Facilities In Florida Research Articles

Assessment of annoyance from traffic noise in a school and a hospital

Traffic noise can cause significant annoyance. We administered noise annoyance surveys in two Florida facilities located near a highway and a busy road while traffic noise levels were being measured. In Trilogy school, thirty middle & high school students rated the annoyance caused by traffic noise inside the school to be an average of 1.9 (SD 2.0) on a scale from 0 to 10. Traffic noise was just as disturbing as other sounds inside the school. However, the fraction of students reporting any level of traffic noise disturbance was significantly higher outdoors (80%) than indoors (48%). Additionally, traffic noise caused some difficulty hearing the teacher for 9.7% of students. In Shands Hospital, the average ratings of annoyance from traffic noise given by 107 staff (M=1.1, SD=2.0) and 104 patients (M=1.2, SD=1.4) were not higher in areas of the hospital that were closer to the road or the helicopter landing pad compared to the other areas of the hospital. Traffic noise was substantially less disturbing than other noise inside the hospital, e.g., tube station. However, traffic noise caused moderate to extreme annoyance for 12.4% of patients and some degree of sleep disruption for 27.9% of patients.

Infection Prevention and Control in Long-term Care Facilities in Florida: A Needs Assessment Survey

Although several surveys of infection prevention and control (IPC) practices have been conducted in the United States, none have focused on the state of Florida, which has the fourth largest number of certified nursing facilities in the country. A needs assessment survey was conducted to better understand the specific needs and practices of individuals responsible for IPC in long-term care facilities (LTCFs) in Florida. In November and December of 2022, a 90-question online survey was distributed to individuals responsible for IPC activities at 3,690 LTCFs in Florida. After omitting incomplete responses, 304 survey responses were analyzed using descriptive statistics. Survey responses regarding hand hygiene, sharps safety, and staff training reflect compliance with recommended IPC practices. Staffing shortages for Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants were high among respondents (30%), while few reported shortages of Personal Protective Equipment (5%). Only 11% of respondents state their facility requires flu vaccines despite the high-risk environment of LTCFs. Concerning the built environment, the results suggest Infection Preventionists have limited awareness of the scope of heating, ventilation, and air conditioning systems in their facilities. Some areas of compliance with IPC best practices were noted, but multiple opportunities for education and training on IPC best practices were identified.

Utilization of palliative care for geriatric veterans with newly diagnosed stage 3 and 4 pancreatic cancer.

e24082 Background: Locally advanced and metastatic pancreatic cancer continues to be difficult to treat with high mortality. For stage 3 and stage 4 pancreatic cancer, there remains no meaningful advances in treatment and standard of care heavily relies on a palliative approach. Yet, there remains reports that early use of palliative care (PC) may be underutilized despite palliative care being mainstay of treatment. We sought to further characterize which factors may play a role in PC referral within the geriatric veteran population. Methods: This retrospective cohort study included veterans who were diagnosed and treated for pancreatic cancer within the Veterans Integrated Services Network (VISN) 8 which includes Veterans Affairs medical facilities in Florida, southern Georgia, Puerto Rico and the U.S. Virgin Islands. Demographic data such as age, sex, race, ethnicity and branch of service and treatment data such as chemotherapy and PC use were pulled from the electronic medical record. We conducted a chart review to determine stage and ECOG status at the time of diagnosis. Of this cohort, 99 veterans were identified who met the criteria of 65 years of age or older at the time of newly diagnosed stage 3 or stage 4 pancreatic cancer. Statistical analyses were conducted using GraphPad Prism 10.1.2 software and analyses consisted of t-test, Mann-Whitney, chi-squared, multiple regression model and odds ratio. Results: The mean age for veterans who did not receive PC was 74.66 years and veterans who did receive PC mean age was 74.79, revealing no statistically significant difference (p = 0.9205). The median ECOG for veterans who did and did not receive PC was 1 (p = 0.6609). Chemotherapy use in the PC and no PC groups did not differ with about 49% of veterans in the no PC group receiving chemotherapy and 42% of veterans received PC and chemotherapy (p = 0.5329). Furthermore, sex, race, ethnicity, stage 3 vs 4, and branch of military service were not found to be statistically significant between the PC and no PC groups. We found no statistically significant relationship between frequency of PC utilization (p = 0.4450) with age (OR = 1.001; 95% CI 0.9331-1.072), ECOG score (OR = 1.059; 95% CI 0.7425 – 1.504) or chemotherapy use (OR = 0.7353; 95% CI 0.2936 – 1.821). The OR for age, ECOG and chemotherapy use all cross 1.0 demonstrating that these independent variables do not have a correlation with PC utilization. Conclusions: Between geriatric veterans with newly diagnosed stage 3 and stage 4 pancreatic cancer who did and did not receive PC, there appears to be no statistically significant difference in ECOG status, age, ethnicity, use of chemotherapy or branch of military service. Our data demonstrates that otherwise prognostic features such as age and ECOG did not differ in veterans who did and not receive PC regardless of chemotherapy use, however overall more PC referrals are still needed within this patient population.

