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Lead exposure that occurs from contamination inadvertently brought home from a workplace is known as take-home exposure. Take-home exposures are a public health hazard that adversely affects health equity for families and communities. This article describes coordinated action by agencies in Minnesota to curb lead exposure among children of workers at a facility that produces fishing sinkers and battery terminals. (Am J Public Health. 2022;112(S7):S655–S657. https://doi.org/10.2105/AJPH.2022.306982 )

Objective Electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health’s (MDH’s) outbreak response to EVALI, including challenges, successes, and lessons learned. Methods MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations. Results MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners. Practice Implications Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.

Objective Overall trends in rates of fully alcohol-attributable mortality may mask disparities among demographic groups. We investigated overall, demographic, and geographic trends in fully alcohol-attributable mortality rates in Minnesota. Methods We obtained mortality data from Minnesota death certificates and defined fully alcohol-attributable deaths as deaths that would not occur in the absence of alcohol. We calculated age-adjusted death rates during 2000-2018 using 5-year moving averages stratified by decedents’ characteristics and geographic location. Results Chronic conditions accounted for most of the alcohol-attributable deaths in Minnesota (89% during 2014-2018). Alcohol-attributable mortality rates per 100 000 population increased from an average rate of 8.0 during 2000-2004 to 12.6 during 2014-2018. During 2000-2018, alcohol-attributable mortality rates were highest among males (vs females), adults aged 55-64 (vs other ages), and American Indian/Alaska Native people (vs other racial and ethnic groups) and lowest among people aged ≤24 years and Asian or Pacific Islander people. During 2014-2018, the alcohol-attributable mortality rate among American Indian/Alaska Native people was more than 5 times higher than the overall mortality rate in Minnesota. Conclusions Results from this study may increase awareness of racial and ethnic disparities and continuing health inequities and inform public health prevention efforts, such as those recommended by the Community Preventive Services Task Force, including regulating alcohol outlet density and increasing alcohol taxes.

Objectives Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. Methods We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non–US-born parents and maternal region of birth. Results Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non–US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). Conclusions Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity.

Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs.This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR.A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure.A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure.The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.

To characterize the epidemiological trends and mortality of cutaneous lupus erythematosus (CLE) between 1976 and 2018 in Olmsted County, Minnesota.In this retrospective population-based cohort study, all incident and prevalent CLE cases among adult residents in Olmsted County, Minnesota, between January 1, 1976, and December 31, 2018, were identified and categorized by subtype through medical record review using the resources of the Rochester Epidemiology Project.The overall incidence rate of CLE between 1976 and 2018 was 3.9 (95% CI, 3.4 to 4.5) per 100,000. The incidence of CLE was relatively stable, with no major trend across sexes or age groups. The age- and sex-adjusted prevalence of CLE was 108.9 per 100,000 on January 1, 2015. Mortality in CLE patients was similar to that of the general population, with a standardized mortality ratio of 1.23 (95% CI, 0.88 to 1.66) with no observed trends in mortality over time.In the past 4 decades, the incidence of CLE remained stable. Patients with CLE have mortality comparable to that of the general population.

This study assesses the correlation between academic grades and gross and fine motor skills in prospective surgical trainees.Forty-seven General Surgery Residency applicants and 32 medical students with prospective surgical interests were recruited. Manual dexterity (MD) was assessed through six tasks: O'Connor Tweezer Dexterity Test and Minnesota Manual Dexterity Test; Peg Transfer Test Fundamentals of Laparoscopic Surgery (box); Ring and Rail, Thread the Ring and Suture Sponge (da Vinci Surgical Simulator).Medical students with higher academic scores had longer completion times for the peg transfer test (P = 0.013). Individuals who played musical instruments and perceived themselves to have "Excellent" MD and motor coordination (MC) were more likely to score higher on the Thread the Ring test (P = 0.007; P = 0.009 ,respectively). Those who perceived themselves to have "Mediocre" MD and MC performed the worst on the: O'Connor Tweezer Dexterity Test (P = 0.023).Preliminary data suggest that MD ability correlates with neither high United States Medical Licensing Examination scores nor high academic grades; however, previous experience playing a musical instrument and high self-ratings of MD/MC may be associated with better test performance.

Alcohol consumption, particularly excessive drinking, incurs a high societal cost. This study aimed to apply current state-specific data from 1 state, Minnesota, to established national methods for estimating the societal cost of excessive alcohol consumption for 2 purposes: first, to update the cost estimate for the state and, second, to understand the potential benefits of using state-specific data versus a national apportionment strategy for economic burden estimates.In 2021, established methods were used to apply alcohol-attributable fractions for health care, lost productivity, crime, and other effects (e.g., motor vehicle crashes) to 2019 Minnesota data. The main outcome measure was the annual prevalence cost (incurred and paid each year) of excessive alcohol use in Minnesota from the societal perspective. Secondary outcome measures were the cost of specific outcomes (e.g., crime), different types of consumption (e.g., drinking during pregnancy), the cost to government payers, and the cost per drink.The societal cost of alcohol use in Minnesota in 2019 was nearly $8 billion dollars (2019 USD) or $1,383 per resident. This estimate is substantially higher than a previous estimate on the basis of apportionment of a national estimate.The cost of alcohol use in Minnesota is considerable. Geographically specific and current cost estimates can inform decision making about the public health impact of excessive alcohol use and the cost effectiveness of prevention strategies. Evidence-based prevention strategies to reduce alcohol use include increased alcohol taxes, enhanced enforcement of laws prohibiting sales to minors, and electronic screening and brief intervention.

Measuring suspended sediment in fluvial systems is critical to understanding and managing water resources. Sampling suspended sediment has been the primary means of understanding fluvial suspended sediment. Specialized samplers, sampling methods, and laboratory methods developed by select U.S. Federal Agencies are more representative of river and stream conditions than commonly used grab sampling and total suspended solids (TSS) laboratory methods but are not widely used because they are expensive, time consuming, and not required as part of water quality standards in the United States. A new suspended-sediment sampling method called a depth-integrated grab (DIG) was developed by combining certain elements from both grab and depth-integrating sampling methods and suspended-sediment concentration (SSC) laboratory methods. The goal of the DIG method was to provide more accurate results than Grab-TSS while being easier and cheaper to sample than specialized samplers and methods. Approximately 50 paired comparison samples were collected at 9 sites in Minnesota from 2018 through 2019. Results showed no significant difference between the DIG and specialized sampling methods and a significant difference between both methods and the Grab-TSS method. The DIG-SSC provided an improved alternative to the Grab-TSS method, but additional research and testing is important to evaluate if this method is appropriate in different conditions than were observed in this study.

