Suffolk County Research Articles

667. An Emerging Tick-Borne Disease in Long Island, New York: Relapsing Fever Caused by Borrelia miyamotoi

BackgroundSuffolk County (Long Island, New York) reports annually the highest absolute number of tick-borne diseases in New York. A new Borrelia species, Borrelia miyamotoi which causes a relapsing fever, has been reported in New York recently. The aim of this study was to identify the number of cases of B. miyamotoi diagnosed in Suffolk county.MethodsA retrospective chart review was performed in Stony Brook (SB) Medicine hospitals, SB University Hospital (the only tertiary medical center in Suffolk County) and Southampton Hospital (a major hospital in the east end of Suffolk County). Laboratory records were queried for a positive B. miyamotoi PCR test from blood or a positive IgG antibody with a B. miyamotoi-specific EIA that utilizes a recombinant GlpQ antigen (both tests performed in a commercial laboratory).ResultsTwenty-eight cases were positive for serology (IgG EIA; n = 19) or PCR (n = 9). None of the IgG-positive cases had a positive PCR result indicating that individuals were likely exposed to B. miyamotoi in the past. Of the nine PCR-positive cases (median age:67 years), eight were men, three were diagnosed in the outpatient clinic (33.3%) and six were diagnosed through the emergency department and required hospitalization (66.6%). Thrombocytopenia and transaminitis were common findings. Two-thirds of these nine cases were diagnosed in the period of 2016–2017 and one-third in the period, 2013–2015 (P = 0.17).ConclusionAn increasing number of cases of B. miyamotoi were observed in Suffolk County during 2013–2017 and two-thirds required hospitalization. The real burden of this tick borne disease in Suffolk County and the rest of the state is unknown.Table 1: Clinical-Demographics Features of B. miyamotoi Cases Diagnosed by PCR Blood Test Year of Presentation Age (Years) Gender Symptoms Leukocytes (/mm 3) Hemoglobin (g/dL) Platelets (/mm 3) Creatinine (mg/dL) AST (U/L) ALT (U/L) 2013 74MN/A4,60014.2154,0000.72128 2015 67FFlu-like syndrome5,50014.7260,0000.83323 2015 64MFlu-like syndrome3,60014.1109,0000.76574 2016 32MN/A3,00015.6166,00019865 2016 68MN/AN/AN/AN/AN/A2018 2016 74MFlu-like syndrome and vomiting6,80015.651,0003.1212165 2017 90MFever and vomiting4,1009.791,0001.467446 2017 22MFever and diarrhea3,20014.799,0000.873117 2017 26MFever and diarrhea5,40016.3127,0001.055168AST, aspartase transaminase; ALT, alanine transaminase; N/A, no available.Disclosures All authors: No reported disclosures.

