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PubMed2001

Intranet-based quality improvement documentation at the Veterans Affairs Maryland Health Care System.

The Pathology and Laboratory Medicine Service of the Veterans Affairs Maryland Health Care System is inspected biannually by the College of American Pathologists (CAP). As of the year 2000, all documentation in the Anatomic Pathology Section is available to all staff through the VA Intranet. Signed, supporting paper documents are on file in the office of the department chair. For the year 2000 CAP inspection, inspectors conducted their document review by use of these Web-based documents, in which each CAP question had a hyperlink to the corresponding section of the procedure manual. Thus inspectors were able to locate the documents relevant to each question quickly and efficiently. The procedure manuals consist of 87 procedures for surgical pathology, 52 procedures for cytopathology, and 25 procedures for autopsy pathology. Each CAP question requiring documentation had from one to three hyperlinks to the corresponding section of the procedure manual. Intranet documentation allows for easier sharing among decentralized institutions and for centralized updates of the laboratory documentation. These documents can be upgraded to allow for multimedia presentations, including text search for key words, hyperlinks to other documents, and images, audio, and video. Use of Web-based documents can improve the efficiency of the inspection process.

Databases, Factual↗
PubMedDate not supplied

Temporal variability of microenvironmental time budgets in Maryland.

Information on human time-activity patterns is often required to interpret environmental exposure data fully and to implement exposure assessment models. Data on short-term time-activity patterns for individuals, such as 1-day measurements, are relatively abundant. The reliability of such data for use in chronic exposure (e.g., 1 or more years) assessments performed for evaluation of health risks is not well understood. As part of the NHEXAS-Maryland investigation, daily time budget data for seven microenvironments were collected from 80 people during as many as six 1-week Cycles over a 12-month period. The data were summarized and analyzed statistically by sampling Cycle, day of week, and individual to characterize long-term average microenvironmental time budgets and to identify their determinants. Median times spent in transit, indoors at home, outside at home, indoors at work or school, outdoors at work or school, indoors at other locations, and outdoors at other locations were found to vary significantly, although not substantively in many cases, by time of year (i.e., Cycle), by day of week, and by individuals. Time budgets for most of the microenvironments also exhibited significant variability by gender, age group, education level, annual household income, and work status. The results indicate that short-term (e.g., 1-day) measures of microenvironmental time budgets for individuals are unlikely to be representative of their long-term patterns. Thus, health risk or epidemiological assessments performed for a population mean or specific quantile may be relatively insensitive to when time budget data were collected. However, the accuracy of such assessments performed for individuals is likely to be greatly improved by collection of time budget data from numerous points in time.

Adolescent↗
PubMed2005

Determinants of temporal variability in NHEXAS-Maryland environmental concentrations, exposures, and biomarkers.

The longitudinal NHEXAS-Maryland study measured metals, PAHs, and pesticides in several media to capture temporal variability. Questionnaires were concurrently administered to identify factors that influenced changes in contaminant levels over time. We constructed mixed-effects regression models for lead, phenanthrene, and chlorpyrifos (including metabolites) in indoor air, dust, dermal wipes, and biological fluids. Significant predictors represented time-varying activities as well as unchanging housing and demographic factors. There was little overlap among the models, with predictors generally reflecting the diverse characteristics of the target compounds. We estimated between- and within-person variance components to evaluate the reliability of the measurements. While only one measurement of lead in blood or chlopyrifos in dust was needed for a dependable estimate of an individual's average level, three to eight measurements were needed for most other compound/exposure medium combinations because of considerable temporal variability. Measurements in biological fluids and dust were generally more consistent than those in indoor air. The significant covariates in the full models preferentially reduced the between-person variance component. Since the regression models explained only 1-37% of the within-person variance, the questionnaires in this study provided only modest insight into the factors responsible for the temporal variability in the contaminant levels.

Air Pollution, Indoor↗
PubMed2000

Celebrating a decade of evaluation and treatment: the University of Maryland Tinnitus & Hyperacusis Center.