PURPOSE: To describe the incidence, prevalence, and clinical characteristics of presumed ocular histoplasmosis syndrome (POHS) in a Histoplasma endemic region. METHODS: The International Classification of Diseases, 9(th) and 10(th) Revision codes were used to search the Rochester Epidemiology Project, a record-linkage system for medical care provided in Olmsted County, MN. Medical records were reviewed to confirm POHS diagnoses in county residents from January 1, 2006 to December 31, 2015. Age- and sex-adjusted incidence rates were calculated and adjusted to the 2010 U.S. White population. RESULTS: There were 18 incident cases (30 eyes) and 87 prevalent cases (131 eyes). The incidence rate was 1.35 per 100,000 per year. The mid-study prevalence rate was 0.064%. Choroidal neovascularization (CNV) occurred in 17.4% of affected eyes. At last follow-up, 16.8% of affected eyes had POHS-related decreased VA (

Hepatic trematodes, such as Fasciola hepatica and Fascioloides magna, have variable distribution throughout the United States. F. magna is endemic in the upper midwestern United States, and F. magna infections are diagnosed frequently in weaned calves and adult beef cattle at the North Dakota State University Veterinary Diagnostic Laboratory (NDSU-VDL). Rarely, liver fluke infestation has also been observed in much younger calves, including aborted fetuses. We describe here, in 2 fetal and 7 neonatal beef calves submitted to the NDSU-VDL between 2011 and 2020, parasitic migration tracts in livers, consisting of regionally extensive, random, linear tracts of fibrosis admixed with black porphyrin pigment, along with foci of necrosis and hemorrhage, and mixed inflammatory cells, which were caused presumptively by F. magna infection. Samples were not available from our 9 cases for PCR assay and sequencing, but we did confirm F. magna within liver samples collected from regional cattle in 2020 and 2021. Fetal and neonatal trematodosis was often concurrent with other common causes of fetal abortion and neonatal calf loss in our cases; however, based on the prepatent period of F. magna, fetal and neonatal beef calf trematode infestations occurred in utero.

The medicalisation of marijuana has occurred rapidly, albeit nonuniformly, across the US and around the world over the past 3 decades. This paper centres on the medicalisation of marijuana in Minnesota-which has one of the most restrictive programs in the country-as a case for evaluating the negotiation of institutional boundaries with the shift from criminalisation to medicalisation after nearly a century of criminal prohibition. Drawing upon Foucauldian discourse analyses of the medical and law enforcement associations' position statements and legislative hearings that shaped medical marijuana policy in Minnesota, this paper demonstrates a symbiotic convergence between medicine and law enforcement through the deployment of shared discursive strategies in their opposition to medical marijuana that reinforce marijuana's criminalised status by solidifying the boundaries between proper medicine and dangerous drugs. Criminal justice and medical institutions draw upon one another's definitions, logics, and practices in a mutually constitutive manner, while still maintaining distinct user subjects and institutional interventions for each based on the user's access to state-approved forms of marijuana. The consequences for the governing of marijuana in Minnesota are explored, as well as the broader implications for the sociological study of medicalisation and criminalisation with respect to the governance of drugs and health.

Interactions between humans and pets are increasingly valued in western countries, leading to more extensive contact between humans and their pets within households. Although the magnitude of the risk of transfer of Escherichia coli between humans and their companion animals is undefined, that such transmission occurs has been established and warrants attention. This study examined 186 fresh faecal samples from companion dogs visiting 22 municipal dog parks in the Minneapolis/Saint Paul metropolitan area, Minnesota, USA. Samples were processed to isolate 3rd-generation cephalosporin-resistant E. coli, which were further characterized using PCR-based virulence genotyping, antimicrobial susceptibility profiling and whole-genome sequencing. Of the 186 faecal samples, 29% yielded cephalosporin-resistant E. coli, and 2.2% yielded extended-spectrum beta-lactamase producers. Co-resistance to sulfonamides was typical (77.3% of isolates), and multidrug resistance (i.e. to ≥3 antimicrobial classes), including to combinations of tetracyclines, phenicols, quinolones and aminoglycosides, was substantial (18.9% of isolates). Identified beta-lactamase genes included bla

To compare reading parameters measured with the Turkish version of the Minnesota Low Vision Reading Test (MNREAD-TR) printed acuity chart and the tablet application version of the same test for both normally sighted and low-vision individuals.A total of 116 individuals (92 normally sighted and 24 low-vision) were included in the study. All participants were tested with both the print version of the MNREAD-TR chart (method 1) and the tablet application version (method 2). Reading acuity (RA), critical print size (CPS), maximum reading speed (MRS), and reading accessibility index (ACC) were compared statistically.No statistically significant difference was found in RA and CPS between the two methods for the normally sighted individuals (p=0.083 and p=0.075, respectively). There was no statistically significant difference in RA and ACC between the two methods for the patients with low vision (p=0.159 and p=0.103, respectively). The mean MRS was 233.1±34.7 words per minute (wpm) with method 1 and 169.3±23.4 wpm with method 2 in the normally sighted group (p0.001) and 93.2±50.2 wpm with method 1 and 68.2±34.7 wpm with method 2 in the low-vision group (p0.001).In our study, it was found that the parameters RA and CPS in the normally sighted individuals and RA and ACC in the low vision individuals provided similar results in both forms of the MNREAD. The tablet application method can be preferred to eliminate evaluators' bias of scoring the printed chart. In addition, applications have other advantages such as being faster and more practical and providing automatic analysis of parameters, especially in low-vision rehabilitation.

PURPOSE: Minneapolis and St. Paul, Minnesota, implemented sales restrictions on all flavored tobacco products in 2016 (“flavor policy”) and expanded the restrictions to menthol tobacco products in 2018 (“menthol policy”). We examined data from surveys of Minnesota youth collected before and after the flavor and menthol policies. METHODS: We measured changes in youth tobacco use prevalence using data from the Minnesota Youth Tobacco Survey and the Minnesota Student Survey. We analyzed tobacco use overall and, where possible, by product category and flavor category among survey respondents in the Twin Cities area (including Minneapolis and St. Paul) and the rest of the state of Minnesota (ROS). RESULTS: In the Minnesota Youth Tobacco Survey, overall youth use of any tobacco product significantly increased in ROS (by 26.6%) but did not change in the Twin Cities after the flavor policies. Similarly, the Minnesota Student Survey showed the youth use of any tobacco product increased to a greater extent in ROS (by 44.6%) than that in the Twin Cities (by 34.6%) after implementation of the menthol policies. In both surveys, increases in youth use of particular tobacco products were less pronounced in the Twin Cities relative to the rest of the state. DISCUSSION: Policies restricting sales of all flavored and menthol tobacco products may be associated with attenuated increases in youth use of tobacco product categories. Policy exemptions and proximity to nonpolicy jurisdictions may have diluted the effect of policies on overall tobacco product use among youth tobacco users.

