Northeastern United States Research Articles

Maintaining reliability in a 100% decarbonized power sector: The interrelated role of flexible resources

Reliability will remain a key requirement for decarbonized power sectors, but also a concern with the high penetration of variable renewable energy (VRE). The traditional approach for reliability is by producing enough energy and adapting rapidly to changes in load with the dispatch of fossil fuel power plants, especially natural gas power plants. However, this will have to evolve as decarbonization progresses. Can various flexibility resources such as transmission, storage and demand response provide the same reliability benefits? This paper uses a detailed, capacity expansion and hourly operation model to investigate the possibility and the cost of reaching different levels of planning reserve margins (PRM), in the multi-regional context of the North American Northeast. We find that while it is possible to entirely avoid natural gas power plants or nuclear ones to obtain high PRM, it would come at a very high cost and would require high levels of transmission, storage and demand response. We also detail why these three flexibility resources are needed in combination. The implications for energy policies are significant: in order for power system's cost to remain reasonable, reliability must count on some carbon-neutral natural gas or nuclear generation, along with interties with neighboring systems, storage and high levels of demand response.

Analysis of Psychotropic Substance Seizures Occurring in 2017–2022 in Tamaulipas, a Mexican Border State with USA

The trafficking of illegal substances is a global issue. Tamaulipas, a northeastern state in Mexico, is strategically located for drug trafficking to the United States by organized crime. In this study, drug seizure events conducted by the Mexican government in the main cities of Tamaulipas between 2017 and 2022 are analyzed. It was noticed that there was a decrease in events from 2017 to 2020, followed by a slight increase in 2021. Marijuana was the most seized drug, with cocaine and amphetamines following behind. The frequency of drug seizure events was higher in the border cities of Nuevo Laredo, Reynosa, and Matamoros due to their international commercial bridges with the USA. Nuevo Laredo and Reynosa showed a high amount of marijuana seized. In Matamoros, a coastal city, the quantity of cocaine seized was the highest. Results suggest that substances seized were intended to be illegally transported to the USA through Mexican border cities.

B-206 Tick-borne disease molecular testing positivity and coinfection incidence in the northeastern united states: 2021-2023

Abstract Background The CDC estimates that Lyme disease affects hundreds of thousands of people each year in the United States. Tick-borne diseases caused by pathogens such as Anaplasma phagocytophilum, Babesia microti, Ehrlichia chaffeensis, and species of Borrelia follow a seasonal pattern due to the life cycle of disease-carrying ticks. In endemic areas, like the northeastern United States, the risk of coinfection by multiple tick-borne disease pathogens is higher and can complicate patient treatment. For example, while Anaplasma and Borrelia can be treated with doxycycline a Babesia coinfection would not be resolved with this medication. In this study, we performed a retrospective analysis of tick-borne disease molecular testing results to monitor positivity rates and incidence of coinfection. Methods This retrospective analysis included whole blood specimens submitted to a regional clinical laboratory in the northeastern United States for tick-borne disease molecular testing. Test results from 2021-2023 were analyzed for positivity rate trends and coinfection incidence. DNA was isolated from patient specimens and tested using laboratory developed real-time Taq polymerase PCR assays. Results Positivity rates for all tick-borne disease pathogens studied followed typical seasonal patterns (Table). Beginning in the early spring, as nymphs ended their dormancy and began to feed, infection rates of tick-borne disease climbed. Infections peaked in mid-summer and remained elevated through late autumn. For Anaplasma, a biphasic pattern was observed, with a smaller peak in late autumn when adult ticks are most active. Coinfections with Anaplasma and Babesia were observed in 136 specimens, while coinfections with Borrelia and Babesia were observed in 145 specimens. Conclusions Positivity rates for tick-borne disease pathogens followed expected seasonal patterns in the northeastern US. The incidence of coinfections involving Babesia microti highlights the importance of properly identifying tick-borne infections given the different treatment regimens indicated.

Health Care Workers' Perspectives on Collecting Sexual Orientation and Gender Identity in the Adult Primary Care Setting.

Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags. This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medical center in the northeastern United States. We created a process map of the flow of patient data from the point of registration to the clinical encounter to identify all staff roles associated with registration and patient demographic data collection. We purposively sampled staff members across these roles and conducted semistructured virtual interviews between November 2021 and February 2022. The research team used deductive and inductive coding and conducted a thematic analysis to identify barriers and facilitators to implementation. Nine clinical staff and eleven nonclinical staff were interviewed. Participants were asked about their general experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, their perspectives on collecting this data, and potential barriers and facilitators to incorporating this into the workflow. The main themes that emerged were the relevance of SOGI data to the clinical practice; concerns about patient acceptability; the prevalence of cis-gender, heteronormative assumptions; and concerns about linguistic, cultural, and generational differences. Differences were noted between clinical and nonclinical staff. Greater education is needed to help both clinical and nonclinical staff understand how patients' SOGI demographics can be used to provide affirming, patient-centered care. Implementation strategies can be tailored to address specific barriers at the individual, organizational, and social levels.

Contrasting Perceptions, Knowledge, and Actions around Lyme Disease in an Urban Area of Emerging Lyme Disease and an Area of Endemic Lyme Disease in the Northeastern United States.

Lyme disease transmission dynamics in the northeastern United States vary by context. Periurban regions, including Block Island, RI, have experienced decades of endemic transmission. In urban areas, including Staten Island, a borough in New York City, NY, Lyme disease is an emerging issue. Knowledge, attitudes, and practices around Lyme disease evolve as an area progresses from emergent to endemic. We conducted focus group discussions and household surveys within Staten Island, NY and Block Island, RI to compare knowledge, attitudes, and practices surrounding Lyme disease and other tick-borne diseases. Qualitative data were coded into themes, and survey data were used to provide more general context of the focus group discussions. Using item response theory, we developed an index of knowledge from relevant factors within the household survey. We identified a significant difference in knowledge scores between the two study areas. Additionally, we identified key differences across multiple domains. Participants from Block Island were more likely to report prior tick exposure and Lyme disease in themselves or household members and were more likely to express concerns about the environmental impact of mitigation strategies. Individuals on Staten Island were more likely to assign responsibility of prevention and control to local, state, and federal government than to take personal prevention measures. Prevention of Lyme disease and other tick-borne diseases must be tailored to the community context and monitored over time as perceptions and priorities may evolve as transmission dynamics transition from emergent to endemic.

A Current View on Strawberry Production Practices and Trends in the Northeastern United States and Canada

Strawberries (Fragaria ×ananassa) are an important crop for diversified fruit and vegetable farms in the northeastern United States as well as in Ontario and Québec, Canada. The industry in this cold climate region differs greatly from that in the major strawberry-producing states of Florida and California because strawberries typically represent a smaller share of total farm revenue and are sold primarily through retail markets. In recent years, strawberry production and marketing methods in the northeastern United States and Canada have diversified to meet the unique challenges of the region, including regional demand, extended seasons, and management of an increasingly challenging pest and disease complex. In 2020, we distributed an online survey to 163 commercial producers to obtain a snapshot of marketing and production practices used on strawberry-producing farms in this region and to assess research and outreach needs to better serve the industry. We conducted in-depth case study interviews with a small number of producers after the survey. We found that traditional June-bearing strawberry production continues to represent >50% of production, and that most fruit are grown conventionally. Day-neutral strawberry production was reported by an increased number of producers in New York as well as in Canada, and a higher percentage of day-neutral growers, compared to that of June-bearing producers, reported using protected culture. Botrytis (gray mold), weeds, and leaf spots were the top overall pest pressures indicated by growers. Survey respondents preferred written outreach materials and on-farm meetings to obtain information. Integrated pest management, organic production, and cultivar performance were the top priorities for subjects. The survey and interviews also provided information about the most common strategies for winter protection, frequency of pesticide applications, lifespan of plantings, and other current strawberry production practices in the region. Our survey results may be used by researchers and extension professionals to better serve this diversifying industry.

