Sites In Wisconsin Research Articles

Complex and highly saturated soundscapes in restored oak woodlands reflect avian richness and abundance.

Temperate woodlands are biodiverse natural communities threatened by land use change and fire suppression. Excluding historic disturbance regimes of periodic groundfires from woodlands causes degradation, resulting from changes in the plant community and subsequent biodiversity loss. Restoration, through prescribed fire and tree thinning, can reverse biodiversity losses, however, because the diversity of woodland species spans many taxa, efficiently quantifying biodiversity can be challenging. We assessed whether soundscapes in an eastern North American woodland reflect biodiversity changes during restoration measured in a concurrent multitrophic field study. In five restored and five degraded woodland sites in Wisconsin, USA, we sampled vegetation, measured arthropod biomass, conducted bird surveys, and recorded soundscapes for five days of every 15-day period from May to August 2022. We calculated two complementary acoustic indices: Soundscape Saturation, which focuses on all acoustically active species, and Acoustic Complexity Index (ACI), which was developed to study vocalizing birds. We used generalized additive models to predict both indices based on Julian date, time of day, and level of habitat degradation. We found that restored woodlands had higher arthropod biomass, and higher richness and abundance of breeding birds. Additionally, soundscapes in restored sites had higher mean Soundscape Saturation and higher mean ACI. Restored woodland acoustic indices exhibited greater magnitudes of daily and seasonal peaks. We conclude that woodland restoration results in higher soundscape saturation and complexity, due to greater richness and abundance of vocalizing animals. This bioacoustic signature of restoration offers a promising monitoring tool for efficiently documenting differences in woodland biodiversity.

Baseline Abundances and Population Demographics at Wood Turtle (Glyptemys insculpta) Monitoring Sites in Wisconsin

Baseline Abundances and Population Demographics at Wood Turtle (Glyptemys insculpta) Monitoring Sites in Wisconsin

Influence of temporary emigration on wood turtle (Glyptemys insculpta) detectability, with implications for abundance estimation.

Reliable population estimates are important for making informed management decisions about wildlife species. Standardized survey protocols have been developed for monitoring population trends of the wood turtle (Glyptemys insculpta), a semi-aquatic freshwater turtle species of conservation concern throughout its distribution in east-central North America. The protocols use repeated active search surveys of defined areas, allowing for estimation of survey-specific detection probability (p) and site-specific abundance. These protocols assume population closure within the survey area during the survey period, which is unlikely to be met as wood turtles are a highly mobile species. Additionally, current protocols use a single-pass design that does not allow for separation of availability (pa) and detectability (pd). If there are systematic influences on pa or pd that are not accounted for in the survey design or data analysis, then resulting abundance estimates could be biased. The objectives of this study were to determine if pa is a random process and if pa and pd are influenced by demographic characteristics. We modified the wood turtle survey protocol used in the upper Midwest to include a double-pass design, allowing us to estimate pa and pd using a robust design capture-recapture model. The modified protocol was implemented at 14 wood turtle monitoring sites in Minnesota and Wisconsin between 2017 and 2022. Our results indicated that pa was non-random and that pd increased with turtle carapace length. Our study suggests that model assumptions for current wood turtle population models may be violated, likely resulting in an overestimation of abundance. We discuss possible protocol and modeling modifications that could result in more accurate wood turtle abundance estimates.

(R)-(+)-γ-Decalactone is Conserved in North America as a Pheromone Component of Osmoderma eremicola (Coleoptera: Scarabaeidae) and a Kairomone of Elater abruptus (Coleoptera: Elateridae).

The scarab genus Osmoderma (Coleoptera: Scarabaeidae) includes several large species called hermit beetles that develop within dead and decaying hardwood trees. Males of at least three Palearctic species produce the aggregation-sex pheromone (R)-(+)-γ-decalactone, including the endangered O. eremita (Scopoli). However, hermit beetles have received less attention in the western hemisphere, resulting in a large gap in our knowledge of the chemical ecology of Nearctic species. Here, we identify (R)-( +)-γ-decalactone as the primary component of the aggregation-sex pheromone of the North American species Osmoderma eremicola (Knoch). Field trials at sites in Wisconsin and Illinois revealed that both sexes were attracted to lures containing (R)-(+)-γ-decalactone or the racemate, but only males of O. eremicola produced the pheromone in laboratory bioassays, alongside an occasional trace of the chain-length analog γ-dodecalactone. Females of the congener O. scabra (Palisot de Beauvois) were also significantly attracted by γ-decalactone, suggesting further conservation of the pheromone, as were females of the click beetle Elater abruptus Say (Coleoptera: Elateridae), suggesting that this compound may have widespread kairomonal activity. Further research is needed to explore the behavioral roles of both lactones in mediating behavioral and ecological interactions among these beetle species.

