Greater Cincinnati Research Articles

Gestational thyroid hormones and autism-related traits in the EARLI and HOME studies.

Thyroid hormones are essential for neurodevelopment. Few studies have considered associations with quantitatively measured autism spectrum disorder (ASD)-related traits, which may help elucidate associations for a broader population. Participants were drawn from two prospective pregnancy cohorts: the Early Autism Risk Longitudinal Investigation (EARLI), enrolling pregnant women who already had a child with ASD, and the Health Outcomes and Measures of the Environment (HOME) Study, following pregnant women from the greater Cincinnati, OH area. Gestational thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured in mid-pregnancy 16 (±3) weeks gestation serum samples. ASD-related traits were measured using the Social Responsiveness Scale (SRS) at ages 3-8 years. The association was examined using quantile regression, adjusting for maternal and sociodemographic factors. 278 participants (132 from EARLI, 146 from HOME) were included. TSH distributions were similar across cohorts, while FT4 levels were higher in EARLI compared to HOME. In pooled analyses, particularly for those in the highest SRS quantile (95th percentile), higher FT4 levels were associated with increasing SRS scores (β = 5.21, 95% CI = 0.93, 9.48), and higher TSH levels were associated with decreasing SRS scores (β = -6.94, 95% CI = -11.04, -2.83). The association between TSH and SRS remained significant in HOME for the 95% percentile of SRS scores (β = -6.48, 95% CI = -12.16, -0.80), but not EARLI. Results for FT4 were attenuated when examined in the individual cohorts. Our results add to evidence that gestational thyroid hormones may be associated with ASD-related outcomes by suggesting that relationships may differ across the distribution of ASD-related traits and by familial likelihood of ASD.

Abstract TMP104: Timing of Recurrence After Ischemic Stroke by Subtype: A Population-Based Study

Introduction: Prior work suggests stroke recurrence timing may vary by subtype, with large vessel disease being associated with earlier recurrence; however, these studies were conducted prior to the current era of secondary stroke prevention strategies. We examined whether the timing of recurrence after ischemic stroke varied by subtype in a large population-based study. Methods: In 2015, we identified all acute ischemic stroke events from hospitals in the Greater Cincinnati and Northern Kentucky area. Events in the last 6 months of 2014 were oversampled for black patients. Trained nurses extracted clinical data, and stroke specialists subtyped and adjudicated cases. We tracked events for 3 years, considering only ischemic strokes after day 14 as a recurrence. To assess recurrence timing variations, we stratified strokes by subtype and analyzed their restricted mean survival times (RMST) at 1, 3, 12, 24, and 36 months. RMST is the area under the survival curve up to a specific follow up point, denoting the average event-free time during that interval. Results: Of 2577 patients with index stroke, 332 recurrent strokes were seen over the ensuing 3 years. Half of the recurrences occurred within 8 months from the index event. At 12 months, large vessel (LV), undetermined, and other identified cause showed a statistically significant smaller RMST compared to small vessel (SV). This difference was nonsignificant at later time points, suggesting later recurrence for SV. There were no statistically significant differences in RMST between cardioembolic, LV, undetermined, and other identified at any time point. Conclusions: Recurrence after initial SV stroke was less likely to occur in the first year when compared to LV, undetermined etiology, or other identified causes of stroke. There was no evidence of difference in recurrence timing between cardioembolic, LV, other identified, and undetermined etiology.

Building a regional pediatric asthma learning health system in support of optimal, equitable outcomes.

Asthma is characterized by preventable morbidity, cost, and inequity. We sought to build an Asthma Learning Health System (ALHS) to coordinate regional pediatric asthma improvement activities. We generated quantitative and qualitative insights pertinent to a better, more equitable care delivery system. We used electronic health record data to calculate asthma hospitalization rates for youth in our region. We completed an "environmental scan" to catalog the breadth of asthma-related efforts occurring in our children's hospital and across the region. We supplemented the scan with group-level assessments and focus groups with parents, clinicians, and community partners. We used insights from this descriptive epidemiology to inform the definition of shared aims, drivers, measures, and prototype interventions. Greater Cincinnati's youth are hospitalized for asthma at a rate three times greater than the U.S. average. Black youth are hospitalized at a rate five times greater than non-Black youth. Certain neighborhoods bear the disproportionate burden of asthma morbidity. Across Cincinnati, there are many asthma-relevant activities that seek to confront this morbidity; however, efforts are largely disconnected. Qualitative insights highlighted the importance of cross-sector coordination, evidence-based acute and preventive care, healthy homes and neighborhoods, and accountability. These insights also led to a shared, regional aim: to equitably reduce asthma-related hospitalizations. Early interventions have included population-level pattern recognition, multidisciplinary asthma action huddles, and enhanced social needs screening and response. Learning health system methods are uniquely suited to asthma's complexity. Our nascent ALHS provides a scaffold atop which we can pursue better, more equitable regional asthma outcomes.

