County Home Research Articles

First Report of Chagas Disease Vector Species Triatoma sanguisuga (Hemiptera: Reduviidae) Infected with Trypanosoma cruzi in Delaware.

In July and October 2023, two live triatomine bugs were found inside a home in New Castle County, Delaware. The bugs were identified as Triatoma sanguisuga, the most widespread triatomine bug species in the United States. Triatoma sanguisuga is a competent vector of Trypanosoma cruzi, the causative agent of Chagas disease. The two specimens were tested via real-time PCR (qPCR) for infection with T. cruzi, and one of the specimens was positive. Despite T. sanguisuga being endemic to the area, attainment of accurate species identification and T. cruzi testing of the bugs required multiple calls to federal, state, private, and academic institutions over several months. This constitutes the first report of T. sanguisuga infected with T. cruzi in Delaware. In addition, this is the first published report of T. sanguisuga in New Castle County, the northernmost and most densely populated county in Delaware. New Castle County still conforms to the described geographic range of T. sanguisuga, which spans from Texas to the East Coast of the United States. The T. cruzi infection prevalence of the species has not been studied in the northeastern United States, but collections in southern states have found prevalences as high as 60%. The Delaware homeowner's lengthy pursuit of accurate information about the vector highlights the need for more research on this important disease vector in Delaware.

Pesticide Residues and Lead: Neurotoxins in the Home Environment

Objectives: To examine the extent to which pesticide residues and lead-laden dust are present in homes. Materials and Methods: This study used a two-stage random sampling procedure to identify a representative sample of homes in non-metropolitan counties of New York State. A technician visited those homes performed wipe tests that were analyzed for lead and pesticide residues. Results: Dangerously high levels of lead were observed. In addition, residues of all 15 pesticides that were tested for were observed in every home. Conclusion: Educators involved in lead and pesticide education programs may want to include program elements that include home maintenance guidelines for prevention and safe eradication of accumulated lead and pesticide residues of which consumers may not be aware. This could be an important component of public health education efforts.

Research on the Problems and Causes of Home and Community Elderly Care Services

From the development status of home and community elderly care services in XX County, we can see the following problems in this field: insufficient public participation; The effectiveness of public value creation is insufficient; The realization of public value is insufficient. These problems are mainly attributed to the following aspects: single publicity means of government and relevant departments, no enough promotion of it, unchanged public pension concept and insufficient government funding.

Optimal interventions in networks during a pandemic

We develop a model of optimal lockdown policy for a social planner who balances population health with short-term wealth accumulation. The unique solution depends on tolerable infection incidence and social network structure. We then use unique data on nursing home networks in the US to calibrate the model and quantify state-level preference for prioritizing health over wealth. We also empirically validate simulation results derived from comparative statics analyses. Our findings suggest that policies that tolerate more virus spread (laissez-faire) increase state GDP growth and COVID-19 deaths in nursing homes. The detrimental effects of laissez-faire policies are more potent for nursing homes that are more peripheral in networks, nursing homes in poorer counties, and nursing homes that operate on a for-profit basis. We also find that US states with Republican governors have a higher tolerable incidence level, but these policies tend to converge with a high death count.

Income and Insurability as Factors in Wildfire Risk

The increasing frequency of destructive wildfire incidents in the United States, particularly in the West, is well-documented, and the key causal variables are increasingly well understood. Among stakeholders with heightened concerns about risks from destructive wildfire are insurance companies and the homeowners they insure. The cancellation and nonrenewal of insurance due to wildfire risk has received media attention in the wake of major wildfire seasons, particularly in California. However, less attention has been directed to wildfire-related risks borne by lower-income policy holders, specifically. For example, the probability of maintaining or replacing an at-risk policy increases when a homeowner invests in fire protection measures. However, these investments are comparatively costly for lower-income homeowners. The present research aims to identify regions in the lower 48 states where moderate and high wildfire risk, lower income, and insurability are coterminous risks. The concentration of at-risk homes in counties with comparatively high wildfire hazard potential and comparatively higher poverty rates are considered. This paper also considers how the concentrated market share of insurance underwriting may pose a risk to lower income homeowners, considering the overlap between highly concentrated insurance markets and states with high wildfire risk and higher poverty rates.