Effect of age on delivering chemotherapy to older adults with advanced pancreatic adenocarcinoma.

e13767 Background: Age is one of the most important risk factors for developing pancreatic adenocarcinoma (PDAC), 65% of the newly diagnosed cancer cases occur in individuals above 65 years of age (yo). The only potential cure for PDAC includes surgical resection, however, the majority of patients (70%) present with locally advanced/unresectable or metastatic PDAC (APDAC). Many oncologists remain hesitant to administer treatment to older adults for fear of perceived increased chemotoxicity risk and the thought of treatment intolerability. Methods: This retrospective cohort study included patients who were diagnosed and treated for APDAC within the Veterans Integrated Services Network (VISN) 8 which includes Veterans Affairs medical facilities in Florida, southern Georgia, Puerto Rico, and the U.S. Virgin Islands. Demographic data such as age, sex, race, ethnicity and treatment data such as chemotherapy and palliative care use were pulled from the VA Cancer Registry, available from Corporate Data Warehouse Data. We conducted a detailed chart review in the VA electronic health record to confirm stage and the eastern cooperative oncology group (ECOG) status at the time of diagnosis. Statistical analyses were conducted using GraphPad Prism 10.1.2 software. Analyses consisted of t-test for normally distributed continuous variables, chi-squared test for categorical variables and the Mann Whitney U test for the ECOG score of both groups. Results: Ninety-nine patients with APDAC above the of age 65 were identified from the period of June 1, 2017 till July 31, 2021. 46 received chemotherapy (C group) and 53 patients did not receive chemotherapy (NC group), characteristics (Table). The mean age for those in the C group were 72 years old (yo) vs 76 yo from the NC group with a P value of 0.0017 which was statistically significant. Looking at the age subgroups, the majority of the patients that received C, were of the 65-74 age subgroup (71%). The median ECOG for the NC group was 2 and that for C was 1 group. 39% of the C group received palliative care as opposed to 32% of the NC group with a P value of 0.532. Conclusions: Despite an acceptable ECOG range between 1 and 2, Age played an important factor in determining who received chemotherapy in APDAC. Studies other than ECOG are needed to help oncologists determine the fitness of APDAC patients and minimize hesitancy to deliver treatment. The involvement of palliative care in patients with APDAC was suboptimal and a push for more involvement of palliative care is needed. [Table: see text]

Elevated drug overdose mortality among Americans who visit Florida, 2003–2020

ObjectiveFlorida state has played a conspicuous role in the current U.S. drug epidemic. Reports suggest that even non-Florida residents may suffer excessive overdose fatalities while visiting the state, possibly in...

Association of frailty index of laboratory tests (FI-LAB) and COVID-19 clinical outcomes in veterans with cancer.

