scholarly journals Impact of non-pharmaceutical interventions for SARS-CoV-2 on norovirus outbreaks: an analysis of outbreaks reported by 9 US States

2020 ◽  
Author(s):  
Alicia N.M. Kraay ◽  
Peichun Han ◽  
Anita K. Kambhampati ◽  
Mary E. Wikswo ◽  
Sara A. Mirza ◽  
...  
Keyword(s):  
United States ◽  
South Carolina ◽  
The United States ◽  
Respiratory Pathogen ◽  
Secondary Outcome ◽  
Interrupted Time Series Analysis ◽  
Official Position ◽  
The Impact ◽  
Pharmaceutical Interventions ◽  
Outbreak Size

AbstractImportanceThe impact of non-pharmaceutical interventions (NPIs) in response to the SARS-CoV-2 pandemic on incidence of other infectious diseases is still being assessed.ObjectiveTo determine if the observed change in reported norovirus outbreaks in the United States was best explained by underreporting, seasonal trends, or reduced exposure due to NPIs. We also aimed to assess if the change in reported norovirus outbreaks varied by setting.DesignAn ecologic, interrupted time series analysis of norovirus outbreaks from nine states reported to the National Outbreak Reporting System (NORS) from July 2012–July 2020.SettingSurveillance data from Massachusetts, Michigan, Minnesota, Ohio, Oregon, South Carolina, Tennessee, Virginia, and Wisconsin were included in the analysis.Participants9,226 reports of acute gastroenteritis outbreaks with norovirus as an epidemiologically suspected or laboratory-confirmed etiology were included in the analysis, resulting in more than 8 years of follow up. Outbreak reports from states that participated in NoroSTAT for at least 4 years were included in the analysis (range: 4–8 years).ExposureThe main exposure of interest was time period: before (July 2012–February 2020) or after (April 2020–July 2020) the start of NPIs in the United StatesMain outcomeThe main outcome of interest was monthly rate of reported norovirus outbreaks. As a secondary outcome, we also examined the average outbreak size.ResultsWe found that the decline in norovirus outbreak reports was significant for all 9 states considered (pooled incidence rate ratio (IRR) comparing April 2020-July 2020 vs. all pre-COVID months for each state= 0.14, 95% CI: 0.098, 0.21; P=<0.0001), even after accounting for typical seasonal decline in incidence during the summer months. These patterns were similar across a variety of settings, including nursing homes, child daycares, healthcare settings, and schools. The average outbreak size was also reduced by 61% (95% CI: 56%, 42.7%; P=<0.0001), suggesting that the decline does not reflect a tendency to report only more severe outbreaks due to strained surveillance systems, but instead reflects a decline in incidence.Conclusions and relevanceWhile NPIs implemented during the spring and summer of 2020 were intended to reduce transmission of SARS-CoV-2, these changes also appear to have impacted the incidence of norovirus, a non-respiratory pathogen. These results suggest that NPIs may provide benefit for preventing transmission of other human pathogens, reducing strain to health systems during the continued SARS-CoV-2 pandemic.DisclaimerThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention (CDC).

scholarly journals Outpatient Fluoroquinolone Prescription Fills in the United States, 2014-2020: Assessing the Impact of Food and Drug Administration Safety Warnings

2021 ◽  
Author(s):  
Deanna J. Buehrle ◽  
Marilyn M. Wagener ◽  
Cornelius J. Clancy
Keyword(s):  
United States ◽  
Drug Administration ◽  
Nurse Practitioners ◽  
Food And Drug Administration ◽  
Interrupted Time Series ◽  
The United States ◽  
Baseline Period ◽  
Interrupted Time Series Analysis ◽  
Prescription Audit ◽  
The Impact