Differences and Disparities Among Self-Referred and Physician-Referred Populations Undergoing Coronary Artery Calcium Scanning.

Coronary artery calcium computed tomography (CAC) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. Despite robust evidence and inclusion in current guidelines, CAC is considered investigational by some US insurance carriers and requires out-of-pocket expenses. CAC can be obtained via self-referral (SR) or physician referral (PR). We aimed to examine differences in patient, socioeconomic, and CAC characteristics between referral groups. We evaluated demographic, medical history, and CAC results of consecutive patients with a CAC completed at one of multiple Wisconsin sites from March 1, 2019, to June 30, 2021. We separated patients into SR and PR groups. Through census data, we analyzed socioeconomic variables at the block level including race and ethnicity, median income, average household size, and high school completion in the areas where patients resided at the time of CAC. The final analysis included 19 726 patients: 13 835 (70.1%) PR and 5891 (29.9%) SR. Most patients in both groups were White (95.2% versus 95.1%), with the Black/African American population representing 2.7% (SR) and 2.3% (PR). The PR group had a higher prevalence of cardiovascular risk factors. SR patients were more likely to have a score of 0 (41.2% versus 38.1%; P<0.001); PR patients had a higher prevalence of CAC >300 (16.8% versus 14.8%; P<0.001). SR patients were more likely to be women (55.1% versus 48.9%; P<0.001) and were found to live in higher income areas (19.5% versus 16.4%; P<0.001). Patients from low-income areas comprised the smallest proportion in both groups (7.5%). Patients who obtain out-of-pocket CAC live predominantly in medium- and high-income areas, and patients from lower income locations are less likely to obtain CAC despite having more cardiovascular disease risk factors. Consideration should be made from a policy perspective to promote health equity and improve utilization of CAC testing among underrepresented groups.

Synthetic auxin herbicides do not injure intermediate wheatgrass or affect grain yield

AbstractIntermediate wheatgrass (IWG) is a cool-season perennial grass developed as a dual-purpose grain and forage crop. One barrier to adopting this crop is a lack of information on the effects of herbicides on IWG for grain production. An experiment was conducted to evaluate herbicide effects on IWG grain yield, crop injury, and weed control over 2 yr (2019 to 2021) at sites in Wisconsin, Minnesota, New York, and North Dakota. This evaluation included broadleaf herbicides registered for use on wheat: 2,4-D amine, clopyralid, MCPA, and a mixture of clopyralid + MCPA (all are categorized as Group 4 herbicides by the Weed Science Society of America). Each herbicide or mixture was applied at 1× and 2× the labeled wheat application rate to newly planted and established (1- to 5-yr-old) IWG stands in the fall or spring. Herbicides were applied during IWG tillering or jointing stages in the fall or during the jointing stage in the spring. Across site years, application timing, herbicide, and application rate showed no effect on IWG grain yield or plant injury. Broadleaf weed control ranged from 71% to 92% across herbicide treatments relative to the nontreated check at the Wisconsin site, whereas weed control at the Minnesota site was variable among treatments. At the New York site, herbicides were equally effective for broadleaf weed suppression, whereas weed pressure was very low at the North Dakota site and treatments did not affect weed cover. The results show that newly planted and established stands of IWG are tolerant to the synthetic auxin herbicides 2,4-D amine, clopyralid, and MCPA when applied during tillering or jointing in the fall or during jointing in the spring. Synthetic auxins represent a potentially useful tool for weed control in IWG cropping systems, especially for problematic broadleaf weed species.

Evaluation of models for estimating hydraulic conductivity in glacial aquifers with NMR logging.

