Introduction In this study we provide an epidemiological description of Elevated Blood Lead Levels (EBLLs) in the pediatric population of Jefferson County, KY. To provide a more thorough epidemiological description of this issue, we put together the largest known pediatric blood lead dataset for Jefferson County and evaluated the data using the Center for Disease Control and Prevention’s current Blood Lead Referent Value (BLRV) of > 3.5 mcg/dL. Methods We collected 111,065 rows of pediatric blood lead data from the Louisville Metro Department of Public Health and Wellness. Descriptive and inferential statistics were used to explore the magnitude of this issue. Unadjusted Risk Ratios (RR) were also calculated by specific demographics. Geographic cluster analysis was produced by the Kulldorff spatial scan statistic. Results There are 74,014 unique children in the blood lead dataset, of which 9,823 had at least one blood lead test > 3.5 mcg/dL. Black children had a 77% increased risk for an EBLL compared to white children (Unadjusted Risk Ratio: 1.77; 95% CI: 1.61, 1.95). Additionally, children who live in the northwest corner of Jefferson County, have an estimated 9.37-fold increased risk for an EBLL compared to children who live elsewhere in the county. Discussion The non-random distribution of EBLLs in Jefferson County is likely due to the distribution of Pre-1950 housing which is a known risk factor for remnant environmental lead. This issue may be a consequence of the systematic financial disinvestment of these neighborhoods via redlining during the 20th century. Childhood lead poisoning remains a critical public health issue in Jefferson County, KY.

Exposure to lead remains a critical public health concern due to its toxic nature and widespread distribution in the environment. Limited research has investigated the risks of lead emissions to the environment by many operating industrial facilities. Using geospatial analysis and multiple regression methods, this article examines racial and class inequalities in proximity to industrial facilities and the concomitant lead exposure. We observe significant positive associations between the proportion of Black residents in census tracts and proximity to lead-emitting facilities and lead exposure after adjusting for other socioeconomic factors. Likewise, median household income was negatively associated with proximity to lead-emitting facilities. Moreover, Black residents and the below-poverty group had larger mean population-weighted lead exposures than white and the above-poverty group respectively. The findings of this study provided further evidence supporting the environmental injustice literature and can inform policies to reduce ambient lead releases from industrial facilities and eliminate health disparities.

Exposure to hydraulic fracturing (HF), an oil and gas extraction method, may be associated with adverse birth outcomes. Nitrogen (N2) HF uses nitrogen gas to extract natural gas, whereas slick water HF uses a combination of chemicals, water and sand. By differentiating outcomes by type of HF performed, recommendations can be made on the methods of gas extraction which confer the lowest risk to pregnant patients. Our aim is to demonstrate the impact of residential proximity to slick water versus N2 based HF wells and preterm birth and low birth weight. This is an ecological study. Ten eastern Kentucky (KY) counties that contain both slick water and N2 fracking were identified. Data from the KY Public Health Department included: demographics, gestational age (GA), and birth weight for singleton pregnancies over 20 years. Individual births were categorized by term (GA > 37weeks) or preterm (GA < 37 weeks) as well as LBW (< 2500g) or VLBW (< 1500g). The KY Geologic survey provided location data for HF wells in 10 eastern KY counties. KY county shapefiles were downloaded from the US Census Bureau’s TIGER/Line Shapefile repository. Data for percent poverty was downloaded from the American Community Survey 2019 5-year estimates. Choropleth maps are expressed by quantiles. All maps were produced in ESRI ArcGIS Pro version 2.8.4. There were 29,360 unique births during the study period. A total of 398 HF wells were identified in all counties, 45.7% were slick water HF and the vast majority were in Lawrence county (n=160). Lawrence county had the highest prevalence of low birth weight (15.37%, n=166). The 9 remaining counties did not show a spatial association between residential proximity and low birth weight. There was no association between preterm birth and slick water or N2 well location. There appears to be a spatial association between slick water HF, and low and very low birth weight. This spatial correlation is not present for preterm birth.