e24023 Background: Veterans with cancer have high COVID-19-attributable mortality. Frailty, a multisystem syndrome characterized by vulnerability to stressors from loss of physiological reserve, is common in cancer patients and confers worse clinical outcomes. In hospitalized cancer patients with COVID-19 infection, the role of frailty remains unclear. Our study aim was to compare clinical and utilization outcomes of cancer patients hospitalized with COVID-19 according to frailty status. Methods: The retrospective cohort study included hospitalized veterans with cancer and acute COVID-19 infection at 7 VA facilities in Florida and Puerto Rico from March-August 2020. Frailty was assessed using a 31-item frailty index of laboratory tests and vital signs (FI-LAB) with scores grouped by tertiles. We chart reviewed VA databases to collect Veterans’ socio-demographics, COVID-19 Polymerase Chain Reaction (PCR) results, and clinical and utilization outcomes. We ran binomial logistic regression analyses to calculate the odds of inpatient death, ICU admission, ICU transfer, prolonged length of stay, new nursing home placement, 30-day readmission, 30-day mortality, 6-month,1-year, and 2-year mortality according to the tertiles, adjusted for age, BMI, sex, race, ethnicity, and other conditions with greater risk for poor COVID-19 outcomes. Patients were followed until death or August 13, 2022. Results: 143 older Veterans with cancer were hospitalized with a mean age of 74.4 years (SD = 11.5) years, 95.9% (n = 117) male, 66.4% white (n = 81), and 9.8% (n = 12) Hispanic. 122 (85.3%) met the inclusion criteria. There were no differences in baseline sociodemographic or clinical characteristics except for a higher prevalence of congestive heart failure. The upper FI-LAB tertile had a higher risk of inpatient death, OR 12.47 (95%CI:1.3-121.4), p = 0.03, 30-day post-discharge mortality, OR 9.78 (95%CI:.21-79.4), p = .03 and 2-yr post-discharge mortality OR 4.9 (1.2-19.6) p < 0.03. There were no differences in other clinical and utilization outcomes. Conclusions: In hospitalized Veterans with cancer and coexistent COVID-19 infection, patients with higher levels of frailty have a greater risk of inpatient death, 30-day post-discharge mortality, and 2-year post-discharge mortality. More studies are needed to confirm the utility of FI-LAB in hospitalized patients with COVID-19 and cancer.

How Florida's facility fee variation can inform the future of ED price transparency.

Academic Emergency MedicineEarly View INVITED COMMENTARY How Florida's facility fee variation can inform the future of emergency department price transparency Jonathan J. Oskvarek MD, MBA, Jonathan J. Oskvarek MD, MBA Department of Emergency Medicine, Summa Health, Akron, Ohio, USA US Acute Care Solutions, Canton, Ohio, USASearch for more papers by this authorAndrew Leubitz DO, MBA, Andrew Leubitz DO, MBA US Acute Care Solutions, Canton, Ohio, USA Department of Emergency Medicine, Adventist Shady Grove Medical Center, Rockville, Maryland, USASearch for more papers by this authorJesse M. Pines MD, MBA, MSCE, Corresponding Author Jesse M. Pines MD, MBA, MSCE [email protected] orcid.org/0000-0003-2292-3052 US Acute Care Solutions, Canton, Ohio, USA Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA Correspondence Jesse M. Pines, US Acute Care Solutions, Canton, OH 44718, USA. Email: [email protected]Search for more papers by this author Jonathan J. Oskvarek MD, MBA, Jonathan J. Oskvarek MD, MBA Department of Emergency Medicine, Summa Health, Akron, Ohio, USA US Acute Care Solutions, Canton, Ohio, USASearch for more papers by this authorAndrew Leubitz DO, MBA, Andrew Leubitz DO, MBA US Acute Care Solutions, Canton, Ohio, USA Department of Emergency Medicine, Adventist Shady Grove Medical Center, Rockville, Maryland, USASearch for more papers by this authorJesse M. Pines MD, MBA, MSCE, Corresponding Author Jesse M. Pines MD, MBA, MSCE [email protected] orcid.org/0000-0003-2292-3052 US Acute Care Solutions, Canton, Ohio, USA Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA Correspondence Jesse M. Pines, US Acute Care Solutions, Canton, OH 44718, USA. Email: [email protected]Search for more papers by this author First published: 16 March 2023 https://doi.org/10.1111/acem.14725 Supervising Editor: Dr. Jeffrey Kline. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Relationships between per- and polyfluoroalkyl substances (PFAS) and physical-chemical parameters in aqueous landfill samples