Introduction: The unpredictable evolution of avian influenza viruses (AIVs) presents an ongoing threat to agricultural production and public and wildlife health. Severe outbreaks of highly pathogenic H5N1 viruses in US poultry and wild birds since 2022 highlight the urgent need to understand the changing ecology of AIV. Surveillance of gulls in marine coastal environments has intensified in recent years to learn how their long-range pelagic movements potentially facilitate inter-hemispheric AIV movements. In contrast, little is known about inland gulls and their role in AIV spillover, maintenance, and long-range dissemination.Methods: To address this gap, we conducted active AIV surveillance in ring-billed gulls (Larus delawarensis) and Franklin's gulls (Leucophaeus pipixcan) in Minnesota's natural freshwater lakes during the summer breeding season and in landfills during fall migration (1,686 samples).Results: Whole-genome AIV sequences obtained from 40 individuals revealed three-lineage reassortants with a mix of genome segments from the avian Americas lineage, avian Eurasian lineage, and a global “Gull” lineage that diverged more than 50 years ago from the rest of the AIV global gene pool. No poultry viruses contained gull-adapted H13, NP, or NS genes, pointing to limited spillover. Geolocators traced gull migration routes across multiple North American flyways, explaining how inland gulls imported diverse AIV lineages from distant locations. Migration patterns were highly varied and deviated far from assumed “textbook” routes.Discussion: Viruses circulating in Minnesota gulls during the summer breeding season in freshwater environments reappeared in autumn landfills, evidence of AIV persistence in gulls between seasons and transmission between habitats. Going forward, wider adoption of technological advances in animal tracking devices and genetic sequencing is needed to expand AIV surveillance in understudied hosts and habitats.

We characterized 2 clusters of blastomycosis cases in Minnesota, USA, using whole-genome sequencing and single-nucleotide polymorphism analyses. Blastomyces gilchristii was confirmed as the cause of infection. Genomic analyses corresponded with epidemiologic findings for cases of B. gilchristii infections, demonstrating the utility of genomic methods for future blastomycosis outbreak investigations.

Antimicrobials are critical for medicine, but the problem of antimicrobial resistance (AMR) threatens the effectiveness of these valuable drugs. In USA, there are no national- or state-level programs or policies in place to track antibiotic use (AU) in dogs, cats, and horses, despite acknowledgement of this sector's importance to both the AMR problem and its solution. AU measurement is a key part of antibiotic stewardship and AMR prevention. This study aimed to fill existing gaps in the veterinary professions' knowledge of antibiotic prescribing in small animals and horses. To address this aim, medical record data were collected on a single day per quarter for 1 year from 19 Minnesota and North Dakota small animal and equine practices, totaling 1,899 veterinarian consults of dogs, cats, and horses. Overall, 25.8% of all canine, feline, and equine consults involved an antibiotic prescription. Third-generation cephalosporins were the most commonly prescribed systemic antibiotic drug class, and the long-acting injectable drug, cefovecin, was the most commonly prescribed antibiotic for cats (34.5%). Topical antibiotic preparations were prescribed frequently, especially in dogs (42.5% of canine prescriptions), though systemic antibiotics were often prescribed concurrently. Common general indications, based on problem or diagnosis recorded in the medical record, for antibiotics in all species combined were skin conditions (24.4%), otitis (22.1%), ophthalmic (9.4%), gastrointestinal (8.3%), respiratory (8.3%), and urinary tract (7.6%) diseases. While 44.2% of patients for which antibiotics were prescribed had cytology performed, only 3.9% had bacterial culture and susceptibility performed. In a pre-study survey, veterinarians' recommendations for AU differed from actual prescribing, suggesting collection of AU data provides more accurate assessments of veterinary prescribing behaviour than surveys. This study shows feasibility of AU measurement in small animals and horses. The data collection tool and standard operating procedures described prove suitable for national AU data collection.

Spectral remote sensing has the potential to improve scouting and management of soybean aphid (Aphis glycines Matsumura), which can cause yield losses of over 40% in the North Central Region of the United States. We used linear support vector machines (SVMs) to determine 1) whether hyperspectral samples could be classified into treat/no-treat classes based on the economic threshold (250 aphids per plant) and 2) how many wavelengths or features are needed to generate an accurate model without overfitting the data. A range of aphid infestation levels on soybean was created using caged field plots in 2013, 2014, 2017, and 2018 in Minnesota and in 2017 and 2018 in Iowa. Hyperspectral measurements of soybean canopies in each plot were recorded with a spectroradiometer. SVM training and testing were performed using 15 combinations of normalized canopy reflectance at wavelengths of 720, 750, 780, and 1,010 nm. Pairwise Bonferroni-adjusted t-tests of Cohen’s kappa values showed four wavelength combinations were optimal, namely model 1 (780 nm), model 2 (780 and 1,010 nm), model 3 (780, 1,010, and 720 nm), and model 4 (780, 1,010, 720, and 750 nm). Model 2 showed the best overall performance, with an accuracy of 89.4%, a sensitivity of 81.2%, and a specificity of 91.6%. The findings from this experiment provide the first documentation of successful classification of remotely sensed spectral data of soybean aphid-induced stress into threshold-based classes.

Knowledge of a species’ phenology can assist with timing accurate surveys to detect presence and density in a novel environment. Trichoferus campestris (Faldermann) (Coleoptera: Cerambycidae) has been found in the United States since the 1990s, but its biology and behavior remain poorly understood. This study investigated the phenology of T. campestris in Minneapolis and St. Paul, Minnesota, USA, based on local temperature data. In the summers of 2019 and 2020, 30 and 40 pheromone-baited traps, respectively, were deployed in trees in suburban parks to monitor capture of local individuals. Traps were suspended from branches of mature trees selected at random, with nine genera of trees selected over both years. Early, peak, and late adult abundance were characterized, and the impact of tree genus in which each trap was hung was evaluated. Abundance was found to be unimodal both summers with a peak around 650 degree days (base 10°C) in early July. Significantly more adult T. campestris were caught in traps hung in trees of the genus Tilia than in trees of the genus Quercus. These findings are important first steps to improving monitoring of T. campestris presence and conducting risk assessments.

OBJECTIVE To document the clinical signs, diagnosis, and treatment of urolithiasis in green iguanas (Iguana iguana) and to report on the composition of uroliths from green iguanas submitted to the Minnesota Urolith Center for analysis. ANIMALS 21 green iguanas with urolithiasis. PROCEDURES Medical record databases of multiple veterinary teaching hospitals were searched from 1996 through 2020. Emails were sent to all facilities that submitted a urolith from a green iguana to the Minnesota Urolith Center from 1996 through 2020. Signalment; presenting complaint; physical examination findings; hematologic, biochemical, and diagnostic imaging findings; treatment; necropsy results; and survival times were described for each patient. RESULTS Iguanas most commonly presented with nonspecific clinical signs, but 9 of the 21 iguanas had clinical signs associated with the urogenital tract. Twelve iguanas had a palpable mass in the caudal coelom. All uroliths were visible on radiographs. Surgery was performed on 15 iguanas; 3 died secondary to intra- or postoperative complications. Iguanas that underwent surgery had a median survival time of 39 months. Necropsy was performed on 5 iguanas, and urolithiasis contributed to the decision to euthanize or was the cause of death for 4. Uroliths from 132 iguanas were analyzed, and all were composed of 100% uric acid salts. CLINICAL RELEVANCE Green iguanas with urolithiasis may not have clinical signs or physical examination findings associated with the urinary system, and hematologic and biochemical abnormalities are nonspecific. Green iguanas should be routinely examined for uroliths, and surgical treatment should be pursued.