Nuclear magnetic resonance (NMR) logging is a promising method for estimating hydraulic conductivity (K). During the past ~60 years, NMR logging has been used for petroleum applications, and different models have been developed for deriving estimates of permeability. These models involve calibration parameters whose values were determined through decades of research on sandstones and carbonates. We assessed the use of five models to derive estimates of K in glacial aquifers from NMR logging data acquired in two wells at each of two field sites in central Wisconsin, USA. Measurements of K, obtained with a direct push permeameter (DPP), KDPP , were used to obtain the calibration parameters in the Schlumberger-Doll Research, Seevers, Timur-Coates, Kozeny-Godefroy, and sum-of-echoes (SOE) models so as to predict K from the NMR data; and were also used to assess the ability of the models to predict KDPP . We obtained four well-scale calibration parameter values for each model by using the NMR and DPP measurements in each well; and one study-scale parameter value for each model by using all data. The SOE model achieved agreement with KDPP that matched or exceeded that of the other models. The Timur-Coates estimates of K were found to be substantially different from KDPP . Although the well-scale parameter values for the Schlumberger-Doll, Seevers, and SOE models were found to vary by less than a factor of 2, more research is needed to confirm their general applicability so that site-specific calibration is not required to obtain accurate estimates of K from NMR logging data. This article is protected by copyright. All rights reserved.

Contextual and Policy Influences on the Implementation of Prenatal Care Coordination.

Prenatal Care Coordination (PNCC) is a Medicaid fee-for-service that provides reimbursement for supportive services to mothers and infants at high risk of adverse outcomes. Services include health education, care coordination, referral to needed services, and social support. Currently, the implementation of PNCC programs is highly variable. We aimed to identify and describe the contextual factors that influence implementation of PNCC. Using a qualitative descriptive approach and theoretical reflexive thematic analysis techniques, we conducted observation and semistructured interviews with all PNCC staff at two PNCC sites in Wisconsin, representing diversity in region and patient population. We thematically analyzed interview data to examine how contextual factors influenced program implementation with the Consolidated Framework for Implementation Research as a sensitizing model. Observational field notes were used to triangulate interview data. Overall, participants endorsed the goals of PNCC and believed in its potential. However, participants asserted that the external policy context limited their impact. In response, they developed local strategies to combat barriers and work toward better outcomes. Our findings support the need to study the implementation of perinatal public and community health interventions and consider "health in all policies." Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period. Nurses who provide PNCC have unique insights that should be leveraged to inform maternal-child health policy.

Cover crops and preemergence herbicides: An integrated approach for weed management in corn-soybean systems in the US Midwest

Adoption of a fall established, high biomass cereal rye cover crop has potential to diversify weed management in corn and soybean production systems, reducing the selection pressure for resistance to postemergence herbicides. However, farmers and crop consultants express concern about limited weed suppression from an overwintering cover crop in areas where high biomass production is limited by cooler spring temperatures, such as in the Upper-Midwest U.S. Use of a preemergence herbicide, regardless of cover crop adoption, is a standard recommendation for improving early season weed control in corn and soybean. Field experiments were conducted at two sites in Wisconsin to assess the effects of six soil management practices (tillage, no-till, and four cereal rye cover crop termination timings/methods) with or without the use of a preemergence herbicide on weed suppression at the time of postemergence herbicide application and crop productivity. Results showed that cereal rye biomass increased &amp;gt; 6x between termination at the time of cash crop planting versus termination two weeks later. In corn and soybean, weed ground cover was lower for soil management with cereal rye cover crop terminated two weeks after cash crop planting (≤ 7% weed cover) compared to all other soil management practices (≥ 23% weed cover) when a preemergence herbicide was not used. Use of a preemergence herbicide resulted in low weed ground cover across treatments in corn (≤ 7% weed cover) and soybean (≤ 13% weed cover). Corn and soybean yield was not affected by preemergence herbicide treatments. Corn yield was lower at the south-central Wisconsin location for the soil management with a cereal rye cover crop terminated two weeks after cash crop planting (9.82 Mg ha-1) compared to all other soil management practices (≥ 12.07 Mg ha-1); at the southwest Wisconsin location, corn yield was greater for the conventional tillage treatment (14.28 Mg ha-1) compared to all other soil management treatments (≤ 10.89 Mg ha-1). Soil management did not affect soybean yield, although yields were different between locations with 3.44 Mg ha-1 at the south-central Wisconsin compared to 4.77 Mg ha-1 at the southwest Wisconsin location. These results indicate that in the absence of a high biomass cereal rye cover crop, preemergence herbicides are important for in-season weed control. Also, the inclusion of a late-terminated cereal rye cover crop in soybean should be considered as an effective management practice for reducing weed ground cover without affecting crop yield.

