First Documented Wild Population of the "Hunter Fly", Coenosia attenuata Stein (Diptera: Muscidae) in North America

Coenosia attenuata is a member of the tigrina-group of Coenosia (sensu Hennig 1964) and is a capable generalist predator in its larval and adult stages. C. attenuata is common in greenhouses worldwide, however, there are few documented cases of its presence in the wild. Here, we estimated C. attenuata presence in the southeastern USA peach orchards using pan traps. Over two years, a total of 717 specimens were collected from both commercially managed and fungicide-only managed peach orchards. C. attenuata is a known biological control agent in artificial greenhouse settings, but its impact on pest species in the wild is still unknown. For the first time in North America, we document an established wild population of C. attenuata, provide an overview of basic identification, and review potential benefits for biological control.

Prospective feasibility study of a mindfulness-based program for breast cancer patients in the southeastern US

BACKGROUND

Mindfulness interventions can improve psychological distress and quality of life (QoL) in cancer survivors. Few mindfulness programs for cancer recovery exist in Southeastern U.S. The primary objective of this study was to assess the feasibility of a modified mindfulness-based stress reduction (MBSR) program for breast cancer patients in Birmingham, Alabama. The secondary objective was to explore potential program effects on mindfulness skills and QoL.

METHODS

This study was a prospective, quasi-experimental feasibility study conducted over 10 months at a university hospital. Feasibility was achieved if 80% of eligible patients screened enrolled in the study and 70% of enrolled patients attended all 8 program sessions. Effectiveness was estimated by changes in mindfulness and QoL indicators measured with validated scales administered at 3 time points and assessed with a non-parametric Friedman test. Sessions included meditation, yoga, and an attention practice called body scan. There were 3 groups of 2-5 patients.

RESULTS

The sample totaled 12 patients. Forty-four percent (12/27) of eligible patients enrolled in the study, and two out of 12 enrolled patients completed 8 program sessions, resulting in 16.7% (2/12) retention. However, more than half (66.7%) of participants completed at least 7 sessions. Between baseline and 8-week follow-up, patients demonstrated statistically significant improvements in distress, general wellbeing, and fatigue-related QoL.

CONCLUSIONS

Feasibility objectives were not achieved. However, a majority of participants (66.7%) completed 7 of 8 program sessions. Program effects were promising for distress, fatigue, and wellbeing. Results warrant further research on MBSR-like programs for breast cancer patients in Alabama.

Testing for HIV infection in the emergency departments of 2 hospitals in the Southeastern United States

BACKGROUND

In 2006, the Centers for Disease Control and Prevention (CDC) recommended non-targeted, opt-out HIV screening in all healthcare settings, including emergency departments (EDs). Multiple HIV testing programs have been implemented in EDs across the United States with varying designs and testing platforms. We report findings from a free, non-targeted, rapid HIV testing program in 2 EDs in the Southeastern United States.

METHODS

From 2008 to 2012, adults ≥18 years of age were offered free rapid HIV testing using an oral swab test (OraQuick ADVANCE Rapid HIV-1/2 antibody test) in the EDs of a large academic medical center and an affiliated community hospital in Durham, North Carolina.

RESULTS

In total, 5443 ED patients were offered HIV testing. The overall acceptance rate was 66.9% (3639/5443). Younger persons were significantly more likely to accept testing (78.2% for 18-29 years old vs 67.1% for ≥30 years old; P < 0.001) as were Black participants (72.6% Black vs 66.5% White; P < 0.001). Acceptance rates improved significantly after opt-out oral consent replaced written consent (71.3% vs 63.1%; P < 0.001). Seven new HIV diagnoses were confirmed during the testing program, resulting in a seropositivity rate of 0.19% (7/3639). There were 8 false-positive rapid oral HIV tests (positive predictive value = 46.7%).

CONCLUSIONS

Although the number of new HIV diagnoses was low, implementation of this rapid, non-targeted ED screening program was feasible with high acceptance rates, particularly after introducing the opt-out oral consent approach.

Myxomycetes collected in the eastern United States and patterns of relative biodiversity

A total of 68 315 digitised records of myxomycetes from the eastern United States were compiled from all readily available sources. After cleaning the database for inconsistencies, 58 594 records remained that were suitable for analysis. A total of 460 different species of myxomycetes were recorded, out of which 410 were classified as rare. Five species were represented by more than 1 500 records and 44 species were represented by only a single record. The states of New York, Virginia and West Virginia have the highest number of records. Almost half of the recognised morphospecies of myxomycetes in the world occur in the eastern United States. A small number of species thrive in different ecological conditions, whereas most species require more specific ecological settings for the formation of fruiting bodies. States associated with high biodiversity have been subjected to more intensive sampling efforts, and southern states seem to have been less studied than northern ones. The project described herein apparently represents one of the few efforts to characterise the myxobiota of a relatively large region of the world.