Prenatal exposure to replacement flame retardants and organophosphate esters and childhood adverse respiratory outcomes

BackgroundThe association of prenatal exposure to organophosphate esters (OPEs) and replacement brominated flame retardants (RBFRs) with respiratory outcomes has not been previously investigated in humans, despite reports that these chemicals can cross the placenta and alter lung development as well as immune functions. MethodsIn a cohort of 342 pregnant women recruited between 2003 and 2006 in the greater Cincinnati, Ohio Metropolitan area, we measured indoor dust OPEs and RBFRs at 20 weeks of gestation and urinary OPEs at 16 and 26 weeks of gestation and at delivery. We performed generalized estimating equations and linear mixed models adjusting for covariates to determine the associations of prenatal OPEs and RBFRs exposures with adverse respiratory outcomes in childhood, reported every six months until age 5 years and with lung function at age 5 years. We used multiple informant modeling to examine time-specific associations between maternal urinary OPEs and the outcomes. ResultsDust concentrations of triphenyl phosphate (TPHP) (RR: 1.40, 95% CI: 1.18–1.66), 2-ethylhexyl-2,3,4,5-tetrabromobenzoate (RR: 1.51, 95% CI: 1.23–1.85), and bis(2-ethylhexyl) tetrabromophthalate (RR: 1.57, 95% CI: 1.28–1.94) were associated with higher risk of wheezing during childhood. Dust TPHP concentrations were associated with higher risk of respiratory infections (RR: 1.43, 95% CI: 1.08–1.94), and dust tris-(2-chloroethyl) phosphate concentrations were associated with hay fever/allergies (RR: 1.11, 95% CI: 1.01–1.21). We also found that dust tris-(2-chloroethyl) phosphate loadings were associated with lower lung function. Urinary OPEs mainly at week 16 of gestation tended to be associated with adverse respiratory outcome, while bis(1-chloro-2-propyl) phosphate and diphenyl phosphate at delivery were associated with lower risk of hay fever/allergies. ConclusionsIn-utero exposure to OPEs and RBFRs may be a risk factor for adverse respiratory outcomes in childhood, depending on the timing of exposure.

Exposure to Perfluoroalkyl Substances and Associations with Pubertal Onset and Serum Reproductive Hormones in a Longitudinal Study of Young Girls in Greater Cincinnati and the San Francisco Bay Area.

Per- and polyfluoroalkyl substances (PFAS), endocrine disrupting chemicals with worldwide exposure, cause changes in mammary gland development in rodents. A few human studies report delay in pubertal events with increasing perfluorooctanoic acid (PFOA) exposure, but to our knowledge none have examined reproductive hormone levels at thelarche. In a cohort of Greater Cincinnati (GC) and San Francisco Bay Area (SFBA) girls recruited at 6-8 years of age, clinical examinations were conducted annually or semiannually with sequential Tanner staging. PFAS concentrations were measured in the first serum sample of 704 girls. In 304 GC girls, estradiol (), estrone (), testosterone (T), and dihydroepiandrosterone sulfate (DHEAS) were measured in serum at four time points around puberty. Relationships between PFAS and age at thelarche, pubarche, and menarche were analyzed using survival and structural equation models. The association between PFAS and reproductive hormones was assessed using linear regression models. Median PFOA serum concentrations in GC (, ) and the SFBA (, ) were higher than in the U.S. In multivariable Cox proportional hazard models [adjusted for race, body mass index (BMI)], increasing serum log-transformed PFOA was associated with a delay in pubarche [; 95% CI: 0.70, 0.99] and menarche (; 95% CI: 0.01, 0.25). Structural equation models indicated a triangular relationship between PFOA, BMI percentile, and the age at the pubertal milestone. Increased PFOA had a statistically significant direct effect of delay on all three milestones, as did BMI. Perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDeA), and 2-(-methyl-perfluorooctane sulfonamido) acetic acid (Me-PFOSA-AcOH) also were associated with later thelarche, and Me-PFOSA-AcOH also with later pubarche. PFOA was inversely associated with DHEAS (), (), and T () concentrations at 6 months prior to puberty. PFAS may delay pubertal onset through the intervening effects on BMI and reproductive hormones. The decreases in DHEAS and associated with PFOA represent biological biomarkers of effect consistent with the delay in onset of puberty. https://doi.org/10.1289/EHP11811.