BACKGROUND: Epidemiological studies from Europe and North America report an increasing incidence of microscopic colitis (MC) in the late twentieth century followed by a plateau. This population-based study assessed recent incidence trends and the overall prevalence of MC over the past decade. METHODS: Residents of Olmsted County, Minnesota diagnosed with collagenous colitis (CC) or lymphocytic colitis (LC) between January 1, 2011 and December 31, 2019 were identified using the Rochester Epidemiology Project. Clinical variables were abstracted by chart review. Incidence rates were age- and sex-adjusted to the 2010 US population. Associations between incidence and age, sex, and calendar periods were evaluated using Poisson regression analyses. RESULTS: A total of 268 incident cases of MC were identified with a median age at diagnosis of 64 years (range, 19–90); 207 (77%) were women. The age- and sex-adjusted incidence of MC was 25.8 (95% confidence interval [CI] 22.7–28.9) cases per 100,000 person-years. The incidence of LC was 15.8 (95% CI, 13.4–18.2) and CC 9.9 (95% CI, 8.1–11.9) per 100,000 person-years. A higher MC incidence was associated with increasing age and female sex (p

Objectives. To describe the prevalence of sex trading by gender and by associations with mental health concerns and protective factors. Methods. We used data from 9th and 11th graders who completed the 2019 Minnesota Student Survey. The analytic sample (n = 67 806) included transgender and gender-diverse (TGD) youths and cisgender youths who reported trading sex. Data on 7 mental health measures and 4 school-related and health care–related protective factors were collected. Results. The prevalence of sex trading (5.9%) was 5 times higher among TGD students than cisgender students (1.2%). In addition, the prevalence of all mental health concerns was high among TGD students who traded sex (e.g., 75.9% reported a lifetime suicide attempt, as compared with 45.9% of cisgender students who traded sex). Fewer statistical differences were found across protective factors. When TGD students who traded sex were compared according to sex assigned at birth, no statistically significant differences were found. Conclusions. Our findings support strong calls for increased competence regarding gender and sex trading or exploitation in clinical and school-based settings to decrease health disparities among TGD youths. Public Health Implications. In this study, we have presented unique prevalence estimates of mental health disparities among TGD students in the United States who trade sex. Our results indicate that TGD students who trade sex are at risk for mental health symptoms and that sensitivity to both gender and sex trading or exploitation will be critical to meeting the needs of this group in clinical as well as school-based settings.

Enlargement of the sinus of Valsalva (SOV) is common in patients with bicuspid aortic valves (BAVs), and management at the time of aortic valve replacement (AVR) and concomitant ascending aorta replacement/repair is controversial.Between January 2000 and July 2017, 400 patients with BAVs underwent AVR and concomitant ascending aorta repair (graft replacement, 79%; aortoplasty, 21%). To assess the impact of the initial SOV dimension on future dilatation and outcomes, patients were stratified into 2 groups: SOV of less than 40 mm (SOV40 mm) (n = 209) and SOV of 40 mm or larger (SOV≥40 mm) (n = 191).Patients with SOV≥40 mm were older and more often male. At a median follow-up of 8.1 years (interquartile range, 7.4-9.1 years), 6 patients underwent reoperations on the ascending or sinus portion of the aorta due to aneurysmal dilatation, and enlargement of the sinus was the primary indication for operation in 1 patient. Adjusted analysis showed that baseline SOV and SOV dimension over time were not associated with late outcomes. A gradual increase in SOV diameter over time was identified (P = .004). Patients with smaller baseline SOV diameters showed an initial early decrease in diameter, followed by gradual increase, whereas those with larger baseline diameters had a stable early phase, followed by gradual dilatation.Ascending aorta replacement may lead to an initial remodeling/stabilizing effect on the spared bicuspid aortic root, which is more pronounced in patients with lower SOV diameters. In addition, our data demonstrate that the retained aortic sinuses enlarge slowly, and within the limited follow-up of our study, SOV diameter was not a risk factor for survival or reoperation.

Background The anomalous circumflex coronary artery (ACCA) from the right coronary artery or sinus of Valsalva lies in proximity to the aortic valve annulus. This study sought to determine the prevalence of injury to the ACCA during surgical aortic valve replacement (SAVR). Methods We queried the databases of the Departments of Cardiovascular Surgery and Cardiovascular Diseases of Mayo Clinic, Rochester, Minnesota for all patients who underwent SAVR in the setting of an ACCA. The study investigators identified 31 patients operated on from September 2002 through December 2018. The end point was myocardial ischemia in the distribution of the ACCA. Results The patients’ mean age was 69 ± 11 years, sex was female in 8 patients (26%), and ejection fraction was 62% (interquartile range, 59% to 68%). No patient underwent exploration of the ACCA, but 5 (16%) had a coronary artery bypass graft to the ACCA. No patient demonstrated myocardial infarction or underwent perioperative intervention on the ACCA; however, discharge echocardiography showed new lateral wall motion abnormality in 5 (16%) patients that was associated with a reduction in ejection fraction of −11% from baseline (P = .007). Coronary artery bypass graft to the ACCA was not protective of new lateral wall motion abnormality (P = .968). Mortality was 34% ± 10% at 10 years and was not associated with new lateral wall motion abnormality (log-rank test P = .183). Conclusions Clinically apparent myocardial infarction was not identified after SAVR, but echocardiographic evidence of myocardial ischemia in the distribution of the ACCA was identified in 16% of patients. Protective adjuvant intervention on the ACCA may be indicated. Further study is warranted.

Zebra mussels (Dreissena polymorpha) are an aquatic invasive species generalist with known ecological and economic impacts due to their settlement and attachment characteristics as well as their filtration abilities. Although zebra mussel attachment to abiotic substrates has been extensively studied, the importance of organic substrates for established zebra mussel populations in North American waters has not been evaluated. We assessed organic substrates in four west-central Minnesota lakes. Using qualitative analysis, we found most substrates were used proportionally to their availability. A quantitative assessment revealed significantly more zebra mussels attached to detritus than pondweeds (P

PROBLEM Family medicine faculty and residents have observed that continuity clinic is often unsatisfying, attributed to a lack of patient and team continuity and erratic clinic schedules pieced together after the prioritization of hospital service and rotation schedules. APPROACH In 2019, a 3-year Clinic First project, called Clinic as Curriculum (CaC), was launched across the 4 family medicine residencies of the Department of Family Medicine and Community Health, University of Minnesota Medical School. The department began publishing quarterly CaC dashboard data. Each clinic completed a baseline assessment of their performance on the 13 Building Blocks of High-Functioning Primary Care Residency Clinics. Using their baseline data, each clinic identified which block or blocks, in addition to the blocks on continuity of care and resident scheduling, to focus on. The plan is to collaboratively implement the overall and local goals using dashboard data and iterative process improvement over 3 years. OUTCOMES At baseline, clinics functioned quite well with respect to the 13 building blocks, but CaC dashboard data varied across the 4 clinics, with large variation between clinics on how frequently faculty were scheduled in the clinic and the proportion of total clinic visits seen by faculty. Resident continuity rates were low (range: 38%-47%). Level loading (consistent physician availability to meet patient demand) rates ranged from 1 to 11 days a month. Regarding resident schedules, 2 programs are moving from 4-week to 2-week inpatient blocks, and 2 programs are exploring longitudinal scheduling. One clinic will assign faculty and residents to specific clinic days. Two clinics are implementing microteams of 1 faculty and 3-4 residents. NEXT STEPS The authors plan to analyze the dashboard data longitudinally; explore microteams, team continuity, and team scheduling adherence; and develop and implement resident scheduling changes over the next 3 years.