La Pastorela

La Pastorela

Factors Associated With Nursing Home Residents’ COVID-19 Infections: A Systematic Review of Literature

Background: Nursing homes were impacted disproportionately by the coronavirus because of their resident’s vulnerabilities and settings. Even many previous studies illustrated factors related to nursing home residents’ Covid-19 infections, there’s no such study epitomizing those factors systematically, while some factors were controversial in different studies. The article aims to summarize major types of factors and provide crucially influential implications for nursing homes to prevent and manage their resident infections. Methods: All articles published between 01 January 2020 - 15 January 2021 in English version were searched through three electronic databases (PubMed, Web of Science, and Scopus). Two authors screened and evaluated a total of 121 studies independently based on selection and extraction criteria. Results: Seventeen identified studies were included in the research, which involved five major types of factors (nursing home’s residence, nursing home, staff, resident, and others). Conclusion: nursing home’s county infection rate, size, and staff residence were the strongest significant factors in many studies. Per-capital income, symptom-based screening and testing, and asymptomatic individuals have impacted resident’s infections variously since the beginning of the pandemic. Nursing home’s star rating and a total count of fines became factors when considered its locations. Other factors, including nursing home’s type, historical health deficiencies, staffing level, and staff working different facilities, etc., were also significant factors. The value of factors suggests healthcare systems reflect appropriate measures and allocate more resources to nursing homes in high prevalence counties on the basis of universal allocation.

Integrated Primary Specialty Care Access for Adults with Sickle Cell Disease in Delaware

INTRODUCTION A major gap in US care for Sickle Cell Disease (SCD) is a dearth of healthcare providers with expertise in adult SCD management. In 2014 TOVA Community Health launched a community-based primary specialty care clinic in Delaware (DE). The Delaware Department of Health and Social Services found that 96 individual adults in DE with Sickle Cell Disease (SCD) utilized hospital services 99.5% of the time for sickle cell crisis (Anderson et al., 2014). The majority of those adults lived in New Castle County, DE. The dearth of sickle cell hematologist/oncologists for adults in this county may drive them to seek recurrent care through the hospital system. Recognizing this as a nationwide public health crisis, the Delaware Department of Health and Social Services (DHSS) partnered with TOVA Community Health in 2014 to establish an adult primary specialty care clinic medical home in New Castle County, DE. This report describes the progress/impact of an integrated primary specialty clinic for adults with SCD METHODS Prospective/ Retrospective tracking of best practices for SCD are featured in the NIH 2014 guidelines. The staff included a hematologist with expertise in SCD, a primary care provider, an advanced practice nurse, a Social Worker (MSW), a nurse care coordinator, and a community health worker, were funded by Sickle Cell Disease Association of America (SCDAA) and Health Resources and Services Administration (HRSA). From 2014 to 2018, integrated primary specialty care services were provided for 33 discrete patients. RESULTS This first cohort of patients was notable for health complications that may be attributed to the lack of coordinated primary specialty sickle cell care access. Therapeutic counseling, support groups and preventive health maintenance services were measured by: outpatient visits to the clinic, access to disease modifying therapies (hydroxyurea therapy or chronic transfusion therapy), immunizations (Pneumococcal), Depression Screens and Personalized Sickle Care Plans (Table). 21 % percent of the patients had no sickle cell provider and/or hematologist/oncologist other than ED or inpatient care for the 12 months preceding their first visit to our clinic. 48% of the patients received a pneumococcal vaccine (Pneumovax 23 val - n=16/33 and Prevnar 13 - n=7/33) and three (n=3/33) received both Pneumococcal vaccines. 30% percent of the patients (n=10/33 patients) seen were offered access to HU but were not on the drug and 42% (n=14) were prescribed HU. All patients did not have a Personalized Sickle Cell Care Plan prior to receiving services at the Primary Specialty Care clinic. 12% (n=4/33) patients had a diagnosis of Substance Abuse Disorder, 15% (n=5/33) had a diagnosis of Opioid Use Disorder and 3% (n=1/33) had both Substance Abuse and Opioid Use Disorder. 70% (n= 7/10) were male and 30% (n-3/10) were female with a diagnosis of Substance Abuse and/or Opioid Use Disorder. 45% (n=15/33) had a Pain Management Agreement established within the time period at the primary specialty clinic. CONCLUSION The creation of an integrated practice primary specialty care clinic for adults with SCD in New Castle County, Wilmington, DE demonstrates the successful leverage of regional networks that engages an academic institution for telehealth consultation, public health, and community-based organizations to develop an adult SCD primary specialty care model. This safety net clinic provides team based primary specialty care to adults whose only option previously was the hospital and/or emergency room. Unique challenges in managing adult SCD acute and chronic pain were addressed. Overall, this is one model for access to integrated primary specialty care and behavioral health services for persons with SCD across their lifespan. Figure 1. Disclosures No relevant conflicts of interest to declare.

