Southeastern Michigan Research Articles

Genomic Data Characterize Reproductive Ecology Patterns in Michigan Invasive Red Swamp Crayfish (Procambarus clarkii).

The establishment and spread of invasive species are directly related to intersexual interactions as dispersal and reproductive success are related to distribution, effective population size, and population growth. Accordingly, populations established by r-selected species are particularly difficult to suppress or eradicate. One such species, the red swamp crayfish (Procambarus clarkii) is established globally at considerable ecological and financial costs to natural and human communities. Here, we develop a single nucleotide polymorphism (SNP) loci panel for P. clarkii using restriction-associated DNA-sequencing data. We use the SNP panel to successfully genotype 1800 individuals at 930 SNPs in southeastern Michigan, USA. Genotypic data were used to reconstruct pedigrees, which enabled the characterization of P. clarkii's mating system and statistical tests for associations among environmental, demographic, and phenotypic predictors and adult reproductive success estimates. We identified juvenile cohorts using genotype-based pedigrees, body size, and sampling timing, which elucidated the breeding phenology of multiple introduced populations. We report a high prevalence of multiple paternity in each surveyed waterbody, indicating polyandry in this species. We highlight the use of newly developed rapid genomic assessment tools for monitoring population reproductive responses, effective population sizes, and dispersal during ongoing control efforts.

Parasite transmission stage abundance varies in lakes over time and space

AbstractEnvironmentally transmitted parasites produce transmission stages that can remain viable and infective for extended periods of time in the environment where susceptible hosts may encounter them. Although many parasites have this mode of transmission, the abundance and distribution of environmental transmission stages have largely been overlooked, especially in aquatic habitats. Without empirical data to characterize spatial and temporal dynamics of parasite transmission stages in the environment, we might make incorrect assumptions about host–parasite contact rates. For aquatic environments, seasonal habitat structure driven by thermal stratification has been hypothesized to affect the patchiness of transmission stages within the water column, leading to uneven exposure risk to hosts. In this study, we quantified transmission stage concentrations of five common parasites of Daphnia spp. and Ceriodaphnia dubia at every meter of the water column at the deep basin of six lakes in southeastern Michigan every 2 weeks from June to November 2021. We found that transmission stage concentration varied by orders of magnitude over time and with depth. We investigated several possible drivers of these spatial and temporal patterns. For instance, our results suggest that greater mixing depth decreased transmission stage vertical patchiness within the water column of lakes with lower Fee's p values. However, horizontal spore patchiness across a lake was not correlated with the nearshore–offshore gradient of our study lakes. Overall, the results of our study show that parasite transmission stage concentrations have spatial and temporal dynamics that could affect disease dynamics within highly structured aquatic environments.

Pollen effects in a changing climate: Ragweed pollen exposure and sleepiness in immunotherapy patients of a Southeastern Michigan allergy clinic.

Allergic rhino-conjunctivitis (AR) is a globally relevant health disorder characterized by sneezing, rhinorrhea and sleep disturbance. Ragweed (Ambrosia artemisiifolia) is a plant common to North America and an important allergen. Coarse methods of measuring airborne pollen counts are used to predict seasonal allergy symptoms. This research used a longitudinal study design with a novel, model-based raster of predicted pollen counts to test associations with self-reported symptoms of AR collected from patients receiving immunotherapy for pollen allergies at an allergy clinic. Researchers visited a clinic six times over three weeks. Immunotherapy patients were asked to fill out a brief intake survey on allergic and symptomatic profiles, daytime sleepiness, housing quality, and demographics. Participants responded to a daily, emailed survey on sleepiness and asthma symptoms for 21 days. Using the date and location of responses, ragweed pollen counts were extracted from a prognostic, model based raster (25km pixels). Lag associations of pollen counts with sleepiness were tested using a logistic regression model , adjusted for housing and demographic characteristics, in a distributed lag non-linear model (DLNM) framework. 49 people participated in the study. 26 (52%) were female. The mean age was 37.9 years. Asthma/allergy symptoms were not associated with ragweed pollen but sleepiness was highest two days after exposure (Estimate: 0.33 [0.04,0.62]). Subjects traveled widely during the study period. Intense exposures to ragweed pollen may be associated with daytime sleepiness within small exposure windows. Model-based predicted pollen counts could be used to study health impacts of pollen in people with disease severe enough to receive immunotherapy. Daytime sleepiness can affect productivity and injury risk, and pollen season length and allergenicity may be increasing with climate change. Thus our results may have important implications for population health.