Objectives: This study was conducted to assess an intervention that was created by a community–academic partnership to address COVID-19 health inequities. We evaluated a community-engaged bidirectional pandemic crisis and emergency risk communication (CERC) framework with immigrant and refugee populations during the COVID-19 pandemic. Methods: A 17-year community-engaged research partnership adopted a CERC framework in March 2020 to address COVID-19 prevention, testing, and socioeconomic impacts with immigrant and refugee groups in southeast Minnesota. The partnership used bidirectional communication between communication leaders and their social networks to refine messages, leverage resources, and advise policy makers. We conducted a mixed-methods evaluation for intervention acceptability, feasibility, reach, adaptation, and sustainability through multisource data, including email communications, work group notes, semistructured interviews, and focus groups. Results: The intervention reached at least 39 000 people in 9 months. It was implemented as intended and perceived efficacy was high. Frequent communication between community and academic partners allowed the team to respond rapidly to concerns and facilitated connection of community members to resources. Framework implementation also led to systems and policy changes to meet the needs of immigrant and refugee populations. Conclusions: Community-engaged CERC is feasible and sustainable and can reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community perspectives in regional pandemic mitigation policies.

Quality of life (QoL) is important to nursing home (NH) residents, yet QoL is only publicly reported in a few states, in part because of concerns regarding measure stability. This study used QoL data from Minnesota, one of the few states that collects the measures, to test the stability of QoL over time. To do so, we assessed responses from two resident cohorts who were surveyed in subsequent years (2012–2013 and 2014–2015). Stability was measured using intra-class correlation (ICC) obtained from hierarchical linear models. Overall QoL had ICCs of 0.604 and 0.614, respectively. Our findings show that person-reported QoL has adequate stability over a period of one year. Findings have implications for higher adoption of person-reported QoL measure in long-term care.

To assess cardiovascular disease (CVD) and CVD risk factors and their association with sociodemographic characteristics and health beliefs among African American (AA) adults in Minnesota.A cross-sectional analysis was conducted of a community-based sample of AA adults enrolled in the Minnesota Heart Health Program Ask About Aspirin study from May 2019 to September 2019. Sociodemographic characteristics, health beliefs, and self-reported CVD and CVD risk factors were collected. Prevalence ratio (PR) estimates were calculated using Poisson regression modeling to assess the association between participants' characteristics and age- and sex-adjusted CVD risk factors.The sample included 644 individuals (64% [412] women) with a mean age of 61 years. Risk factors for CVD were common: hypertension (67% [434]), hyperlipidemia (47% [301]), diabetes (34% [219]), and current cigarette smoking (25% [163]); 19% (119) had CVD. Those with greater perceived CVD risk had a higher likelihood of prevalent hyperlipidemia (PR, 1.34; 95% CI, 1.14 to 1.57), diabetes (PR, 1.61; 95% CI, 1.30 to 1.98), and CVD (PR 1.61; 95% CI, 1.16 to 2.23) compared with those with lower perceived risk. Trust in health care provider was high (83% [535]) but was not associated with CVD or CVD risk factors.In this community sample of AAs in Minnesota, CVD risk factors were high, as was trust in health care providers. Those with greater CVD risk perceptions had higher CVD prevalence. Consideration of sociodemographic and psychosocial influences on CVD and CVD risk factors could inform development of effective cardiovascular health promotion interventions in the AA Minnesota community.

BACKGROUND Benzodiazepines are the gold standard for alcohol withdrawal treatment but choice and dosing vary widely. In 2015, our institution implemented a Minnesota detoxification scale (MINDS) and single standardized high-dose diazepam based protocol for treatment of alcohol withdrawal to replace multiple Clinical Institute Withdrawal Assessment for Alcohol (CIWA) based protocols using lower dose benzodiazepines. OBJECTIVE We compared use of MINDS versus CIWA assessment protocols with high front loading diazepam treatment in care of patient experiencing alcohol withdrawal during hospitalization. METHODS Retrospective cohort study of hospitalized patients experiencing alcohol withdrawal to statistically analyze difference in outcomes between CIWA based lower benzodiazepine dose protocols used in 2013-2015 versus the MINDS based high-dose front-loading diazepam protocol used in 2015-2017. RESULTS Patients treated with MINDS based high dose diazepam protocol were less likely to have physical restraints used (AOR = 0.8, CI: 0.70 - 0.92), had a shorter hospital length of stay, and fewer days on benzodiazepines (p < 0.001). Patients were more likely to be readmitted to the hospital within 30 days (AOR = 1.13, CI: 1.03 - 1.26) in MINDS based diazepam treatment group. Total diazepam equivalent dosing was similar in both groups. Mortality rates and ICU use rates were similar between the groups. CONCLUSIONS Higher dose front loading long acting benzodiazepine can be safely used with beneficial outcomes in hospitalized alcohol withdrawal patients.

Despite an increasing demand for pediatric home care nursing, there is no comprehensive or universal standard of care for prescribing pediatric home care nursing hours based on a child's medical complexity. Adoption of a qualification tool (QT) to allocate home care nursing hours based on the medical complexity of a child may mitigate inequality in access to care and improve the patient and family experience. A QT, developed in Minnesota, recommends home care nursing hours based on the level of medical complexity and need for skilled nursing interventions. Four hypothetical case studies demonstrate the use of the QT to calculate recommended nursing hours. To validate the tool, a survey of discharge planners found a percentage difference in calculated hours of 4.1, 5.7, 11.2, and 24.9 in the four case studies. Discharge planners rated the usability of the QT as favorable with a score of 3.6 on a Likert scale of 5. The recommended nursing hours prescribed for families, based on the QT, was perceived as meeting the needs of the child by 56% and 42% of surveyed parents and home care nurses (HCNs), respectively. The need for additional nursing hours was expressed by 33% and 50% of parents and nurses, respectively. In general, HCNs' assessment of allocated nursing hours paralleled that of parents. Further refinement and adoption of a standardized QT to allocate home care nursing hours may improve access and outcomes for children requiring home care nursing.