Spatial Variation of Changes in Extreme Discharge Seasonality Across the Northeastern United States

ABSTRACTThe Northeast United States exhibits significant spatial heterogeneity in flood seasonality, with spring snowmelt‐driven floods historically dominating northern areas, while other regions show more varied flood seasonality. While it is well documented that since 1996 there has been a marked increase in extreme precipitation across this region, the response of flood seasonality to these changes in extreme precipitation and the spatial distribution of these effects remain uncertain. Here we show that, historically, snowmelt‐dominated northern regions were relatively insensitive to changes in extreme precipitation. However, with climate warming, the dominance of snowmelt floods is decreasing and thus the extreme flood regimes in northern regions are increasingly susceptible to changes in extreme precipitation. While extreme precipitation increased everywhere in the Northeastern United States in 1996, it has since returned to near pre‐1996 levels in the coastal north while remaining elevated in the inland north. Thus, the inland north region has and continues to experience the greatest changes in extreme flooding seasonality, including a substantial rise in floods outside the historical spring flood season, particularly in smaller watersheds. Further analysis reveals that while early winter floods are increasingly common, the magnitude of cold season floods (Nov‐May) have remained unchanged over time. In contrast, warm season floods (June‐Oct), historically less significant, are now increasing in both frequency and magnitude in the inland north. Our results highlight that treating the entire Northeast as a uniform hydroclimatic region conceals significant regional variations in extreme discharge trends and, more generally, climate warming will likely increase the sensitivity of historically snowmelt dominated watersheds to extreme precipitation. Understanding this spatial variability in increased extreme precipitation and increased sensitivity to extreme precipitation is crucial for enhancing disaster preparedness and refining water management strategies in affected regions.

A modified matrix model captures the population dynamics for the primary vector of Lyme disease in North America

AbstractLyme disease, the most prevalent tick‐borne disease in North America, is caused by the bacterium Borrelia burgdorferi, and in the eastern and central United States, it is spread to humans by the black‐legged tick (Ixodes scapularis). Due to the complex, multiyear and multihost life cycle of this species, a matrix modeling approach is needed to effectively estimate subseasonal, multistage survival and transition dynamics in order to better understand and predict when population growth is high. Of the three questing tick life stages (larvae, nymphs, and adults), nymphs are most often associated with transmitting the bacteria to humans, and previous work suggests a mix of abiotic and biotic drivers are associated with nymph abundance. However, understanding tick population growth requires understanding mortality and transition probabilities for each stage and each stage may be individually and uniquely impacted by climate and host availability. A larval tick, for example, may experience warming temperatures differently than nymph or adults, because they are present on the landscape at different times. Here, we describe and validate a model that accounts for field sampling design and evaluates abiotic (temperature, relative humidity, precipitation) and biotic (host abundance) drivers of variation in tick population growth. To account for the drivers of subseasonal and interannual variability in demography, phenology, and population density, we built stage‐structured population models that account for variability in meteorology and host population abundance throughout the full tick lifecycle. Our model is fit and validated with 11 years of tick and host data from the northeastern United States. In this context, we found that a four‐stage model that includes unique transitions to and from a dormant, overwintering nymph state outperforms a model that only includes the three questing stages, and that incorporating the abundance of the predominant host species, Peromyscus leucopus, and weather variables improved predictions and model fit. Additionally, the model accurately predicted all three questing stages at sites different than where they were calibrated, showing that this model structure is generally transferable. Overall, this model lays a foundation for the real‐time iterative forecasting of tick populations needed to effectively protect public health.

Integrating Values to Improve the Relevance of Climate‐Risk Research

AbstractClimate risks are growing. Research is increasingly important to inform the design of risk‐management strategies. Assessing such strategies necessarily brings values into research. But the values assumed within research (often only implicitly) may not align with those of stakeholders and decision makers. These misalignments are often invisible to researchers and can severely limit research relevance or lead to inappropriate policy advice. Aligning strategy assessments with stakeholders' values requires a holistic approach to research design that is oriented around those values from the start. Integrating values into research in this way requires collaboration with stakeholders, integration across disciplines, and attention to all aspects of research design. Here we describe and demonstrate a qualitative conceptual tool called a values‐informed mental model (ViMM) to support such values‐centered research design. ViMMs map stakeholders' values onto a conceptual model of a study system to visualize the intersection of those values with coupled natural‐human system dynamics. Through this mapping, ViMMs integrate inputs from diverse collaborators to support the design of research that assesses risk‐management strategies in light of stakeholders' values. We define a visual language for ViMMs, describe accompanying practices and workflows, and present an illustrative application to the case of flood‐risk management in a small community along the Susquehanna river in the Northeast United States.

