Northern Virginia Research Articles

Racial Microaggressions in U.S. High Schools: An Illustration of the Full YPAR Process From the Youth Research Council

In 2021, the Youth Research Council (“YRC”) was formed to bring together high school students in the Northern Virginia region of the United States to conduct research on topics important to those youth (“YRC Fellows”). In its inaugural year, YRC Fellows designed a multi-method study to explore the effects of racial microaggressions on the mental health of their peers and to better understand how young people resist racial microaggressions and their often-deleterious effects on mental health. This article details the YRC’s full process, from formation of research questions to sharing findings in critical and participatory ways, as a model of youth participatory action research (YPAR). In addition to describing the ways in which the YRC embodies a YPAR epistemology, we are also showing our methods. To do this, we have built the article around a transcribed conversation held in July 2023 with the intention of teasing out and sorting through the implications of the YRC’s findings based on our first two years of research. The authors of this article include YRC Fellows and university-based researchers who facilitate the YRC.

The association between short-term temperature variability and mortality in Virginia

The objective of this study is to determine the relationship between short-term temperature variability on neighboring days and mortality. The change in maximum temperature in Northern Virginia, Richmond, Roanoke, and Norfolk, Virginia, on neighboring days was calculated from airport observations and associated with total mortality over a multi-county area surrounding each weather station. The association between day-to-day temperature change and mortality, lagged over a 28-day period, was analyzed using distributed lag non-linear models that controlled for air quality, temporal trends, and other factors. Days following large temperature declines were associated with an increased risk of mortality in three of the four locations, and temperature increases were linked to higher mortality risk in two cities. For example, the relative risk of mortality for a 12°C daily temperature decline (1st percentile) was 1.74 [0.92, 3.27] in Roanoke and 1.16 [0.70, 1.92] in Richmond. The net effect of short-term temperature increases was smaller, with the largest relative risk of 1.03 [0.58, 1.83] for a 12°C increase (99th percentile) in maximum temperature in Norfolk. In Richmond and Roanoke, there was an observed lagged effect of increased mortality (maximum relative risks varying from 1.08 to 1.10) that extended from 5 to 25 days associated with large temperature declines of 15°C or more. In contrast, there was a strong and immediate (lag 0–3 day) increase in the risk of mortality (1.10 to 1.15) in northern Virginia and Norfolk when the temperature increase exceeded 10°C (short-term warming). In general, consecutive day warming had a more immediate mortality impact than short-term cooling, when the peak mortality is lagged by one week or more. However, cooling of at least 10°C after a hot (summer) day reduced mortality relative to comparable cooling following a cold (winter) day, which is associated with high mortality. This differential mortality response as a function of temperature suggests that there is some relationship between average temperature, temperature variability, and season. The findings of this study may be useful to public health officials in developing mitigation strategies to reduce the adverse health risks associated with short-term temperature variability.

Human-derived food shrinks home ranges and alters resource selection of mammals at the urban-wild interface

Protected lands are an important source of food, shelter, and reproductive opportunities for wildlife, especially in urban landscapes. When urban development abuts the edges of undisturbed ecosystems, synanthropic species can alter their foraging behaviors and movement to utilize human-supplemented resources throughout the urban-wild interface. Therefore, urban development on the edges of protected lands can have pronounced effects on animal movement and ecosystem functions. Iconic urban adaptive mesopredators such as northern raccoons (Procyon lotor) and Virginia opossums (Didelphis virginiana) often benefit from human-supplemented food sources such as unsecured garbage, pet food, and fresh water when available. To investigate how urban edges affect the movements of urban-adapted omnivores within conservation lands, we estimated home ranges and third-order resource selection of 27 raccoons and 12 opossums with GPS collars throughout the protected areas of northern Key Largo, FL, USA between April 2022–October 2023. The proportion of urban development in an individual's home range was the most influential factor associated with home range size, followed by species and sex. Individuals with greater proportions of residential neighborhoods and commercial areas in their home ranges exhibited smaller home ranges. Third-order resource selection functions identified both mesopredator species using residential and commercial land use areas more than they were available on the landscape. These results indicate that urban areas attract urban-adapted mesopredators from protected areas and result in smaller home ranges in the face of abundant human-derived food. Reduced home ranges on edges can support higher densities of animals, which may increase rates of disease transmission, especially when the urban borders support populations of feral domestic species. Shifting foraging behaviors from the protected areas to urban edges could have cascading downward effects if seed-dispersing roles are diluted. As urbanization increases and the distance between wild lands and human disturbance decreases, it is increasingly important to study the mechanisms of how urban development on the edges of protected areas affect the movement of wildlife.