Variation in Susceptibility to Permethrin in Culex pipiens and Culex restuans Populations in the Great Lakes Region of the United States.

Two Culex pipiens form Pipiens colony strains and a field population of Cx. restuans from Michigan were susceptible and a Cx. pipiens form Molestus colony strain was comparatively less susceptible to a dose of 43 μg/ml of permethrin in Centers for Disease Control and Prevention (CDC) bottle bioassays. Using this diagnostic dose and these populations as controls, adult female Cx. pipiens and Cx. restuans were reared from egg rafts from 28 sites in Illinois, Ohio, Michigan, Iowa, Indiana, Wisconsin, and Minnesota. Tested mosquitoes showed high mortality in populations from 12 sites, less mortality (90-96%) at 9 sites, and less than 90% mortality from 7 sites during 30-min exposures. However, all tested populations showed 97-100% mortality at 60 min, indicating low phenotypic penetrance of resistance factors. These results indicate variation in susceptibility to permethrin in populations of West Nile virus vectors in the Great Lakes region of the United States, with evidence of modest resistance at 7 of 28 (25%) of the sampled populations.

Anomalous snow events increase mortality for a winter-adapted species

Winter is a costly time for animals, requiring individuals to adapt to increased energetic costs and reduced resources. Porcupines ( Erethizon dorsatum (Linnaeus, 1758)) confront winter by storing and catabolizing somatic stores. Increasing temperatures and attenuated snow conditions due to climate change increase porcupine survival, but impacts of greater weather variability have not been explored. In April of 2018, an anomalously heavy and late snowstorm occurred at our long-term study site in central Wisconsin followed by multiple mortalities among adult porcupines. We assessed cause of mortality and determined nutritional condition by extracting bone marrow and quantifying lipid content. Porcupines that died following the snow event had lower fat stores than the fall 2019 group and likely died of starvation. We estimated survival of female porcupines during the winters of 2012 and 2015–2018 to assess the effects of snow conditions and nutritional condition on survival. Survival declined with increased snow depth but increased with improved nutritional condition. The mass starvation event we observed in 2018 appeared to have resulted from deep snow increasing locomotive costs and reducing nutritional condition. As climate change increases the frequency of extreme weather events, including extreme snowfalls, we predict that the frequency of such clustered mortalities will increase.

Postacute Sequelae of SARS-CoV-2 Infection—Lessons Learned From a Coordinated Health System Response

ObjectiveTo outline a consensus-designed process for triaging and managing patients with post-coronavirus disease (COVID-19) syndrome at Mayo Clinic. Patients and MethodsWe convened a central multidisciplinary team including members from the departments of general internal medicine, occupational medicine, physical medicine and rehabilitation, psychology, allergy and immunology, infectious disease, pulmonology, neurology, cardiology, and pediatrics and otorhinolaryngology with membership from all Mayo Clinic sites in Arizona, Florida, Iowa, Minnesota, and Wisconsin. ResultsConsensus recommendations were made for the best practice guidelines on triaging and managing patients. Several innovations were agreed upon, including a postacute sequelae of COVID-19-specific appointment request form for data collection, a bioregistry, a biorepository, and a postacute sequelae of COVID-19-specific treatment program. ConclusionGiven that each clinical site had individual clinical practices, these recommendations were implemented using different models, which may provide broad applicability to other clinical settings.

Agent Blue Spraying in the Mekong Delta during the Vietnam War: Fate of the Arsenic Based Herbicide Weapon Used to Destroy Rice Crop and Mangrove Forests