A Decade of Diversity: Exploring Ethnic Disparities in Kidney Donation in the Northeast United States

A Decade of Diversity: Exploring Ethnic Disparities in Kidney Donation in the Northeast United States

Idiopathic cervical abscesses in dogs follow seasonal trends and geographic risk factors, predominantly affecting young, large breeds: a case-control study of 67 dogs in New England.

Describe and identify risk factors and spatiotemporal trends associated with the development of idiopathic cervical abscesses (CAs) in dogs in the Cape Cod region. The authors hypothesized that CAs without an external communicating tract would have a seasonal trend and would not be associated with identifiable foreign material. 67 dogs. Retrospective observational case-control study enrolling dogs between 2016 and 2020. Compiled patient information included age, breed, sex, weight, date of presentation, and ZIP code. Statistical evaluation was performed by use of multivariate logistic regression modeling and spatiotemporal analyses with government-compiled land cover data. Control dogs were randomly selected in a 3:1 ratio to cases. 67 cases were investigated. The final multivariable logistic regression model found a significant seasonal effect, with most cases in September (OR, 4.80; 95% CI, 1.91 to 12.02). Spatial analyses revealed increased risk in a cluster of 13 ZIP codes, with OR of 4.40 (95% CI, 1.95 to 9.95). Weight was a risk factor; each additional kilogram was associated with an 18.8% increase in odds (OR, 1.188; 95% CI, 1.053 to 1.341) until a maximum risk at 15 kg. Younger dogs were at greater odds; for each additional year of age, the odds of having CAs were reduced by 8.9% (OR, 0.911; 95% CI, 0.837 to 0.991). No foreign material inciting cause was identified in any of the 67 cases. Idiopathic CAs should be a differential for young, large-breed dogs with cervical swelling in the Northeastern US. This study documented seasonality, geographical trends, and signalment predispositions for idiopathic CAs.

Ambient air pollution and low birth weight in Brazil: A nationwide study of more than 10 million births between 2001 and 2018

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM2.5, NO2, and O3) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.

Establishment of Amblyomma maculatum Ticks and Rickettsia parkeri the Northeastern United States.

We document a case of Rickettsia parkeri rickettsiosis in a patient in Connecticut, USA, who became ill after a bite from a Gulf Coast tick (Amblyomma maculatum). We used PCR to amplify R. parkeri DNA from the detached tick. The patient showed a 4-fold rise in IgG reactive with R. parkeri antigens.

Filling the Treatment Gap: Geographic Expansion of Buprenorphine Providers Across the U.S.

ObjectiveWith opioid-related deaths reaching epidemic levels, gaining a better understanding of access to treatment for opioid use disorder (OUD) is critical. Buprenorphine is an effective medication for the treatment of opioid addiction. The analysis is critical post-X-waiver elimination which extended the ability to prescribe buprenorphine for the treatment of OUD to all practitioners with DEA Schedules II-V on their DEA Registration. The primary purpose of the analysis was to explore the geographic patterns of substance use treatment and establish a geographical baseline to assess the removal of the X-Waiver in the future. Data and MethodsWe assessed the expansion of buprenorphine providers across the data from all US counties up to December 31, 2022. We used all certified buprenorphine providers' data from the database of the buprenorphine waiver notification system (BWNS). We used county-level population data from the US Census of American Community Survey (ACS) of 2021 and the CDC's Drug-related mortality data. We implemented spatial scan statistics to identify the spatial clusters using SaTScan. ResultsThe results from our analysis show that Doctor of Medicine/Doctor of Osteopathic Medicine (MD/DO) have the highest numbers of certified providers at 8134 (65.08%) in 2018 and 14525 (57.87%) in 2022. Our analysis shows that the distribution of buprenorphine providers across the counties of the United States was significantly clustered. Higher clusters with RR of more than 1 (p-value <0.001) were found in the states of Washington, Oregon, Northern California, and the Western borders of Montana. Similar clusters of counties with RR more than 1 (p-value <0.001) were found in the northeastern states of Maine, Vermont, and New Hampshire. ConclusionsFrom our analysis, it is evident that buprenorphine-certified providers are clustered in areas of higher drug-related mortality filling a treatment gap. The elimination of the X-waiver will be a significant step towards increasing access to MOUD and this analysis may be used as a geographical baseline to assess in the future.