Variable chemistries of liquids from landfills can potentially impact levels of per- and polyfluoroalkyl substances (PFAS). The objective of the current study was to evaluate relationships between physical-chemical properties (bulk measurements, oxygen demand components, and metals) and PFAS concentrations in different types of aqueous landfill samples. Aqueous landfill samples were collected from 39 landfill facilities in Florida, United States. These samples included leachates from landfills that receive different waste types, such as municipal solid waste incineration ash (MSWA), construction and demolition debris (C&D), and municipal solid waste (MSW). Additional aqueous landfill samples were sourced from treated landfill leachate, gas condensate, stormwater, and groundwater from within and near the landfill boundaries. Results showed significant correlations (p < 0.05) between ∑26PFAS and alkalinity (rs = 0.83), total organic carbon (TOC) (rs = 0.84), and ammonia (rs = 0.79) for all leachate types. Other physical-chemical parameters that were significantly correlated (rs > 0.60, p < 0.05) with PFAS included specific conductivity, chemical oxygen demand (COD), and to a lesser extent, total dissolved solids (TDS) and total solids (TS). For gas condensates, PFAS was significantly correlated with TOC. Stormwater and groundwater, within and near the landfill boundaries, had considerably lower levels of PFAS and had a minimal correlation between PFAS and physical-chemical parameters. Although PFAS concentrations and physical-chemical parameters and their correlations varied between different types of aqueous landfill samples, results suggest that physical-chemical properties can be useful indicators of relative PFAS concentrations within a leachate type. More research is needed to validate the mechanisms that relate physical-chemical parameters to PFAS concentrations in landfill leachates.

Educators’ and Visitors’ Perceptions of Invasive Species Education in Zoos

Management of invasive alien species (IAS) depends on public awareness and cooperation, which may be increased by effective IAS education by zoos. We administered a questionnaire to visitors (n = 221) and educators (n = 44) at three Association of Zoos and Aquariums facilities in Florida to explore their perceptions of the content and effectiveness of IAS education at these facilities. Most visitors recalled seeing IAS on display, with 80% of visitors stating that they considered zoos to be a place to learn about IAS. Both visitors and educators agreed that minimal information on how IAS are introduced to Florida was presented. They also agreed that greater implementation of shows and presentations pertaining to IAS would be highly effective in educating the public about IAS and the need for actions to mitigate species invasions. Zoos may improve their educational effectiveness by making visitors aware of IAS citizen science programs and implementing interactive educational methods.

Sociodemographic Correlates of Affordable Community Behavioral Health Treatment Facility Availability in Florida: A Cross-Sectional Study.

Behavioral health disorders such as mental disorders (MD) and substance use disorders (SUD) are epidemics in the US; however, the availability of treatment and prevention services remains low. This study assessed neighborhood-level sociodemographic attributes to characterize the availability of behavioral health treatment facilities in Florida. The American Community Survey and SAMHSA's Behavioral Health Treatment Locator were used to identify behavioral health treatment facilities in Florida and calculate their density by census tract. Spatial lag regression models were used to assess census tract-level correlates of facility density for 390 MD treatment facilities, 518 SUD facilities, and subsets of affordable MD and SUD facilities. Behavioral health treatment facility density was negatively associated with rurality and positively associated with the proportion of non-Latino Black, Latino, insured, and college-educated populations. Stark rural-urban disparities in behavioral health treatment availability present opportunities to prioritize telehealth and mobile interventions and improve treatment utilization.

Effect of Frequent SARS-CoV-2 Testing on Weekly Case Rates in Long-Term Care Facilities, Florida, USA.

We analyzed 1,292,165 SARS-CoV-2 test results from residents and employees of 361 long-term care facilities in Florida, USA. A 1% increase in testing resulted in a 0.08% reduction in cases 3 weeks after testing began. Increasing SARS-CoV-2 testing frequency is a viable tool for reducing virus transmission in these facilities.

Embalming and Maintenance of a Pliable Cadaver Over a Two‐Year Period for Clinical Procedure Learning