Quantitative microbiome profiling of honey bee (Apis mellifera) guts is predictive of winter colony loss in northern Virginia (USA)

For the past 15 years, the proportion of honey bee hives that fail to survive winter has averaged ~ 30% in the United States. Winter hive loss has significant negative impacts on agriculture, the economy, and ecosystems. Compared to other factors, the role of honey bee gut microbial communities in driving winter hive loss has received little attention. We investigate the relationship between winter survival and honey bee gut microbiome composition of 168 honey bees from 23 hives, nine of which failed to survive through winter 2022. We found that there was a substantial difference in the abundance and community composition of honey bee gut microbiomes based on hive condition, i.e., winter survival or failure. The overall microbial abundance, as assessed using Quantitative Microbiome Profiling (QMP), was significantly greater in hives that survived winter 2022 than in those that failed, and the average overall abundance of each of ten bacterial genera was also greater in surviving hives. There were no significant differences in alpha diversity based on hive condition, but there was a highly significant difference in beta diversity. The bacterial genera Commensalibacter and Snodgrassella were positively associated with winter hive survival. Logistic regression and random forest machine learning models on pooled ASV counts for the genus data were highly predictive of winter outcome, although model performance decreased when samples from the location with no hive failures were excluded from analysis. As a whole, our results show that the abundance and community composition of honey bee gut microbiota is associated with winter hive loss, and can potentially be used as a diagnostic tool in evaluating hive health prior to the onset of winter. Future work on the functional characterization of the honey bee gut microbiome’s role in winter survival is warranted.

Widespread Circulation of Tick-Borne Viruses in Virginia-Evidence of Exposure to Heartland, Bourbon, and Powassan Viruses in Wildlife and Livestock.

Emerging tick-borne viruses such as Powassan virus (POWV), Bourbon virus (BRBV), and Heartland virus (HRTV), whilst rare, can cause severe health problems in humans. While limited clinical cases have been reported thus far in Virginia, the presence of tick-borne viruses poses a serious health threat, and the extent of their prevalence in Virginia is unknown. Here, we sought evidence of POWV, BRBV, and HRTV exposure in Virginia via a serological assessment of wildlife and livestock. Wildlife in Virginia were found to be seropositive against POWV (18%), BRBV (8%), and HRTV (5%), with western and northern regions of the state having a higher prevalence. Multiple wildlife species were shown to have been exposed to each virus examined. To a lesser extent, cattle also showed exposure to tick-borne viruses, with seroprevalences of 1%, 1.2%, and 8% detected in cattle against POWV, BRBV, and HRTV, respectively. Cross-reactivity against other known circulating mosquito-borne flaviviruses was ruled out. In conclusion, there is widespread exposure to tick-borne viruses in western and northern Virginia, with exposure to a diverse range of animal populations. Our study provides the first confirmation that HRTV is circulating in the Commonwealth. These findings strengthen the existing evidence of emerging tick-borne viruses in Virginia and highlight the need for public health vigilance to avoid tick bites.

Raccoons and opossums respond similarly to high and low development in the East Texas Pineywoods

Over the last half-century, cities across the southeastern United States have experienced consistent human population growth, which has increased the rate of urban sprawl and subsequent habitat fragmentation with resource subsidies from development. The northern raccoon (Procyon lotor) and Virginia opossum (Didelphis virginiana) are mesopredators commonly associated with and benefiting from urbanized areas. We conducted a small-scale study of raccoons and opossums within the Nacogdoches, Texas, in January 2014. We captured and marked individual raccoons and opossums and used occupancy and spatial-capture-recapture models to examine habitat use, detection, and population density in high- and low-density urban study areas. We predicted to find high densities of each mesopredator, relative to other studies in larger metropolitan areas. We also expected to find a response to landscape features in the high-development study area to be closely associated with anthropogenic features and proximity to water, but less pronounced in the low-development study area. Contrary to our predictions, the detectability of each species in the high-development study area had a positive association with areas further from buildings, and raccoon habitat use had a positive association farther from natural water. Similarly, in the low-development study area, we found raccoon detectability had a positive association with areas farther from the urban edge and opossums had a positive association with areas with smaller forest patches (i.e., edge habitat). We were able to estimate 13.66 raccoons/km2 (95% CI 7.10–26.30) in the high-development study area and 12.55 opossums/km2 (95% CI 04.36–36.15) in the low-development study area. Our results indicate high densities of each species, and the first urban density of Virginia opossum using spatial-capture-recapture methods which further supports that these mesopredators are adapted to and benefit from urban-derived resources in urban areas. This study highlights the adaptability of these small mesopredators and the need for managers to consider adaptive strategies across different urban intensities as the ecology of these species may differ as compared to larger cities.