Exposure to dust organophosphate and replacement brominated flame retardants during infancy and risk of subsequent adverse respiratory outcomes

BackgroundChildren are highly exposed to flame retardants in indoor environments, partly through inhalation. However, the associations of early life exposure to novel organophosphate (OPFRs) and replacement brominated flame retardants (RBFRs) with adverse respiratory outcomes during childhood are unclear. MethodsWe used a prospective birth cohort of 234 children recruited from the greater Cincinnati, Ohio metropolitan area between 2003 and 2006. OPFRs and RBFRs were analyzed in dust sampled from the homes' main activity room and the children's bedroom floor at child age 1 year. Caregivers reported subsequent respiratory symptoms every six months until child age 5 years and we measured forced expiratory volume in 1 s as well as peak expiratory flow (PEF) at child age 5 years. We performed generalized estimating equations and linear regression modeling adjusted for covariates to examine the exposure-outcome associations. ResultsGeometric means (GMs) (standard error [SE]) for dust concentrations were 10.27 (0.63) μg/g for total OPFRs (ΣOPFRs) and 0.48 (0.04) μg/g for total RBFRs (ΣRBFRs); GMs (SE) for dust loadings were 2.82 (0.26) μg/m2 for ΣOPFRs and 0.13 (0.01) μg/m2 for ΣRBFRs. Dust ∑OPFRs concentrations at age 1 year were associated with higher subsequent risks of wheezing (relative risk [RR]: 1.68, 95% confidence interval [CI]: 1.20–2.34), respiratory infections (RR: 4.01, 95% CI: 1.95–8.24), and hay fever/allergies (RR: 1.33, 95% CI: 1.10–1.60), whereas ∑OPFRs dust loadings at age 1 year were associated with higher risks of subsequent respiratory infections (RR: 1.87, 95% CI: 1.05–3.34) and hay fever/allergies (RR: 1.34, 95% CI: 1.19–1.51). PEF (mL/min) was lower with higher ∑OPFRs dust loadings (β: -12.10, 95% CI: -21.10, −3.10) and with the RBFR bis(2-ethylhexyl) tetrabromophthalate (β: -9.05, 95% CI: -17.67, −0.43). ConclusionsExposure to OPFRs and RBFRs during infancy may be a risk factor for adverse respiratory outcomes during childhood.

Reductions In Hospitalizations Among Children Referred To A Primary Care-Based Medical-Legal Partnership.

Medical-legal partnerships integrate legal advocates into health care settings to address health-related social needs. However, their effect on health outcomes is unclear. This retrospective cohort study examined the effect of referral to a medical-legal partnership on hospitalization rates among urban, low-income children in Greater Cincinnati, Ohio, between 2012 and 2017. We compared 2,203 children referred to a pediatric primary care-based medical-legal partnership with 100 randomly selected control cohorts drawn from 34,235 children seen concurrently but not referred. We found that the median predicted hospitalization rate for children in the year after referral was 37.9percent lower if children received the legal intervention than if they did not. We suspect that this decrease in hospitalizations was driven by the ability of legal advocates to address acute legal needs (for example, threat of eviction and public benefit denial) and, when possible, to confront root causes of ill health (for example, unhealthy housing conditions). Interventions such as those provided through a medical-legal partnership may be important components of integrated, value-based service delivery models.