Background Research has demonstrated dietary quality benefits of family meals and meals prepared at home. Less is known about associations between the proportion of family evening meals made at home and key personal, behavioral, and environmental characteristics. Moreover, most studies often measure these data retrospectively. Objective The objective of this study is to describe the proportion of evening meals made at home measured in real time and to assess associations between personal, behavioral, and environmental characteristics that are associated with a higher proportion of evening meals prepared and consumed at home. Design This study is a cross-sectional secondary analysis of baseline data collected during 2017 and 2018 from the New Ulm at Home study, a randomized controlled trial conducted in rural Minnesota to evaluate the effectiveness of a childhood obesity prevention program for school-aged children. Participants/setting The present study analyzes a subset of the New Ulm at Home trial data from families (N = 108) who completed at least four evening meal screeners collected in real time with ecological momentary assessment technology over a 2-week period. Main outcome measure The main outcome measure was the proportion of family evening meals made at home, calculated using two cutpoints (≤50% of evening meals prepared at home vs >50%; ≤70% vs >70%). Statistical analysis Descriptive statistics were used to describe the proportion of evening meals prepared at home. Logistic regression analyses adjusted for parent education were used to assess associations between family characteristics and the two different proportions of meals made at home. Results Most family evening meals were prepared and eaten at home (62%). Logistic regression models indicated meal planning skills (odds ratio=1.19, 95% CI 1.01 to 1.39) and mealtime routines (odds ratio=1.20, 95% CI 1.03 to 1.40) were significantly associated with odds of preparing more than 50% of evening meals at home. Only meal planning skills (odds ratio=1.27, 95% CI 1.06 to 1.51) was significantly associated with odds of preparing more than 70% of evening meals at home. Conclusions Study findings indicated mealtime routines and meal planning skills were associated with preparing more than 50% of evening meals at home, but only meal planning skills were associated with preparing more than 70% of evening meals at home, which may suggest the importance of adapting interventions for families. Future research should build on these findings in randomized controlled trials.

Objective The evaluation of women with perimenopausal abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) to detect endometrial cancer (EC) and its precursors is not standardized and can vary widely. Consequently, costs associated with the workup and management undoubtedly vary. This study aimed to quantify costs of AUB/PMB evaluation to understand the healthcare burden associated with securing a pathologic diagnosis. Methods Women ≥45 years of age presenting to a single institution gynecology clinic with AUB/PMB for diagnostic workup were prospectively enrolled February 2013–October 2017 for a lower genital tract biospecimen research study. Clinical workup of AUB/PMB was determined by individual provider discretion. Costs of care were collected from administrative billing systems from enrollment to 90 days post enrollment. Costs were standardized and inflation-adjusted to 2017 US Dollars (USD). Results In total, there were 1017 women enrolled with 5.6% diagnosed with atypical hyperplasia or endometrial cancer (EC). Within the full cohort, 90-day median cost for AUB/PMB workup and management was $2279 (IQR $512–4828). Among patients with a diagnostic biopsy, median 90-day costs ranged from $2203 (IQR $499–3604) for benign or disordered proliferative endometrium (DPE) diagnosis to $21,039 (IQR $19,084-24,536) for a diagnosis of EC. Conclusions The costs for diagnostic evaluation of perimenopausal AUB and PMB vary greatly according to ultimate tissue-based diagnosis. Even reassuring benign findings that do not require further intervention—the most common in this study's cohort—yield substantial costs. The development of sensitive, specific, and more cost-effective diagnostic strategies is warranted.

OBJECTIVE: To determine the association of socioeconomic status at the census block group level with chronic conditions, and to determine whether the associations differ by age, sex, race, or ethnicity. PATIENTS AND METHODS: Adults aged ≥20 years on April 1, 2015 from 7 counties in Southern Minnesota were identified using the Rochester Epidemiology Project records-linkage system. We estimated the prevalence of 19 chronic conditions (7 cardiometabolic, 7 other somatic, and 5 mental health conditions) at the individual level, and a composite measure of neighborhood socioeconomic disadvantage (the area deprivation index; ADI) at the census block group level (n=249). RESULTS: Among the 197,578 persons in our study, 46.7% were male, 49.5% were aged ≥50 years, 12.3% were of non-White race, and 5.3% were Hispanic. The risk of most chronic conditions increased with increasing ADI. For each cardiometabolic condition and most other somatic and mental health conditions, the pattern of increasing risk across ADI quintiles was attenuated, or there was no association across quintiles of ADI in the oldest age group (ages ≥70 years). Stronger associations between ADI and several cardiometabolic, other somatic, and mental health conditions were observed in women. CONCLUSION: Higher ADI was associated with increased risk of most chronic conditions, with more pronounced associations in younger persons. For some chronic conditions, the associations were stronger in women. Our findings underscore the importance of recognizing the overall and potentially differential impact of area-level deprivation on chronic disease outcomes for diverse populations.

This work engages the perspectives of law enforcement personnel and ex-personnel within the Twin Cities, Minnesota metropolitan area. It particularly focuses on their opinions and experiences during and after the social upheaval sparked by George Floyd’s murder on May 25, 2020. Five respondents provided in-depth interviews focusing most on feeling under siege, the challenges in rank and officer accountability, and the critical issues around mental health support in the field. They also talked about a clear increase in anti-cop media. Despite this, however, they all spoke about a “silent majority” of supporters - which seemed to be a critical element to each respondent in their own way. It seemed that if the perceived support in their communities fades, so too could the pride in doing the job. All five also discussed the intense challenges presented by the critical staffing decrease since 2020, seeing all aforementioned existing issues and tensions exacerbated through their staffing shortages and spread-thin workloads. This research will hopefully contribute to an understanding of policing and systemic issues from within, especially in the Twin Cities. With just five participants, this study’s small scope is a way to begin engaging with this community about these complex topics. Ideally, following this research thread will help to address factors that affect individual officers and decrease the amount of people negatively impacted, injured or killed by the police system.

To assess the effectiveness of coronavirus disease 2019 (COVID-19) prevention strategies used during sports participation.To analyze prospective reports of student-athletes with COVID-19-positive tests to assess prevention strategies and risk factors by sports and seasons.Minnesota high schools.Fall 2020 (August 24-October 30) and winter 2021 (January 2-March 12) student-athletes.Sports, indoor location, mask use, physical distancing, and season.COVID-19-positive test rates.Self-selected schools voluntarily reported, in 2-week intervals, the number of student-athletes with COVID-19-positive tests in each sport and the number of athletes participating in each sport during the fall and winter sports seasons. The positive testing rates per 100 000 athletes were calculated for participants in each sport and compared by sports type and risk variables.The high school age community-positive testing rate was 1298 per 100 000 students in the fall and 2396 in the winter. The student-athlete positive testing rate was 1500 per 100 000 athletes during the fall and 2800 during the winter (χ2 = 1.98, df = 1, P = 0.350). Positive tests per 100 000 athletes ranged from 197 (girls alpine skiing) to 4151 (wrestling). The incidence rates comparing indoor with outdoor sports (P = 0.001) and close-contact with physically distanced sports (P = 0.023) were significantly different, but the incidence rates comparing indoor masked with unmasked sports (P = ns) were not different.Athletes competing in outdoor individual sports have less risk of a COVID-19-positive test compared with age-matched individuals in the community and indoor sports participants either wearing or not wearing masks during competition. Unmasked athletes in close proximity have the highest positive test rates, and unenforced masking is not associated with lower positive testing rates. More study is needed to understand mask effectiveness.