IntroductionSoft Cue Embalmed (SCE) cadavers can be used in various procedure learnings, such as ultrasound guided regional anesthesia (UGRA), laparoscopic, orthopedic surgeries, and developing new equipment and surgical approaches. However, the SCE technique is not well known in Northern America due to lack of knowledge to make a SCE cadaver and because the original Thiel method (1992) needs a highly specific sequence, quality, and quantity of fluid injection with a long submersion. The aim of the project is to develop SCE cadavers in the Anatomical Board of the State of Florida’s facility for the residents’ procedure learning at UF.MethodsThe SCE method (Sikon &amp; Boaz 2012, unpublished) was used. Briefly, the donor was first perfused with 8‐liter Freedom Art (Formalin free, The Dodge Company), followed with Surgical Reality Fluid (SRF, Trinity Fluids, LLC) perfusion. 4‐gallon SRF was perfused with a pressure of 10 lb/ft over 90 minutes, then 1‐gallon SRF was to freely drip overnight. The completed SCE body was bagged and kept at room temperature for 4 weeks. The body was rinsed with soap and water at 2 weeks post SCE to remove the loose stratum corneum. Maintenance included monthly vacuuming extra transudate fluid in the 1 year, and spraying with SRF to prevent dehydration with wrapping film covering the donor in the 2nd year.ResultsThe 1st donor with SCE was 8 days postmortem without receiving pre‐conditioning perfusion which decomposed in 30 days after SCE. The 2nd donor was SCE prepared 2 days postmortem, and pre‐perfused with SCE following the preservation protocol restoring an intact fresh lifelike cadaver. Qualitatively, ultrasound images from the SCE cadaver were highly similar with those from a living person. Nerve, fascia, ligaments, vasculature and muscle images were clearly and easily identified. Skin elasticity and texture were lifelike. The successful SCE cadaver was stored and maintained for 25 months (2019 to 2021), which provided a long‐lasting lifelike simulating platform for procedure learning. Using SCE cadaver, ultrasound guided procedure learning included UGRA, lung ventilation, chest tube placement &amp; pericardiocentesis, and exploration of a novel prostate biopsy training. Other procedures included the dissection of hand &amp; facial areas as compared with formaldehyde embalmed donor, tracheal tube intubation, tracheotomy, and suturing practice during students' clerkships. There was no significant difference in CT images before and after SCE.DiscussionThe modified and simplified SCE method can make a “Thiel cadaver” more efficiently. Using a SCE cadaver, a learner can exercise hand‐on skill in a near‐real condition without psychological pressure and learning time can be individualized, which greatly increases the beginning learner’s confidence to master the procedure before working with patients. One SCE cadaver can be shared in various procedure training. Further, quantitative studies will be designed to optimize procedure learning. Integrating SCE cadavers into current simulation training programs appears both feasible and desirable.

More surgery in December among US patients with commercial insurance is offset by unrelated but lesser surgery among patients with Medicare insurance.

Study ObjectiveEvaluate whether there is more surgery (in the US State of Florida) at the end of the year, specifically among patients with commercial insurance.DesignObservational cohort study.SettingThe 712 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019.ResultsAmong patients with commercial insurance, December had more cases than November (1.108 [1.092–1.125]) or January (1.257 [1.229–1.286]). In contrast, among patients with Medicare insurance (traditional or managed care), December had fewer cases than November (ratio 0.917 [99% confidence interval 0.904–0.930]) or January (0.823 [0.807–0.839]) of the same year. Summing among all cases, December did not have more cases than November (ratio 1.003 [0.992–1.014]) or January (0.998 [0.984–1.013]). Comparing December versus November (January) ratios for cases among patients with commercial insurance to the corresponding ratios for cases among patients with Medicare, years with more commercial insurance cases had more Medicare cases (Spearman rank correlation +0.36 [+0.25], both p < 0.0001).ConclusionsIn the US State of Florida, although some surgeons' procedural workloads may have seasonal variation if they care mostly for patients with one category of insurance, surgical facilities with patients undergoing many procedures will have less variability. Importantly, more commercial insurance cases were not causing Medicare cases to be postponed or vice‐versa, providing mechanistic explanation for why forecasts of surgical demand can reasonably be treated as the sum of the independent workloads among many surgeons.

"You Just Forge Ahead": The Continuing Challenges of Disaster Preparedness and Response in Long-Term Care.

Background and ObjectivesProtecting nursing home and assisted living community residents during disasters continues to be a challenge. The present study explores the experiences of long-term care facilities in Florida that were exposed to Hurricane Irma in 2017.Research Design and MethodsWe used an abductive approach, combining induction and deduction. Interviews and focus groups beginning in May 2018 were conducted by telephone and in person with 89 administrative staff members representing 100 facilities (30 nursing homes and 70 assisted living communities). Analyses identified themes and subthemes. Findings were further analyzed using the social ecological model to better understand the preparedness and response of nursing homes and assisted living communities to Hurricane Irma.Results3 main themes were identified including: (1) importance of collaborative relationships in anticipating needs and planning to shelter in place or evacuate; (2) efforts required to maintain safety and stability during an unprecedented event; and (3) effects, repercussions, and recommendations for change following the disaster.Discussion and ImplicationsPreparing for and managing disasters in nursing homes and assisted living communities involves actions within multiple environments beyond the residents and facilities where they live. Among these, community-level relationships are critical.