Platforms and Palimpsests

Data platforms increasingly mediate the relationship of society to the data it produces and therefore form a critical layer of the contemporary link between data and urbanisation. However, the current discussion of the impact of data platforms on urbanisation is limited on one hand by an overly metaphoric articulation of platforms, which obscures the material geographies and infrastructural landscapes of data production; and on the other hand, by an administratively bounded reading of platforms, which confines the discussion to only their most visible impact in cities. In this article I argue that to fully capture the impact of platforms on urbanisation we need to overcome these limitations by examining the ‘operational landscapes’ of data production and circulation. This extended ontology of platforms positions the spatial discourse of technology in relationship with other forms of capitalist spatial production and opens up the material geographies and infrastructural landscapes of data production for critical engagement as integral parts of the sociotechnical construction of platforms. By examining the data landscapes of Northern Virginia, I illustrate how historic and contemporary forces, actor networks, and urban dynamics contribute to the construction and maintenance of the extended geography of data platforms.

Geographic drivers more important than landscape composition in predicting bee beta diversity and community structure

AbstractThe importance of microhabitat traits such as floral availability is well known; however, forest bee spatial dynamics have been variably studied across local to broad geographic scales. Past literature suggests that landscape factors from proximate to distal are important in determining forest bee community metrics, including richness, abundance, and taxonomic composition. Leveraging the interest and assistance of citizen science volunteers, we employed standard bee bowl trap transects across Maryland, Delaware, northern Virginia, and the District of Columbia and identified correlations between bee community composition, local and regional land cover, and broader geospatial patterns. We also identified the partial contributions of both specific species and sampling sites to total beta diversity. Various land cover metrics were significantly related to bee community structure, with bee abundance positively and negatively correlated with forest and wetland cover, respectively. In general, land cover metrics within 1000‐m buffer exhibited stronger correlations with bee communities; however, broader geographic variation, using Cartesian coordinates north and east as indices, was most significantly correlated with the bee community. Specifically, bee communities were less rich in the east and south of the study area. We also identified similar correlations with the bee community as categorized by both trophic and nesting behaviors, with both geographic northing and easting proving to be most strongly correlated with the forest bee community. Results of beta diversity and cluster analyses showed that the most species‐depauperate sites exhibited the highest contributions to beta diversity and that species‐poor sites consisted of a reduced subset of the greater community. Our results show that successful bee conservation must consider, beyond local‐scale resource availability, broad geospatial considerations and forest habitat connectivity across political and administrative boundaries.

Small forested watershed weathers effects of climate change better than a nearby urban watershed in Northern Virginia, USA

AbstractSouth Fork Quantico Creek (SFQ; 19.8 square kilometre (km2), forested) and Fourmile Run (4MR; 32.4‐km2, urban) are small watersheds in northern Virginia, United States. Precipitation and streamflow data for both watersheds were examined from water year (WY) 1952 through 2022. Temporal changes in hydrologic metrics were identified by calculating trends in annual precipitation, annual peak flow, mean daily flow, minimum daily flow, stream flashiness, and the runoff ratio. The impact of climate and urbanization on watershed hydrology was assessed by computing trends on both raw and precipitation‐adjusted data. Despite increasing precipitation in both watersheds, increasing monotonic trends in most hydrologic metrics were observed only in 4MR. At 4MR, the long‐term trend in annual peak flow was non‐linear, thus trends were calculated on separate periods. Annual peak flow increased from WY 1952 through 1968, coinciding with a period of rapid urbanization. During WY 1969 through 1981, annual peak flows decreased, coinciding with construction of a flood channelization project. Trends for both periods were robust to precipitation adjustment. From WY 1982 through 2022, no change in the precipitation‐adjusted annual peak flows occurred, suggesting annual peak flows increased due to climate factors during this period. Comparison of area‐normalized hydrologic metrics between the two watersheds revealed higher flows in 4MR than SFQ across all flows, not just high flows. Runoff ratio and stream flashiness also were higher in 4MR. Differences in hydrologic metrics between the two watersheds were driven primarily by differences in land use, land cover, and modifications to the water balance related to urbanization. Climate change has altered watershed hydrology at both sites, but extensive urbanization in 4MR has altered the hydrology more than that of SFQ. We conclude that urban watersheds are likely at greater risk of increased flooding than less developed areas as the climate intensifies.

Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program

IntroductionEmergency department turnover rates increased at Sentara Northern Virginia Medical Center. Most applicants were new graduate registered nurses. A strength, weakness, opportunity, threat analysis revealed 3 weaknesses regarding new graduate registered nurses in emergency departments. Transition to practice program was necessary, new graduate registered nurse competency needed to progress rapidly, and retention rates needed improvement. MethodsThe emergency department registered nurse transition to practice pathway was created to address these challenges. Retention statistics were garnered through new graduate registered nurses length of employment. Improving retention rates at Sentara Northern Virginia Medical Center led to expansion of the program to the other 11 hospitals in the system. Self-report surveys were created later to evaluate the new graduate registered nursess' satisfaction with the program and perception of clinical confidence. ResultsUsing the emergency department registered nurse transition to practice pathway, turnover rates at Sentara Northern Virginia Medical Center dropped from 46% to 5.1%. Post expansion, the overall program retention rates were 96% at 6 months, and 86% at 1 year. The 2-year retention rate prior to COVID-19 was 82%, afterward, it dropped to 65%. Most surveyed new graduate registered nurses had a confidence level of 25% or less on the first day. After their 17-week orientation, 54% reported confidence levels had risen to 75%. Within 6 months, 81% reported 75% confidence, at 1 year, 87% reported levels between 75% and 100%, and at 2 years, 100% reported a confidence level between 75% and 100%. DiscussionThis development of the emergency department registered nurse transition to practice pathway resulted in improved emergency department registered nurse retention and confidence. Savings from reduced turnover and reduced temporary labor staffing were achieved with this program. Implementation takes careful resource management, ongoing analysis, and research to validate return on investment.

Youth-Led Research and the Tensions Between Relational Methodologies and Fast Methods: Learning and Living in the In-Between

Youth Participatory Action Research (YPAR) has often been characterized as a meaningful way of including young people in research about and for them. Much has been written about the need to develop trusting relationships between adult and youth researchers in this process. These types of research relationships take time to develop authentically and we see a need for that relationship-building time to be built into research designs and timelines. At the same time, in our experience working with the Youth Research Council in Northern Virginia, USA, we have seen youth researchers express desires to use “rapid” research methods, such as hallway interviews, text messaging, speak-back surveys, and video testimonials to gather data from peers. The purpose of this article is to explore these tensions, to uncover the privilege of what have been called slow ontologies, and to offer recommendations for other youth-led research teams.

Estimating added roadway GHG emissions from climate change effects and related adaptations

Civil infrastructure is vulnerable to climate-based event impacts that are increasing. A comparative with-and-without simulation-based GHG emissions change estimation methodology is proposed for estimating the changes in roadway transportation-related GHG emissions, a key contributor to climate change, from repairs required to mitigate damage and the execution of adaptations taken to prevent future damage. Riverine flooding from precipitation, coastal flooding from surge and high tide, and pavement deterioration from high temperatures and dry conditions are considered. A GHG emissions-based link criticality index is developed for identifying links for proactive adaptations. The tool provides insights for climate impact reduction policy creation and evaluation, and can aid in assessing the effectiveness of roadway infrastructure investment plans for combatting climate change effects. The methodology is illustrated on a case study in Northern Virginia. The results uncover how climate change events and actions taken can exacerbate conditions that accelerate climate change in the long term.

A Survey of Xylella fastidiosa in the U.S. State of Virginia Reveals Wide Distribution of Both Subspecies fastidiosa and multiplex in Grapevine.