Abstract 132: Projections Of Endovascular Therapy-eligible Patients For The Us Population In 2021

Introduction: Endovascular (EVT) eligibility estimates using population-based, NIH-funded Greater Cincinnati Northern Kentucky (GCNK) Stroke Study 2010 data have been reported. Given the evolving EVT landscape, we present updated estimates of annual EVT eligibility using the 2015 GCNK epidemiological data and extrapolate to the 2021 US census. We project the potential increase in eligible patients in the US for each possible expanded indication with a randomized trial currently planned/underway. Methods: We ascertained all hospitalized AIS patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 within GCNK population; all cases were physician-reviewed. Patients presenting within 0-5 hrs of last known well (LKW) were considered EVT eligible if they had a pre-stroke mRS<2, NIHSS ≥6 and ASPECTS ≥6. Those within 5-23 hrs of LKW were considered EVT-eligible if they had a pre-stroke mRS <3, NIHSS≥6, and favorable perfusion imaging. Expanded EVT eligible patients were defined as those with NIHSS <6, and pre-stroke mRS >1 (for 0-5 hrs) or ≥2 (for 5-23 hrs), or larger core. Estimates of vessel occlusion and favorable imaging were applied based on literature review and expert opinions. The derived estimates were age, race and sex-adjusted to the 2015 US adult population and extrapolated to 2021 population. Results: Among the 1.3 million total (1.05m adult) GCNK population in 2015, 2741 adults had an ischemic stroke and 2176 had data available for this analysis. A total of 1978 presented within 23 hrs of LKW, and 1233 within 0-5 hrs of LKW. Further results are outlined in the figure. Conclusions: It is estimated 18,484 adult patients in the US in 2021 meet strict EVT eligibility criteria. An estimated 15,699 patients with low NIHSS, 9621 with unfavorable imaging, and 28,107 with pre-stroke disability may become eligible for EVT in the future annually. US stroke systems should be optimized to handle all EVT-eligible stroke patients both now and in the future.

Abstract WP192: Ischemic Stroke Mechanisms By Sex And Race Over Time In The Greater Cincinnati Northern Kentucky Stroke Study

Background: Identifying the mechanism of acute ischemic stroke (AIS) is critical to determining secondary stroke prevention strategies. As past data conflict on sex and race differences in stroke mechanism, we aimed to describe stroke mechanisms by sex and race over time in a population-based study of AIS cases with a focus on strokes with unknown mechanism. Methods: We included physician adjudicated, hospital ascertained incident AIS among adults over five study periods (1993/4, 1999, 2005, 2010, 2015) from the Greater Cincinnati Northern Kentucky Stroke Study. Stroke mechanisms were adjudicated by trained study physicians and included: small vessel disease, cardioembolic, large artery disease, other, and unknown. The percentage of AIS cases in each of the 5 categories was reported by sex and race in each of our five 1-year study periods, and trends over time by subgroup were tested using the Cochran-Armitage trend test. Results: We included 8349 AIS over 5 study periods: 4693 (56%) were women, 1607 (19%) were Black, mean age was 70.5 (14.3). Over the 22-year time period, the proportion of strokes whose mechanism was ‘unknown’ decreased in women (46.1%, 1993/4 to 38.5%, 2015 , p<0.0001), men (46.2%, 1993/4 to 33.9%, 2015, p<0.0001), Black (51.8%, 1993/4 to 40.7%, 2015, p=0.004), and White (45.0%, 1993/4 to 40.7%, 2015, p<0.0001) patients. The proportion of small vessel strokes increased over time in men, strokes of ‘other’ mechanisms increased in all subgroups, and cardioembolic strokes increased in women and White individuals only (Figure). Conclusions: In a large population-based stroke study, the proportion of AIS with an unknown mechanism has decreased over time in all demographic groups, while trends in those categorized as cardioembolic or small vessel disease varied by sex and/or race. As changes in imaging utilization may be a contributor to our findings, future work investigating possible sex and race differences in diagnostic evaluations of AIS is warranted.

Abstract TP220: Clinical And Demographic Characteristics Associated With Poor Posterior Circulation Stroke Outcomes: Greater Cincinnati/Northern Kentucky Stroke Study

