5 results
Decreased Hospitalizations and Costs From Infection in Sixteen Nursing Homes in the SHIELD OC Regional Decolonization Initiative
- Gabrielle M. Gussin, James A. McKinnell, Raveena D. Singh, Ken Kleinman, Amherst Loren Miller, Raheeb Saavedra, Lauren Heim, Marlene Estevez, Tabitha D. Catuna, Eunjung Lee, Thomas Tjoa, Rachel Slayton, Nimalie Stone, John Jernigan, Matthew Zahn, Lynn Janssen, Shruti K Gohil, Philip Alan Robinson, Steven Park, Robert Weinstein, Mary Hayden, Cassiana E. Bittencourt, Ellena M. Peterson, Susan Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s7-s8
- Print publication:
- October 2020
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Distinguished Oral
Background: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.
Funding: None
Disclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.
A comparative ecological risk assessment for herbicides used on spring wheat: the effect of glyphosate when used within a glyphosate-tolerant wheat system
- Robert K. D. Peterson, Andrew G. Hulting
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- Journal:
- Weed Science / Volume 52 / Issue 5 / October 2004
- Published online by Cambridge University Press:
- 20 January 2017, pp. 834-844
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Glyphosate-tolerant spring wheat currently is being developed and most likely will be the first major genetically engineered crop to be marketed and grown in several areas of the northern Great Plains of the United States. The public has expressed concerns about environmental risks from glyphosate-tolerant wheat. Replacement of traditional herbicide active ingredients with glyphosate in a glyphosate-tolerant spring wheat system may alter ecological risks associated with weed management. The objective of this study was to use a Tier 1 quantitative risk assessment methodology to compare ecological risks for 16 herbicide active ingredients used in spring wheat. The herbicide active ingredients included 2,4-D, bromoxynil, clodinafop, clopyralid, dicamba, fenoxaprop, flucarbazone, glyphosate, MCPA, metsulfuron, thifensulfuron, tralkoxydim, triallate, triasulfuron, tribenuron, and trifluralin. We compared the relative risks of these herbicides to glyphosate to provide an indication of the effect of glyphosate when it is used in a glyphosate-tolerant spring wheat system. Ecological receptors and effects evaluated were avian (acute dietary risk), wild mammal (acute dietary risk), aquatic vertebrates (acute risk), aquatic invertebrates (acute risk), aquatic plants (acute risk), nontarget terrestrial plants (seedling emergence and vegetative vigor), and groundwater exposure. Ecological risks were assessed by integrating toxicity and exposure, primarily using the risk quotient method. Ecological risks for the 15 herbicides relative to glyphosate were highly variable. For risks to duckweed, green algae, groundwater, and nontarget plant seedling emergence, glyphosate had less relative risk than most other active ingredients. The differences in relative risks were most pronounced when glyphosate was compared with herbicides currently widely used on spring wheat.
Dalmatian Toadflax (Linaria dalmatica): New Host for Cucumber Mosaic Virus
- Courtney L. Pariera Dinkins, Sue K. Brumfield, Robert K. D. Peterson, William E. Grey, Sharlene E. Sing
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- Journal:
- Weed Technology / Volume 21 / Issue 1 / March 2007
- Published online by Cambridge University Press:
- 20 January 2017, pp. 41-44
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To date, there have been no reports of Dalmatian toadflax serving as a host for cucumber mosaic virus (CMV). Infestations of Dalmatian toadflax may serve as a reservoir of CMV, thereby facilitating aphid transmission of CMV to both agricultural crops and native plants. The goal of this study was to determine whether Dalmatian toadflax is a host for CMV. Dalmatian toadflax seedlings were randomly assigned to two treatments (18 replicates/treatment): no inoculation (control) and inoculation with CMV (Fast New York strain). The Dalmatian toadflax seedlings were inoculated by standard mechanical methods and tested for the presence of CMV using enzyme-linked immunosorbent assay (ELISA). Ten of the 18 CMV-inoculated toadflax plants tested positive for the virus; 6 of the 18 displayed systemic mosaic chlorosis and leaf curling. All control plants tested negative. Transmission electron microscopy obtained from CMV-positive plants confirmed the presence of CMV based on physical properties. To verify CMV infestation, tobacco plants were assigned to the following treatments (six replicates/treatment): no inoculation (control), CMV-negative (control) inoculation, and a CMV-positive inoculation. Plants were inoculated by standard methods. Five of the 6 tobacco plants treated with the CMV-positive inoculum tested positive for CMV using ELISA. All control plants tested negative for the virus.
Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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Chapter 3 - Economic decision rules for IPM
- Edited by Edward B. Radcliffe, University of Minnesota, William D. Hutchison, University of Minnesota, Rafael E. Cancelado
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- Book:
- Integrated Pest Management
- Published online:
- 01 September 2010
- Print publication:
- 11 December 2008, pp 25-32
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Summary
The year 2009 marks the 50th anniversary of the elaboration of the economic injury level (EIL) and the economic threshold (ET) concepts by Stern et al. (1959). The EIL and ET are widely recognized as the most important concepts in IPM. Because IPM is posited on the premise that certain levels of pests and pest injury are tolerable, the EIL and ET represent a crucial underpinning for any theory of IPM. Given the centrality of economic decision rule concepts to IPM, it follows that every IPM program should be based on these concepts. But this clearly is not the case. Why? In this chapter, we will discuss the historical development of economic decision levels, current approaches, and limitations of the EIL and ET. Finally, we will argue that EILs should be incorporated much more into IPM programs and that EILs are central to the continued development of environmental and economic sustainability concepts so important to IPM.
Economic decision levels
The concept of tolerating pest injury was not introduced by Stern et al. (1959); it was discussed at least as early as 1934 (Pierce, 1934) but does not seem to have been developed further until 1959 (Kogan, 1998). In response to failures in pest control in California because of insecticide resistance by pests and insecticide mortality of natural enemies, Stern et al. (1959) first proposed the fundamental concepts of the EIL, the ET, economic damage and pest status.