Economics and Energy Consumption of Brackish Water Reverse Osmosis Desalination: Innovations and Impacts of Feedwater Quality.

Brackish water desalination, using the reverse osmosis (BWRO) process, has become common in global regions, where vast reserves of brackish groundwater are found (e.g., the United States, North Africa). A literature survey and detailed analyses of several BWRO facilities in Florida have revealed some interesting and valuable information on the costs and energy use. Depending on the capacity, water quality, and additional scope items, the capital cost (CAPEX) ranges from USD 500 to USD 2947/m3 of the capacity (USD 690–USD 4067/m3 corrected for inflation to 2020). The highest number was associated with the City of Cape Coral North Plant, Florida, which had an expanded project scope. The general range of the operating cost (OPEX) is USD 0.39 to USD 0.66/m3 (cannot be corrected for inflation), for a range of capacities from 10,000 to 70,000 m3/d. The feed-water quality, in the range of 2000 to 6000 mg/L of the total dissolved solids, does not significantly impact the OPEX. There is a significant scaling trend, with OPEX cost reducing as plant capacity increases, but there is considerable scatter based on the pre- and post-treatment complexity. Many BWRO facilities operate with long-term increases in the salinity of the feedwater (groundwater), caused by pumping-induced vertical and horizontal migration of the higher salinity water. Any cost and energy increase that is caused by the higher feed water salinity, can be significantly mitigated by using energy recovery, which is not commonly used in BWRO operations. OPEX in BWRO systems is likely to remain relatively constant, based on the limitation on the plant capacity, caused by the brackish water availability at a given site. Seawater reverse osmosis facilities, with a very large capacity, have a lower OPEX compared to the upper range of BWRO, because of capacity scaling, special electrical energy deals, and process design certainty.

Most surgeons' daily elective lists in Florida comprise only 1 or 2 elective cases, making percent utilization unreliable for planning individual surgeons' block time

Study objectiveOperating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas. DesignObservational cohort study. SettingThe 602 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019. SubjectsThe providers licensed to perform surgery in Florida (physician, oral surgeons, dentists, and podiatrists) were identified by their national provider number. Hospitals were deidentified before analysis. MeasurementsThe primary endpoint was the mean among facilities in percentages of surgeon-day combinations (“lists”) containing 1 or 2 cases. Proportions were calculated using Freeman-Tukey transformation and the harmonic mean of the number of lists at each facility. Comparison to “most” (>50%) used Student's two-sided one-group t-test. Main resultsAveraging among hospitals, most surgeons' lists included 1 or 2 cases (64.4%; 99% confidence interval [CI] 61.3%–67.4%) P < 0.00001). Many lists had 1 case (44.2%, 99% CI 41.2%–47.2%). Nearly all (96.7%) surgeons operated at just one hospital on their OR days. ConclusionsMost surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.

Using the CDC Worksite Health ScoreCard to Promote Organizational Change.

To measure the impact of tying adoption of evidence-based worksite health promotion (WHP) interventions to annual organizational strategic objectives, as measured by the Centers for Disease Control and Prevention (CDC) Worksite Health ScoreCard (ScoreCard). A prospective cohort study following Johns Hopkins Medicine (JHM) affiliates against industry-specific and large employer benchmarks from 2016-2020. JHM, the largest private employer in Maryland with facilities in Florida and the District of Columbia. Twelve JHM affiliates representing over 40,000 employees. A strategic objective was established annually based on the ScoreCard and organizational priorities. JHM affiliates measured their WHP efforts annually using the ScoreCard. CDC industry-specific and large employer benchmarks were collected for comparison. ScoreCard data was assessed annually to measure deviations from CDC benchmarks, determine whether strategic objectives were met, and inform additional annual objectives. JHM demonstrated improvement from 8.9 percentage points above industry-specific and 3.4 percentage points below large employer benchmarks in 2016, to 26.4 percentage points above industry-specific and 21.8 percentage points above large employer benchmarks in 2020. Large employers face unique challenges in implementing WHP programs. Our study suggests embedding health promotion in annual strategic objectives may alleviate these challenges by prioritizing the goal and ensuring adequate resources to be successful. There are however, some limitations on using benchmarking data for comparison.