Pesticide exposure and ocular toxicity

Pesticide residues accumulate in homes with higher amounts that are found in the Child Breathing Zone. Negative health effects are known to exist from exposure to pesticide residues, including ocular toxicity. This paper reports on a study of pesticide residues found in a random sample of 132 homes in non-metropolitan counties of New York State. Fifteen pesticides were tested for and residues from all fifteen pesticides were found in all 132 homes. Potential consequences of human exposure to these residues are discussed as is a potential remedy.

Assessing storage requirements, water and energy savings, and costs associated with a residential rainwater harvesting system deployed across two counties in Southeast Florida

This article analyzes the feasibility of a widely-deployed residential rainwater harvesting (RWH) system for reducing demands and supplementing existing, centralized water supply systems in a heavily populated region in Southeast Florida. The analysis employs a unique integration of models and approaches, which are portable and applicable in diverse contexts and include: a nonparametric bootstrapping model for synthetically generating multiple realizations of regional rainfall, water supply and demand, and storage size and reliability outcomes; and an approach for determining expected water and energy savings and costs associated with the RWH system. Findings suggest that a RWH system designed to meet the outdoor irrigation demands of detached homes in Florida's Broward and Palm Beach Counties could meet 54% of the total additional water demand created by the growing population in this region. This is significantly greater than the percentages of demand that could be met by several proposed centralized approaches to water supply using groundwater recharge by reclaimed water, comparable to the percentage of demand that could be met by desalinating brackish water from the Floridian Aquifer, but less than the percentage of demand that could be met by a proposed new reservoir and canal system for groundwater recharge. The findings also suggest that the expected cost of water provided by the decentralized RWH system, which includes substantial savings in energy requirements and costs, would be significantly less than the expected costs of water provided by all centralized water supply system alternatives considered, with the exception of the reservoir and canal system.

A nonparametric bootstrapping method for synthetically generating daily precipitation, water supply, and irrigation demand for rainwater harvesting system storage sizing

This article describes a nonparametric bootstrapping method for synthetically generating daily precipitation, water supply, and irrigation demand for rainwater harvesting (RWH) system storage sizing and reliability determination. The method is illustrated using the case example of determining storage size and associated reliability outcomes for residential RWH systems that provide for the outdoor landscape irrigation demands of single-family homes in Broward and Palm Beach Counties, located in Southeast Florida, U.S.A. The method is useful not only for individual property owners, RWH system designers, and contractors, but also for policy makers who wish to analyze potential savings in water and energy amounts and costs that could result from widespread deployment of residential RWH systems, as discussed in Wurthmann (2019). The method can be easily implemented in Excel and is unique in its combination of:•precision – determines daily levels of precipitation, water supply, and irrigation demand, incorporating the effects of seasonality,•adaptability – user specified historical rainfall data and functional relationships between precipitation and water supply and demand are fully customizable, and•portability – the nonparametric bootstrapping approach overcomes the key challenge posed by parametric stochastic methods; that statistical relationships describing rainfall processes derived in one location are likely not applicable to other locations

Utilization of Mental Health Services by Children Displaced by Hurricane Katrina.