The impact of heat exposure on reduced gestational age in pregnant women in North Carolina, 2011-2015

Research on the impact of heat on pregnant women has focused largely on outcomes following extreme temperature events, such as particular heat waves or spells of very cold weather on pregnant women. Consistently, the literature has shown a statistically significant relationship between heat with shortened gestational age with studies concentrated largely in the western states of the USA or other nations. The association between heat and shortened gestational age has not been examined in the Southeastern US where maternal outcomes are some of the most challenging in the nation. Unlike previous studies that focus on the impacts of a single heat wave event, this study seeks to understand the impact of high heat over a 5-year period during the annual warm season (May-September). To achieve this goal, a case-crossover study design is employed to understand the impact of heat on preterm labor across regions in North Carolina (NC). Temperature thresholds for impact and the underlying relationships between preterm labor and heat are investigated using generalized additive models (GAM). Gridded temperature data (PRISM) is used to establish exposure classifications. The results reveal significant impacts to pregnant women exposed to heat with regional variations. The exposure variable with the most stable and significant result was minimum temperature, indicating high overnight temperatures have the most impact on preterm birth. The magnitude of this impact varies across regions from a 1% increase in risk to 6% increase in risk per two-degree increment above established minimum temperature thresholds.

Race and Sex Differences in Modifiable Risk Factors and Incident Heart Failure

OBJECTIVES

The purpose of this study was to examine race- and sex-based variation in the associations between modifiable risk factors and incident heart failure (HF) among the SCCS (Southern Community Cohort Study) participants.

BACKGROUND

Low-income individuals in the southeastern United States have high HF incidence rates, but relative contributions of risk factors to HF are understudied in this population.

METHODS

We studied 27,078 black or white SCCS participants (mean age: 56 years, 69% black, 63% women) enrolled between 2002 and 2009, without prevalent HF, receiving Centers for Medicare and Medicaid Services. The presence of hypertension, diabetes mellitus, physical underactivity, high body mass index, smoking, high cholesterol, and poor diet was assessed at enrollment. Incident HF was ascertained using International Classification of Diseases-9th revision, codes 428.x in Centers for Medicare and Medicaid Services data through December 31, 2010. Individual risk and population attributable risk for HF for each risk factor were quantified using multivariable Cox models.

RESULTS

During a median (25th, 75th percentile) 5.2 (3.1, 6.7) years, 4,341 (16%) participants developed HF. Hypertension and diabetes were associated with greatest HF risk, whereas hypertension contributed the greatest population attributable risk, 31.8% (95% confidence interval: 27.3 to 36.0). In black participants, only hypertension and diabetes associated with HF risk; in white participants, smoking and high body mass index also associated with HF risk. Physical underactivity was a risk factor only in white women.

CONCLUSIONS

In this high-risk, low-income cohort, contributions of risk factors to HF varied, particularly by race. To reduce the population burden of HF, interventions tailored for specific race and sex groups may be warranted.

Prevalence of endoparasites in northern Mississippi shelter cats

Parasitism of domestic cats impacts feline health and public health, when zoonotic parasites are present. Our objective was to evaluate endoparasite prevalence in cats from northern Mississippi animal shelters. Feline cadavers (n = 56) were collected from seven shelters from August 2017 to January 2018. Data included shelter, sex, reproductive status, intake date, originating source, and treatment records. Cadavers were processed to isolate stomach, and small and large intestines. Contents were strained and examined using stereomicroscopes for helminth collection and identification. Centrifugal flotation using Sheather's solution was performed on feces; urine sediments were also examined. Descriptive statistics in SAS was performed using the Frequency procedure. Kappa agreement statistics were obtained to determine agreement between fecal flotation and necropsy results. Separate logistic regression models were developed to test effects of risk factors on the probability for cats to test positive for outcomes of interest. Helminths were recovered in 82% of cats (46/56); specifically, Ancylostoma spp. (52%), Toxocara cati (43%), Taenia taeniaeformis (36%), Dipylidium caninum (29%), and Spirometra spp. (4%) were identified. Thirty-seven of 56 cats (66%) had parasite eggs or oocysts on fecal examination, including T. cati (39%), Ancylostoma spp. (34%), Cystoisospora spp. (23%), Spirometra spp. (9%), T. taeniaeformis (9%), and capillarid-type eggs (5%). Feline originating source was associated with presence of T. cati eggs in feces and presence of D. caninum in the gastrointestinal tract. Feral cats were more likely to have T. cati eggs in feces than owner surrender cats (OR 28; 95% CI: 1.9, 423), or stray cats (OR 8, 95% CI: 1.1, 57.0). Owner surrender cats were more likely to have D. caninum helminths in the gastrointestinal tract than stray cats (OR = 19.5; 95% CI: 2.0, 190). Toxocara cati exhibited strong agreement (κ = 0.70, 95% CI: 0.52, 0.89), Ancylostoma spp. exhibited moderate agreement (κ = 0.44, 95% CI: 0.22, 0.65), and cestodes exhibited poor agreement (κ = 0.02, 95% CI: -0.12, 0.15) between presence of eggs and gross helminths. Capillarid eggs (Pearsonema feliscati) were recovered in urine sediment of 6% (3/48) of cats. Overall, our study demonstrates a high level of parasitism in cats that entered Mississippi animal shelters. Parasites with zoonotic potential, such as Alaria spp., Ancylostoma spp., D. caninum, Physaloptera spp., T. taeniaeformis, T. cati, and Spirometra spp. were identified. Our results support the need for effective antiparasitic treatment of cats entering animal shelters in order to improve feline health and prevent environmental contamination with zoonotic parasites.