PurposeCancer registries offer an avenue to identify cancer clusters across large populations and efficiently examine potential environmental harms affecting cancer. The role of known metal carcinogens (i.e., cadmium, arsenic, nickel, chromium(VI)) in breast and colorectal carcinogenesis is largely unknown. Historically marginalized communities are disproportionately exposed to metals, which could explain cancer disparities. We examined area-based metal exposures and odds of residing in breast and colorectal cancer hotspots utilizing state tumor registry data and described the characteristics of those living in heavy metal-associated cancer hotspots.MethodsBreast and colorectal cancer hotspots were mapped across Kentucky, and area-based ambient metal exposure to cadmium, arsenic, nickel, and chromium(VI) were extracted from the 2014 National Air Toxics Assessment for Kentucky census tracts. Among colorectal cancer (n = 56,598) and female breast cancer (n = 77,637) diagnoses in Kentucky, we used logistic regression models to estimate Odds Ratios (ORs) and 95% Confidence Intervals to examine the association between ambient metal concentrations and odds of residing in cancer hotspots, independent of individual-level and neighborhood risk factors.ResultsHigher ambient metal exposures were associated with higher odds of residing in breast and colorectal cancer hotspots. Populations in breast and colorectal cancer hotspots were disproportionately Black and had markers of lower socioeconomic status. Furthermore, adjusting for age, race, tobacco and neighborhood factors did not significantly change cancer hotspot ORs for ambient metal exposures analyzed.ConclusionAmbient metal exposures contribute to higher cancer rates in certain geographic areas that are largely composed of marginalized populations. Individual-level assessments of metal exposures and cancer disparities are needed.

Background: Childhood lead poisoning remains a critical public health problem in the United States. The neurotoxic effects of early life lead exposure have been associated with numerous behavioral issues, including violence. To explore this association further, we evaluated whether there was spatial association between topsoil lead levels and violent crime in Jefferson County, Kentucky.Methods: Our study collected topsoil samples from four pre-specified areas; one high crime area (Study Area), and three normal-to-low crime areas (Northeast, Southeast, Southwest). A spatial error model was used to compare topsoil lead content between the four collection areas. A Bayesian sparse spatial generalized linear mixed model was used to examine the relationship between topsoil lead levels and violent crime.Results: The Study Area had an 8.25-fold increase in topsoil lead concentration compared with the referent Southeast Control Area (beta: 8.25, 95% confidence intervals [CI]: 5.12-13.27). In addition, for every 100-unit increase in the estimated mean topsoil lead concentration per census-tract, there was a 62% increased risk for violent crime (risk ratio: 1.62, 95% CI: 1.59-1.68). Model results were attenuated but remained significant after adjusting for pertinent confounders (risk ratio: 1.05, 95% CI: 1.03-1.08).Discussion: Results from our study suggest that lead contaminated topsoil may be an important modifiable risk factor for violent crime. Although there are individual-level and sociological risk factors associated with violence, environmental lead remains a known developmental neurotoxicant that may increase the risk for violent behavior.Conclusion: Remediating lead contaminated environments may be an important consideration for legislative policies aimed at preventing violent crime.

BACKGROUND AND AIM: Noise exposure is generally reported as year-round and source-specific. Recent studies, predominately outside of the US, have reliably estimated environmental noise with land-use regression (LUR). We estimated cumulative environmental noise exposure in Jefferson County, Kentucky via LUR for different seasons and time windows. METHODS: Noise data were collected using a Class 1 sound level meter at 15 sites for 24 hours in January 2021 and April 2021. Noise data were averaged to represent combinations of season and time of day. LUR models were built based on prior literature and statistical thresholds using geographic predictors, such as Normalized Difference Vegetation Index (NDVI), length of streams, railways, and major roads within a buffer; distance to airports; hospitals and police stations; traffic volume and more. R2 values assessed model fit and the leave-one-out cross validation and root-mean squared errors (RMSE) assessed the predictive ability. RESULTS:Models resulted with R2 values ranging from 0.50 to 0.73 and RMSE values between 4.57 and 6.49 decibels. NDVI and distance to flightpaths were consistent predictors of noise across seasons and time windows. Compared to living within 1 km of flightpaths, living further away resulted in lower noise estimates (beta coefficient range: -0.99 to -4.86). A 0.1 increase in NDVI resulted in lower noise estimates (coefficients range: -2.01 to -5.97). Length of major roads (beta=1.5 95% CI -3.3, 6.4) and streams (beta=-4.1 95% CI -13.0, 4.9) were predictors of January noise. Traffic volume and railroad length were positive predictors of April noise but not January noise. Noise was approximately 10 decibels louder in April than in January. CONCLUSIONS:Multiple models may be needed to estimate environmental noise for varying seasons and times when considering total ambient noise exposures. Consideration of other noise sources (ex. NDVI, streams) in noise LUR models is warranted in future work. KEYWORDS: Noise, spatial statistics, modeling, exposure assessment, environmental epidemiology