The University of Maryland Tinnitus & Hyperacusis Center in Baltimore was the first center in the United States dedicated to the evaluation and treatment of tinnitus and hyperacusis patients implementing an habituation-based protocol that has become known internationally as Tinnitus Retraining Therapy (TRT). A crucial feature of the model is the postulate that a number of systems in the brain are involved in the emergence of tinnitus. The cochlea and auditory periphery play only a secondary role. To facilitate the goal of habituation of the tinnitus signal, TRT implements both directive counseling to neutralize the negative emotional associations toward the tinnitus, and sound therapy to interfere with the signal. As an outgrowth of the work with tinnitus, the evaluation and treatment of hyperacusis has emerged as an increasingly important part of our program. This report describes the unique facility, staff, and services of the Center as we celebrate a decade of research and clinical management dedicated to the scientific understanding of tinnitus and hyperacusis.

Acoustic Stimulation↗
PubMed1976

The Johns Hopkins experience in Columbia, Maryland.

A university-related prepaid group practice was established in Columbia, Maryland, in 1969, by the Johns Hopkins Medical Institutions with the cooperation of the Connecticut General Life Insurance Company. Objectives were based on the traditional triad of service, teaching and research. The effort continues. There has been visible success in the achievement of each of the objectives. It is evident, however, that the development of the Columbia Medical Plan would have been facilitated if there had been a larger population base in which to market membership in the Plan, if marketing had been under the direction of the health-care provider, and if the burden of the building and running of a hospital had not been assumed. Overall, the experience suggests that the Health Maintenance Organization movement has only modest ultimate potential as an option in health-care delivery in the current economic milieu of American medicine.

Comprehensive Health Care↗
PubMed2006

Disparities in the circumstances of asthma deaths in Maryland.

The reasons for significant disparities in asthma mortality are unclear. Maryland vital statistics and medical examiner data were used to examine timing, location, and circumstances of asthma deaths. We found that unexplained deaths increased substantially over the past 10 years and that young, male, and black asthmatics were more likely to die before hospital admission. Factors contributing to disparities included better availability of anti-inflammatory medications among whites versus blacks, and a higher incidence of positive toxicology screens among males versus females. Disparities in asthma mortality might be reduced through efforts to optimize asthma treatment and reduce illicit drug use.

Adolescent↗
PubMed1984

Variations of phthalate ester concentrations in sediments from the Chester River, Maryland.

Phthalate esters discharged from a plasticizer-manufacturing plant were distinguished from those of other sources in the Chester River, Maryland by comparing the distinctive patterns of alkyl phthalate species of the plant to those of sediment samples from sites along the mid-river axis. The magnitude of the changes in individual phthalate species were placed in perspective by charting their concentrations with distance along the river. Short sediment cores were also analyzed to determine the profile of phthalate ester pollution in the Chester River during the previous decade in which the river experienced a significant oyster mortality. A significant level of phthalate ester pollution was found in the Chester River sediment but its source was not found to be the plasticizer plant.

Dibutyl Phthalate↗
PubMed1984

Trace metal residues in shellfish from Maryland waters, 1976-1980.

Levels of seven heavy metal residues, arsenic, cadmium, chromium, copper, lead, mercury and zinc were monitored in samples of the American oyster (Crassostrea virginica), the soft shell clam (Mya arenaria), the hard shell clam (Mercinaria mercinaria) and the blue crab (Callinectes sapidus). Samples were taken from the Maryland section of the Chesapeake Bay and its tributaries over a five year period (1976-80). This study was undertaken to provide an estimate of a baseline for values of trace heavy metals. Also, the oyster, being a non-mobile filter feeder, provides information regarding the level of metal residues in its environment (water and sediment), because heavy metal uptake is related to the surrounding metal concentrations. Additionally, this type of monitoring program is essential to ensure that shellfish sold for human consumption are within safe limits established for toxic substances by the United States Food and Drug Administration. Results of the study are consistent with data from previous years and no statistically significant year-to-year trends were observed over the period of the investigation.

Animals↗
PubMed1984

Organochlorine residues in shellfish from Maryland waters, 1976-1980.