Algorithmically detected rain-on-snow flood events in different climate datasets: a case study of the Susquehanna River basin

Abstract. Rain-on-snow (RoS) events in regions of ephemeral snowpack – such as the northeastern United States – can be key drivers of cool-season flooding. We describe an automated algorithm for detecting basin-scale RoS events in gridded climate data by generating an area-averaged time series and then searching for periods of concurrent precipitation, surface runoff, and snowmelt exceeding predefined thresholds. When evaluated using historical data over the Susquehanna River basin (SRB), the technique credibly finds RoS events in published literature and flags events that are followed by anomalously high streamflow as measured by gauge data along the river. When comparing four different datasets representing the same 21-year period, we find large differences in RoS event magnitude and frequency, primarily driven by differences in estimated surface runoff and snowmelt. Using dataset-specific thresholds improves agreement between datasets but does not account for all discrepancies. We show that factors such as meteorological forcing and coupling frequency, as well as choice of land surface model, play roles in how data products capture these compound extremes and suggest care is to be taken when climate datasets are used by stakeholders for operational decision-making.

The Erosion of Seasonality in Avian Communities

ABSTRACTAimSeasonality governs species composition at a given place and time. However, the effects of climate and land‐use change can vary by season, altering species composition. These changes can lead to a loss of distinct seasonal community composition, representing a novel form of biotic homogenisation. We ask if breeding and winter bird communities are becoming more similar over time. If so, is homogenisation occurring more rapidly in winter than in the breeding season, and has the presence of individual species changed between seasons?LocationNortheastern United States.Time Period1989–2019.Major Taxa StudiedTwo hundred thirty‐eight bird species.MethodsWe use data from The National Audubon Society's Christmas Bird Count and the North American Breeding Bird Survey to test if winter and breeding bird communities have become more similar (homogenised). We evaluate this change using the Sørensen dissimilarity index, and its components of turnover (species replacement) and nestedness (a subset of a more species rich community) and describe the mechanism in which the seasonal winter and breeding bird communities are changing.ResultsWe found that winter and breeding bird communities are homogenising, driven by significant decrease in turnover and a marginal decrease nestedness. When viewing breeding and wintering communities separately, we observe different trends. Breeding communities are becoming more unique with decreasing turnover and nestedness. Winter communities are becoming more similar to each other, with decreasing turnover and nestedness. More breeding species are declining and species that are typically found in the winter and year‐round residents are the main contributors to the homogenisation between seasons.Main ConclusionsWe show for the first time homogenisation between winter and breeding bird communities over time across the northeastern United States. This insight into how individual species are faring between seasons, and how they impact community structure, can be used when implementing conservation measures for maintaining ecological functioning and integrity.

Essential fatty acid content in the ethnozoological products used in the folklore medicines by the Tangkhul tribe of the North East India

Tangkhul tribes are main habitant of the Ukhrul district of Manipur, a north eastern state of India and popular for using the products of animal fauna in the folklore medicines for curing certain human ailments. To our knowledge, no investigation has been done on the essential fatty acids content in the animal products used in the traditional medicines by the Tangkhul tribe of Manipur. The objective of the study is to determine the essential fatty acids concentration in the selected ethnozoological products namely, Periplaneta americana, Upupa epops, Scolopendra gigantea, Pheretima posthuma, Hoplobatrachus tigerinus, Sus scrofa domesticus, and Tylototriton verrucosus by Fatty Acid Methyl Esters (FAME) methods. The result of the study revealed that unsaturated fatty acids are found to be contained generally higher than saturated fatty acids in the seven-ethnozoological products studied. Among the monounsaturated fatty acids, Oleic Acid (7579.19 ± 70.23 mg/100g) is found to be highest in concentration and is recorded in the P. americana. Some of the common essential PUFAs recorded in the samples of the ethnozoological products studied were Linolenic Acid, Linoleic acids, Erucic Acid, Oleic Acid, Elaidic Acid, Palmetoleic Acid, Myristoleic Acid etc. with the highest concentration of linolenic acid (5518.03mg/100g) found in the P. americana. The used of seven ethnozoological products mentioned per se by Tangkhul Tribes of Manipur in their folklore medicines for the treatment of various human ailments may be attributed to the presence of various polyunsaturated fatty acids especially high amount of omega-3 fatty acids, palmetoleic acid, ecosapentanoic acid in them.