Objectives The influence of socioeconomic disparities on adults with pneumonia is not well understood. The objective of our study was to evaluate the relationship between community-level socioeconomic position, as measured by an area deprivation index, and the incidence, severity, and outcomes among adults with community-acquired pneumonia (CAP). Methods This was an ancillary study of a population-based, prospective cohort study of patients hospitalized with CAP in Louisville, Kentucky, from June 1, 2013, through May 31, 2015. We used a race-specific, block group-level area deprivation index as a proxy for community-level socioeconomic position and evaluated it as a predictor of CAP incidence, CAP severity, early clinical improvement, 30-day mortality, and 1-year mortality. Results The cohort comprised 6349 unique adults hospitalized with CAP. CAP incidence per 100 000 population increased significantly with increasing levels of area deprivation, from 303 in tertile 1 (low deprivation), to 467 in tertile 2 (medium deprivation), and 553 in tertile 3 (high deprivation) (P < .001). Adults in medium- and high-deprivation areas had significantly higher odds of severe CAP (tertile 2 odds ratio [OR] = 1.2 [95% confidence interval (CI), 1.06-1.39]; tertile 3 OR = 1.4 [95% CI, 1.18-1.64] and 1-year mortality (tertile 2 OR = 1.3 [95% CI, 1.11-1.54], tertile 3 OR = 1.3 [95% CI, 1.10-1.64]) than adults in low-deprivation areas. Conclusions Compared with adults residing in low-deprivation areas, adults residing in high-deprivation areas had an increased incidence of CAP, and they were more likely to have severe CAP. Beyond 30 days of care, we identified an increased long-term mortality for persons in high-deprivation areas. Community-level socioeconomic position should be considered an important factor for research in CAP and policy decisions.

Background: Prescription opioid abuse has increased to epidemic proportions in the United States. Kentucky, along with other states, passed comprehensive legislation to monitor and curb opioid prescribing. Objectives: This paper characterizes patients who presented to the emergency department (ED) after abusing prescription opioids and heroin prior to and after the passage of House Bill 1 (HB1) in April 2012. Methods: Based on a retrospective review of ED visits from 2009-2014 in one urban adult facility, patients were included if the chief complaint or diagnosis was directly related to prescription opioid or heroin abuse. The primary outcome is the number and type of substance abused by each ED patient. Results: From 2009-2014, 2945 patients presented to the ED after prescription opioid or heroin abuse. The number of prescription opioid patients decreased from 215 (of 276 patients) in 2009 to 203 (of 697 patients) in 2014; 77.9% of patients abused opioids in 2009, vs. 29% in 2014 (a 63% decrease). The number of heroin patients increased from 61 in 2009 to 494 in 2014; 22% of patients in 2009 abused heroin, vs. 71% in 2014 (a 221% increase). Both piecewise regression and autoregressive integrated moving average trend models showed an increased trend in patient heroin abuse beginning in 2011-2012. Conclusions: Our facility experienced a decrease in the number of patients who abused prescription opioids and an increase in the number of patients who abused heroin over the study period. The transition seemed to occur just prior to, or concurrent with, enforcement of statewide opioid legislation. (C) 2017 Elsevier Inc. All rights reserved.

Background: Improvement in left ventricular ejection fraction (LVEF) can occur with prompt treatment of the culprit arrhythmia in patients with arrhythmia-induced cardiomyopathy (AIC). Predictors of recovery, however, are not well understood. We assessed the impact of arrhythmia duration and index

PURPOSE:We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients.MATERIALS AND METHODS:Prospective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups.RESULTS:124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99).CONCLUSION:We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation.

The estimated burden of community-acquired pneumonia in the United States is substantial, with > 1.5 million adults being hospitalized annually. The projected mortality for the US is 100000 deaths occurring during hospitalization, reaching 480000 deaths 1 year after hospital discharge.Understanding the burden of community-acquired pneumonia (CAP) is critical to allocate resources for prevention, management, and research. The objectives of this study were to define incidence, epidemiology, and mortality of adult patients hospitalized with CAP in the city of Louisville, and to estimate burden of CAP in the US adult population. This was a prospective population-based cohort study of adult residents in Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Consecutive hospitalized patients with CAP were enrolled at all adult hospitals in Louisville. The annual population-based CAP incidence was calculated. Geospatial epidemiology was used to define ecological associations among CAP and income level, race, and age. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization. During the 2-year study, from a Louisville population of 587499 adults, 186384 hospitalizations occurred. A total of 7449 unique patients hospitalized with CAP were documented. The annual age-adjusted incidence was 649 patients hospitalized with CAP per 100000 adults (95% confidence interval, 628.2-669.8), corresponding to 1591825 annual adult CAP hospitalizations in the United States. Clusters of CAP cases were found in areas with low-income and black/African American populations. Mortality during hospitalization was 6.5%, corresponding to 102821 annual deaths in the United States. Mortality at 30 days, 6 months, and 1 year was 13.0%, 23.4%, and 30.6%, respectively. The estimated US burden of CAP is substantial, with > 1.5 million unique adults being hospitalized annually, 100000 deaths occurring during hospitalization, and approximately 1 of 3 patients hospitalized with CAP dying within 1 year.