Agent Blue, a mixture of cacodylic acid (CH3) As O2H) and sodium cacodylate (C2H6 AsNaO2), was a tactical arsenic-based herbicide used during the Vietnam War to destroy grasses and rice crops. Natural and synthetic sources of arsenic can degrade into water-soluble forms and persist in groundwater and potentially contribute to elevating As levels in drinking water. The United States Department of Defense (DOD) and United States Department of Agricultural (USDA) Operation Ranch Hand records for tactical herbicides including Agent Blue sprayed in southern Vietnam during the Vietnam War (1961-1971) are very detailed, rather complete and publicly available. The same is not true for tactical herbicides sprayed by the Republic of Vietnam (RV) during the Khai Quang program which was supported by the U.S. Army, U.S. Navy and Central Intelligence Agency (CIA) in the Mekong Delta. Agent Blue was sprayed by the RV military for three years before the official start of the American-Vietnam War. Few, if any, RV military, US Army, US Navy and CIA spray records exist from 1962 to 1965. Vietnam War veterans, historians and scholars have reported the spraying of 3.2 million liters (468,008 kg As) of Agent Blue on rice paddies and mangrove forests in the Mekong Delta and Central Highlands by the RV military with the support of the US Army, US Navy and CIA. The Institute of Medicine estimated that 3.2 million liters (468,000 kg As) were sprayed during the RV Khai Quang program. This was in addition to the U.S. Air Force’s Operation Ranch Hand spraying of the tactical herbicide Agent Blue primarily by C-123 aircraft. The Operation Ranch Hand missions maintained location and quantities of herbicides sprayed (over 4,712,000 liters (664,392 kg As) from 1961-1971. The RV military and US military (Army and Navy) spray equipment included hand and backpack sprayers, sprayers mounted on Brown Water Navy boats, on Army track vehicles and Army land-based helicopters and helicopters based on the decks of Blue Water Navy ships. Some of these spray missions were a military secret and spray records were classified or if kept were not maintained. Agent Blue containing cacodylic acid had a short half-life and degraded to water-soluble arsenic, which was released into the surface water and/or leached into the groundwater. Once the water-soluble arsenic leached into the Vietnam Mekong Delta groundwater, the arsenic-rich water was pumped back to the surface by tens of thousands of tube wells for urban and agricultural use. The primary objectives of this research are to explore the conditions during the Vietnam War under which 1) the RV military herbicide spray program with the support of the US Navy, CIA and US Army, and 2) the US Air Force spray program during Operation Ranch Hand may have significantly contributed to the natural and anthropic As spikes found in the Mekong Delta today. The environmental impacts of Agent Blue, on the Menominee River at manufacturing sites in the United States, were studied to identify possible As remediation and mitigation strategies. The lessons previously learned at the manufacturing sites in Wisconsin and Michigan, United States can be considered and applied to the Mekong Delta to help mitigate and remediate the arsenic-rich surface water, soil, sediment and groundwater found in the Mekong Delta.

Within-Year Effects of Prescribed Fire on Bumble Bees (Hymenoptera: Apidae) and Floral Resources.

Despite the importance of bumble bees (genus Bombus Latreille) for their services to natural and agricultural environments, we know little about the relationship between grassland management practices and bumble bee conservation. Prescribed fire is a common grassland maintenance tool, including in areas where endangered and threatened bumble bees are present. Thus, knowledge of the effects of prescribed fire on bumble bees is essential for designing management schemes that protect and bolster their populations. Using nonlethal surveys to record bumble bee species richness, abundance, and community composition, we evaluated the effects of spring controlled burns on summer bumble bee gynes and workers across five sites in southern Wisconsin. In addition, we explored the effects of fire on floral resources by measuring floral genus richness, abundance, ground cover, and proportion of transects containing blooming flowers in adjacent burned and unburned parcels. Prescribed fire had no measurable effects on bumble bee gyne or worker community composition, species richness, or abundance. However, consistent with previous studies prescribed fire increased floral genus richness and ground cover. The disconnect between bumble bee and floral responses to fire highlights some opportunities for improving our understanding of fire’s effects on bumble bee diapause, nest site choice, and foraging.

Functional trait data for vascular plant species from northeastern North America.