665. Key Clinical and Laboratory Features in Early Diagnosis of Ehrlichiosis in an Endemic Area of Long Island, New York

BackgroundHuman monocytic ehrlichiosis (HME) is a tick-borne disease caused by Ehrlichia chafeensis in the northeast United States. Suffolk County, New York has the highest amount of HME cases in NY (176 from 2010 to 2014). Our aim is to identify risk factors for HME and compare clinical presentation and laboratory findings of young vs. older adults.MethodsA retrospective chart review from January 1, 2014 to December 31, 2017 was performed on all patients ≥18 years who presented to the ER at Stony Brook University Hospital (SBUH) or Stony Brook Southampton Hospital (SBSH) with (i) ICD-9 code 082.4 or ICD-10 code A77.40 and (ii) a positive E. Chafeensis PCR. Data were collected on demographics, clinical presentation, and laboratory results.ResultsTwenty-seven cases of HME were found and separated into Group 1 (G1, n = 10) or Group 2 (G2, n = 17) based on age (Table 1). G1 had a significantly higher chance of being Hispanic than G2. Twenty-four of the 27 patients (89%) were hospitalized with an average length of stay of 3.4 days (range 1–14 days).The only significant difference in clinical presentation was that G1 was more likely to have myalgia (P = 0.02). 40% or more of patients in both groups presented with an acute kidney injury and the average length of hospital stay in days was 4.0 ± 2.9 and 3.2 ± 3.1 for G1 and G2, respectively. The number of cases overall have increased 6.0% per year between 2014 and 2017. Thrombocytopenia presented in all cases. Ehrlichiosis <65 years (n = 10) ≥ 65 years (n = 17) P value Median age 5779SD6.575.45 Average length of hospital stay (days)4.03.2SD2.943.10 Sex Male8 (80%)10 (58.8%)0.3Female2 (20%)7 (41.2%)0.3 Ethnicity Hispanic3 (30%)00.02Non-Hispanic7 (70%)17 (100%)0.02 Clinical presentation Fever7 (70%)12 (70.6%)1.0Headaches/dizziness5 (50%)7 (41.2%)0.7Arthralgia3 (30%)2 (11.8%)0.2Fatigue10 (100%)14 (82.4%)0.4Myalgia7 (70%)4 (23.5%)0.02Tick exposure4 (40%)10 (58.8%)0.4 Laboratory Leukopenia8 (80)15 (88.2)0.6Anemia3 (30%)10 (58.8%)0.2Thrombocytopenia10 (100%)17 (100%)1.0AKI4 (40%)8 (47.1%)0.7Transaminitis8 (80%)15 (88.2%)0.6Conclusion. HME is prevalent in Suffolk County. Clinical presentation and laboratory findings were largely similar between the two groups, except the younger population more often presented with myalgia. A risk factor in this study was to be young and Hispanic, likely due to occupational exposure.Disclosures All authors: No reported disclosures.

662. Tick Borne-Associated Thrombocytopenia Among United States Veterans in Long Island New York

BackgroundLong Island, New York, is highly endemic for tick borne illnesses (TBI) with rising numbers of cases in the past years. Thrombocytopenia is a known complication of babesiosis caused by Babesia microti, anaplasmosis caused by Anaplasma phagocytophilum, and ehrlichiosis caused by Ehrlichia chaffeensis. We identified cases of thrombocytopenia attributed to TBI in our institution.MethodsRetrospective chart review of patients diagnosed with babesiosis, anaplasmosis, and ehrlichiosis from 2000 to 2017 at Northport Veterans Affairs Medical Center. Demographics, method of diagnosis (PCR/serologies), CBC/chemistries, treatment choices, and outcomes were analyzed.ResultsThirty-two veterans (VETS) were identified with the following TBI: Babesiosis 22, Ehrlichiosis 6, Anaplasmosis 4. The majority of cases (19) were from Suffolk County, Long Island. The median (MED) age of this group was 62 years (range 31–89). Ninety-one percent were Caucasian, 9% Black. 37.5% had history of tick bite. The MED temperature on presentation was 101.9°F (range 97.6–105.2°F). 56% had HTN, 6% DM, 37% HLD, 9% hepatitis C, 3% HIV. Laboratory studies: MED platelet count 88,000/µL (36,000–161,000); MED hemoglobin 12 gm/dL (5.6–15.6); MED ALT 41 IU/L (6–330); MED LDH 335 IU/L (193–1,322). Twelve VETS had positive C6 peptide. The peak MED B. microti parasitemia was 1.4% (0.1–3%). PCR tests were available in the later years of the study period: three were positive for E. chaffeensis, two for A. phagocytophilum, and 14 for B. microti. The majority of the cases (19) were observed after year 2010. Morulae were seen in only one case. Haptoglobin in eight VETS was undetectable. One veteran with history of splenectomy and babesiosis with 3% parasitemia required exchange transfusion with 12 units of PRBCs. Two other babesiosis cases required regular transfusion of PRBCs. 20 babesiosis cases were treated with azithromycin-atovaquone and two with clindamycin-primaquine. Doxycycline was used in the other cases. One patient developed NSTEMI and required coronary stent placement. Platelet counts returned to baseline levels with treatment. No deaths occurred.ConclusionThe incidence of TBI in Long Island, New York is rising. PCR testing for TBI can be utilized in our VETS presenting with febrile illness and thrombocytopenia to help identify the possible tick borne pathogen during the months of high tick activity.Disclosures All authors: No reported disclosures.