Uranium in Drinking Water and Bladder Cancer: A Case-Control Study in Michigan.

Uranium is naturally occurring in groundwater used for drinking; however, health risks from naturally occurring concentrations are uncertain. Uranium can cause both radiological and chemical toxicity following ingestion. Bladder and kidneys receive a dose when uranium is excreted into the urine. Investigate the association between uranium in drinking water and bladder cancer risk in a case-control study. A population-based bladder cancer case-control study was conducted in 11 counties of southeastern Michigan. A total of 411 cases and 566 controls provided drinking water and toenail samples and answered questions about lifestyle and residential history. Uranium was measured in drinking water and toenails, and its association with bladder cancer was assessed via unconditional logistic regression models. Median uranium concentration in water was 0.12 μg L-1, with a maximum of 4.99 μg L-1, and median uranium concentration in toenails was 0.0031 μg g-1. In adjusted regression models, there was a suggestion of a protective effect among those exposed to the upper quartile of uranium in drinking water (HR = 0.64, 95% CI: 0.43, 0.96) and toenails (HR 0.66; 95% CI 0.45, 0.96) compared to those in the lowest quartile. Our objective is to investigate additional adjustment of drinking water source at home residence at time of recruitment to address potential selection bias and confounding attenuated results toward the null for drinking water uranium (HR = 0.68, 95% CI: 0.44, 1.05) and toenail uranium (HR = 0.80, 95% CI: 0.53, 1.20). This case-control study showed no increased risk of bladder cancer associated with uranium found in drinking water or toenails.

Neighborhood Poverty and Clinic Attendance in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program.

Higher neighborhood-level poverty is associated with greater odds of missing a free eye disease screening appointment, underscoring the importance of community-based interventions to address upstream social determinants of health. To investigate the association between neighborhood-level characteristics and attendance for a free eye disease screening. The MI-SIGHT program is conducted in two community clinics in Southeastern Michigan. Participant-level demographics were extracted from electronic health records. Neighborhood level-characteristics including Area Deprivation Index (ADI), median household income (HHI), percent of households with >30% rent burden, percent of households without vehicles, percent of households in subsidized housing, and energy burden were obtained from the Wisconsin Neighborhood Atlas and the United States census. Logistic regression was used to model the probability of clinic visit attendance, which was the main outcome measure. 1431 participants were scheduled for screening appointments between July 2020 to November 2021, with a no-show rate of 23%. Individuals lived an average of 7.7 miles from each clinic (SD=8.1) and in neighborhoods with a mean ADI of 6.8 (SD=3.2, 1-10 scale where 10 is the most deprived). After adjusting for age, sex, race, and ethnicity, participants from neighborhoods with higher deprivation were more likely to have missed clinic visits. For example, there was an 8% higher odds of missed clinic visits for every 1-point increase in ADI (odds ratio, OR=1.08, P=0.020) and an 18% higher odds of a missed visit with every 10% increase in households without a vehicle (OR=1.18, P=0.013). Higher neighborhood-level poverty was associated with greater odds of missing a free eye disease screening appointment after adjusting for individual characteristics. Increased neighborhood-level resources are likely needed to bolster engagement in preventive eye care.

Cervical cancer screening and vaccination acceptability and attitudes among Arab American women in Southeastern Michigan: a qualitative study

Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community’s perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women’s health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.

Association between ABO blood type and coronavirus disease 2019 severe outcomes across dominant variant strains.