Hematology and Biochemistry Panel Reference Intervals for Captive Saddleback Clownfish Amphiprion polymnus and Tomato Clownfish A.frenatus.

Reference intervals of blood analytes are important diagnostic tools that clinicians use as a basis for making clinical decisions and that have been documented for many fish species. Although the effects of dietary supplementation on hematology and blood biochemistry variables in clownfish have been shown, there are no published reference intervals to date for routine hematology and blood biochemistry panels for these popular cultured marine fish (including Amphiprion spp.). The objective of this study was to establish de novo reference intervals for selected hemogram data and, using whole-blood analysis, commonly utilized chemistry analytes in two species of aquacultured clownfish: the Tomato Clownfish Amphiprion frenatus and Saddleback Clownfish A.polymnus. This study is based on blood samples from 25 clinically normal Tomato Clownfish and 38 clinically normal Saddleback Clownfish from two clownfish production facilities in Florida. Guidelines by the American Society for Veterinary Clinical Pathology were followed to generate robust reference intervals from the data collected. We report descriptive statistics and reference intervals for several hematology (n=12) and biochemistry (n=8) analytes using a small sample size and a small amount of blood per sample. The blood analyte data from this study are comparable with hematology and biochemistry data that have been reported in other teleost species. These results provide baseline health data for clownfish species that can be used in various clinical settings while also serving as a springboard for further research studies.

Gastrointestinal entamoebiasis in captive anurans in North America.

Infections with Entamoeba spp. are recognized as a cause of clinical disease in many species including humans and reptiles; however, cases in amphibians are under-reported. Investigation of a mortality event among a captive population of Cranwell's horned frogs Ceratophrys cranwelli at a production facility in Florida, USA, revealed that deaths were due to the newly described Entamoeba species CT1. Infection caused severe necroulcerative gastroenterocolitis with a predilection for the colon. To date, this Entamoeba species has only been described in invasive cane toads Rhinella marina in Australia. Retrospective screening of archived anuran cases from a zoological pathology service identified 8 cases from captive populations that had histological evidence of gastrointestinal entamoebiasis. Molecular characterization was positive in 3 cases. Two cases, 1 in a Puerto Rican crested toad Peltophryne lemur and 1 in an Amazon milk frog Trachycephalus resinifictrix, showed 100% homology to E. ranarum and 1 case in a White's tree frog Litoria caerulea showed 100% homology to Entamoeba sp. CT1. This is the first report of novel Entamoeba sp. CT1 being associated with clinical disease in anurans within North America and also the first report of this Entamoeba species causing disease within managed collections as far back as 2003.

Dynamics and Spread of Bacterial Spot Epidemics in Tomato Transplants Grown for Field Production.

Tomato transplants are the primary means of establishing commercial tomato production fields in the eastern United States. Transplants are often suspected as the source of inoculum for major outbreaks in production fields of bacterial spot of tomato (BST) caused by Xanthomonas perforans (Xp). A combination of high plant densities with overhead irrigation, high humidity, and high temperatures are conducive to BST outbreaks during transplant production. In addition to chemical control, transplant growers use roguing to remove diseased transplants, as a primary way to manage BST during transplant production. The value of roguing is often questioned, because information about the rate of pathogen spread and the incubation period between infection and symptom development is limited. In this study, we evaluated the extent of X. perforans spread on tomato transplants relative to symptom development by using a rifampicin-resistant X. perforans strain and conducting experiments in an environmentally controlled greenhouse simulating grower practices and also at a commercial transplant facility in Florida. BST symptom development typically lagged behind X. perforans dispersal by at least 5 to 7 days depending on environmental conditions. Furthermore, X. perforans was capable of aerosolization, which resulted in long-distance dispersal of ≤2 m under highly favorable conditions. Growers should rogue diseased plants and surrounding nonsymptomatic plants by >1 and ≤3 m, depending on outbreak severity, to limit disease spread. As a result, proper disease management should reduce introduction of nonsymptomatic transplants into the field and subsequently reduce pesticide applications.