2202. The Hepatitis C Virus Cascade of Care at Stony Brook University Hospital: Risk Factors for Linkage to Care

BackgroundHuge efforts are being made to screen high-risk populations for Hepatitis C virus (HCV) infection, however linkage to care (LTC) rates remain low. The aim of this study was to assess the factors affecting LTC among HCV positives in a major tertiary academic medical center in eastern New York.MethodsA retrospective chart review was performed on all patients with ICD-9 or 10 diagnostic codes for HCV positive antibody over a period of 2 years (2016–2017) at Stony Brook Medicine. Data were collected for HCV RNA, LTC, demographics, type of insurance, employment status, psychiatric diagnosis, comorbidities, HIV or HBV coinfections, substance use disorder, and level of fibrosis. Univariate and multivariate analyses were performed to find associated factors with LTC.ResultsA total of 600 cases (62.6% male; 74% White; median age: 59 years) had a positive HCV antibody, 264 (44.4%) had a positive follow-up HCV RNA test and 138 (52.2%) were LTC. The average time for LTC was 1.5 months (50 days; interquartile range 21–121). In the univariate analysis, the following factors were significantly associated with LTC: older age (OR 1.022), having medicaid (OR 0.421), people who inject drugs (PWID) (OR 0.216), cocaine and marijuana use (OR 0.457), polysubstance use (OR 0.311), having a primary care provider (OR 2.290) and being a baby boomer (OR 1.718). The vast majority of patients came from three zip codes within south central Suffolk County, coinciding with the highest prevalence of heroin use.ConclusionIn this population insurance type, younger age and substance use (injection drugs, marijuana, cocaine, polysubstance) were associated with lower odds of LTC. Having a primary care provider and being a baby boomer were the only two independent risk factors associated with increased odds of LTC. Due to an increased number of HCV cases in younger populations, particularly PWID, further outreach efforts are urgently needed to spread HCV screening awareness and increase testing in high prevalence areas.Disclosures All authors: No reported disclosures.

Twenty years of surveillance for Eastern equine encephalitis virus in mosquitoes in New York State from 1993 to 2012

BackgroundThe year 1971 was the first time in New York State (NYS) that Eastern equine encephalitis virus (EEEV) was identified in mosquitoes, in Culiseta melanura and Culiseta morsitans. At that time, state and county health departments began surveillance for EEEV in mosquitoes.MethodsFrom 1993 to 2012, county health departments continued voluntary participation with the state health department in mosquito and arbovirus surveillance. Adult female mosquitoes were trapped, identified, and pooled. Mosquito pools were tested for EEEV by Vero cell culture each of the twenty years. Beginning in 2000, mosquito extracts and cell culture supernatant were tested by reverse transcriptase-polymerase chain reaction (RT-PCR).ResultsDuring the years 1993 to 2012, EEEV was identified in: Culiseta melanura, Culiseta morsitans, Coquillettidia perturbans, Aedes canadensis (Ochlerotatus canadensis), Aedes vexans, Anopheles punctipennis, Anopheles quadrimaculatus, Psorophora ferox, Culex salinarius, and Culex pipiens-restuans group. EEEV was detected in 427 adult mosquito pools of 107,156 pools tested totaling 3.96 million mosquitoes. Detections of EEEV occurred in three geographical regions of NYS: Sullivan County, Suffolk County, and the contiguous counties of Madison, Oneida, Onondaga and Oswego. Detections of EEEV in mosquitoes occurred every year from 2003 to 2012, inclusive. EEEV was not detected in 1995, and 1998 to 2002, inclusive.ConclusionsThis was the first time in NYS that EEEV was detected in Cx. salinarius, Ps. ferox and An. punctipennis. The detection of EEEV in mosquitoes every year for 10 years was the longest time span since surveillance began in 1971. The calendar date of the earliest annual appearance of EEEV in mosquitoes did not change during surveillance spanning 42 years.

Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State.

Ocular infections caused by human adenovirus (HAdV) are highly contagious. The most severe are usually caused by members of species HAdV-D (types HAdV8, 19, 37, 53, 54, and 56) and can manifest as epidemic keratoconjunctivitis (EKC), often resulting in prolonged impairment of vision. During the early months of 2012, EKC outbreaks occurred in neonatal intensive care units (NICUs) in 3 hospitals in New York State (New York and Suffolk Counties). A total of 32 neonates were affected. For 14 of them, HAdV8 was laboratory-confirmed as the causative agent. Nine healthcare workers were also affected with 3 laboratory-confirmed, HAdV-positive EKC. A fourth EKC outbreak was documented among patients attending a private ophthalmology practice in Ulster County involving a total of 35 cases. Epidemiological linkage between the neonatal intensive care unit outbreaks was demonstrated by molecular typing of virus isolates with restriction enzyme analysis and next generation whole genome sequencing. The strain isolated from the ophthalmology clinic was easily distinguishable from the others by restriction enzyme analysis.

Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period?

Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period?

Using Scan Statistic to Detect Heroin Overdose Clusters with Hospital Emergency Room Visit Data

ObjectiveTo utilize syndromic surveillance data timely detecting herion overdose outbreaks in the community.IntroductionEarly detection of heroin overdose clusters is important in the current battle against the opioid crisis to effectively implement prevention and control measures. The New York State syndromic surveillance system collects hospital emergency department (ED) visit data, including visit time, chief complaint, and patient zip code. This data can be used to timely identify potential heroin overdose outbreaks by detecting spatial-temporal case clusters with scan statistic.MethodsHeroin overdose cases (Heroin_OD) were identified from ED visits by searching Heroin_OD key terms in the chief complaints. Then the space-time permutation model (using the SaTScan package) was applied to detect clusters of Heroin_OD. ED visit date served as the time variable and the case residential zip code was the spatial coordinate variable for the SaTScan analysis. A SAS program was developed to carry out the prospective scan statistics analysis weekly and produces reports of detected clusters in table and map format. Cluster detection parameters were set to detect heroin overdose aggregation in maximum geographic radium of 20 kilometer (km) and maximum time span up of 21 days at the P-value &lt;= 0.05. Chief complaints within the clusters are reviewed to ensure accuracy of detection. Messages have been developed and are shared with community members including law enforcement and public health identifying the cluster and offering suggestions of activities that can occur at the local level to identify and address the cause of the cluster, as well as to reduce potential harm. This includes the 23 syringe exchange programs (SEPs) regulated by the New York State Department of Health.ResultsUsing ED visit data from 138 NY upstate hospitals, a total of 12 Heroin_OD clusters were detected by the SaTScan analysis during the period of 9/1/2016 through 9/17/2017. There were 845 cases identified. The average age was 35 years and ranged from 7 to 95 years. Sixty nine percent (69%) of the cases was in 20 to 39 age group and 66% in males. A cluster was identified earlier 2017 in Suffolk County, and the local SEP was alerted. This encouraged communication between partners within the alerted county which ultimately resulted in identifying the substance endangering people who used drugs in the area. It also helped public health to partner with public safety, ensuring that the availability of the substance was interrupted.ConclusionsAs the space-time permutation scan statistic only requires disease counts, event date and disease location, the method can be easily implemented for detecting disease outbreaks using data routinely collected from disease surveillance systems. The current study showed that scan statistic is a useful tool for identifying clusters of non-fatal overdoses from specific drugs. This method also returns important information to assist outbreak investigations, such as geographic location and time-span of the potential outbreaks.

An 85-Year-Old Man With Recurrent Fever and Multiple Splenic Infarcts.

An 85-Year-Old Man With Recurrent Fever and Multiple Splenic Infarcts.