Background: Posterior circulation strokes (PCS) make up 20% of all strokes, yet there is poor understanding of what factors contribute to poor clinical outcomes. We investigated clinical and demographic characteristics associated with poor clinical outcomes in PCS using a population-based biracial cohort. Methods: Greater Cincinnati Northern Kentucky Stroke Study (GSNKSS) 2010 and 2015 data was utilized to identify 1842 patients who were >20 years old with MRI-proven PCS. Eligible patients were then stratified based on functional outcomes (modified Rankin Scale<3 vs >/= 3, with >= 3 considered poor) according to demographics, stroke risk factors, tPA treatment, stroke location, and stroke mechanism. A multivariable logistic model was used to identify the predictors for poor functional outcomes. Results: Age, higher NIHSS, higher baseline mRS, hypertension, temporal, thalamus, and brainstem location, and cardioembolic mechanism were associated with poor clinical outcomes (Table). After multivariable analysis, age, higher NIHSS, higher baseline mRS, hypertension, temporal, thalamus, and brainstem location, and cardioembolic mechanism remained associated with poor outcomes. Conclusion: Understanding these factors associated with poor prognosis after posterior circulation stroke will allow for better prognostication and family counseling.

Abstract TMP102: Timing Of Withdrawal Of Antithrombotics And Impact On Stroke

Background: Antithrombotic medications (AT) are often withheld before procedures to reduce risk of bleeding. In 2005, members of our team reported that 5.2% of ischemic strokes were associated with the withdrawal of AT in the preceding 60 days. Subsequently, new medications, including DOACs, have become widely used. Given changing prescription and practice patterns we sought to compare rates of stroke in the setting of antithrombotic withdrawal in 2010 and 2015. Methods: The GCNKSS is a population-based stroke study from the Greater Cincinnati region. In 2005, 2010, and 2015, we captured all strokes in the Greater Cincinnati/Northern Kentucky 5 county area by screening ICD9 codes 430-436 and ICD10 (2015) codes I60-I68, and G45-46. Study nurses abstracted all cases and physicians adjudicated each event. Data regarding the withdrawal of AT and timing were captured. 2005 data was included as a reference. Fisher’s exact test was used to examine differences by years. Results: In 2010 and 2015, 4768 cases of ischemic stroke were identified. Across the study periods, those that were on AT at time of stroke versus those who stopped AT <60 days prior to incident stroke were of similar median age, 73 and 74 years respectively, and of similar sex (55 vs 52%) and race (21 vs 18%) distribution. Atrial fibrillation (30 vs 52%) and median baseline NIHSS (3 vs 4) were higher in those who stopped AT < 60 days prior to stroke than those on AT. Of the 4768, 228 (4.8%) occurred within 60 days of withdrawal of an antithrombotic medication. The proportion of strokes in the setting of warfarin being held is the only AT that had a significant change, decreasing in 2015 (Table). Conclusions: The withdrawal of AT is associated with 228 (4.8%) of ischemic strokes within 60 days in our study population. These rates remain consistent across our study periods. This highlights that despite new agents, stroke in the setting of AT withdrawal remains consistent and the decision to stop AT must be carefully considered.

Abstract WMP12: Disparities In Acute Stroke Care According To Pre-stroke Functional Status

Introduction: Disparities in acute ischemic stroke (IS) care due to patients’ pre-stroke disabilities remain understudied. Using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study, we aimed to understand the differences in acute stroke presentation and care according to patients’ pre-stroke functional status. Methods: We ascertained all hospitalized IS patients ≥18 years old presenting to emergency departments in the GCNK region in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46; all cases were physician-reviewed. Trained nurses ascertained pre-stroke functional status from the medical record. Acute IS presentation, time metrics, and treatment were compared between patients with pre-stroke mRS 0-1 vs ≥2 using Wilcoxon rank-sum or chi-square tests. Logistic regression was used to evaluate the association between pre-stroke mRS and intravenous thrombolysis (IVT) and endovascular treatment adjusting for age, presenting NIHSS, time to presentation, and baseline anticoagulation use. Results: Of 2191 patients with IS, 1134 had a pre-stroke mRS ≥2. Patients in the latter group were older, more likely be female, had higher rates of medical comorbidities, had higher presenting NIHSS (3[1-8] vs 2[1-5], p<0.01, Table). They were less likely to receive IVT (aOR 0.43[0.28-0.68], p<0.01, for patients presenting within 0-4 hours) and EVT (aOR 0.32[0.13-0.78], p=0.01, for patients presenting within 0-23.5 hours). They had a higher rate of presentation via EMS, but the time from stroke onset to ED presentation was longer. Conclusions: Acute IS patients with pre-stroke disability presented later, with more severe strokes, and were less likely to receive reperfusion treatments. Further research into factors driving acute stroke medical decision-making for patients with a pre-stroke disability is needed to ensure optimal acute neurovascular care for all IS patients across the nation and worldwide.