Shellfish samples, including the American oyster (Craessostrea virginica), the soft shell clam (Mya arenaria), the hard shell clam (Mercenaria mercenaria) and the blue crab (callinectes sapidus), were taken from the Maryland section of the Chesapeake Bay and its tributaries over a five year period (1976-80) and analyzed to determine residue levels of various organochlorine pesticides. Qualitative and quantitative information was obtained for a variety of polychlorinated hydrocarbons. The purpose of this study includes the establishment of baseline values for levels of shellfish contamination, utilization of the data as an indicator of probable levels of water and sediment contamination in the vicinity of the sampling site and ensurance that shellfish harvested for human consumption are within U.S. Food and Drug Administration guidelines for organochlorine contamination. All mean values and virtually all individual values were within FDA guidelines.

Animals↗
PubMed1985

Organochlorine residues in finfish from Maryland waters 1976-1980.

Organochlorine pesticide and herbicide levels were monitored in samples of a variety of edible finfish harvested from the Maryland section of the Chesapeake Bay and its tributaries over a five-year period (1976-80). Qualitative and quantitative information was obtained for the various polychlorinated biphenyls (PCB's), heptachlor, alpha-BHC, chlordane, DDD, DDE, DDT, dieldrin, endrin, heptachlorepoxide, lindane, mirex, methoxychlor, aldrin, toxaphene, hexachlorobenzene, kepone and dacthal. In addition to analyses of the flesh of the animals, organochlorine residue levels were determined in roe or gonad tissue of several samples. Striped bass, white perch and yellow perch samples showed significantly higher concentrations of certain of these substances in roe or gonad tissue, especially PCB's, chlordane, DDD and dieldrin. Significantly higher levels of six organochlorine residues were found in the gonad tissue of striped bass; however, similar studies on gonad tissue of American Shad, harvested from the same region, show no such enhancement. Rather, the reverse is true; levels of certain organochlorine residues are higher in flesh tissue. All mean values, and virtually all individual values of organochlorine concentrations in the edible portion of the fish were within the U.S. Food and Drug Administration guideline, where such guidelines have been established.

Animals↗
PubMed1986

Trace metal residues in finfish from Maryland waters, 1978-1979.

Levels of seven heavy metal residues, arsenic, cadmium, chromium, copper, lead, mercury and zinc were monitored in samples of various species of finfish harvested from the Maryland section of the Chesapeake Bay and its tributaries over a two year period (1978-79). Results of the analysis of the edible portions of these finfish are presented along with the species of finfish, date and location of harvest. A number of samples of finfish gonad and liver tissue were analyzed to study the relative level of preconcentration of heavy metals in these tissues compared to the edible (flesh) portion. Results of this study are consistent with other available data for Atlantic Coast finfish. Gonad tissue, when compared to flesh, show enrichment of copper and zinc and decreased mercury and cadmium levels. Liver tissue shows enrichment in copper, zinc and cadmium and generally lower levels of mercury compared to flesh.

Animals↗
PubMed1996

Educational program in palliative and hospice care at the University of Maryland School of Medicine.

BACKGROUND: The objective of this enterprise was and is to develop a validatable educational program on palliative and hospice care with a multidisciplinary perspective for the University of Maryland School of Medicine. METHODS: An interdisciplinary education committee consisting of experts in palliative and hospice care and an expert in educational design and evaluation was established to develop the program. Program development, which is ongoing, includes a comprehensive instructional design phase, vertical integration of the program into the medical school curriculum, and outcome evaluation. RESULTS: The instructional design phase has been accomplished; hence, the focus of this paper is on this aspect of program development. In addition, some integration of specific content areas into the medical school curriculum has been implemented. CONCLUSIONS: When complete, the program will focus on developing skills and knowledge using a variety of interactive educational modalities, including problem-based learning, case study discussions, role playing, and practical experience at hospice and palliative care sites. Topics to be covered are symptom control, the compassionate approach to patient care, communication between physicians and patients or family members, professional collaboration on a multidisciplinary palliative care team, ethical and legal issues pertaining to end-of-life care, and the value of palliative medicine as a profession.