Background: The impact of United States (US) Food and Drug Administration (FDA) safety warnings on outpatient fluoroquinolone use is unclear. Methods: Annual changes in outpatient ciprofloxacin, levofloxacin and moxifloxacin prescription fills (IQVIA National Prescription Audit databases) were assessed using a regression model. Monthly fills during baseline (August 2014–April 2016), first (May 2016–June 2018), and second FDA warning periods (July 2018–February 2020) were compared by interrupted time series analysis. Results: From 2015 through 2019, total fluoroquinolone fills decreased from 35,616,786 (111.1/1000 persons) to 21,100,050 (64.3/1000 persons) annually (10.8% annually (P=0.001)). Ciprofloxacin, levofloxacin, and moxifloxacin fills decreased annually by 10.4% (P=0.001), 11.2% (P<0.001), and 17.7% (P=0.008), respectively. During the baseline period, there was no significant change in monthly fluoroquinolone fills. In May 2016 and during the first warning period, monthly fluoroquinolone fills decreased significantly (P-values<0.001); the trend of decreased fills was significantly greater than that of the baseline period (P=0.02). There was no change in fluoroquinolone fills in July 2018. Monthly fills decreased significantly throughout the second warning period (P<0.001), but the trend did not differ from that of the first warning period. Trends for ciprofloxacin, the most commonly prescribed fluoroquinolone, were similar to those for the class. Fills of prescriptions by infectious diseases specialists (P<0.005) and nurse practitioners (P=0.04) significantly increased during the study. Conclusions: US outpatient fluoroquinolone prescription fills significantly decreased from August 2014-February 2020, most strongly in association with May 2016 FDA warnings. FDA safety warnings are useful tools for leveraging outpatient antimicrobial stewardship.

scholarly journals Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database

2021 ◽  
Vol 12 ◽  
Author(s):  
Chengyuan Wu ◽  
Sean J. Nagel ◽  
Rahul Agarwal ◽  
Monika Pötter-Nerger ◽  
Wolfgang Hamel ◽  
...  
Keyword(s):  
United States ◽  
Risk Reduction ◽  
De Novo ◽  
The United States ◽  
Secondary Outcome ◽  
Administrative Claims ◽  
Complication Rates ◽  
Claims Database ◽  
The Impact ◽  
Deep Brain

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.Design: Retrospective, contemporaneous cohort study.Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, of which 3,869 patients had a de novo implant and primary diagnosis of PD or ET. Follow-up of 3 months was available for 3,810 patients, 12 months for 3,561 patients, and 24 months for 1,812 patients.Intervention: Implantation of a modern directional (MD) or traditional omnidirectional (TO) DBS system.Primary and Secondary Outcome Measures: We hypothesized that MD systems would impact complication rates. Reoperation rate was the primary outcome. Associated diagnoses, patient characteristics, and implanting center details served as covariates. Kaplan–Meier analysis was performed to compare rates of event-free survival and regression models were used to determine covariate influences.Results: Patients implanted with modern systems were 36% less likely to require reoperation, largely due to differences in acute reoperations and intracranial lead reoperations. Risk reduction persisted while accounting for practice differences and implanting center experience. Risk reduction was more pronounced in patients with PD.Conclusions: In the first multicenter analysis of device-related complications including modern DBS systems, we found that modern systems are associated with lower reoperation rates. This risk profile should be carefully considered during device selection for patients undergoing DBS for PD or ET. Prospective studies are needed to further investigate underlying causes.

George Trenholm Sees the Future

2020 ◽  
pp. 9-18
Author(s):  
Charles D. Ross
Keyword(s):  
United States ◽  
New York ◽  
South Carolina ◽  
The United States ◽  
General Assembly ◽  
Confederate States Of America ◽  
The South ◽  
Southern States ◽  
The Right ◽  
The Impact

This chapter tells the story of George Trenholm, one of the savviest businessmen in the United States and probably the richest man in the South when the Civil War began. It describes Trenholm's international powerhouse firm that was highly respected by the powerful in New York and Europe. The chapter then turns to review the impact of Abraham Lincoln's election as president on the slaveholding Southern states and the more industrial Northern states. Three days later George Trenholm introduced a measure in the South Carolina General Assembly denouncing the election and stating that South Carolina should preserve her sovereignty by securing supplies and weapons to arm the state. As South Carolina joined Alabama, Mississippi, Louisiana, Georgia, and Florida in establishing the Confederate States of America, Trenholm started a trend that would be rapidly copied by others: he began to change the registry of his ships to British and obscuring the names of the true owners. The chapter then introduces Captain Sam Whiting, the person who paid the courtesy of dipping his US flag to the Union defenders of the fort. It investigates how both the Union and Confederate governments scrambled to put people in the right places to win the war.

