425, and 42426) from January 1990 to June 2007 at Dartmouth-Hitchcock Medical Center, a rural medical center that provides both primary and tertiary care to a local population of 14,000, with a catchment area of 600,000 people. Information was collected on initial patient presentation, use of fine-needle aspiration, extent of surgery, final pathologic diagnosis, and complications. Results: We performed 341 parotidectomy procedures in 334 patients. The largest number of malignancies came from metastatic tumors; squamous cell carcinoma was the most common (37% of malignancies). The most common presenting complaint overall was a painless mass. The most common complication was facial weakness in 17% (57 of 341); 36 of the 57 cases of facial weakness (63%) were associated with surgery for malignancy. The most common benign tumor was pleomorphic adenoma (114 of 186; 61%). Mucoepidermoid carcinoma was the most common primary parotid malignancy (12%). Conclusions: In this 17-year rural case series of all parotidectomy procedures done for nontrauma indications, the largest number of malignancies came from metastatic tumors. Although facial nerve paralysis is not a common complication, it occurs most often when surgery is performed for either primary or metastatic malignancy. Surgeons will benefit from this information as they counsel patients who are considering parotidectomy.

Objective: 1) Understand time trends in total laryngectomy rates across the US, including rates of surgery, cost, length of stay, teaching status, size of hospital, and insurance payer. 2) Understand what role the paradigm shift in primary treatment of laryngeal cancer may mean for surgical outcomes, cost, and length of stay.Method: Population-based study from 1997 to 2008 utilizing the HCUP-NIS database: a stratified sample of all US hospital discharges. The sample was all patients who had a principal procedure of ICD-9 code 30.3 or 30.4 (complete or radical laryngectomy). The unit of analysis was census area: Northeast, South, Midwest, and West.Results: The number of laryngectomies done in the US decreased by 32% during the study period. New cases of laryngeal cancer decreased 26% during the same time. The highest rate of laryngectomy is in the South, the lowest in the Midwest and West. Mortality for the procedure is highest in the Northeast: 2.1%. Mean length of stay over the study period increased fro...