Curriculum↗
PubMed2004

Exposure to the sobriety "Checkpoint Strikeforce" campaign in Maryland: impact on driver perceptions of vulnerability and behavior.

OBJECTIVES: To compare drivers who were: (1) exposed to Maryland's sobriety "Checkpoint Strikeforce" campaign; (2) not exposed but were aware of it; and (3) neither exposed nor aware of it. This six-month campaign involved periodic road-side sobriety checkpoints, in which police attempted to detect and arrest drunk drivers and a series of radio Public Service Announcements (PSAs) that promoted public awareness. METHODS: A statewide sample of 1725 drivers were interviewed by telephone to determine their exposure to and awareness of this campaign, as well as their beliefs and behaviors concerning drunk driving and seat belt usage. RESULTS: Relatively few people (9.6%) were exposed in any way to the campaign; however almost 30% were aware of it. Significant increases in perceived vulnerability to arrest for drinking and driving were found among those who were exposed. There were no differences in reported drinking and driving, but seat belt usage in the last 30 days was higher among those who were exposed. There were no differences among those people who had been directly exposed to the campaign (i.e., personally gone through a sobriety checkpoint) and those who were indirectly exposed (i.e., knew a family member or someone else who went through a checkpoint). CONCLUSIONS: Exposure to a sobriety checkpoint was associated with increased perceptions of drink-driving risk (i.e., likelihood of getting caught by the police), which was not dependent upon having personally experienced it. Awareness without exposure appears to be insufficient to change perceived risk. The need to increase the reach and frequency of the sobriety "Checkpoint Strikeforce" campaign is indicated.

Adolescent↗
PubMedDate not supplied

Differentials in the incidence of births while on welfare: evidence from Maryland.

Births while on public assistance has been one of the central topics in the welfare debate in Maryland because the welfare grant increases with the number of children, and there is debate about whether or not to continue the increased income provision. Based on the Quality Control (QC) data for the period from July 1991 to June 1992, this study examined differentials in the incidence of births conceived and borne while the mothers were on welfare. The results indicate that about one-quarter of recipient children were born on welfare and that higher incidences of these births occur among mothers with less than high-school education, never-married, young, Baltimore residents, and with fewer children at entry on welfare. The presence of parents of welfare mothers or of any adults in the household is found to reduce the incidence of births. Disallowance of the increased welfare grant for additional children may increase the number of families in poverty and the number of children in foster care unless efforts are made to reduce unintentional births and school drop-outs and to fill the gap between mothers' schooling and the needs of the job market.

Adult↗
PubMed2001

Variations of well water radon in Virginia and Maryland.

In north-central Virginia and south-central Maryland, municipal water supplies obtained from reservoirs provide radon-free potable water. However, about 10 percent of the population consumes well water. Radon in drinking water from some wells exceeds 4,000 pCi/L. Only about 30% of the radon is lost between the well storage tanks and the homes. The average radon concentration is about 2,000 pCi/L, which greatly exceeds the U.S. Environmental Protection Agency's recommended Maximum Contamination Level of 300 pCi/L. In this study of a geologically diverse area, the well water comes from granite (radon averages about 3,000 pCi,/L), schist and phyllite (about 2,000 pCi/L), sandstone (about 1,500 pCi/L), and quartzite (about 1,100 pCi/L). Aeration experiments on well water in storage tanks indicated that about 60-70% can be removed using a splash box with an exhaust fan on the storage tank, and about 60-70% can be removed using bubble aeration. About 90% of the radon can be removed by the simultaneous use of bubble aeration, splash box, and an exhaust fan. However, this combination does not become less efficient through time. Passing the water through tanks of activated charcoal can remove about 90% of the radon, though the charcoal becomes less efficient over an interval of a few months.

Air↗
PubMed2002

A predominant role for Norwalk-like viruses as agents of epidemic gastroenteritis in Maryland nursing homes for the elderly.