A comparative analysis of documented contraceptive use among women aged 18-30 living with and without HIV in Alabama

OBJECTIVES

To compare contraception use in 18-30-year-old women living with and without HIV. We also explored factors associated with contraceptive use.

STUDY DESIGN

We reviewed outpatient medical records for women living with HIV aged 18-30 years seen in one of two university-affiliated HIV-subspecialty clinics in Birmingham, Alabama, between July 2015 and June 2016. We selected an age-matched sample of women living without HIV seen in one of two university-affiliated non-HIV primary care clinics as the comparator group and focused our analysis on women with a documented discussion of contraception in clinic. For women with more than one clinic visit during the 1-year study period, the most recent visit was used for analysis. Multinominal and binary logistic regressions were used to identify factors associated with contraception use, and models were adjusted for HIV status.

RESULTS

This study included 197 women (58 HIV-positive, 139 HIV-negative). Short-acting contraception methods were the most common methods used by women with (41.4%) and without HIV (47.5%, p=.43). Long-acting reversible contraception (LARC) use was 14% among women with HIV and 32% among women without HIV (p=.12). Contraception use predictors included HIV status, mental health comorbidities, obesity and number of pregnancies.

CONCLUSION

Documented contraceptive method use among 18-30-year -old women seen in clinics in urban Alabama varied by HIV status. Women with HIV were less likely to use LARC methods compared to women without HIV.

IMPLICATIONS

Future studies should focus on identifying factors that influence contraceptive choice and which methods are offered to young women in the South. Providers should document contraception discussions at each visit and remove any barriers to LARC provision.

Paediatric brain tumours managed in Enugu, Southeast Nigeria: Review of one centre experience

BACKGROUND

Nothing has been published about paediatric brain tumours (PBTs) in Southeast Nigeria. This pioneer study analyses the tumour characteristics and management outcome of PBTs in Enugu, Southeast Nigeria.

METHODOLOGY

Retrospective longitudinal study utilising information from medical, radiology and histopathology records of all paediatric tumour cases managed at Memfys Hospital for Neurosurgery, Enugu, a major referral centre, from 2006 to 2017.

RESULTS

The total number of cases was 54. Peak age group at the diagnosis were 0-5 years (37.0%) and >10 years (40.8%). Frequent presenting symptoms of supratentorial tumours were limb weakness (70%), convulsions (50%) and altered consciousness (48%). Infratentorial tumours presented mostly with gait disturbance (82%), vomiting (72%) and altered consciousness (48%). There were 51 (94.4%) primary and three metastatic tumours. Supratentorial tumours were 28 (51.9%) and infratentorial tumours were 26 (48.1%). Histopathologic types were glioma 20 (37.0%), medulloblastoma 13 (24.1%), craniopharyngioma 11 (20.4%), meningioma 2 (3.7%) and others 8 (14.8%). The most common supratentorial tumours were gliomas 11 (39.3%) and craniopharyngioma 11 (39.3%), and the most common infratentorial tumour was medulloblastoma 13 (50.0%). Gross total resection (GTR) was achieved in 28 (51.9%) and subtotal resection (STR) in 26 (48.1%). Patients with Karnofsky score ≥70% had 16 (65.2%) GTR and patients with ≤60% score had more STR 18 (58.1%). At 1-year post-surgery, 16 (64%) of those with GTR lived normal lives compared with only 4 (20%) of STR. Among GTR group, 7 (28.0%) died compared to the 11 (55.0%) deaths recorded following STR. Overall, 55.6% of patients were at least independent at 1 year.

CONCLUSION

Glioma, medulloblastoma and craniopharyngioma are the most common PBTs. The management outcome is good and affected by extent of tumour resection.