This report describes the development and validation of a new coding system for the Current Relationship Interview (CRI) that assesses individual differences in secure base script knowledge with respect to adult romantic partners. Drawing on data from the Minnesota Longitudinal Study of Risk and Adaptation (

Purpose This study aims to develop and test feasibility of a colorectal cancer (CRC) education video appropriate for Somali immigrants. Design One-group pretest–posttest design. Setting Minneapolis, MN. Sample Thirty-one Somali men (mean age = 60.6; SD = 13.0). Intervention A CRC education video was developed in the Somali language with Somali community partners. Participants were invited to a workshop and watched the video. Measures Levels of understanding about CRC and screening were assessed before vs after the video. Analysis Binomial tests were conducted to examine changes in level of understanding. Results Analysis on pre–post, within-person changes in understanding about cancer, and CRC screening showed that proportions with a positive change in understanding risks of cancer (80%) and benefits of CRC screening (90%) were significantly higher than expected if the video had no effect (50%; P = .012, P < .001, respectively). Ninety-three percent of participants agreed that the video contained useful information. Conclusion These results provide evidence of usefulness of culturally tailored videos to facilitate CRC screening in the Somali community. Results of this study were limited by a small sample size and lack of a control group.

Background Previous COVID-19 pandemic research has focused on assessing the severity of psychological responses to pandemic-related stressors. Little is understood about (a) resilience as a mental health protective factor during these stressors, and (b) whether families from Eastern and Western cultures cope differently. This study examines how individual resilience and family resilience moderate the associations between pandemic-related stressors and symptoms of depression, anxiety, and stress in two culturally distinct regions. Methods A total of 1,039 adults (442 from Minnesota, United States, and 597 from Hong Kong) living with at least one family member completed an online survey about COVID-19-related experiences, mental health, individual resilience and family resilience from May 20 to June 30, 2020. Predictors of depression, anxiety, and stress symptoms were examined separately using hierarchical regression analyses. Results In both regions, pandemic-related stressors predicted higher symptoms of depression, anxiety, and stress. Individual resilience and two domains of family resilience were associated with positive mental health. In Minnesota, higher levels of individual resilience buffered the negative relationship between pandemic-related stressors and depressive symptoms; higher levels of family communication and problem solving also buffered the negative relationship between pandemic-related stressors and stress symptoms. In Hong Kong, higher family-level positive outlook magnified the negative relationship between pandemic-related stressors and anxiety symptoms. Conclusions Individual and family resilience is protective against the adverse psychological effects of pandemic stressors, but they vary across cultures and as exposure to pandemic-related stressors increases.

The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 is continuing to spread globally. SARS-CoV-2 infections of feline and canine species have also been reported. However, it is not entirely clear to what extent natural SARS-CoV-2 infection of pet dogs and cats is in households. We have developed enzyme-linked immunosorbent assays (ELISAs) using recombinant SARS-CoV-2 nucleocapsid (N) protein and the receptor-binding-domain (RBD) of the spike protein, and the SARS-CoV-2 spike-pseudotyped vesicular stomatitis virus (VSV)-based neutralization assay to screen serum samples of 239 pet cats and 510 pet dogs in Minnesota in the early phase of the COVID-19 pandemic from mid-April to early June 2020 for evidence of SARS-CoV-2 exposures. A cutoff value was used to identify the seropositive samples in each experiment. The average seroprevalence of N- and RBD-specific antibodies in pet cats were 8% and 3%, respectively. Among nineteen (19) N-seropositive cat sera, fifteen (15) exhibited neutralizing activity and seven (7) were also RBD-seropositive. The N-based ELISA is also specific and does not cross react with antigens of common feline coronaviruses. In contrast, SARS-CoV-2 antibodies were detected at a very low percentage in pet dogs (~ 1%) and were limited to IgG antibodies against SARS-CoV-2 N protein with no neutralizing activities. Our results demonstrate that SARS-CoV-2 seropositive rates are higher in pet cats than in pet dogs in MN early in the pandemic and that SARS-CoV-2 N-specific IgG antibodies can detect SARS-CoV-2 infections in companion animals with higher levels of specificity and sensitivity than RBD-specific IgG antibodies in ELISA-based assays.

Dementia is a growing problem that is the cause for an increase in care provision needs. Staff shortages are having an adverse effect by creating an atmosphere where the people affected with dementia feel neglected and isolated. This is resulting in reduced quality of life for the people residing in assisted living facilities and nursing homes. Family members and caregivers have been forced to reduce contact with the residents due to the fear of infection given the vulnerability of the residents. The residents are losing emotional stimulation and this is adversely affecting their disease progression.Freeing caregivers of mundane caregiving activities that require more patience and less caregiving in activities such as reminding/prompting, watching and monitoring can allow them to focus on activities that require more attention and will benefit the residents. Repetitive activities such as prompting, reminding of daily living activities such as brushing teeth and hair, washing hands, keeping the oxygen or face mask on etc. can be repetitive and stressful for caregivers. If these activities can be performed by a humanoid robot that can repeat the same activity or prompt without getting frustrated or changing the tone, the caregivers will have more time to tend to activities that require more attention such as medication management, tending to finances, medical followup appointments etc. University of Minnesota is collaborating with nursing homes in deploying robots to help augment care in the domains of emotion, cognition and physical wellbeing. These robots will have tasks assigned to them that they will perform throughout the day. They work in conjunction with sensors that will provide them with stimulation and feedback for tracking and monitoring activities of daily living. The sensors will also track the physiological well being to ensure the residents are not adversely affected by the robots.Humanoid robots are being deployed in nursing homes. A combination of humanoid robots and wearable and spatial sensors track and monitor care provision for residents at nursing homes.The humanoid robots are helping fill staff shortage gaps. Most importantly residents feel more engaged and have an improved sense of wellbeing.