Global travel and trade in combination with climate change are expanding the geographic distribution of plant pathogens. The bacterium Xylella fastidiosa is a prime example. Native to the Americas, it has spread to Europe, Asia, and the Middle East. To assess the risk that pathogen introductions pose to crops in newly invaded areas, it is key to survey their diversity, host range, and disease incidence in relation to climatic conditions where they are already present. We performed a survey of X. fastidiosa in grapevine in Virginia using a combination of quantitative PCR, multilocus sequencing, and metagenomics. We also analyzed samples from deciduous trees with leaf scorch symptoms. X. fastidiosa subspecies fastidiosa was identified in grapevines in all regions of the state, even in Northern Virginia, where the temperature was below -9°C for 10 days per year on average in the years preceding sampling. Unexpectedly, we also found for the first time grapevine samples infected with X. fastidiosa subspecies multiplex (Xfm). The Xfm lineage found in grapevines had been previously isolated from blueberries in the Southeastern United States and was distinct from that found in deciduous trees in Virginia. The obtained results will be important for risk assessment of X. fastidiosa introductions in other parts of the world.

Acculturation and self-rated health among Chinese and Korean immigrants aged 49 to 75.

Given the rapidly growing Asian populations in the U.S. due to immigration, and the aging demographic of Asian immigrants, it is crucial to understand how acculturation shapes health among older adult Asian immigrants. We study the relationship between acculturation and self-rated health (SRH) and moderating roles of age and Asian subgroup. Our cross-sectional study consisted of 200 Chinese and 200 Korean immigrants aged 49-75 living in Baltimore-Washington DC metropolitan area, who were recruited from primary care physicians' clinics in Maryland and Northern Virginia. The participants completed the survey either in-person or by phone in their preferred language. Multidimensional proxies were used to measure acculturation: years living in the U.S. (≥23 years, <23 years), English proficiency (fluently/well, so-so, poorly/not at all), and ethnic identity (very Asian, mostly Asian, bicultural/westernized). SRH was measured using the question "How would you rate your general health?" (excellent/very good/good, fair/poor). Poisson regression models with robust error variance examined associations between acculturation and SRH, accounting for socioeconomic and health insurance factors. Speaking English so-so and fluently/well had 0.73 (95% confidence intervals (CI): 0.55-0.97) and 0.51 (95% CI: 0.30-0.87) times the prevalence of having fair or poor SRH compared to speaking English poorly/not at all, respectively. The magnitudes and statistical significance of these associations were stronger among Chinese participants than Korean participants. Moreover, individuals who self-identified as bicultural/westernized had 0.63 times the prevalence of having fair or poor SRH (95% CI: 0.43-0.92) as those who self-identified as very Asian. The association was more pronounced among older participants (≥58) compared to younger participants (<58). Further research should identify the possible mechanisms linking acculturation with health to find effective strategies to enhance health among aging Asian immigrant populations.

High hydroxyurea usage in sickle cell anemia regardless of patient demographics.

Hydroxyurea is highly effective in sickle cell disease, but it is still underutilized. Reports of hydroxyurea utilization largely use Medicaid data, and socioeconomics is often cited as a barrier. To address whether patient demographics influenced the high hydroxyurea usage rate recently reported for the pediatric sickle cell program of Northern Virginia, analysis of data from 2011 to 2021 revealed no statistical difference in hydroxyurea usage rate between Medicaid and non-Medicaid, African American and African, or age less than 13 and age greater than or equal to 13years cohorts, demonstrating that hydroxyurea can be successfully implemented across demographic groups.

The sanitary sewer unit hydrograph model: A comprehensive tool for wastewater flow modeling and inflow-infiltration simulations

Sanitary sewer systems are critical urban water infrastructure that protect both human and environmental health. Their design, operation, and monitoring require novel modeling techniques that capture dominant processes while allowing for computationally efficient simulations. Open water flow in sewers and rivers are intrinsically similar processes. With this in mind, we formulated a new parsimonious model inspired by the Width Function Instantaneous Unit Hydrograph (WFIUH) approach, widely used to predict rainfall-runoff relationships in watersheds, to a sanitary sewer system consisting of nearly 10,000 sewer conduits and 120,000 residential and commercial sewage connections in Northern Virginia, U.S.A. Model predictions for the three primary components of sanitary flow, including Base Wastewater Flow (BWF), Groundwater Infiltration (GWI), and Runoff Derived Infiltration and Inflow (RDII), compare favorably with the more computationally demanding industry-standard Storm Water Management Model (SWMM). This novel application of the WFIUH modeling framework should support a number of critical water quality endpoints, including (i) sewer hydrograph separation through the quantification of BWF, GWI, and RDII outflows, (ii) evaluation of the impact of new urban developments on sewage flow dynamics, (iii) monitoring and mitigation of sanitary sewer overflows, and (iv) design and interpretation of wastewater surveillance studies.