Abstract WP199: Disparities In Post-stroke Evaluation And Treatment According To Pre-stroke Functional Status

Introduction: Stroke patients with a pre-existing disability are less likely to receive acute stroke treatments compared to those without a pre-existing disability. Using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study, we aimed to understand the disparities in inpatient and outpatient continuum of stroke care according to the patients’ pre-stroke functional status. Methods: We ascertained all hospitalized stroke patients ≥18 years old in year 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 within GCNK population; all cases were physician-reviewed. Per-stroke functional status was ascertained by trained research nurses during medical record review. We compared rates of in-hospital rehabilitative therapies, initiation of stroke prevention treatments, inpatient stroke workup (cardiac/vessel imaging), in-hospital and post-discharge rehabilitative therapies between ischemic stroke patients with pre-stroke modified Rankin score (mRS) 0-1 vs ≥2. Logistic regression was used to evaluate the association between pre-stroke mRS and these outcomes adjusting for age, presenting NIHSS, and insurance status. Results: Of 2476 patients with ischemic stroke in the GCNK population during 2015, 1326 (53%) had a pre-stroke mRS ≥2. Compared to those with pre-stroke mRS 0-1, these patients were less likely to receive complete stroke workup (aOR 0.86 [0.71-1.04]) and certain stroke prevention treatments (aOR 0.46[0.26-0.81], p<0.01), but more likely to require in-hospital and post-discharge rehabilitative therapies (aOR 2.6[2.11-3.21] and 2.27[1.86-2.77], p<0.01, respectively). Conclusions: Ischemic stroke patients with pre-stroke disability were less likely to receive complete in-hospital stroke workup and initiation of certain stroke preventive treatments. Further research into factors driving medical decision-making for stroke patients with a pre-stroke disability is urgently needed to ensure optimal continuum of stroke care.

Abstract TP136: Disparities In Care Of Patients With Intracerebral Hemorrhage According To Baseline Functional Status

Introduction: Disparities exist in acute ischemic stroke care according to patients’ pre-stroke functional status. However, the effects of baseline disability on the presentation and care of patients with intracerebral hemorrhage (ICH) are unknown. We aimed to understand this using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study. Methods: We ascertained all hospitalized ICH patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 GCNK) population; all cases were physician-reviewed. Per-stroke functional status was ascertained by medical record review. Baseline NIHSS, Glasgow coma scale (GCS), imaging modalities (CT/MRI), in-hospital rehabilitative therapies (rate and frequency), initiation of antihypertensive treatment, and discharge disposition between patients with pre-ICH mRS 0-1 vs ≥2 were compared using Wilcoxon rank-sum or chi-square tests. Logistic regression was used to evaluate the association between pre-stroke mRS and in-hospital therapy, post-discharge therapy, and ICH workup adjusting for age, Glasgow score, insurance status, and ICH location. Results: Of 350 patients with ICH, 187 (53%) had a pre-ICH mRS ≥2. Compared to those with pre-stroke mRS 0-1, these patients had more severe clinical presentation as measured by NIHSS and GCS (table). Among patients who were not made comfort care, no association between pre-ICH mRS and performance of inpatient MRI or in-hospital and post-discharge rehabilitative therapies was found in adjusted analyses. Conclusions: Patients with pre-ICH mRS >2 were made comfort care at a higher rate, but for those not made comfort care there were no post-ICH disparities of care seen in the 2015 GCNK population-based cohort of 350 patients.

The presence of Wolbachia in Brood X cicadas

Wolbachia is an inherited bacterial symbiont that lives within the reproductive cells of approximately 60% of insect species. It manipulates sexual reproduction in insects in multiple ways that ultimately lead to an increased number of Wolbachia-infected females. It is not known if Wolbachia is a symbiont present in the Brood X seventeen-year periodical cicadas. Brood X cicadas have declining populations in Ohio and Indiana and factors that impact their declining numbers have not been identified. We hypothesized that Brood X cicadas would be infected with Wolbachia. Genomic DNA was isolated from one hundred cicadas from two species, 50 from Magicicada septendecim and 50 from the Magicicada cassini, collected in the greater Cincinnati, Ohio area. A polymerase chain reaction protocol screened the DNA samples and identified one M. septendecim cicada with a Wolbachia- specific 16S rRNA amplicon. A Basic Local Alignment Search Tool nucleotide (BLASTN) analysis of the 388 nucleotide sequence confirmed Wolbachia species which conformed toWolbachia supergroup A.Wolbachia infection is low in Brood X M. septendecim cicadas and not identified in Brood X M. cassini cicadas. Efforts within the scientific community should continue the search for Wolbachia in cicadas, so the full ramifications of this symbiont on declining populations of Brood X cicadas can be uncovered.