Sex Offender Residence Restrictions and Homelessness: A Critical Look at South Carolina

2019 ◽  
Vol 31 (8) ◽  
pp. 1119-1135 ◽  
Author(s):  
Deanna Cann ◽  
Deena A. Isom Scott
Keyword(s):  
United States ◽  
South Carolina ◽  
Sex Offenders ◽  
Sex Offender ◽  
Strong Association ◽  
The United States ◽  
Policy Implications ◽  
Interrupted Time Series Analysis ◽  
Residence Restrictions ◽  
Registered Sex Offenders

Sex offender residence restrictions (SORRs) have been widely implemented across the United States since the 1990s. A common concern regarding the implementation of SORRs is the decrease in viable housing options for registered sex offenders, which could potentially lead to homelessness. The vast application of SORRs across the United States, in addition to the known association between homelessness and crime, necessitates a deeper understanding of how SORRs impact rates of homelessness among this population. Utilizing data from South Carolina’s Sex Offender Registry, this study describes patterns of homelessness among this population. Specifically, using an interrupted time series analysis, we examine whether the state’s implementation of its SORR has an effect on the proportion of registered sex offenders reported as homeless. Our findings reveal a strong association between the implementation of residence restriction policies and rates of homelessness for registered sex offenders in South Carolina. Policy implications are discussed.

scholarly journals Impact of slavery System in America with Reference to Colson Whitehead’s the Underground Railroad.

2020 ◽  
Vol 8 (2) ◽  
pp. 5
Author(s):  
Chellapandian K
Keyword(s):  
United States ◽  
South Carolina ◽  
Slave Trade ◽  
The United States ◽  
17Th Century ◽  
Rapid Expansion ◽  
Christopher Columbus ◽  
African Slaves ◽  
The Impact ◽  
Cotton Gin

This article tells you that how the slavery system flourished in America and the impact of slavery system in America. Slavery system in America started when Christopher Columbus discovered America in the year 1492. In 1508 the first colony settlement was established by Ponce de Leon in Samjuan. The first African slaves arrived in South Carolina in 1526. During the 16th and 17th century the city St. Augustine was the Hub of the slave trade. Once Britishers established colonies in America, they started importing slaves from Africa. At one point Mary land and Virginia full of African slaves. After the discovery America Britishers came to know that America is suitable for cotton cultivation so they dawned with an idea that for cultivating cotton in America, Africans are the most eligible persons. On the other hand Britishers believed that Africans know the methods of cultivation and they are efficient labours. So they brought African through the Atlantic slave trade to work in cotton plantation. The amounts of slaves were greatly increased because of rapid expansion of the cotton industry. At the beginning of 17th century Britishers were cultivating only cotton and later on they invented the cotton gin. The invention of the cotton gin demanded more manpower and they started importing more slaves from Africa.At the same time southern part of America continued as slave societies and attempted to extend slavery into the western territories to keep their political share in the nation. During this time the United States became more polarized over the issue of slavery split into slaves and free states. Due to this in Virginia and Maryland a new community of African and American culture developed. As the United States expanded southern states, have to maintain a balance between the number slave and free state to maintain political power in the united states senate.

scholarly journals Quantifying the impact of lifting community non-pharmaceutical interventions for COVID-19 during vaccination rollout in the United States