High Hydroxyurea Usage in Sickle Cell Anemia Regardless of Patient Demographic

Introduction/Background: Hydroxyurea is highly effective in sickle cell disease, yet it is still underutilized. The Pediatric Sickle Cell Program of Northern Virginia recently published a 10-year analysis of uniform hydroxyurea (HU) implementation starting in infancy for all patients with sickle cell disease of severe genotype (SCA), demonstrating rise in HU usage from 32.5% baseline rate to 79.6% after two years, and to &amp;gt; 90% after 8 years. 1 Other HU utilization studies reporting lower rates largely use Medicaid data, and lower socioeconomics is often cited as a barrier to HU utilization. The Northern Virginia study reported on all patients with SCA regardless of insurance coverage, thus raising the question whether the high HU usage rate achieved in this program was influenced by a high proportion of non-Medicaid patients or other unusual demographic features. Therefore, we analyzed 10 years of HU usage data by insurance, ethnicity, and age. Methods: HUdata extracted from a longitudinal REDCap database and electronic medical records (EMR) with IRB approval (Children's National Medical Center IRB, Pro00002745, Pro00013374) previously reported 1 for five 2-year intervals are additionally analyzed for insurance, ethnicity, and age, with new data for 2019-2021. HU-eligibility includes SCA patients age ≥ 9 months and not chronically transfused. HU users (on HU) are patients demonstrating Hgb F rise and expected hemogram changes in response to HU, monitored every 2-3 months; HU non-users (not on HU) are patients who refuse HU or are grossly non-adherent as evidenced by lack of changes in Hgb F and hemogram. Pharmacy dispense records available in Epic EMR are used as corroborative information. Results: 1. Medicaid patients comprised 39 - 46% and non-Medicaid patients comprised 54 - 61% of all patients over the five 2-year periods. African-American (AA) and African patients comprised 85% of all patients. Medicaid coverage ranged from 24 - 39% for AA patients and 38 - 48% for African patients. (African is defined as born in Africa or having parents born in Africa who immigrated to the US.) 2. Comparing HU usage by insurance over the five 2-year periods, HU users increased from 72% to 91% for Medicaid patients and from 83% to 95% for non-Medicaid patients. Conversely, HU non-users decreased from 28% to 9% for Medicaid patients and from 17% to 5% for non-Medicaid patients. No statistical difference was detected in HU usage by Medicaid versus non-Medicaid insurance in any interval (p = 0.13 to 0.91) (Table 1). 3. HU usage rates in AA and African patients were not statistically different (p = 0.07 to 0.32), except in one interval (2013-15) (p = 0.006) (Table 1). 4. Comparison of HU usage in two age groups, 9 months-12 years and ≥ 13 years, showed that while HU non-acceptance/non-adherence tended to be higher in the age ≥ 13 group, no statistical significance was reached in any interval (p = 0.13 to 0.97) (Table 1). 5. The uniform HU implementation program targeted for fetal hemoglobin (Hgb F) 30% or higher by frequent HU dose optimization and close adherence monitoring. Hgb F &amp;gt; 20% was considered good adherence, and Hgb F 10-20% reflected partial adherence. Partially adherent patients did not distribute differently between Medicaid and non-Medicaid insurance (p = 0.07 to 0.86) but were predominantly age &amp;gt; 13 (p = 0.0005 to 0.001) (Table 2). Conclusion: 1. HU users and HU non-users did not disproportionately distribute to any demographic group. 2. Uniform HU implementation was effective in both Medicaid and non-Medicaid populations. 3. Ethnicity and age were not significant factors in HU uptake or acceptance, but decreased HU adherence is more frequent in teenagers. 4. HU can be effectively implemented for all SCA patients across demographic groups. Medicaid insurance, as a proxy for socioeconomic level, is not a barrier to high HU usage. Reference: 1. Phan V, Park JA, Dulman R, Lewis A, Briere N, Notarangelo B, Yang E. Ten-year longitudinal analysis of hydroxyurea implementation in a pediatric sickle cell program. Eur J Haematol. 2022 Nov;109(5):465-473. doi: 10.1111/ejh.13827. Epub 2022 Sep 2. PMID: 35811388.