Distinct Inhibitory Control Mechanisms Underlie Selective Social Inferences

ABSTRACT We investigated the role of distinct inhibitory processes as 4- to 6-year-olds from the Northeastern United States (N = 48, Mage = 68.27 months, 22 boys, 26 girls; 63% White, 6% Black, 4% Asian, 2% Hispanic, 8% more than one race, with 17% not reporting) and adults evaluated accurate or deceptive information from human or non-human (arrow) cues indicating particular locations in space. We achieved this by tracking the trajectories of our participants’ manual responses in 3D space over time. This approach allowed us to isolate inhibitory mechanisms that monitor for conflict between stimuli and representations from inhibitory mechanisms that resolve that conflict to make a response. Regardless of the cue’s accuracy, the participants we tested needed more inhibitory resources to monitor human cues that indicated the location of a hidden object than arrows. The inhibitory resources the children we tested needed to control their response (i.e., respond where the cue was pointing when it was accurate or respond alternatively when it was deceptive) was stable across the trials when the cue was a human pointing. When it was an arrow, older children needed fewer resources. These data suggest that there is continuity in participants' use of the resources necessary to monitor human information for deception, but development in the resources needed to resolve such information when learning selectively.

Todos pela Alfabetização (everyone for literacy): lessons for adult literacy policy from Bahia, Brazil

ABSTRACT In this article we describe and reflect on a large-scale regional adult literacy initiative in the north-eastern Brazilian state of Bahia, Todos pela Alfabetização (Everyone for Literacy), known locally as TOPA, was active between 2007 and 2014. In Brazil 7% of the adult population (11 million people), are illiterate; in the state of Bahia the rate is 11% (over 1m people). A common approach to addressing such a challenge is to launch national or regional campaigns, often with heavy involvement of volunteers, to identify and ‘teach’ adults to read and write. In Brazil there have been a number of such initiatives. TOPA was underpinned by Freirean principles and committed to promoting adult education in Bahia, to ensure participants‘ social, political, economic and cultural inclusion. Despite substantial investment, TOPA had limited impact on Bahian literacy levels. Despite this, a new state-wide programme is in development, drawing on the approach and methodology of TOPA. Through a review of academic literature and policy documents we analyse the historical context and development of TOPA, reflecting on the challenges of delivering such a programme at the scale required. We conclude by identifying the lessons to be learnt from TOPA to inform future adult literacy initiatives.

Educational and personal impacts of the COVID-19 pandemic on emergency medicine resident physicians: a qualitative study

BackgroundThe COVID-19 pandemic had a significant impact on both the clinical practice and the psychological states of frontline physicians in the emergency department. Trainees, at the beginning of their careers and thus still developing their practice styles and identities as physicians, were uniquely affected.ObjectiveIn this qualitative study, we sought to explore how the pandemic environment shaped the experiences of emergency medicine resident physicians.MethodsThis was a qualitative study. We conducted in-depth interviews with emergency medicine faculty, resident physicians, and staff at a single emergency department based at an urban academic institution in the northeastern United States. Interviews were audio recorded and transcribed, and transcripts were then analyzed in an iterative process by our coding team for recurring themes related to the resident experience.ResultsWe reached data saturation with 27 individuals. Of those who were interviewed, 10 were resident physicians [6 senior residents (PGY-3 or PGY-4) and 4 junior residents (PGY-1 or PGY-2)]. Three major recurring themes regarding resident physician experience emerged during our analysis of the interviews: (1) novel educational experiences dampened by negative structural forces from the pandemic, (2) fracturing of social interactions and mitigation through ad-hoc support systems and community of practice, and (3) development of negative emotions and psychological trauma including fear, resentment, and moral injury causing lasting harm.ConclusionsOur results suggest that emergency medicine resident physicians training during the COVID-19 pandemic faced unique experiences concerning their education, social support systems, and emotional states. While the educational and social experiences were described as having both negative and positive impacts, the emotional experiences were largely negative. Residency program leadership may use these insights to improve resident preparation, wellness, and resilience in the face of future adverse events.