Existing evidence suggests a link between ABO blood type and severe outcomes in coronavirus disease 2019 (COVID-19). We aimed to assess the relationship between blood type and severe outcomes across variant strains throughout the pandemic. This was a multicenter retrospective observational cohort analysis from a large health system in southeastern Michigan using electronic medical records to evaluate emergency encounters, hospitalization, and severe outcomes in COVID-19 based on ABO blood type. Consecutive adult patients presenting to the emergency department with a primary diagnosis of COVID-19 (U07.1) from March 1, 2020 through December 31, 2022 were assessed. Patients who presented during three distinct time intervals that coincided with Alpha, Delta, and Omicron variant predominance were included in the analysis. Exclusions included no record of ABO blood type, positive PCR COVID-19 test within the preceding 28 days, and if transferred from out of the health system. Severe outcomes were inclusive of intensive care unit admission, mechanical ventilation, or death, which, as a composite, represented our primary outcome. Secondary outcomes were hospital admission and length of stay. A logistic regression model was employed to test the association between ABO blood type and severe outcome, adjusting for age, sex, race, vaccination status, Elixhauser comorbidity indices, and the dominant variant time period in which the encounter occurred. Of the 33,796 COVID-19 encounters, 9416 met inclusion criteria; 4071 (43.2%) were type O, 3417 (36.3%) were type A, 459 (4.9%) were type AB, and 1469 (15.6%) were type B blood. Note that 66.4% of the cohort was female (p=0.18). The proportion of composite severe disease among the four blood types was similar and ranged between 8.6% and 8.9% (p=0.98). Note that 53.0% of type A blood patients required hospital admission, compared to 51.9%, 50.4%, and 48.1% of type AB, B, and O blood, respectively (p<0.001). Compared to patients with O blood type (43.2%), non-O blood type (58.8%; composite of A, AB, and B) exhibited no statistically significant difference in the proportion of composite severe disease (8.8%vs. 8.7%; p=0.81) Multivariable regression analyses exhibited no significant difference regarding the presence of severe outcomes among the four blood types or O versus non-O blood types during T1, T2, and T3. ABO blood type was not associated with COVID-19 severe outcomes across the Delta, Alpha, and Omicron dominant COVID waves across a large health system in southeastern Michigan. Further research is needed to better understand if ABO blood type is a risk factor for severe disease among evolving COVID-19 variants and other viral upper respiratory infections.

How does parasite environmental transmission stage concentration change before, during, and after disease outbreaks?

Outbreaks of environmentally transmitted parasites require that susceptible hosts encounter transmission stages in the environment and become infected, but we also know that transmission stages can be in the environment without triggering disease outbreaks. One challenge in understanding the relationship between environmental transmission stages and disease outbreaks is that the distribution and abundance of transmission stages outside of their hosts have been difficult to quantify. Thus, we have limited data about how changes in transmission stage abundance influence disease dynamics; moreover, we do not know whether the relationship between transmission stages and outbreaks differs among parasite species. We used digital PCR to quantify the environmental transmission stages of five parasites in six lakes in southeastern Michigan every 2 weeks from June to November 2021. At the same time, we quantified infection prevalence in hosts and host density. Our study focused on eight zooplankton host species (Daphnia spp. and Ceriodaphnia dubia) and five of their parasites from diverse taxonomic groups (bacteria, yeast, microsporidia, and oomycete) with different infection mechanisms. We found that parasite transmission stage concentration increased prior to disease outbreaks for all parasites. However, parasites differed significantly in the relative timing of peaks in transmission stage concentration and infection outbreaks. The "continuous shedder" parasites had transmission stage peaks at the same time as or slightly after the outbreak peaks. In contrast, parasites relying on host death for transmission ("obligate killers") had transmission stage peaks before outbreak peaks. For most parasites, lakes with outbreaks had higher spore concentrations than those without outbreaks, especially once an outbreak began; the exception was for a parasite, Pasteuria ramosa, with very strong genotypic specificity of infection. Overall, our results show that disease outbreaks are tightly linked to transmission stage concentration; outbreaks were preceded by increases in transmission stage concentration in the environment and then were fueled by the production of more transmission stages during the outbreak itself, with concentrations decreasing to pre-outbreak levels as outbreaks waned. Thus, tracking transmission stages in the environment improves our understanding of the drivers of disease outbreaks and reveals how parasite traits may affect these dynamics.

Abstract C130: Increasing prostate cancer education and screening for black men in southeastern Michigan: Your prostate, your health