Wisconsin's plant communities are responding to shifting disturbance regimes, habitat fragmentation, aerial nitrogen deposition, exotic species invasions, ungulate herbivory, and successional processes. To better understand how plant functional traits mediate species' responses to changing environmental conditions, we collected a large set of functional trait data for vascular plant species occupying Wisconsin forests and grasslands. We used standard protocols to make 76,213 measurements of 34 quantitative traits. These data provide rich information on genome size, physical leaf traits (length, width, circularity, thickness, dry matter content, specific leaf area, etc.), chemical leaf traits (carbon, nitrogen, phosphorus, potassium, calcium, magnesium, ash), life history traits (vegetative and flower heights, seed mass), and traits affecting plant palatability (leaf fiber, fat, and lignin). These trait values derive from replicate measurements on 12+ individuals of each species from multiple sites and 45+ individuals for a selected subset of species. Measurements typically reflect values for individuals although some chemical traits involved composite samples from several individuals at the same site. We also qualitatively characterized each species by plant family, woodiness, functional group, and Raunkiaer lifeform. These data allow us to characterize trait dimensionality, differentiation, and covariation among temperate plant species (e.g., leaf and stem economic syndromes). We can also characterize species' responses to environmental gradients and drivers of ecological change. With survey and resurvey data available from >400 sites in Wisconsin, we can analyze variation in community trait distributions and diversity over time and space. These data therefore allow us to assess how trait divergence vs. convergence affects community assembly and how traits may be related to half-century shifts in the distribution and abundance of these species. The data set can be used for non-commercial purposes. The data set is licensed as follows: CC-By Attribution 4.0 International. We request users cite both the OSF data set and this Ecology data paper publication.

Landscape- and local-level variables affect monarchs in Midwest grasslands

ContextIt is estimated that over one billion milkweed stems need to be restored to sustain the eastern North American migratory population of monarch butterflies; where and in what context the stems should be placed on the landscape is key to addressing habitat deficits.ObjectivesWe assessed how the amount of appropriate habitat surrounding a particular patch of monarch habitat affects monarch presence and reproduction. To ensure that habitat restoration efforts are targeted towards areas that maximize monarch population growth, it is important to understand the effects of landscape heterogeneity on monarch occurrence in habitat patches (i.e. grasslands with milkweeds) across the landscape.MethodsOver two summers (2018–2019), we surveyed monarch adults, larvae, and eggs at sixty grassland sites in Wisconsin that varied in patch size and landscape context (proportion grassland, forest edge density, and road density). We also estimated milkweed density and floral richness to characterize local patch quality.ResultsAdult monarch abundance was highest at patches with the lowest proportion of surrounding grassland and lowest road density, and was heavily influenced by patch quality variables. Egg and larva density in a patch increased with milkweed density and floral richness within a patch. Patch size was unrelated to monarch abundance.ConclusionsThese results suggest that optimal sites for monarch habitat restoration are within landscapes which contain little habitat and that high milkweed density and floral richness and abundance should be conservation goals.

Casirivimab-Imdevimab treatment is associated with reduced rates of hospitalization among high-risk patients with mild to moderate coronavirus disease-19.

BackgroundReal-world clinical data to support the use of casirivimab–imdevimab for the treatment of outpatients with mild to moderate coronavirus disease-19 (COVID-19) is needed. This study aimed to assess the outcomes of casirivimab–imdevimab treatment of mild to moderate COVID-19.MethodsA retrospective cohort of 696 patients who received casirivimab–imdevimab between December 4, 2020 and April 9, 2021 was compared to a propensity-matched control of 696 untreated patients with mild to moderate COVID-19 at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Primary outcome was rate of hospitalization at days 14, 21 and 28 after infusion.FindingsThe median age of the antibody-treated cohort was 63 years (interquartile range, 52–71); 45·5% were ≥65 years old; 51.4% were female. High-risk characteristics were hypertension (52.4%), body mass index ≥35 (31.0%), diabetes mellitus (24.6%), chronic lung disease (22.1%), chronic renal disease (11.4%), congestive heart failure (6.6%), and compromised immune function (6.7%). Compared to the propensity-matched untreated control, patients who received casirivimab–imdevimab had significantly lower all-cause hospitalization rates at day 14 (1.3% vs 3.3%; Absolute Difference: 2.0%; 95% confidence interval (CI): 0.5–3.7%), day 21 (1.3% vs 4.2%; Absolute Difference: 2.9%; 95% CI: 1.2–4.7%), and day 28 (1.6% vs 4.8%; Absolute Difference: 3.2%; 95% CI: 1.4–5.1%). Rates of intensive care unit admission and mortality at days 14, 21 and 28 were similarly low for antibody-treated and untreated groups.InterpretationAmong high-risk patients with mild to moderate COVID-19, casirivimab–imdevimab treatment was associated with a significantly lower rate of hospitalization.FundingMayo Clinic.

Regional Specialty Surgical Practice Efficiencies Gained as a Result of COVID-19.