2021 ◽  
Author(s):  
Laura Matrajt ◽  
Holly Janes ◽  
Joshua T Schiffer ◽  
Dobromir Dimitrov
Keyword(s):  
United States ◽  
Mathematical Model ◽  
Small Proportion ◽  
The United States ◽  
The Us ◽  
Potential Impact ◽  
Nonpharmaceutical Interventions ◽  
The Impact ◽  
Pharmaceutical Interventions

Abstract Using a mathematical model, we estimated the potential impact in mortality and total infections of completely lifting community nonpharmaceutical interventions when only a small proportion of the population has been fully vaccinated in two states in the US. Lifting all community nonpharmaceutical interventions immediately is predicted to result in twice as many deaths over the next 6 months than a more moderate reopening allowing 70% of pre-pandemic contacts.

scholarly journals The impact of vaccination on COVID-19 outbreaks in the United States

2021 ◽  
Author(s):  
Seyed M Moghadas ◽  
Thomas N Vilches ◽  
Kevin Zhang ◽  
Chad R Wells ◽  
Affan Shoukat ◽  
...  
Keyword(s):  
United States ◽  
Vaccine Efficacy ◽  
Vaccine Development ◽  
The United States ◽  
Adverse Outcomes ◽  
Base Case ◽  
Relative Reduction ◽  
Substantial Impact ◽  
The Impact ◽  
Pharmaceutical Interventions

Abstract Background Global vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. We evaluated the impact of a 2-dose COVID-19 vaccination campaign on reducing incidence, hospitalizations, and deaths in the United States (US). Methods We developed an agent-based model of SARS-CoV-2 transmission and parameterized it with US demographics and age-specific COVID-19 outcomes. Healthcare workers and high-risk individuals were prioritized for vaccination, while children under 18 years of age were not vaccinated. We considered a vaccine efficacy of 95% against disease following 2 doses administered 21 days apart achieving 40% vaccine coverage of the overall population within 284 days. We varied vaccine efficacy against infection, and specified 10% pre-existing population immunity for the base-case scenario. The model was calibrated to an effective reproduction number of 1.2, accounting for current non-pharmaceutical interventions in the US. Results Vaccination reduced the overall attack rate to 4.6% (95% CrI: 4.3% - 5.0%) from 9.0% (95% CrI: 8.4% - 9.4%) without vaccination, over 300 days. The highest relative reduction (54-62%) was observed among individuals aged 65 and older. Vaccination markedly reduced adverse outcomes, with non-ICU hospitalizations, ICU hospitalizations, and deaths decreasing by 63.5% (95% CrI: 60.3% - 66.7%), 65.6% (95% CrI: 62.2% - 68.6%), and 69.3% (95% CrI: 65.5% - 73.1%), respectively, across the same period. Conclusions Our results indicate that vaccination can have a substantial impact on mitigating COVID-19 outbreaks, even with limited protection against infection. However, continued compliance with non-pharmaceutical interventions is essential to achieve this impact.

scholarly journals The Impact of the mKidney mHealth System on Live Donor Follow-Up Compliance: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Macey L Henderson ◽  
Alvin G Thomas ◽  
Ann K Eno ◽  
Madeleine M Waldram ◽  
Jaclyn Bannon ◽  
...  
Keyword(s):  
United States ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
The United States ◽  
Secondary Outcome ◽  
Hospital Level ◽  
Process Data ◽  
Randomized Controlled ◽  
The Impact