24.3 EIGHTEEN-YEAR COURSE OF COGNITIVE FUNCTIONING IN PSYCHOTIC DISORDERS: FINDINGS FROM THE SUFFOLK COUNTY MENTAL HEALTH LONGITUDINAL STUDY

BackgroundKnowledge about the long-term cognitive course in psychotic disorders is limited. In this 18-year follow-up of participants of the Suffolk County project we report on the longitudinal course of cognitive performance in individuals with schizophrenia spectrum disorders, affective psychoses and other psychoses. We investigate (i) change in functioning in 6 cognitive domains from 2-years to 20-years follow-up after first admission; (ii) 20-year performance and age-related differences in cognitive performance in patients relative to a never psychotic comparison group; and (iii) key predictors of clinically meaningful cognitive decline in patients.MethodsData came from the Suffolk County Mental Health Project, a prospective study of first-admission patients. Cognitive tests were administered 2 years (n = 399; schizophrenia spectrum: 285, affective psychoses: 226, other psychoses: 117) and 20 years (n = 240; 115, 92, and 34, respectively) after first admission, with 195 individuals completing cognitive tests at both time points. A never psychotic comparison group (N=260) was assessed at year 20.ResultsIndividuals with schizophrenia spectrum disorders showed lower cognitive functioning than those with affective and other psychoses. Over time, patients declined in cognitive performance on almost all tests (d = 0.24 (range 0.12- 0.44)) with comparable magnitude across diagnoses. Longer duration of untreated psychosis and low childhood IQ were significantly associated with clinically relevant decline (>0.5SD) in general verbal ability and processing speed, but there were no robust predictors of cognitive decline across tests. Cross-sectional comparisons of patients to controls showed increasing impairments with age for general verbal ability, verbal fluency, and executive functioning.DiscussionOur findings indicate that cognitive functioning in psychotic disorders continues to decline after the illness onset, that this decline is not specific to schizophrenia but present across psychotic disorders, and that, relative to never-psychotic individuals, impairments on some key-cognitive domains worsen with age. These results imply that cognitive treatment should not only include cognitive remediation but also prevention of age-related cognitive stagnation and/or decline.

5. RETHINKING THE TAXONOMY, COURSE, AND OUTCOME OF PSYCHOSES: DIMENSIONAL, LATENT TRAJECTORY, AND TRANSDIAGNOSTIC APPROACHES

Overall : Evidence continues to accumulate on heterogeneity in phenomenology, course and outcome of non-affective and affective psychotic disorders. Both DSM and ICD classification systems have evolved to include a large number of categories of psychosis. However, doubt remains about this categorical approach because of high comorbidity, common etiological factors and the absence of zones of relative rarity between categorical diagnoses. Some authors have nevertheless argued that categorical representations of psychosis may still be of clinical utility if used in combination with dimensional indicators.It is now widely accepted that psychotic symptoms partition into several symptom dimensions that would support the heterogeneity of psychotic disorders. However, there is no consensus on the exact number of these dimensions, with previous factor-analytic work pointing towards models with two to twelve specific symptom dimensions. However, recently, there has been evidence for a transdiagnostic dimension underlying affective and non-affective psychotic symptoms in schizophrenia, schizoaffective and bipolar disorder that challenges their classification as distinct diagnostic constructs. There is also considerable heterogeneity in clinical course and outcome of psychotic disorders, but how to best map and model this over time remains to be established. Taken together, this presents significant challenges for the classification of psychotic disorders as separate diagnostic entities.This symposium brings together international researchers at the forefront of research into the phenomenology, course and outcome of psychotic disorders. Roman Kotov will present novel data on symptom dimensions and examines the course of these dimensions in an epidemiologic cohort of 628 first-admission inpatients with psychosis interviewed 6 times over two decades in the Suffolk County Mental Health Project. Craig Morgan will report new findings from the 10-year follow-up of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP-10) study, an epidemiological cohort of 552 patients with a first episode psychosis, using a data driven approach to identify latent trajectory classes to account for heterogeneity in patterns of change in psychotic symptoms over time and characterize these trajectories with the WHO classification, baseline demographic characteristics and diagnoses. Ulrich Reininghaus will present novel data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium to investigate whether there is a transdiagnostic dimension cutting across symptoms of schizophrenia, schizoaffective disorder and psychotic bipolar I disorder. Diego Quattrone will report recent findings from EU-GEI Functional Enviromics Study on genetic and socio-environmental factors associated with transdiagnostic and specific symptom dimensions of non-affective and affective psychosis. Robin Murray will discuss these findings in the context of new challenges in the field and directions for future research.