Abstract Background Black Men (BM) have disproportionately higher mortality rates from prostate cancer (PCa) and present with more advanced disease. Early screening may improve outcomes. The aim of our project was to provide education, screening, and provider outreach in efforts to decrease the disproportionate number of PCa deaths in Black men. Methods We conducted focus group discussions with BM to assess their perceptions and understanding of PCa and screening. Focus groups aided in the development of educational materials. Educational materials were distributed at community events. Attendants were asked to participate in a survey to assess their knowledge, interest, and perceptions of prostate cancer screening and diagnosis. Screening was offered, at select events, using prostate-specific antigen (PSA) testing. Men with PSA levels of ≥4 ng/ml were contacted for follow-up. The project included training for Henry Ford Health (HFH) providers and an assessment of their PCa screening practice. Results We completed 4 focus groups and distributed ~1000 PCa educational brochures. To date, 136 men completed the survey. The least common response (n=33, 21.17%) to signs and symptoms associated with prostate cancer was “Prostate cancer can have no symptoms.” while the most common response (n=108, 66.42%) stated that prostate cancer is associated with “Having a hard time passing urine.” The most common response (n=106, 79.1%) to the perceived barrier to prostate cancer screening was “Lack of education around the importance of screening.” Furthermore, when participants were asked why men do not get prostate cancer screening the most common response (n=119, 79.33%) was “Fear of diagnosis.” The greatest number of survey responses (n=90, 69.77%) stated that “Social Media” is how they learned about prostate cancer screening. The largest number of responses (n=83, 57.24%) for the preferred method of communication regarding getting a prostate cancer screening was, “Text message reminder to schedule an appointment.” We participated in 42 community events between March 2022 to May 2023. 323 men were screened. 27 men had an elevated PSA, and 14 of these men did not complete follow-up. The reasons for the lack of follow-up were inability to re-contact (n=10, 71%), lack of insurance (n=2, 14%), no show to appointment (n=1, 7%), fear (n=1, 7%), and unknown (n=1, 7%). HFH provider educational sessions were conducted. Of 129 providers who completed a screening practice assessment, 78 (60%) routinely offered PSA screening to men between ages 55-69. Between 2018 to 2023 at HFH, the PSA screening rate overall increased from 8.2% to 12.7%. Conclusion Although our outreach efforts were effective at increasing PSA screening, half the men with elevated PSA did not follow-up. Future efforts should further reduce barriers to PCa screening and follow-up. Citation Format: Shane A. Tinsley, Doreen Dankerlui, Camille Romain, Wilma Ruffin, Clarence Burnett, Donna Long, Karen Yacobucci, Jaye Clement, Abisola Fasakin, Biola Makinde-Odusola, Eric Williams, Tiffany Fields, Firas Abdollah, Daniel Moore, Clara Hwang, Eleanor M. Walker. Increasing prostate cancer education and screening for black men in southeastern Michigan: Your prostate, your health [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C130.

Abstract 278: Injuries and Outcomes Associated With Manual vs Mechanical CPR Post Out of Hospital Cardiac Arrest

Objectives: Mechanical CPR is increasingly being used for field out of hospital cardiac arrest (OHCA) care. However, existing literature does not identify a survival benefit of mechanical versus manual CPR. We hypothesized that CPR related injury may impact patient outcomes. For that reason, our primary objective is to compare mechanical and manual CPR-related injury in resuscitated OHCA patients. Our secondary objective is to compare hospital outcomes including length of stay (LOS) and survival between these two CPR methods. Methods: We performed a retrospective study of adult OHCA patients admitted to three teaching hospitals in Southeastern Michigan from 2017-2021. Resuscitated patients were matched to hospital electronic medical records (EMRs), included if they had CT imaging of chest or abdomen/pelvis, and then dichotomized by CPR method. Patients were excluded if no EMR match or CPR method was unknown. Hospital EMRs were queried for CT imaging results, LOS variables and survival to hospital discharge. Injuries are identified using hospital ICD-10 codes. Univariate statistics are reported. Results: There were 808 patients admitted after OHCA, with 235 (103 mechanical CPR, 132 manual CPR) meeting the inclusion criteria. Demographics between groups were similar in age, gender, or body mass index (BMI). There were no abdominal/visceral injuries and few patients (4) had a pneumothorax. CPR associated injury was more common with manual CPR (28.8% vs 15.5%, p=0.02) and an increased rate of rib(s), sternum, or thoracic spine fracture (27.3% vs 14.6%, p=0.02). . We identified no differences in survival to hospital discharge (39 (29.5%) vs. 29 (28.2%), p=0.8), median hospital LOS, ICU LOS, and ventilator time between groups. Paradoxically amongst survivors, mechanical CPR was associated with longer LOS (15.7 vs 11.0 days, p=0.012) and a non-significant increased ventilator time (143 vs 99 hours, p=0.23). Conclusion: We identified a higher rate of injury with manual CPR compared to mechanical CPR in resuscitated OHCA patients We also did not identify any association between CPR method and ICU LOS, ventilator time, and survival. Further work is needed to assess the impact on outcome of CPR method and injuries typically associated with resuscitation.