The National Institutes of Health (NIH) remains one of the predominant sources of biomedical research funding in the United States, yet its impact on total hip and knee arthroplasty research is poorly understood. This study defines the portfolio of NIH funding for total joint arthroplasty (TJA) and the impact of orthopaedic surgeons on this portfolio.The Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was queried for NIH grants that had been awarded for total hip and knee arthroplasty and total NIH funding from 2010 to 2020. Compound annual growth rates (CAGRs) were calculated. Funding totals were compared with those from 20 other clinical areas. The principal investigators (PIs) and grants were characterized, and comparisons were made with use of the Student t test.A total of 489 grants were awarded, totaling $181 million (CAGR of 10.3%). This was3 times the growth rate for the total NIH budget (CAGR of 2.9%), which increased from $31.2 to $41.7 billion over the 11-year period. When compared with 20 other clinical areas, TJA received the least amount of NIH funding over that period. Alzheimer disease received the most funding ($12.1 billion, CAGR of 19.5%), and cerebral palsy received the penultimate amount of funding ($284 million, CAGR of 6.3%). The R01 grant mechanism was the predominant source (63.1%), and the Mayo Clinic (Rochester, Minnesota) received the most funding (9.7%). Departments of orthopaedic surgery were awarded the most funding (23.5%), yet only 20 orthopaedic surgeons were identified as PIs (16.0%). There were no significant differences in NIH funding totals by PI demographic and academic characteristics (p0.05), yet orthopaedic surgeons had among the highest Hirsch indices (h-indices) (p0.001). Funding supported clinical (63.5%), translational (19.3%), basic science (7.1%), and other types (10.1%) of research. The top areas with funding were postoperative complications (44.4%), postoperative pain management (17.6%), rehabilitation (15.1%), and implant design (12.4%).There is a paucity of orthopaedic surgeon representation among NIH grants awarded for TJA. Opportunities may exist for orthopaedic surgeons to collaborate in identified areas of clinical interest. Additional research is needed to understand the obstacles to obtaining NIH grant funding for orthopaedic surgeon PIs.Increasing the levels of funding from the NIH is a strategic priority for departments of orthopaedic surgery. Understanding levels of funding for clinical areas in total joint arthroplasty is critical to foster research and discovery support from the NIH.

BACKGROUND Self-directed supports (SDS) are a model of disability service delivery that focuses on supporting increased decision-making authority and budget autonomy for people with disabilities and their families. This study identifies supervisory and administrative staff's perspectives within a self-directed, individualised budgeting programme for people with intellectual and developmental disabilities. METHOD Data were collected through 28 face-to-face interviews with supervisory and fiscal administrative staff in Minnesota, USA. RESULTS A qualitative analysis of these interviews resulted in four major themes: (1) the benefits of SDS, (2) the relationship between SDS and person-centred strategies, (3) the perception that a natural tension arises when balancing person-centred approaches with the need for consistent and fair state policy-including rules and regulations within state systems and (4) the unique challenges related to SDS benefits and challenges occurring across Minnesota. CONCLUSIONS The results indicate the importance of providing effective communication and training to all stakeholders.

Hepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low-barrier linkage to HCV therapy among individuals accessing homeless shelters. HCV rapid testing was performed at four large shelters in San Francisco (SF) and Minneapolis (MN). Sociodemographic status, HCV risk, barriers to testing, and interest in therapy were captured. Participants received information about HCV. Those testing positive underwent formal HCV education and onsite therapy. Multivariable modeling assessed predictors of receipt of HCV therapy and sustained virologic response (SVR). A total of 766 clients were tested. Median age was 53.7 years, 68.2% were male participants, 46.3% were Black, 27.5% were White, 13.2% were Hispanic, and 57.7% had high school education or less; 162 (21.1%) were HCV antibody positive, 107 (66.0%) had detectable HCV RNA (82.1% with active drug use, 53.8% history of psychiatric illness), 66 (61.7%) received HCV therapy, and 81.8% achieved SVR. On multivariate analysis, shelter location (MN vs. SF, odds ratio [OR], 0.3; P = 0.01) and having a health care provider (OR, 4.1; P = 0.02) were associated with receipt of therapy. On intention to treat analysis, the only predictor of SVR when adjusted for age, sex, and race was HCV medication adherence (OR, 14.5; P = 0.01). Conclusion: Leveraging existing homeless shelter infrastructure was successful in enhancing HCV testing and treatment uptake. Despite high rates of active substance use, psychiatric illness, and suboptimal adherence, over 80% achieved HCV cure. This highlights the critical importance of integrated models in HCV elimination efforts in people experiencing homelessness that can be applied to other shelter settings.

Adolescents and emerging adults with chronic health conditions such as type 1 diabetes mellitus (T1D) are more likely to engage in high-risk behaviors. Previous studies regarding substance use in adolescents and emerging adults with T1D are mostly derived from cross-sectional studies utilizing self-administered questionnaires and are limited by lack of population-based comparison groups. In addition, despite the rising popularity of vaping, little is known about the incidence of vaping in adolescents and emerging adults with T1D. We explored the incidence and prospective risk of substance use disorders and vaping in adolescents and emerging adults with T1D compared to age and gender matched non-diabetic referents residing in Olmsted County, Rochester, MN. Risk of incident substance use disorder washigher in those with T1D compared to matched referents with alcohol, marijuana, and smoked tobacco being most common substances. When stratified by gender, these differences remained significant in males, but not females. While further work is needed to delineate the causative relationships between T1D, mental health, and substance abuse; our findings confirm the critical need for substance use screening and mental health support for adolescents and emerging adults with T1D. This article is protected by copyright. All rights reserved.

The geographic ranges of forensically informative taxa on decomposing remains vary across regions. To determine which calliphorid flies would be expected to occur in Minnesota and the upper Midwest, individual freshly killed pig carcasses (Sus scrofa L.) were placed in the field in St. Paul, MN, at monthly intervals from May to October 2017 and May to September 2018. Aerial nets, forceps, and pitfall traps were used to collect and preserve associated adult and immature insects. Sixty-four forensically informative insect taxa were recorded, representing three insect orders and 14 families. Ten informative calliphorid species were recorded on carcasses, adding four new Minnesota records. Comparison of species lists from 26 human forensic cases indicated agreement between the two lists, except for Lucilia coeruleiviridis Macquart, Calliphora vomitoria (L.), and Cynomya cadaverina Robineau-Desvoidy, which occurred on pig carcasses but not human remains, and Calliphora livida Hall, which occurred on human remains, but not carcasses. The composite fauna list from cadavers agreed largely with the 2-yr list from pig carcasses.

Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals.A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group.A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27–5.83) for in-hospital mortality and an OR 4.54 (3.25–6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.

Objectives: We explored memory clinic care provision in Minnesota, examining diversity and similarities of services provided and challenges faced. We also considered how well their services and care philosophies aligned with national dementia care practice recommendations. Methods: We created a 53-question interview guide and interviewed 11 memory clinics across Minnesota in late 2019. Interview transcripts were analyzed using Braun and Clarke’s thematic analyses in NVivo 12. Results: We identified 6 themes regarding financial issues, staffing, appointment logistics, care provision during and after the memory evaluation as well as features of an ideal clinic. Conclusions: Memory evaluation and care provision were very different across clinics, primarily due to team make-up, particularly team size and specialty. However, memory care providers shared a passion for providing patient-centered memory care, emphasizing family and patient education and partnership. Their care was largely aligned with national memory care recommendations. Common challenges, including maintaining financial stability and clinic efficiency, exerted significant influence on clinic functioning and survival.