Body Image Models among Low-income African American Mothers and Daughters in the Southeast United States

Obesity among low-income African American women has been studied using the concepts of both satisfaction and acceptance. The satisfaction frame suggests greater satisfaction with their bodies than their white counterparts, irrespective of size. The acceptance frame suggests that alternative aesthetics serve as resistance against intersectional marginalization. Yet, while these women accept their body size in defiance of thinness ideals, they may not be satisfied. We describe cultural models of body image among mothers and daughters in Alabama. We found that respectability, material consumption, and parental support were important factors determining positive body image, exceeding descriptions of physical features. We further found that those expressing greater body dissatisfaction emphasized respectability, whereas those with less dissatisfaction assigned importance to consumerism and physical form. These findings suggest divergences between biomedical messaging and lived experience. They also challenge uncritical or universalist applications of these frames when interpreting African American women's perceptions of their own bodies.

American health improvement depends upon addressing class disparities

The gap in health status between the United States and other (OECD) developed countries not only persists but has widened over the past decade. This has occurred despite major declines in smoking prevalence. But as with other health problems, such as obesity, gun violence, and teenage pregnancy, progress against smoking has disproportionately benefitted the better off segments of the American population. Thus smoking, as well as other problems, is now concentrated among the vulnerable members of our society: the poor and less educated, as well as disadvantaged groups such as those with mental illness and substance use disorders, the homeless, those who are incarcerated, and the LGBT community. Although this is a national issue, these problems, as well as overall poverty, are especially concentrated in the Southeastern part of the country. Compared with the other OECD countries, the U.S. has much greater inequality of income and wealth. Furthermore, we are unique in leaving substantial portions of our population not covered by health insurance, again most prominently in the southeastern region. This national health disparity is not simply a factor of the multicultural nature of American society, because it persists when the health of the whites only is compared with the more racially homogeneous OECD nations. The complexity of our poor health performance rules out a single intervention. But it is clear that without focusing on the less fortunate members of our society, especially those in the Southeast, our performance will continue to lag, and possibly deteriorate further.

Knowledge of Asthma among Doctors Practicing in Three South Eastern States of Nigeria

Background:

Asthma is a chronic airway disease that has a significant impact on patients with substantial global socioeconomic burden. Appropriate knowledge by health care practitioners is important in the management of asthma.

Aim:

The aim was to assess the knowledge of asthma among doctors practicing in health care facilities in three South-Eastern states of Nigeria.

Subjects and Methods:

This was a descriptive cross-sectional study. The participants were selected using multi-staged sampling method and interviewed with structured, self-administered questionnaires. Comparison of the different outcome variables using the Chi-square (categorical) and Student's t-test (noncategorical) with the characteristics of the participants were done.

Result:

A total of 283 doctors were interviewed. Eighty-eight percent of them identified asthma as a common disease in our environment, (P = 0.04) but unrelated to socioeconomic status. Knowledge of epidemiology was poor among medical officers and registrars (P = 0.04). Most of the doctors (80%)(226/283) recognized the pathogenic significance of bronchospasm in exacerbation, while 58.6% (166/283) of them considered chronic inflammation as a significant factor in asthma pathogenesis P < 0.001. Majority of the doctors (84.1%) (238/283) were aware of the use of steroids in acute exacerbation, while 59.4% (168/283) considered aminophylline as the first line medication in exacerbation (P = 0.02). Knowledge about the use of steroids as controller medication was noted in 1.7% (5/283) of the respondents. Only 47.3% (134/283) of the participants were aware of the Global Initiative on Asthma guideline, (P = 0.03).

Conclusion:

There was good knowledge of epidemiology and clinical features of asthma, but a small number of the doctors had knowledge of pathophysiology and treatment of the disease. For best practices in asthma management, there is a need for further education.

Kidney transplant access in the Southeast: view from the bottom

The Southeastern region of the United States has the highest burden of end-stage renal disease (ESRD) but the lowest rates of kidney transplantation in the nation. There are many patient-, dialysis facility-, ESRD Network- and health system-level barriers that contribute to this regional disparity. Compared to the rest of the nation, the Southeast has a larger population of African-Americans and higher poverty, as well as more prevalent ESRD risk factors including hypertension, obesity and diabetes. Dialysis facilities--where ESRD patients receive the majority of their healthcare--play an important role in transplant access. Identifying characteristics of individual dialysis units with low rates of kidney transplantation, such as understaffing or for-profit status, can help identify targets for quality improvement initiatives. Geographic differences across the country can identify opportunities to increase funding for healthcare resources in proportion to patient and disease burden. Focusing interventions among dialysis facilities with the lowest transplant rates within the Southeast, such as provider and patient education, has the potential to increase referrals for kidney transplantation, leading to higher rates of kidney transplants in this region. Referral for transplantation should be measured on a national level to monitor disparities in early access to transplantation. Transplant centers have an obligation to assist underserved populations in ensuring equity in access to services. Policies that improve access to care for patients, such as the Affordable Care Act and Medicaid expansion, are particularly important for Southern states and may alleviate geographic disparities.