Bridging the Gap in Traditional PIVC Placement: An Evaluation of Operation STICK Vascular Access Outcomes.

Education and training is core to improving peripheral intravenous access outcomes. This study aimed to show that a vascular access training program (Operation STICK) in the emergency department (ED) improves the outcomes of traditionally placed peripheral intravenous catheters (PIVC). This was a pre-post quasi-experimental study of traditionally placed PIVCs at a large ED in southeastern Michigan, United States. A control group (non-OSTICK) was compared to an experimental group (OSTICK) using a 3:1 propensity score matched analysis. Groups were comprised of ED patients with traditional PIVC placements in two separate six-month periods: non-OSTICK PIVCs from April to September 2021 and OSTICK PIVCs (placed by an OSTICK graduate) from October 2022 to March 2023. The primary outcome was PIVC functionality. The secondary outcome was adherence to best practices. A total of 6512 PIVCs were included in the study; 4884 (75.0%) were in the non-OSTICK group, while 1628 (25.0%) were in the OSTICK group. 68.1% of OSTICK PIVCs and 59.7% of non-OSTICK PIVCs were placed by ED technicians (p < 0.001). 91.3% of OSTICK PIVCs were placed on the first attempt, and 98.5% were placed within two attempts. A subgroup analysis of admitted patients (2540 PIVCs; 553 (21.8%) OSTICK-trained and 1987 (78.2%) non-OSTICK-trained) revealed 87.6% of OSTICK PIVCs and 80.3% of non-OSTICK PIVCs were 20 gauge (p < 0.001). The median proportion of dwell time to hospital length of stay was 94% for OSTICK PIVCs, compared to 88% for non-OSTICK PIVCs (p < 0.001). This study underscores the value of education and training in enhancing vascular access outcomes. Implementing Operation STICK, a comprehensive vascular access training program, at a large ED has led to high first-stick success, adherence to best practice recommendations for site and device selection, and improved PIVC functionality for traditionally placed catheters.

Opinion: inappropriate applications of phosphorus loading models in lake management regulatory policy

Lehman J. 2023. Opinion: inappropriate applications of phosphorus loading models in lake management regulatory policy. Lake Reserv Manage. 39:273–277.Imposition of total maximum daily load (TMDL) regulations based on external loading has little or no effectiveness when nuisance conditions are caused almost entirely by internal loading. A case study example from southeastern Michigan illustrates how persistent application of flawed management theory fails to achieve water quality objectives. Observations reveal that nuisance blooms are nearly contemporaneous with polymictic episodic injections of anoxic, phosphorus-rich hypolimnetic water into surface waters. Even a 10-fold increase in external loading during the Great Northeast Blackout of 2003 failed to trigger a nuisance bloom.

The Low-Back-Merger Shift: Evidence from MENA Americans in the Upper Midwest and southern California

Middle Eastern or North African (MENA) Americans are an understudied speech community in sociolinguistics. In terms of racial classification and identification, MENA Americans have been legally and historically classified as white but are not socially perceived as white (Beydoun, 2013, 2015). While early immigrants from MENA regions to the US were mostly Christians, ever since 1947, the majority of immigrants from MENA regions to the US have been from Muslim backgrounds (Orfalea, 2006); this demographic change can result in more ethnic visibility for MENA Americans in the US (cf., e.g., Shryock &amp; Lin, 2009, for a discussion of ethnic visibility of MENA Americans in southeastern Michigan). Higher ethnic visibility can in turn lead to certain linguistic performances on the part of MENA Americans. Several studies have looked at the interaction of ethnic identity/visibility and local vowel patterns such as the merging of the low back vowels (the vowels in THOUGHT and LOT1). For example, Hall–Lew (2009) showed that Asian Americans in San Francisco took part in the low back vowel merger and high back vowel fronting, which both index local meanings being part of the California Vowel Shift (Eckert, 2008). Going beyond one particular locality, Wong and Hall–Lew (2014) demonstrated clear influence of local dialect on the speech of Asian Americans in two different localities, with Asian Americans from NYC having distinct low back vowels and those from San Francisco merged low back vowels. Comparing the speech of three different ethnic groups in the multicultural context of Toronto, Hoffman and Walker (2010) explored two features of the Canadian Vowel Shift: the retraction of TRAP and the lowering and retraction of DRESS. Their findings showed that while Chinese Canadians disfavored these two patterns, British/Irish and Italian Canadians favored them. In another study in the context of California English, Cardoso et al. (2016) looked at subclasses of the TRAP vowel in the speech of Chinese Americans and white Americans of San Francisco. They found that the nasal split of TRAP (it being raised when followed by a nasal consonant, and being retracted and lowered when followed by an oral consonant) was more advanced for white speakers than the Chinese group. Cardoso et al. (2016) associated the observed difference to the social meaning of the TRAP nasal split in California indexing white or non-Chicanx social personae.