This study examined changes in utilization of mental health services after Hurricane Katrina among children with preexisting conditions who were displaced from their homes in Louisiana disaster counties and resettled in Texas. A retrospective analysis was performed on Medicaid claims data for 101,950 children from 2004 to 2006. Pre-post changes in utilization of mental health services by the displaced children and three control groups were compared. The control groups were children from Louisiana disaster counties who were not displaced, Louisiana children from nondisaster counties, and Texas children enrolled in Medicaid. The proportion of children who had a prescription fill for psychotropic medication and the average days' supply per child decreased in each group, but the decreases were significantly larger for the displaced group than for the control groups. The decreases in both measures were largest for stimulants and antidepressants, the two most common medication classes. By contrast, changes in the proportion of children with an encounter involving psychiatric services and the average number of psychiatric services encounters per child did not vary systematically across the displaced and control groups. The contrast between the results for medication utilization and encounters reveals a potential gap in post-Katrina provision of care. Although the findings for encounters indicate that, on average, displaced children did not experience a disruption in provider visits, the medication estimates suggest that they often did not obtain pharmaceutical treatment. Future disaster responses may be improved by addressing logistical impediments faced by disaster victims in filling their prescriptions for psychiatric medications.

Bloody Engagements: John R. Kelso's Civil War ed. by Christopher Grass

Reviewed by: Bloody Engagements: John R. Kelso's Civil War ed. by Christopher Grass Madeleine Forrest Bloody Engagements: John R. Kelso's Civil War. Ed. Christopher Grass. New Haven: Yale University Press, 2017. ISBN 978-0-3002-1096-5. 264pp., cloth, $35.00. With the overall acceptance of the importance of guerrilla warfare to our understanding of the Civil War, guerrilla scholars have turned the focus to specific individuals, events, and regions. Much of the academic literature focuses on Missouri, and for good reason—some of the harshest guerrilla fighting during the war occurred within the state. Bloody Engagements: John R. Kelso's Civil War offers a new point of view of the partisan warfare that occurred in southwest Missouri, showing it through the eyes of a Union soldier. Union guerrilla Kelso comes to life in this very first edited edition of his autobiography, ably edited by Christopher Grasso. A former Methodist preacher and Missouri schoolteacher living in Dallas County, Kelso first enlisted in his county's home guard to aid the Union troops commanded by Capt. Nathaniel Lyon. Following the Federals' loss at Wilson's Creek in August 1861, Kelso joined the 24th Infantry Regiment as a private, by war's end ultimately serving as a cavalry officer and guerrilla fighter. Although he came from a proslavery family, Kelso considered himself an ardent patriot (who embraced the ideals of the American Revolution) and resented the institution and the wealthy men who perpetuated it. His natural talents and aptitude for military life were quickly [End Page 309] recognized as he was sent into Confederate-occupied areas of Missouri as a spy. His introduction to guerrilla life came in late 1861 when the Union army retreated from southwest Missouri, where Kelso's family lived. Helping unionist families, including his own, escape the looting and pillaging by Confederate troops, Kelso vowed to get revenge. And revenge he got. Through a beautifully written introduction and exhaustive footnotes, Grasso brings Kelso to life. While the exploits of fellow Missouri guerrillas and bushwhackers such as Jesse James, Bill Anderson, and William Quantrill are now well known, Kelso's autobiography adds a much-needed Union guerrilla voice to the historiography. In many ways, he seems incredibly similar to the men whom he found himself fighting, and he was described in a newspaper article published after the war as "brave to the point of recklessness" (xxiv). Kelso can pinpoint the moment he felt his "whole nature changing" with a vengeance reminiscent of other vicious Confederate guerrillas. "I found myself thirsting for blood," Kelso writes. "In my madness,—what else shall I call my condition?—I vowed to slay twenty five rebels before I cut my hair. If it was madness to make such a vow, what was it to keep it, as I did?" (52–53). Kelso's unionist views provide another framework by which to interpret the horrific fighting in the state's unconventional war. Like his pro-Confederate counterparts, Kelso relished his time as a guerrilla and believed the violence in which he took part was necessary in the storm of war. While only the chapters written through 1863, written in Kelso's own hand, survived the test of time, Grasso makes sure to chart Kelso's postwar life, first as a representative to Congress and then again as a schoolteacher and writer. To this end, two of his political speeches from 1864 and 1865 are appended to the work. Kelso became quite disillusioned with the country he fought to protect, as he believed the ideals of the Declaration of Independence were not being realized, especially when it came to the fate of the newly freed African Americans. Voting with Radical Republicans in Congress, Kelso became a champion for "negro equality" (xxxi). Surrounded by the wealth and excess of the Gilded Age by the time of his death in 1891, the wizened Union guerrilla fighter once considered "a monster" who was "fanatical in his Unionism" grew to regret his wartime experience and became a self-proclaimed anarchist (xxiv). Kelso's wartime experiences are riveting, and Grasso does a superb job of placing in historical context the many events the soldier only briefly discusses or embellishes...