Exposure to Suicide in High Schools: Impact on Serious Suicidal Ideation/Behavior, Depression, Maladaptive Coping Strategies, and Attitudes toward Help-Seeking.

Adolescents’ exposure to a peer’s suicide has been found to be associated with, as well as to predict, suicidal ideation and behavior. Although postvention efforts tend to be school-based, little is known about the impact of a schoolmate’s suicide on the school’s student population overall. The present study seeks to determine whether there is excess psychological morbidity among students in a school where a schoolmate has died by suicide, and whether students’ attitudes about coping and help-seeking strategies are more or less problematic in such schools. Students in twelve high schools in Suffolk and Westchester counties in New York State—2865 students at six schools where a student had died by suicide within the past six months, and 2419 students at six schools where no suicide had occurred within the current students’ tenure—completed an assessment of their suicidal ideation and behavior, depressive symptoms, coping and help-seeking attitudes, stressful life events, and friendship with suicide decedent (if applicable). No excess morbidity (i.e., serious suicidal ideation/behavior and depression) was evident among the general student population after a schoolmate’s death by suicide; however, the risk of serious suicidal ideation/behavior was elevated among students at exposed schools who had concomitant negative life events. There was a significant relationship between friendship with the decedent and morbidity, in that students who were friends, but not close friends, of the decedents had the greatest odds of serious suicidal ideation/behavior. Overall, students in exposed schools had more adaptive attitudes toward help-seeking; but this was not true of the decedents’ friends or students with concomitant negative life events. The implications of the findings for postvention strategies are discussed.

Editor's perspective – Per‐ and polyfluorinated substances pose substantial challenges to remediation practitioners

Editor's perspective – Per‐ and polyfluorinated substances pose substantial challenges to remediation practitioners

Associations of independent living and labor force participation with impairment indicators in schizophrenia and bipolar disorder at 20-year follow-up

BackgroundSince the Iowa 500 study, residential and occupational status have been frequently used as indicators of everyday achievements in research on schizophrenia and bipolar disorder. The relationships of residential and occupational status with impairment in multiple domains including physical health indicators across these two diagnoses, however, have rarely been studied. We examined these relationships at the 20-year follow-up assessment of a first-admission sample. MethodsWe included 146 participants with schizophrenia and 87 with bipolar disorder with psychosis who participated in the 20-year follow-up of the Suffolk County Mental Health Project. In addition to interviewer-based ratings of employment and residential independence, we examined self-reported impairment derived from the WHODAS, standard measures of current psychopathology, indicators of obesity, as well as performance-based measures of physical and cognitive functioning. ResultsParticipants with bipolar disorder were more likely to live independently and be gainfully employed; they also performed significantly better on each indicator of impairment apart from balance ability. In both groups, unemployment, but not residential independence, was associated with greater self-reported disability on the WHODAS. Residential independence, gainful employment, and subjective disability were also associated with better physical functioning. Across the two groups, psychiatric symptoms and physical functioning were the major determinants of subjective disability. DiscussionPeople with psychotic bipolar disorder were more likely to be gainfully employed and living independently than participants with schizophrenia but as a group, much less frequently than population standards. Interventions aimed at physical fitness may have the potential to improve both objective functioning and perceived disability.

Exploring the role of voluntary disease schemes on UK farmer bio-security behaviours: Findings from the Norfolk-Suffolk Bovine Viral Diarrhoea control scheme.