Honeybee visitation to shared flowers increases Vairimorpha ceranae prevalence in bumblebees.

Vairimorpha (=Nosema) ceranae is a widespread pollinator parasite that commonly infects honeybees and wild pollinators, including bumblebees. Honeybees are highly competent V. ceranae hosts and previous work in experimental flight cages suggests V. ceranae can be transmitted during visitation to shared flowers. However, the relationship between floral visitation in the natural environment and the prevalence of V. ceranae among multiple bee species has not been explored. Here, we analyzed the number and duration of pollinator visits to particular components of squash flowers-including the petals, stamen, and nectary-at six farms in southeastern Michigan, USA. We also determined the prevalence of V. ceranae in honeybees and bumblebees at each site. Our results showed that more honeybee flower contacts and longer duration of contacts with pollen and nectar were linked with greater V. ceranae prevalence in bumblebees. Honeybee visitation patterns appear to have a disproportionately large impact on V. ceranae prevalence in bumblebees even though honeybees are not the most frequent flower visitors. Floral visitation by squash bees or other pollinators was not linked with V. ceranae prevalence in bumblebees. Further, V. ceranae prevalence in honeybees was unaffected by floral visitation behaviors by any pollinator species. These results suggest that honeybee visitation behaviors on shared floral resources may be an important contributor to increased V. ceranae spillover to bumblebees in the field. Understanding how V. ceranae prevalence is influenced by pollinator behavior in the shared floral landscape is critical for reducing parasite spillover into declining wild bee populations.

Mapping cover crop species in southeastern Michigan using Sentinel-2 satellite data and Google Earth Engine.

Cover crops are a critical agricultural practice that can improve soil quality, enhance crop yields, and reduce nitrogen and phosphorus losses from farms. Yet there is limited understanding of the extent to which cover crops have been adopted across large spatial and temporal scales. Remote sensing offers a low-cost way to monitor cover crop adoption at the field scale and at large spatio-temporal scales. To date, most studies using satellite data have mapped the presence of cover crops, but have not identified specific cover crop species, which is important because cover crops of different plant functional types (e.g., legumes, grasses) perform different ecosystem functions. Here we use Sentinel-2 satellite data and a random forest classifier to map the cover crop species cereal rye and red clover, which represent grass and legume functional types, in the River Raisin watershed in southeastern Michigan. Our maps of agricultural landcover across this region, including the two cover crop species, had moderate to high accuracies, with an overall accuracy of 83%. Red clover and cereal rye achieved F1 scores that ranged from 0.7 to 0.77, and user's and producer's accuracies that ranged from 63.3% to 86.2%. The most common misclassification of cover crops was fallow fields with remaining crop stubble, which often looked similar because these cover crop species are typically planted within existing crop stubble, or interseeded into a grain crop. We found that red-edge bands and images from the end of April and early July were the most important for classification accuracy. Our results demonstrate the potential to map individual cover crop species using Sentinel-2 imagery, which is critical for understanding the environmental outcomes of increasing crop diversity on farms.

An Initiative to Increase Nurse Knowledge and Decrease Postpartum Readmissions for Preeclampsia

ObjectiveTo increase nurses’ knowledge using innovative education and to improve maternal outcomes by reducing postpartum readmission rates of women with preeclampsia. DesignQuality improvement project implementing escape room–style education for nurses. Setting/Local ProblemA large tertiary hospital in southeastern Michigan with initial postpartum readmission rates of women with preeclampsia exceeding national averages. ParticipantsRegistered nurses (n = 71) working on the hospital postpartum unit; 70 completed the project. Intervention/MeasurementsParticipants completed a knowledge survey on the care and management of women in the postpartum period with preeclampsia and then engaged in an escape room game scenario involving an increasingly acute case of a woman with preeclampsia. Debriefing occurred after the education, and then participants completed the same survey. Using data collected after the project, we compared postpartum readmission rates of women with preeclampsia to the median national average of 3.55%. ResultsNurse knowledge increased by 10.5% from the pre- to posttest period. For the 2-month project time period, the average readmission rate was 1.49%. ConclusionOffering innovative, interactive education to nurses, such as an escape room game, appeared to be an effective method to increase nurses’ knowledge and may have improved maternal outcomes, as demonstrated through a readmission rate lower than the median national average. Further projects using longer time periods are needed to understand the true impact of the education on readmission rates.