Stool specimens from 156 Maryland nursing home residents, who became ill during 20 outbreaks of gastroenteritis from November 1987 through February 1988, were analyzed. All tested negative for astroviruses, enteroviruses, Group A rotaviruses, Sapporo-like caliciviruses, and enteric bacteria (i.e., Salmonella, Clostridium, and Shigella species). Eighty-two (52%) were positive for Norwalk-like viruses (NLVs), members of the family Caliciviridae. Six distinct genetic clusters within genogroups I and II of the NLVs were detected; a genogroup II (GII) virus closely related to the Camberwell virus in the NLV GII/4 genetic cluster was the predominant strain. Serologic evidence of infection with > or = 1 NLV was detected in 61 (56%) of 109 patients tested against 3 NLV antigens (i.e., Norwalk, Hawaii, and Toronto viruses). Sixteen (80%) outbreaks met the definition for an NLV outbreak. Taken together with a retrospective analysis of bacterial gastroenteritis in this same setting, these data support a major role for NLVs as etiologic agents of gastroenteritis in elderly persons.

Aged↗
PubMed2006

Epidemiology of community-onset candidemia in Connecticut and Maryland.

BACKGROUND: Almost one-third of patients with bloodstream infections with Candida species (candidemia) have onset of disease that occurs outside of the hospital or < or = 2 days after hospital admission (i.e., community-onset candidemia). We compared the characteristics of patients who developed candidemia by the timing of onset of infection. METHODS: Incident episodes of candidemia were identified through active, population-based surveillance in Connecticut and in Baltimore and Baltimore County, Maryland, during 1 October 1998-30 September 2000. The molecular subtypes of a sample of 45 Candida parapsilosis isolates were evaluated using Southern blots hybridized with the complex probe Cp3-13. RESULTS: Overall, 356 (31%) of the 1143 incident episodes of candidemia were classified as community-onset disease (occurring < or = 2 days after hospital admission), and 132 (37%) were caused by Candida albicans, 89 (25%) were caused by Candida glabrata, 57 (16%) were caused by C. parapsilosis, and 53 (15%) were caused by Candida tropicalis. Community-onset disease was less likely to be associated with concurrent immunosuppressive therapy, recent surgery, or use of a central venous catheter, compared with inpatient disease. Among patients with community-onset disease, the median time from blood culture to initiation of antifungal treatment was 2.7 days, the 30-day case-fatality rate was 26%, and 262 patients (75%) had been hospitalized at least once in the previous 3 months. Although there were few differences between patients with very recent hospitalization (in the previous 1 month), less recent hospitalization (previous 1-3 months), and no documented past hospitalization, C. parapsilosis was more frequently associated with community-onset disease as hospitalization became more distant. C. parapsilosis strains tended to be unique to the patient, with little similarity found between strain types, on the basis of epidemiologic classification of patients. CONCLUSION: We report that community-onset candidemia is common and occurs in patients with extensive contact with the health care system. Disease caused by C. parapsilosis tends to involve unique strains.

Adolescent↗
PubMed1997

Impact of tuberculosis control measures and crowding on the incidence of tuberculous infection in Maryland prisons.

Our aim was to determine the incidence of tuberculin skin test (TST) conversion in the Maryland state correctional system. We conducted a historical longitudinal cohort study. A sample of 1,289 inmates, incarcerated in 16 of 23 prisons, who had a negative TST and a second test within 24 months was selected. The incidence of recent conversion was 6.3 per 100 person-years. Risk factors for conversion included high prison-population density (relative risk [RR] = 2.4; 95% confidence interval [CI], 1.5-3.8) and incarceration in a higher-security institution (RR = 2.4; 95% CI, 1.4-4.3). Incarceration in an institution with higher levels of isoniazid prophylaxis (> 65% of TST positives) reduced the risk of infection by 50% (RR = 0.5; 95% CI, 0.3-0.7). Crowding was strongly correlated with risk of conversion (r = 0.83; P < .001), while rates of isoniazid prophylaxis initiation were inversely correlated with risk of infection (r = -0.82; P < .001). In stepwise regression, higher prison-population density was the strongest predictor of increased infection. In a final model, inclusion of the rate of isoniazid prophylaxis initiation reduced the risk associated with crowding (RR = 1.4; P = .4). Annual screening programs for prisons can identify recent conversions that may not otherwise be detected.

Adult↗