The article describes the influence of a disease control scheme (the Norfolk-Suffolk Bovine Viral Diarrhoea Disease (BVD) Eradication scheme) on farmers' bio-security attitudes and behaviours. In 2010, a survey of 100 cattle farmers (53 scheme members vs. 47 out of scheme farmers) was undertaken among cattle farmers residing in Norfolk and Suffolk counties in the UK. A cross-sectional independent measures design was employed. The main analytical tool was content analysis. The following variables at the farmer-level were explored: the specific BVD control measures adopted, livestock disease priorities, motivation for scheme membership, wider knowledge acquisition, biosecurity behaviours employed and training course attendance. The findings suggest that participation in the BVD scheme improved farmers' perception of the scheme benefits and participation in training courses. However, no association was found between the taking part in the BVD scheme and livestock disease priorities or motivation for scheme participation, or knowledge about BVD bio-security measures employed. Equally importantly, scheme membership did appear to influence the importance accorded specific bio-security measures. Yet such ranking did not appear to reflect the actual behaviours undertaken. As such, disease control efforts alone while necessary, are insufficient. Rather, to enhance farmer bio-security behaviours significant effort must be made to address underlying attitudes to the specific disease threat involved.

Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project.

Kraepelin considered declining course a hallmark of schizophrenia, but others have suggested that outcomes usually stabilize or improve after treatment initiation. The authors investigated this question in an epidemiologically defined cohort with psychotic disorders followed for 20 years after first hospitalization. The Suffolk County Mental Health Project recruited first-admission patients with psychosis from all inpatient units of Suffolk County, New York (response rate, 72%). Participants were assessed in person six times over two decades; 373 completed the 20-year follow-up (68% of survivors); 175 had schizophrenia/schizoaffective disorder. Global Assessment of Functioning (GAF), psychotic symptoms, and mood symptoms were rated at each assessment. Month 6, when nearly all participants were discharged from the index hospitalization, was used as a reference. In the schizophrenia group, mean GAF scores declined from 49 at month 6 to 36 at year 20. Negative and positive symptoms also worsened (Cohen's d values, 0.45-0.73). Among participants without schizophrenia, GAF scores were higher initially (a mean of approximately 64) but declined by 9 points over the follow-up period. Worsening began between years 5 and 8. Neither aging nor changes in antipsychotic treatment accounted for the declines. In all disorders, depression improved and manic symptoms remained low across the 20 years. The authors found substantial symptom burden across disorders that increased with time and ultimately may undo initial treatment gains. Previous studies have suggested that better health care delivery models may preempt this decline. In the United States, these care needs are often not met, and addressing them is an urgent priority.

A case study of an autonomous wireless sensor network system for environmental data collection

This article presents a case study of the design of an autonomous wireless sensor network for environmental monitoring to provide data for understanding the relationships among food, energy, and water systems in suburban areas in Long Island New York. The study focuses on the existing water quality data for the two counties on Long Island, Nassau and Suffolk Counties, to understand the impact of energy and food production on the coastal waters of Long Island Sound and Peconic Bay. The analysis of existing data from the US Environmental Protection Agency database reveals the challenges in using such data to understand the relationships between water quality, weather events and identified point sources of pollutants. Maintaining on-going data collection programs is expensive, time-consuming and personnel intensive which is why this project examines new ways to obtain and utilize environmental data. The researchers propose the design of an autonomous wireless sensor network environmental monitoring system with an optimal sensor placement strategy to identify targeted locations for water quality monitoring. The goal is to provide environmental data that can facilitate a better understanding of the interactions of farming activities and energy production resulting in undesirable impacts on water quality. The proposed design can be used to provide real-time data to help stakeholders improve efficiency in resource management and advance early detection of potential hazardous events. © 2017 American Institute of Chemical Engineers Environ Prog, 2017

Health status and mobility limitations are associated with residential and employment status in schizophrenia and bipolar disorder