Transient rise in medical abortions at Michigan clinic during SARS-CoV-2 “stay-at-home” order

Background In response to the SARS-CoV-2 (COVID-19) pandemic, the State of Michigan enacted a “stay-at-home” executive order detailing social distancing guidelines on March 24, 2020, with an expiration date of June 1, 2020. Objectives Given that medical abortions allow for pregnancy tissue to be passed in the privacy of one’s home, the authors hypothesized that there would be an increase in medical abortions over first trimester surgical abortions in 2020 compared to 2019 due to social distancing guidelines. Study Design Retrospective data was collected from an abortion clinic in Southeastern Michigan between January 1, 2019 and December 31, 2020 (n=4,703). A negative binomial statistical model compared the number of medical abortions in 2019 to 2020. Each year was divided into quartile (Q) periods of three consecutive months. Analysis focused on the frequency and percentage of medical abortions in 2020 compared to 2019, with a focus on the relationship between quartiles. Results Medical abortions increased from a count of 702 in 2019, to 979 in 2020 (p-value=0.00499). There were statistically significant differences between 2019 and 2020 for Q2 (31.47% to 40.89%, p-value&lt;0.001) and Q3 (33.15% to 53.70%, p-value&lt;0.001), as well as a return-to-baseline in Q4, which is demonstrated by pre-executive order 2020 Q1 at 33.91% and post-executive order 2020 Q4 at 37.19%. Conclusions Statistically significant differences between 2019 and 2020 for Q2 and Q3 support the hypothesis that an increase in preference towards medical abortions over surgical abortions coincided with Michigan’s stay-at-home mandates; it was further supported by insignificant differences in 2019 and 2020 for Q1 and Q4. Understanding trends in patient choices for abortion access provides vital information for policymakers and healthcare providers to expand medical abortion care using remote options.

Risk of midline catheter-related thrombosis due to catheter diameter: An observational cohort study

ObjectiveDeep vein thrombosis is a common and serious complication associated with midline catheters (MC). The aim of this investigation was to determine if catheter diameter is related to development of thrombosis. MethodsThis was an observational cohort study conducted at a tertiary care academic center in Southeastern Michigan. Hospitalized adults that required a MC were eligible participants. Primary outcome was symptomatic MC associated upper extremity deep vein thrombosis (DVT) comparing three catheter diameters. Secondary outcomes included complications based on size and DVT comparing catheter to vein ratio. ResultsBetween January 1, 2017, and December 31, 2021, 3088 MCs met inclusion criteria; the distribution of 3 French (Fr), 4 Fr, and 5 Fr MCs was 35.1 %, 57.0 %, and 7.9 %, respectively. The majority of the population was female (61.2 %) and the average age was 64.2 years old. DVT occurred in 4.4 %, 3.9 %, and 11.9 % of 3 Fr, 4 Fr, and 5 Fr MCs, respectively (p < 0.001). In multivariable regression analysis, there was no difference in the odds of developing DVT for the 4 Fr MC compared to the 3 Fr (aOR 0.88; 95 % CI 0.59–1.31; p = 0.5243), however, there was significantly higher odds for the 5 Fr (aOR 2.72; 95 % CI 1.62–4.51; p = 0.001). Additionally, for every additional day the MC was in place, the odds of DVT increased by 3 % (aOR 1.03; 95 % CI 1.01–1.05; p = 0.0039). When comparing accuracy of the size model versus catheter to vein ratio model for predicting DVT, receiver operating characteristic curve analysis demonstrated the area under the curve for size was 73.70 % (95 % CI 68.04 %–79.36 %) compared to 73.01 % (95 % CI: 66.88 %–79.10 %) for catheter-to-vein ratio. ConclusionsSmaller diameter catheters should be preferentially chosen to mitigate the risk of thrombosis when therapy via midline catheters is required. Choosing a catheter based on reduced size or 1:3 catheter to vein ratio threshold has similar accuracy in predicting DVT.

