SARS-CoV-2 Seroprevalence in Florida Department of Health in Palm Beach County Obstetric Clinics: A Cross-Sectional Study during the First Pandemic Surge

Objective Estimating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence is an important part of the public health approach to coronavirus disease 2019 (COVID-19) understanding and containment. This is particularly relevant to an obstetric population because of implications in the management of the pregnant host, care of the newborn, and disease progression within the community. Study Design A cross-sectional seroprevalence study was performed in four Department of Health Palm Beach County clinics from June 29, 2020, to August 5, 2020. Samples were collected from asymptomatic antepartum and postpartum participants. A web-based surveillance system was used to identify subsequent antibody or polymerase chain reaction (PCR) testing encounters. Results A total of 163 of 618 subjects were seropositive (26.4%). Racial makeup was white 2.5%, black 19.0%, and Hispanic 78.5%. Positive serology was seen in 16.0, 35.6, and 30.1% of first, second, and third trimesters, respectively; 18.4% were positive postpartum. Only four patients voluntarily reported PCR positivity prior to antibody testing. Six home zip codes accounted for the majority (68.1%) of positive results. Thirty-two patients had repeat serology (65.6% positive and 34.4% negative). Of the 163 subjects, 65 underwent later PCR testing with 92% negative for SAR-CoV-2. Conclusion Almost one in four subjects had serologic evidence of previous SARS-CoV-2 infection. These very high seroprevalence rates have not been previously reported and highlight the concern for health disparities in the United States. Most were asymptomatic and without a history for SARS-CoV-2 exposure. There was a loss of seropositivity in a significant number of subjects, raising concern for risk of reinfection, inadequate transplacental antibody transfer, and subsequent limited passive protection to the newborn. These seroprevalence data will also allow for better newborn follow-up of unanticipated consequences of COVID-19 infection in pregnancy. Key Points

Subaerial beach morphology change from multiple storms during the 2020 hurricane season

Frequent or consecutive storms impacting coastal areas can result in unexpected or variable impacts. This study evaluates spatiotemporal variability and cumulative impacts on the subaerial beach from four major tropical storms of varying intensity and proximity impacting the study area of Palm Beach County, Florida, during the 2020 Atlantic Basin Hurricane season. Impacts from Hurricanes Isaias, Laura, Sally, and Teddy were measured using Real-Time Kinematic Global Positioning System (RTK GPS) at 14 transects throughout the northern and southern portion of the county. Alongshore morphologic variability resulted from each storm, with some expected patterns of erosion and accretion with a few unexpected impacts. The first three storms caused swash or collision regime impacts on the Sallenger scale. Hurricane Teddy was the fourth storm to impact the study area, causing overwash at numerous locations. Whereas the first two storms of the season caused mostly erosion of the subaerial beach, the southeasterly approach of Hurricane Sally reversed the cumulative volume loss trend in the northern portion of the study area with accretion. Hurricane Teddy was the most distant storm but occurred at the highest tide and produced the largest waves and highest winds. The most variable patterns in erosion and accretion resulted from Hurricane Teddy, which also dominated the overall (or cumulative) volume and contour change. Further study is recommended for a multi-storm season that includes the subaqueous portion of the beach profile to elucidate trends of cross-shore and alongshore drivers of storm-induced morphology change.

Novel and Nonroutine Benzodiazepines and Suvorexant by LC–MS-MS

ABSTRACT Benzodiazepines are a commonly prescribed class of drugs that have the potential for abuse. The Palm Beach County Sheriff’s Office received drug seizure submissions that included novel and/or nonroutine benzodiazepines of increasing prevalence from 2017 to 2019. This prompted the development of a method of analysis for these compounds in biological specimens. The method tests for 16 novel and nonroutine benzodiazepines and suvorexant in whole blood by liquid chromatography–tandem mass spectrometry (LC–MS-MS). The target analytes included bromazepam, clobazam, clonazolam, clotiazepam, diclazepam, estazolam, etizolam, flualprazolam, flubromazepam, flubromazolam, loprazolam, lormetazepam, phenazepam, prazepam, suvorexant, tetrazepam and triazolam. The method uses 200 µL of sample, protein precipitation and an instrument run-time of 8 min. The limit of detection was either 1 or 5 ng/mL and the limit of quantitation was either 5 or 25 ng/mL depending on the analyte. The method was validated for quantitative analysis for 15 out of the 17 analytes. Flubromazepam and prazepam were validated for qualitative identification only. A quadratic calibration model (r2 > 0.990) with 1/x weighting was used for all analytes for quantitative analysis. The calibration range was either 5–100 or 25–500 ng/mL depending on the analyte. The coefficient of variation of replicate analyses was within 14% and bias was within ±14%. The method provides a sensitive, efficient and robust procedure for the quantitation and/or qualitative identification of select novel and nonroutine benzodiazepines and suvorexant using LC–MS-MS and a sample volume of 200 µL.