IntroductionSchizophrenia (SCZ) and bipolar disorder (BP) are linked to multiple impairments in everyday functioning which share cognitive and symptom risk factors. Other risk factors for critical aspects of every day functioning (e.g., gainful employment; residential independence) such as physical health have not been evaluated, despite poor health in SCZ and BP. MethodsWe analyzed 20-year follow-up data from the Suffolk County Mental Health Project cohort of consecutive first admissions with a psychotic disorder to 12 psychiatric facilities in Suffolk County, NY, between September 1989 and December 1995. Both 20-year symptom, health, and cognition data, and the 20-year course of weight gain were included as predictors of employment and residence status. ResultsThe analysis sample consisted of 122 participants with SCZ ad BP, with SCZ participants less likely to work or live independently. Correlational analyses showed symptoms and cognition predicted vocational outcomes in both samples. The effect of diagnosis was significant for both gainful employment and independence in residence. After consideration of diagnosis, mobility and negative symptoms predicted gainful employment in both samples, but there were no additional predictors of residential independence. Prospective analysis of BMI found that baseline BMI, but not changes during the 20-year follow up, predicted labor force participation. DiscussionHealth status limitations were associated with residential and, particularly, employment status independent from other, previously established predictors of everyday outcomes, including cognition and symptoms. The importance of health status limitations for predicting outcome was confirmed in both SCZ and BP, with schizophrenia representing the more impaired group.

Do hospital admission rates increase in colder winters? A decadal analysis from an eastern county in England.

The aim of the study was to measure the effect of colder winters compared to warmer winters on hospital admission rates in Suffolk County. The setting of this study was Suffolk County in eastern England. The period of the study was financial years 2003/04-2012/13. The study was an analytic ecological study. Analysis involved calculation of rate ratios of hospital admission rates in colder winters compared to warmer winters, in all persons and the elderly. The main finding of the study was that all rate ratios for hospital admission rates in colder winters compared to warmer winters were significantly raised with effects of 2-5%. Rate ratios for all admissions in persons of all ages and persons aged 65 years and over were, respectively, 1.02 (99% confidence interval (CI): 1.01, 1.03; P < 0.001) and 1.02 (99% CI: 1.01, 1.04; P < 0.001). Rate ratios for emergency admissions in persons of all ages and persons aged 65 years and over were, respectively, 1.05 (99% CI: 1.03, 1.06; P < 0.001) and 1.04 (99% CI: 1.01, 1.06; P < 0.001). In Suffolk County, hospital admission rates are significantly raised in colder winters compared to warmer winters. This evidence may be useful in planning hospital services.

Twenty-year progression of body mass index in a county-wide cohort of people with schizophrenia and bipolar disorder identified at their first episode of psychosis.

There is an increased prevalence of obesity in schizophrenia and bipolar disorder, leading to a disproportionate risk of adverse health conditions. Prospective, long-term weight gain data, however, are scarce. We analyzed data from the Suffolk County Mental Health Project cohort of consecutive first admissions with psychosis recruited from September 1989 to December 1995 and subsequently followed for 20years, focusing on people with schizophrenia (n=146) and bipolar disorder (n=87). The time course of weight gain was examined using a 2 (group)×5 (time) mixed-model repeated measures ANOVA, and body mass index (BMI) scores at the first (6months) and second (2years) assessments were compared to examine whether early overweight predicted later obesity. There was a statistically significant effect of time (F(1,210)=68.06, P<.001) and diagnosis (F(1,210)=29.18, P<.001) on BMI, but not the interaction of time×diagnosis (F(1,210)=0.88, P=.48). Most participants had normal BMIs at the first two assessments. Early overweight was a predictor of eventual obesity for both groups. At the 20-year follow-ups, approximately 50% of the bipolar and 62% of the schizophrenia sample were obese, with a greater prevalence of obesity in schizophrenia at each assessment (all P<.02), except for years 4 (P=.12) and 20 (P=.27). Nearly two-thirds of the participants with schizophrenia and over half of those with bipolar disorder were obese 20years after first hospitalization for psychosis, considerably higher than the rate for adults in New York State (27%). Early intervention may be required to prevent long-term consequences of obesity-related morbidity and mortality.