Understanding refugee and immigrant health literacy and beliefs toward antimicrobial resistance

Background: Antimicrobial resistance (AMR) is a global health threat, particularly in refugee populations, due to challenges posed by migration. Little guidance has been provided by public health agencies regarding antimicrobial stewardship specific to this demographic. Studies have primarily focused on encampment areas abroad. We sought to better understand health literacy and beliefs regarding AMR in local refugee and immigrant populations in southeastern Michigan. Methods: From November 1, 2022 to March 10, 2023, we distributed an anonymous questionnaire to adult patients at four primary care clinics in Southeastern Michigan and made it available online. The questionnaire collected demographic information and used 5-point Likert scale responses regarding antibiotic use in children with symptoms of respiratory infection. We binarized the questions and responses to determine whether respondents provided the preferred response and added these to create an overall health literacy score, then used simple linear and multivariable linear regression modeling to identify demographic variables independently associated with the health literacy score. Chi-squared and Mann-Whitney tests were also performed where appropriate. Results: Immigrants and refugees/asylum-seekers from low or middle-income countries (group A, n = 109) were compared to native-born Americans and immigrants from high-income countries (group B, n = 171) with participants from 40 countries (Figure 1). Age distribution did not differ between groups, while group B had generally longer duration of living in the United States (Figure 2). Differences were found in other demographic categories except female gender, with group B reporting higher income, educational levels, and English ability (Figure 3). Simple linear regression revealed that all demographic variables except age significantly correlated with responses (Figure 4). Multivariable linear regression showed that female gender, educational level, and age correlated with greater health literacy, while being in group A trended towards significance with respect to correlating with lesser health literacy (Figure 5). Conclusions: Immigrants and refugees/asylum-seekers from LMICs demonstrated beliefs suggesting deficits in knowledge of AMR compared to native-born Americans and those from high-income countries, independent of other potentially confounding demographic characteristics. Female gender, educational level, and age independently correlated with greater health literacy. These results could inform future patient-centered antimicrobial stewardship educational interventions in certain target populations such as immigrants and refugees/asylum-seekers in the United States.Disclosures: None

Genetic relatedness among Neisseria gonorrhoeae isolates in southeastern Michigan

Background: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) is an emerging public health crisis. Whole-genome sequencing (WGS) is an efficient way of predicting AMR determinants and their spread in the population. In a previous study, genotype–phenotype correlation analyses among NG isolates to determine antimicrobial resistance revealed discordance for azithromycin (AZM) and ceftriaxone (CRO) compared to other antibiotics. We investigated the evolutionary relatedness of NG isolated from patients with sexually transmitted infection (STI) using WGS in southeastern Michigan. Methods: Isolates, corresponding demographic data, and minimum inhibitory concentrations (MIC) via E-test (CRO) and broth microdilution (AZM) were obtained from the Michigan Department of Health and Human Services. Whole-genome libraries were prepared using the QIAseq FX kit followed by sequencing on a NovaSeq6000 (&gt;200X Coverage); samples were aligned to NG reference strain TUM19854 (NZ_AP023069.1) using Snippy before phylogenetic tree generation using Neighbor-joining clustering on the core.aln files. Phylogenetic trees were visualized using ATGC:PRESTO. Results: In total, 38 isolates were analyzed. Demographic data and susceptibility testing results are noted in Table 1. Most isolates were from males (63%), Blacks (44.7%), individuals living in Detroit City proper (47.3%), and those with unknown HIV status (55.2%). More than one-third had prior STI, including NG. All isolates were susceptible to CRO (CLSI susceptible breakpoint MIC, 1). Within the phylogenetic tree, 8 main branches were identified (Fig. 1). Moreover, 1 branch contained a cluster with 12 closely related isolates, which included the 9 isolates with nonsusceptible AZM. Nearly all isolates in that cluster had been collected from Detroit City proper and Wayne County, suggesting epidemiological overlap and potential spread of resistant strains in those counties.Conclusions: Comparative whole-genome and phylogenetic analyses among a subset of NG isolates revealed clustering of AZM resistance strains, suggesting a genomic component to AMR. Further studies are needed to determine the utility of WGS in diagnosis, outbreak investigations, and management of NG infections.Disclosures: None