Risk perception and communal coping in families affected by type 2 diabetes

Despite a recent decline, rates of type 2 diabetes remain high among older adults. Preventing and delaying the onset of the condition with lifestyle changes is key to reducing disease burden in the population. Type 2 diabetes is a complex disease, likely a result from the joint effect of genetic, socio-environmental and lifestyle risk factors that are clustered in families. As such, the prevention of type 2 diabetes is a communal coping process, where individuals communicate about risk and establish routines to facilitate one another’s health habits and compliance with therapeutics. This poster investigates how such a process is affected by one’s perception of risk based on his/her knowledge about family health history (FHH). We collected family network data from families of different racial backgrounds in the greater Cincinnati area (28 white and 17 black/ African American households; 127 participants). The analysis focuses on how the density of diabetes diagnosis in one’s FHH affects communication about shared risk for type 2 diabetes and encouragement to maintain or adopt a healthy lifestyle. Results suggest a higher concentration of diabetes diagnosis in one’s FHH is associated with a higher number of risk communication ties in all families. With regards to encouragement ties, high rates of diabetes diagnosis in FHH are associated with an increased number of encouragement ties only in families of black/African heritage. The findings highlight the need and promise of using FHH to motivate co-encouragement to maintain/adopt a healthier lifestyle in families of black/African heritage.

Biofilm Propensity of Staphylococcus Aureus Skin Isolates Is Associated With Increased Atopic Dermatitis Severity and Barrier Dysfunction in the MPAACH Pediatric Cohort

Atopic dermatitis (AD) patients are commonly colonized with Staphylococcus aureus, and staphylococcal biofilms have been described in adult AD lesions. The commensal Staphylococcus epidermidis can antagonize S aureus, but its role in AD is unclear. These investigators sought to characterize S aureus and S epidermidis colonization and biofilm propensity and determine their association with AD severity, barrier function, and epidermal gene expression in an early-life cohort of children with AD.The Mechanisms of Progression of Atopic Dermatitis to Asthma in Children (MPAACH) cohort consists of children aged 1 to 2 years in the greater Cincinnati, Ohio area with either physician-diagnosed AD or a positive parental response to all 3 questions on the Children’s Eczema Questionnaire.A total of 500 children are being enrolled. The current study was focused on the first 400 MPAACH participants. Demographic, environmental, asthma trigger, and personal and family allergy and asthma history data were compiled. AD severity was documented with the Scoring of Atopic Dermatitis scale. Topical medications were withheld the night before the visit. The biofilm propensity of staphylococcal isolates was assessed by crystal violet assays. Gene expression of filaggrin and antimicrobial alarmins S100A8 and S100A9 were measured in keratinocyte RNA extracted from skin tape strips. Staphylococcal biofilms were visualized with scanning electron microscopy.Among the entire 400 children, 26.5% had positive cultures for S aureus, whereas 71% were positive for S epidermidis. A total of 62% of staphylococcal isolates formed moderate or strong biofilms, whereas 68% of those co-colonized with both staphylococcal species exhibited strains that formed cooperative mixed-species biofilms. Scanning electron microscopy verified presence of biofilms. S aureus strains showing higher relative biofilm propensity compared with S epidermidis were associated with increased AD severity and increased lesional and nonlesional transepidermal water loss. Biofilm propensity was associated with decreased FLG expression, which otherwise encodes filaggrin, a structural protein essential to prevent water loss.Collectively, these data suggest that, although S. aureus colonization is associated with increased AD severity, it is the ability of S. aureus to form strong biofilms and the balance between biofilm-forming S. aureus and S epidermidis strains that are particularly important factors affecting AD severity and barrier dysfunction.Biofilms are important in many complex disease processes, and atopic dermatitis appears to be no exception. Whether through genetic (eg, allergy and filaggrin mutations), environmental, or other factors, the altered skin barrier predisposes to S aureus colonization. This jibes with the common clinical observation that acute AD flares are often responsive to a course of both systemic and topical antistaphylococcal therapy while aggressively employing moisturizing measures.