Integrating Data Across Multiple Sites in the Northeastern United States to Examine Associations Between a Prenatal Metal Mixture and Child Cognition.

We applied a novel hierarchical Bayesian weighted quantile sum (HBWQS) regression to combine data across 3 study sites to examine associations between prenatal exposure to metals and cognitive functioning in childhood. Data from 326 mother-child dyads enrolled in an ongoing cohort study, the Programming of Intergenerational Stress Mechanisms (PRISM) Study, based in New York, New York (recruitment in 2013-2020) and Boston, Massachusetts (recruitment 2011-2013), and the First Thousand Days of Life (FTDL) cohort study (recruitment 2012-2019), based in northern Virginia, were used. Arsenic, cadmium, manganese, lead, and antimony were measured in urine collected during pregnancy. Cognitive functioning was assessed in children aged 3-11 years using the National Institutes of Health Toolbox Cognition Battery. The HBWQS regression showed a negative association between the urinary metal mixture and the Cognition Early Childhood Composite Score in the PRISM New York City (β = -3.67, 95% credible interval (CrI): -7.61, -0.01) and FTDL (β = -3.76, 95% CrI: -7.66, -0.24) samples, with a similar trend in the PRISM Boston sample (β = -3.24, 95% CrI: -6.77, 0.144). We did not detect these associations in traditionally pooled models. HBWQS regression allowed us to account for site heterogeneity and detect associations between prenatal metal-mixture exposure and cognitive outcomes in childhood. Given the ubiquity of metals exposure, interventions aimed at reducing prenatal exposure may improve cognitive outcomes in children. This article is part of a Special Collection on Environmental Epidemiology.

Depression, Anxiety, Energy, and Fatigue Among Nurses Who Cared for Patients During the COVID-19 Pandemic: A Cross-Sectional Study.

Purpose of Study: Nurses around the world have faced challenges during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the association between depression and anxiety and trait energy and trait fatigue, and baseline health status and work characteristics. Design of Study: A cross-sectional study. Methods: A survey was conducted to collect self-reported data from nurses involved in patient care in Northern Virginia. Depression and anxiety were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales. To measure trait energy and trait fatigue, the Mental and Physical State and Trait Energy and Fatigue Scale (MPSTEFS) was used. Findings: There was a significant association between depression and energy (b=-0.46, t = -1.78, p < .001) and loneliness (b=1.38, t = 4.00, p < .001) and increased alcohol use (b=2.11, t = 2.04, p = .045). We also found that nurses with depression were significantly more likely to seek mental health counseling (b=-2.91, t = 2.54, p = 0.013), which was also the case for anxiety (b=3.13, t = 2.14, p = .036). Conclusions: Our study highlights the mental health burden among nurses who worked in the early phase of the COVID-19 pandemic and its association with increased alcohol use and loneliness. The findings may help healthcare leaders identify early signals of deterioration in nurses' well-being.

Why is it taking so long to move down the road?: Creating a regional border agreement in the DMV as an alternative for the Interstate Compact on the Placement of Children

AbstractThe Interstate Compact on the Placement of Children (ICPC) is an agreement between all 50 states and the District of Columbia governing the process of placing a foster child out of state. Notorious for its long wait times and system backlog, the ICPC presents a host of problems for children attempting to move mere minutes across state lines to be with a relative or kin placement instead of state foster care. In an effort to make this process smoother, 18 different “border agreements” have been adopted by several neighboring states across the U.S. Such border agreements give temporary placement licenses to relatives and kin while the ICPC process is ongoing. While this is a good start towards a solution, the ICPC could be further streamlined if border agreements were used more widely, especially in regional contexts. This article considers the possibility of such a regional agreement between the District of Columbia, Maryland, and Northern Virginia (known as the “DMV”). By comparing and contrasting two existing border agreements in these three jurisdictions, a regional DMV border agreement can be created implementing the best terms of both agreements.