BACKGROUND Every year, more than 5500 healthy people in the United States donate a kidney for the medical benefit of another person. The Organ Procurement and Transplantation Network (OPTN) requires transplant hospitals to monitor living kidney donors (LKDs) for 2 years postdonation. However, the majority (115/202, 57%) of transplant hospitals in the United States continue to fail to meet nationally mandated requirements for LKD follow-up. A novel method for collecting LKD follow-up is needed to ease both the transplant hospital-level and patient-level burden. We built mKidney—a mobile health (mHealth) system designed specifically to facilitate the collection and reporting of OPTN-required LKD follow-up data. The mKidney mobile app was developed on the basis of input elicited from LKDs, transplant providers, and thought leaders. OBJECTIVE The primary objective of this study is to evaluate the impact of the mKidney smartphone app on LKD follow-up rates. METHODS We will conduct a two-arm randomized controlled trial (RCT) with LKDs who undergo LKD transplantation at Methodist Specialty and Transplant Hospital in San Antonio, Texas. Eligible participants will be recruited in-person by a study team member at their 1-week postdonation clinical visit and randomly assigned to the intervention or control arm (1:1). Participants in the intervention arm will receive the mHealth intervention (mKidney), and participants in the control arm will receive the current standard of follow-up care. Our primary outcome will be policy-defined complete (all components addressed) and timely (60 days before or after the expected visit date) submission of LKD follow-up data at required 6-month, 1-year, and 2-year visits. Our secondary outcome will be hospital-level compliance with OPTN reporting requirements at each visit. Data analysis will follow the intention-to-treat principle. Additionally, we will collect quantitative and qualitative process data regarding the implementation of the mKidney system. RESULTS We began recruitment for this RCT in May 2018. We plan to enroll 400 LKDs over 2 years and follow participants for the 2-year mandated follow-up period. CONCLUSIONS This pilot RCT will evaluate the impact of the mKidney system on rates of LKD and hospital compliance with OPTN-mandated LKD follow-up at a large LKD transplant hospital. It will provide valuable information on strategies for implementing such a system in a clinical setting and inform effect sizes for future RCT sample size calculations. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11000

scholarly journals The impact of vaccination on COVID-19 outbreaks in the United States

2020 ◽  
Author(s):  
Seyed M. Moghadas ◽  
Thomas N. Vilches ◽  
Kevin Zhang ◽  
Chad R. Wells ◽  
Affan Shoukat ◽  
...  
Keyword(s):  
United States ◽  
Vaccine Efficacy ◽  
Vaccine Development ◽  
The United States ◽  
Adverse Outcomes ◽  
Base Case ◽  
Relative Reduction ◽  
Substantial Impact ◽  
The Impact ◽  
Pharmaceutical Interventions

AbstractBackgroundGlobal vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. We evaluated the impact of a 2-dose COVID-19 vaccination campaign on reducing incidence, hospitalizations, and deaths in the United States (US).MethodsWe developed an agent-based model of SARS-CoV-2 transmission and parameterized it with US demographics and age-specific COVID-19 outcomes. Healthcare workers and high-risk individuals were prioritized for vaccination, while children under 18 years of age were not vaccinated. We considered a vaccine efficacy of 95% against disease following 2 doses administered 21 days apart achieving 40% vaccine coverage of the overall population within 284 days. We varied vaccine efficacy against infection, and specified 10% pre-existing population immunity for the base-case scenario. The model was calibrated to an effective reproduction number of 1.2, accounting for current non-pharmaceutical interventions in the US.ResultsVaccination reduced the overall attack rate to 4.6% (95% CrI: 4.3% - 5.0%) from 9.0% (95% CrI: 8.4% - 9.4%) without vaccination, over 300 days. The highest relative reduction (54-62%) was observed among individuals aged 65 and older. Vaccination markedly reduced adverse outcomes, with non-ICU hospitalizations, ICU hospitalizations, and deaths decreasing by 63.5% (95% CrI: 60.3% - 66.7%), 65.6% (95% CrI: 62.2% - 68.6%), and 69.3% (95% CrI: 65.5% - 73.1%), respectively, across the same period.ConclusionsOur results indicate that vaccination can have a substantial impact on mitigating COVID-19 outbreaks, even with limited protection against infection. However, continued compliance with non-pharmaceutical interventions is essential to achieve this impact.Key pointsVaccination with a 95% efficacy against disease could substantially mitigate future attack rates, hospitalizations, and deaths, even if only adults are vaccinated. Non-pharmaceutical interventions remain an important part of outbreak response as vaccines are distributed over time.

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