ObjectiveTo identify opportunities for discontinuing elective and nonemergency surgical cases in a regional surgical practice in response to coronavirus disease 2019 (COVID-19).Patients and MethodsCOVID-19 began to affect surgical practices across the United States in March 2020. On March 17, 2020, all elective and nonemergency surgical care was deferred to prepare the Mayo Clinic Health System sites in northwestern Wisconsin for an anticipated surge in patients with COVID-19. When the decision was made to reactivate the surgical practice, several major structural and operational changes were made to the regional surgical practice to optimize efficiencies.ResultsThe structural and operational changes implemented during reactivation resulted in improved utilization of surgical resources including improvement in operating room (OR) block utilization, increased available OR time, and increased case volumes.ConclusionSurgical and procedural leaders should consider a limited-time deferral of elective surgical cases to implement widespread OR efficiency strategies. The time selected for deferral of surgical cases should target a period of historically low surgical volume to minimize disruption to patient care and impact on overall OR functions.

Casirivimab-Imdevimab Treatment Is Associated with Reduced Rates of Hospitalization Among High-Risk Patients with Mild to Moderate Coronavirus Disease-19

Background: Real-world clinical data to support the use of casirivimab-imdevimab for the treatment of outpatients with mild to moderate coronavirus disease-19 (COVID-19) is needed. This study aimed to assess the outcomes of casirivimab-imdevimab treatment of mild to moderate COVID-19.Methods: A retrospective cohort of 696 patients who received casirivimab-imdevimab between December 4, 2020 and April 9, 2021 was compared to a propensity-matched control of 696 untreated patients with mild to moderate COVID-19 at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Primary outcome was rate of hospitalization at days 14, 21 and 28 after infusion.Findings: The median age of the antibody-treated cohort was 63 years (interquartile range, 52-71); 45·5% were ≥65 years old; 51·4% were female. High-risk characteristics were hypertension (52·4%), body mass index ≥35 (31·0%), diabetes mellitus (24·6%), chronic lung disease (22·1%), chronic renal disease (11·4%), congestive heart failure (6·6%), and compromised immune function (6·7%). Compared to the propensity-matched untreated control, patients who received casirivimab-imdevimab had significantly lower all-cause hospitalization rates at day 14 (1·2% vs 3·4%; Odds Ratio [OR], 0·26; 95% confidence interval (CI): 0·11-0·64), day 21 (1·2% vs 4·2%; OR, 0·22; 95% CI: 0·09-0·52), and day 28 (1·3% vs 4·9%; OR, 0·21; 95% CI: 0·09-0·48). Rates of intensive care unit admission and mortality at days 14, 21 and 28 were similarly low for antibody-treated and untreated groups.Interpretation:Among high-risk patients with mild to moderate COVID-19, casirivimab-imdevimab treatment was associated with a significantly lower rate of hospitalization.Funding Information: This work was funded by an intramural grant from Mayo Clinic to RRR.Declaration of Interests: CP, AP, AV, and PL are employees of nference and have financial interests in the company. JCO is supported by grants from nference, and is a paid consultant for Elsevier, Inc. and Bates College. ADB is supported by grants from NIAID (grants AI110173 and AI120698) Amfar (#109593) and Mayo Clinic (HH Shieck Khalifa Bib Zayed Al-Nahyan Named Professorship of Infectious Diseases). ADB is a paid consultant for Abbvie and Flambeau Diagnostics, is a paid member of the DSMB for Corvus Pharmaceuticals and Equilium, owns equity for scientific advisory work in Zentalis and Nference, and is founder and President of Splissen therapeutics. RRR is supported by research grants from Regeneron, Roche, Gilead and the Mayo Clinic, and is a member of DSMB for Novartis. All other have nothing to disclose. Ethics Approval Statement: The Mayo Clinic Institutional Review Board approved this study. Informed consent was waived and patients without research authorization were excluded.

Hospitalist perspectives on barriers to recommend and potential benefit of the COVID-19 vaccine

ABSTRACT Background: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients. Methods: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from 14 December 2020 through 4 January 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians. Results: The overall response rate was 42.7% (n = 128/300) and comprised of 53.9% women (n = 69/128) and 41.4% APPs (n = 53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n = 119/128) and influenza (97.7%; n = 125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and coworkers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32–6.59]; P< .008), whereas hospitalist age, gender, and profession showed no association. Conclusion: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.