Sclérodermie systémique et difficultés professionnelles : résultats d’une enquête prospective

Between 9000 and 14000 people have systemic sclerosis (ScS) in France. The work is often affected. Our study aims to assess the frequency of professional difficulties (DP) of scleroderma patients, identify these DP, the symptoms involved and the solutions used. A heteroquestionnaire was offered to scleroderma patients the Lille University Hospital. Data were cross-checked with the clinical database of the National Observatory of scleroderma patients. We used 104 questionnaires of which 84% are women. A total of 62.5%, (95% CI [52.5 to 71.8]) patients had experienced DP related to SSc, 55% reported symptoms worsened at work, 41% lower efficiency and a 19% job loss. Symptoms responsible for their DP were mainly asthenia, Raynaud syndrome, arthralgias and finger ulcerations. Only 40% of patients in difficulty were initiating steps with the county home for disabled people and 45% in informing their doctor at work (MT). The MT information absence was related to a misunderstanding of possible aid in 45% of cases, 57% of patients had not found a solution, 41% of them have lost their jobs and 31% of patients in the cohort experienced a drop in income. The impact of SSc the work is important. The aid job retention devices are under-used due to lack of knowledge of steps to take and the role of MT. Taking into account the symptoms responsible for PD must be improved to participate in this retention.

In Memoriam: Steve Wing

In Memoriam: Steve Wing

Combatting California's Notario Fraud

Author(s): Carvajal, Bianca | Abstract: The state of California is home to the largest undocumented immigrant population in the United States (U.S.), housing one-fourth of our nation’s undocumented immigrants. Because of its unsurpassed undocumented immigrant population, California is a breeding ground for notario fraud, which is essentially the unauthorized practice of immigration law.The long-awaited opportunity to effectively address notario fraud has arrived, as Los Angeles County Supervisor Hilda Solis co-authored a motion to create a licensing program for immigration consultants, which includes payment rates for service and penalties for violations. The motion was passed on September 13, 2016. Once in place, the licensing program and other regulations in this motion provide an opportunity for Los Angeles County—home to more undocumented individuals than any other area in California—to set an example for the rest of California, other states, and eventually the federal government as to what type of laws and enforcement task forces will most effectively combat notario fraud.I argue that the attempt to combat notario fraud in California will only be effective if officials shift the burden from requiring victims to self-report notario fraud to requiring government agencies to proactively find perpetrators through a notario fraud task force and community and County involvement. Those perpetrators must then be prosecuted, subjected to license revocations, heavy fines, or even incarceration. Parts I through III of this article explain what notarios and notario fraud are, analyze why undocumented immigrants become notario fraud victims, and examine how California has attempted to combat notario fraud—but failed. Part IV examines how other states and cities have attempted to combat notario fraud, and the lessons that Los Angeles County can draw from those attempts. Part V explains Los Angeles County Supervisor Hilda Solis’ efforts to combat notario fraud, which are of great importance, as she is responsible for reigniting combatting efforts and providing a blue print on how to combat notario fraud. Lastly, in Part VI, I propose new ways for Los Angeles County and ultimately California to combat notario fraud.