BACKGROUND:Although not all health care-associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitter's anomaly and breakout detection algorithms. METHODS:SPC and anomaly/breakout detection (ABD) charts were created for vancomycin-resistant Enterococcus, Acinetobacter baumannii, catheter-associated urinary tract infection, and central line-associated bloodstream infection data. RESULTS:Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin-resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line-associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. DISCUSSION:SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. CONCLUSIONS:Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data.

Background: Transmissibility of several etiologies of lower respiratory tract infections (LRTI) may vary based on outdoor climate factors. The objective of this study was to evaluate the impact of outdoor temperature, relative humidity, and absolute humidity on the incidence of hospitalizations for lower respiratory tract infections due to influenza, rhinovirus, and respiratory syncytial virus (RSV).

Background: Predicting if a hospitalized patient with community-acquired pneumonia (CAP) will or will not survive after admission to the hospital is important for research purposes as well as for institution of early patient management interventions. Although population-level mortality prediction scores for these patients have been around for many years, novel patient-level algorithms are needed. The objective of this study was to assess several statistical and machine learning models for their ability to predict 30-day mortality in hospitalized patients with CAP.

Background: Quality improvement is central to Infection Prevention and Control (IPC) programs. Challenges may occur when applying quality improvement methodologies like process control charts, often due to the limited exposure of typical IPs. Because of this, our team created an open-source database with a process control chart generator for IPC programs. The objectives of this report are to outline the development of the application and demonstrate application using simulated data.Methods: We used Research Electronic Data Capture (REDCap Consortium, Vanderbilt University, Nashville, TN), R (R Foundation for Statistical Computing, Vienna, Austria), and R Studio Shiny (R Foundation for Statistical Computing) to create an open source data collection system with automated process control chart generation. We used simulated data to test and visualize both in-control and out-of-control processes for commonly used metrics in IPC programs.Results: The R code for implementing the control charts and Shiny application can be found on ourWeb site (https://github. com/ul-research-support/spcapp). Screen captures of the workflow and simulated data indicating both common cause and special cause variation are provided.Conclusions: Process control charts can be easily developed based on individual facility needs using freely available software. Through providing our work free to all interested parties, we hope that others will be able to harness the power and ease of use of the application for improving the quality of care and patient safety in their facilities. (C) 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

PurposeThere is a scarcity of studies assessing the patient population admitted to the intensive care unit (ICU) with opioid overdose. We sought to characterize the epidemiologic features and outcomes of this patient population.Materials and methodsThis is a retrospective cohort study of adult patients admitted to the ICU at University of Louisville Hospital for opioid overdose. We reviewed each patient's hospital record for demographic data, comorbidities, opioid used, coingestions, and outcomes.ResultsWe included 178 adult patients, of which 107 (60%) were females. The median age was 41 years (interquartile range [IQR], 23). Oxycodone and hydrocodone were the 2 most commonly abused opioids. Benzodiazepines were the most common drug coingested, followed by amphetamines. Tobacco smoking, chronic pain, and alcoholism were the most frequent comorbidities identified. Mental disorders were also common. Most patients required invasive mechanical ventilation (84.8%). Median ICU length of stay was 3 days. Eighteen patients (10.1%) died in the hospital, whereas 6 patients (3.4%) were discharged to a nursing home. Patients who had any coingestion were significantly more likely to undergo invasive mechanical ventilation (91% vs 77%; P=.014) and had longer ICU length of stay (3 [IQR, 2] vs 2 [IQR, 1.8] days; P=.024).ConclusionOpioid overdose is a common cause of ICU admission and affects a relatively young population. Most have respiratory failure requiring mechanical ventilation. It is associated with a relatively high inhospital mortality. Coingestions appear to have an impact on outcomes.

ObjectiveAchieving patient recruitment goals is critical for the successful completion of a clinical trial. We designed and developed a web-based dashboard for assisting in the management of clinical trial screening and enrollment.Materials and methodsWe use the dashboard to assist in the management of two observational studies of community-acquired pneumonia. Clinical research associates and managers using the dashboard were surveyed to determine its effectiveness as compared with traditional direct communication.ResultsThe dashboard has been in use since it was first introduced in May of 2014. Of the 23 staff responding to the survey, 77% felt that it was easier or much easier to use the dashboard for communication than to use direct communication.ConclusionWe have designed and implemented a visualization dashboard for managing multi-site clinical trial enrollment in two community acquired pneumonia studies. Information dashboards are useful for clinical trial management. They can be used in a standalone trial or can be included into a larger management system.

Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are increasing on a global scale. Because of the need for CRE transmission prevention and control, we sought to evaluate the efficacy of a silver-based skin antiseptic against these organisms. Using a human skin analog, a third party laboratory conducted efficacy testing. The results suggest that this product provides antimicrobial activity against CRE on human skin. Because of the unique properties, this antiseptic may be useful for daily bathing of hospitalized patients to assist in the control of CRE.