Refugee experiences in Cincinnati, Ohio: A local case study in the context of global crisis

AbstractWe examined refugees’ perceptions of their experiences living in greater Cincinnati, Ohio, USA and linked these findings to colonial context, coloniality theory, and decolonial psychology. We describe the process of developing a community based participatory research process with members of local refugee communities, and then discuss the findings of a survey completed by 280 local refugees that was collaboratively designed and administered. Noting historic and continuing disenfranchisement of the Black community in Cincinnati, in our survey analyses we compared the experiences of African refugees (Burundian, Congolese, and Somali) to the experiences of Bhutanese, Latinx, and Middle Eastern refugees residing in greater Cincinnati on several aspects of civic life. Analyses indicate that refugees from African countries reported more negative outcomes than other refugees residing in this area. Further, refugees residing in neighborhoods with a higher percentage of Black residents reported less satisfaction, likely due to neighborhood disinvestment. We discuss the costs and benefits of these findings and interpretation in the context of decolonial theory. Specifically, we connect racist colonial history to differences in treatment of refugees based on their physical appearance (i.e., Blackness) to the continued disenfranchisement of African Americans.

Seroprevalence of SARS-CoV-2 infection in Cincinnati Ohio USA from August to December 2020.

The world is currently in a pandemic of COVID-19 (Coronavirus disease-2019) caused by a novel positive-sense, single-stranded RNA β-coronavirus referred to as SARS-CoV-2. Here we investigated rates of SARS-CoV-2 infection in the greater Cincinnati, Ohio, USA metropolitan area from August 13 to December 8, 2020, just prior to initiation of the national vaccination program. Examination of 9,550 adult blood donor volunteers for serum IgG antibody positivity against the SARS-CoV-2 Spike protein showed an overall prevalence of 8.40%, measured as 7.56% in the first 58 days and 9.24% in the last 58 days, and 12.86% in December 2020, which we extrapolated to ~20% as of March, 2021. Males and females showed similar rates of past infection, and rates among Hispanic or Latinos, African Americans and Whites were also investigated. Donors under 30 years of age had the highest rates of past infection, while those over 60 had the lowest. Geographic analysis showed higher rates of infectivity on the West side of Cincinnati compared with the East side (split by I-75) and the lowest rates in the adjoining region of Kentucky (across the Ohio river). These results in regional seroprevalence will help inform efforts to best achieve herd immunity in conjunction with the national vaccination campaign.

Abstract P224: Management of TIA Over Time in the Greater Cincinnati Northern Kentucky Stroke Study

Introduction: The availability of rapid tissue and vessel imaging for TIA has increased, but the utilization rates of these and other diagnostic and management strategies for TIA over time are unknown. Objective: To investigate trends in TIA diagnostic and management strategies over time in the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS). Methods: The GCNKSS is a population-based study of 1.3 million people living in a 5-county area of southern Ohio and Northern Kentucky. For this study, all physician-adjudicated, first-ever cases of TIA (defined clinically as sudden onset of focal symptoms lasting < 24 hours) presenting to an emergency department over five study periods (1993/4, 1999, 2005, 2010, 2015) were included. Use of AHA-recommended aspects of TIA management as well as disposition of TIA patients (admission to hospital or discharge from ED) and length of stay were compared across study periods. Rates of acute infarct on MRI were also reported. Trends were examined using the Cochran-Armitage test for trend. Results: In total, over all study periods, there were 2251 first-ever TIAs. Overall, 14% (n=311) occurred in Black individuals, and 57% (n=1275) occurred in women. Utilization of diagnostic modalities [non-contrast CT brain, vascular imaging (CTA, MRA, or carotid dopplers), tissue imaging (MRI), and echocardiogram] increased significantly over time (all p<0.0001). In terms of management, both admission to the hospital and discharge from the hospital on an antiplatelet agent increased over time (both p<0.0001; Table). Conclusions: The management of TIA has changed significantly over time. Utilization of tissue and vessel imaging as well as echocardiogram during the hospital stay has increased; in 2015, the vast majority of patients with TIA in this population-based study received each of these testing modalities and were admitted to a hospital for TIA work-up. Further work is needed to understand the best practices for work-up of suspected TIA.