Potential Economic Impact of a Coordinated Home Visitation Program

Background and Purpose Evidence about the efficacy of healthy pregnancy home visitation programs is needed in California’s underserved Hispanic population, where preterm birth rates are higher than nonHispanic Whites. This study describes birth outcome data in a sample of families participating in the MOMS Orange County home visitation program. Methods: A descriptive comparative design was used. Birth outcome data for 1,102 women who participated in MOMS Orange County and had a live birth in 2010 were compared with data from the county of Orange (N = 38, 237) and the state of California (N = 509, 979) for the same time period, derived from county and state birth and death reports. Measures included social background, birth outcomes, and potential cost savings. Results: Although MOMS program mothers were less educated and had a higher level of poverty compared to both county and state samples, they had significantly fewer preterm births compared with the countywide and statewide samples. It was estimated that the provision of a home visitation program both countywide and statewide would result in a potential cost saving that $1.1 and $ 2.1 million, respectively. Conclusion: This coordinated prenatal program may improve birth outcomes among communities of impoverished women at potentially reduced costs.

Archaic Period Domesticated Plants in the Mid-Ohio Valley

Abstract Late Archaic archaeobotanical remains from the County Home site (33AT40), southeastern Ohio, are described. Measurements of chenopod (Chenopodium berlandieri) seed-coat thicknesses and marshelder (Iva annua) achene and kernel lengths from the site are indicative of domesticated types (ssp. jonesianum and var. macrocarpa, respectively) dating to ca. 3000 B.P. to 3600 B.P. Together, these specimens represent some of the earliest evidence of plant domestication outside the oak-hickory and oak-savannah forests of eastern North America. The recovery of these plants with other cultigens in hearths and earth ovens at the County Home site indicates that the timing for the arrival of the Initial Crop Complex in the Appalachian mixed forest of the middle Ohio Valley occurred earlier than previously documented. The results of this research contribute to the growing database of early plant domestication and a broader understanding of the origins of food production.

The Anabaptists of Juniata County: A Historical Profile

ABSTRACT The Anabaptist story in Juniata County begins with Johannes Kröebiel Jr., a young, ambitious Swiss Mennonite seeking a wider place in the New World. In the 1770s Johannes began to carve a future for his own family and succeeding generations on central Pennsylvania's frontier land. Within the next century, Mennonite, Amish, Brethren, and Brethren-in-Christ groups had growing settlements in the beautiful Juniata Valley. Today dozens of Anabaptist congregations of various affiliations have found their home in the rural county and the saga of faith continues. Their story is similar to Anabaptist settlement in other central and western Pennsylvania rural counties.

Archaic Period Domesticated Plants in the Mid-Ohio Valley: Archaeobotanical Remains from the County Home Site (33at40), Southeastern Ohio

Late Archaic archaeobotanical remains from the County Home site (33AT40), southeastern Ohio, are described. Measurements of chenopod (Chenopodium berlandieri) seed-coat thicknesses and marshelder (Iva annua) achene and kernel lengths from the site are indicative of domesticated types (ssp. jonesianum and var. macrocarpa, respectively) dating to ca. 3000 B.P. to 3600 B.P. Together, these specimens represent some of the earliest evidence of plant domestication outside the oak-hickory and oak-savannah forests of eastern North America. The recovery of these plants with other cultigens in hearths and earth ovens at the County Home site indicates that the timing for the arrival of the Initial Crop Complex in the Appalachian mixed forest of the middle Ohio Valley occurred earlier than previously documented. The results of this research contribute to the growing database of early plant domestication and a broader understanding of the origins of food production.