SEDIMENTOLOGY OF BEACHES IN NORTHERN PALM BEACH COUNTY, FLORIDA, USA

Beach nourishment is a common strategy for erosion mitigation that also increases coastal resilience to storm impacts, provides habitat, and supports the economy. Regulations often require that placed sediment closely match the native grain size distribution and composition, however characteristics can vary based on the borrow site. Certain sediment properties will also influence beach slope and other critical beach functions. This study evaluates the 3-dimensional sediment properties and beach morphology of nourished and non-nourished barrier island beaches in northern Palm Beach County, Florida, USA. Surveyed beach profiles were compared with predicted slope based on median grain size. The inlet-adjacent beach managed with annual placement of beneficial use of dredged materials consisted of poorly sorted coarse sand and the steepest measured slope. Sediment was progressively finer and better sorted downdrift with decreasing foreshore slopes. Although sediment near the shoreline is typically the coarsest, clasts were finer than the mid-beach location suggesting that the sampling period coincided with beach recovery and onshore sediment transport of finer material. Sediment at the surface differed from sediment at depth, likely due to the frequent introduction of sediment from various borrow areas compared to the dominance of weathered coquina at depth. The non-carbonate, siliciclastic fraction was primary quartz with few other minerals. The estimated beach slope at the location with the coarsest sediment matched the measured slope. A lower beach slope was predicted for the other locations with finer grain sizes at the shoreline that was attributed to slightly steeper slopes associated with beach accretion. Therefore, complicated spatio-temporal morphodynamics of beaches should be considered when using median grain size from only one sampling event.

A Clustering Approach for Characterizing Voter Types: An Application to High-Dimensional Ballot and Survey Data

Large-scale ballot and survey data hold the potential to uncover the prevalence of swing voters and strong partisans in the electorate. However, existing approaches either employ exploratory analyses that fail to fully leverage the information available in high-dimensional data, or impose a one-dimensional spatial voting model. I derive a clustering algorithm which better captures the probabilistic way in which theories of political behavior conceptualize the swing voter. Building from the canonical finite mixture model, I tailor the model to vote data, for example by allowing uncontested races. I apply this algorithm to actual ballots in the Florida 2000 election and a multi-state survey in 2018. In Palm Beach County, I find that up to 60 percent of voters were straight ticket voters; in the 2018 survey, even higher. The remaining groups of the electorate were likely to cross the party line and split their ticket, but not monolithically: swing voters were more likely to swing for state and local candidates and popular incumbents.

Birth across Borders: Migueleña Maternal Experience in Palm Beach County, Florida

Inbal Mazar is an Assistant Professor of Spanish language and culture at Drake University. Living in six countries sparked an appreciation for cultures worldwide. She strives to share this enthusiasm by promoting culture in and out of the classroom and building connections between students with local, national and international communities. She earned a PhD in Comparative Studies (Florida Atlantic University 2015) with a focus on Gender Studies and Sociology and a master’s degree in Spanish (Florida Atlantic University 2008). Her research centers on migration and health from a transnational perspective. She has conducted comparative transnational fieldwork in San Miguel Acatán, a highland hamlet in Huehuetenango, Guatemala and in Palm Beach County, Florida to better understand how migration influences Guatemalan Maya maternal care.

IDENTIFYING COGNITIVE IMPAIRMENT WITH PRIMARY CARE IMPLEMENTATION OF THE BRIEF INTERVIEW FOR MENTAL STATUS

Overview: An estimated 5.7 million Americans are affected by Alzheimer’s disease (AD; 2018 Alzheimer’s disease facts and figures, 2018, p. 367). Cognitive impairment fails to be identified in the primary care setting as often as 76% of the time (Moyer, 2014, p. 793). Screening can identify patients with emerging impairment who might otherwise appear cognitively intact Grober, Wakefield, Ehrlich, Mabie & Lipton, 2017, p.191). Early identification of cognitive impairment promotes evaluation of treatable causes (Possin et al., 2018, p. 150), and access to early treatment for irreversible disease, facilitating future planning (Swallow, 2017, pp. 57, 63). Methods: This quantitative study’s aim was to identify patients with occult cognitive impairment. After training staff in a Palm Beach County Florida primary care practice, the Brief Interview of Mental Status (BIMS) was administered to patients aged 45 years and older. Results: Seven of 120 screened patients, with no known AD diagnosis, scored as moderately impaired. One of these patients was 64 years of age, the remaining six ranged from age 71 to 93. Fourteen patients scored at the lowest range of “cognitively intact,” eight were under age 65. Conclusion: Cognitive screening of primary care patients with no known diagnosis of AD identified approximately 7% scoring as moderately impaired; an additional 12% scored at the lowest range of “cognitively intact,” suggesting a potentially emerging cognitive impairment warranting follow up evaluation for treatable causes, developing AD, or a related neurocognitive disorder.