Journal articles on the topic 'Colorado. Public Board of Health'

Background The proliferation of technology galvanizes providers, researchers, and entrepreneurs to revolutionize health care and care delivery with diverse audiences. Digital health provides promise in improving health outcomes; however, the pace of technology requires rapid research to remain relevant in the marketplace. User experience (UX) research provides critical information about patient/client preferences while rigorous research trials demonstrate digital health efficacy. Despite the need for such research, the recruitment and enrollment process for digital health research remains time consuming and expensive, particularly when engaging underrepresented populations. Developed in the Colorado School of Public Health, the mHealth Impact Registry is a newly launched platform designed for rapid and responsive recruitment of participants for digital health research studies. While the use of registries in research is robust, the application in digital health research is quite limited. Objective This poster illustrates the development and testing of the mHealth Impact Registry’s Web-based platform, health status survey, mobile app, and participant database to reach underrepresented populations in digital health research. Methods Formative methods used a user centered approach to document user preferences for Registry design followed by iterative testing to ensure usability and navigability. Results End-user feedback was captured from multiple stakeholder groups (ie, Patient and Family Research Advisory Panel and mHealth Community Advisory Board) to refine recruitment strategy (ie, letters, video development). A health status survey was developed in both English and Spanish using the online software (ie, Qualtrics) that informs the back-end database. A detailed requirements document outlined technical and functional requirements for the mobile app (ie, iOS and Android) and Web-based platform (ie, Wordpress and Amazon Web Services). Conclusions Due to the need for rapid, rigorous, and inclusive research in digital health, a registry containing a pool of diverse participants would not only accelerate the recruitment and enrollment process but would also help to improve the reach and engagement of digital health solutions for underrepresented populations. The mHealth Impact Registry would house diverse participants, supporting quick enrollment and active participation in studies for which they are eligible. Improving the accessibility of participants and the speed of enrollment has promise in ensuring digital health solutions are relevant upon dissemination and commercialization.

Background: Acalabrutinib is a highly selective, covalent irreversible Bruton tyrosine kinase inhibitor with minimal activity against other kinases. Acalabrutinib has demonstrated durable responses as a single agent or combined with O in treatment-naïve (TN) CLL. Here, interim results are presented for the multicenter, open-label Phase 3 ELEVATE-TN study (NCT02475681), which evaluated the efficacy and safety of acalabrutinib + O vs acalabrutinib alone vs O + Clb in pts with TN CLL. Methods: Eligible pts had TN CLL requiring treatment per iwCLL criteria and were aged ≥65 y or <65 y with coexisting conditions (CIRS score >6, creatinine clearance <70 mL/min). Pts were randomized 1:1:1 to receive oral acalabrutinib (100 mg twice daily continuously) alone or combined with intravenous O (1000 mg on Days 1, 2 [split 100/900], 8, and 15 of Cycle 2, and Day 1 of subsequent 28-day cycles for a total of 6 cycles), or O plus oral Clb (0.5 mg/kg on Days 1 and 15 of each 28-day cycle for 6 cycles). Pts were stratified by del(17p) status, ECOG status (≤1 vs 2), and geographic region. The primary endpoint was independent review committee (IRC)-assessed progression-free survival (PFS) with acalabrutinib + O vs O + Clb. Key secondary endpoints included IRC-assessed PFS with acalabrutinib vs O + Clb, IRC-assessed overall response rate (ORR), overall survival (OS), and safety. Minimal residual disease (MRD) in peripheral blood or bone marrow was assessed in pts with investigator-assessed complete response (CR)/CR with incomplete marrow recovery (CRi). Crossover to acalabrutinib monotherapy was allowed for pts in the O + Clb arm with IRC-confirmed progression. Results: From 9/14/2015-2/8/2017, 535 pts were randomized to the acalabrutinib + O (n=179), acalabrutinib (n= 179), or O + Clb (n=177) arms. The median age was 70 y (range, 41-91); 69% had high- and 12% had very high-risk CLL IPI scores. At a median follow-up of 28 mo, acalabrutinib + O significantly prolonged PFS vs O + Clb (median not reached [NR] vs 22.6 mo; HR 0.10, 95% CI 0.06-0.18, P<0.0001), reducing the risk of progression or death by 90% (Figure). Acalabrutinib (median NR) also prolonged PFS vs O + Clb (HR 0.20, 95% CI 0.13-0.31, P<0.0001). Estimated 30-mo PFS rates with acalabrutinib + O, acalabrutinib, and O + Clb were 90%, 82%, and 34%, respectively. PFS improvement with acalabrutinib + O or acalabrutinib vs O + Clb was consistent across subgroups examined including del(17p) (HR [95% CI]; 0.13 [0.04-0.46]; 0.20 [0.06-0.64]). Median OS was not reached in any arm; (HR [95% CI]; acalabrutinib + O vs O + Clb, 0.47 [0.21-1.06], P=0.0577; acalabrutinib vs O + Clb, 0.60 [0.28-1.27], P=0.1556). In the acalabrutinib + O, acalabrutinib, and O + Clb arms, the estimated 30-mo OS rates were 95%, 94%, and 90%, respectively. Five pts (3%) in the acalabrutinib + O arm, 11 pts (6%) in the acalabrutinib arm, and 55 pts (31%) in the O + Clb arm had received a next therapy; 45 pts (25%) in the O + Clb arm crossed over to the acalabrutinib monotherapy arm. IRC-assessed ORR was higher with acalabrutinib + O (94%; 95% CI, 89.3%-96.5%) vs O + Clb (79%; 95% CI, 71.9%-83.9%; P<0.0001); the ORR with acalabrutinib monotherapy was 85%. CR rates were higher with acalabrutinib + O (13%) vs O + Clb (5%); there was 1 CR in the acalabrutinib monotherapy arm. MRD data will be presented. The median treatment duration was 27.7 mo for acalabrutinib + O (range, 2.3-40.3) and acalabrutinib (range, 0.3-40.2) and 5.6 mo (range, 0.9-7.4) for O + Clb. Common adverse events (AEs) are shown in the Table. AEs were similar between the acalabrutinib-containing arms. Infusion reactions were less frequent with acalabrutinib + O (13%) than with O + Clb (40%). AEs led to treatment discontinuation in 20 pts (11%) on acalabrutinib + O, 16 pts (9%) on acalabrutinib, and 25 pts (14%) on O + Clb. With >2 y of follow-up, 79.3% of pts in both the acalabrutinib-containing arms remain on single-agent acalabrutinib. AEs of interest (acalabrutinib + O or acalabrutinib vs O + Clb) were atrial fibrillation (any grade: 3% or 4% vs 1%), bleeding (any grade/Grade ≥3: 43%/2% or 39%/2% vs 12%/0%), and hypertension (Grade ≥3: 3% or 2% vs 3%). Conclusions: Acalabrutinib + O and acalabrutinib monotherapy significantly improved PFS vs O + Clb, with tolerable safety in pts with TN CLL. Despite cross over for disease progression in the O + Clb arm, a trend toward improved OS was observed in both acalabrutinib arms, though longer follow-up is needed. Disclosures Sharman: AbbVie: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; TG Therapeutics: Consultancy, Honoraria, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding; Acerta: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Research Funding. Banerji:CIHR: Research Funding; LLSC: Research Funding; Research Manitoba: Research Funding; CCMF: Research Funding; CancerCare Manitoba/University of Manitoba: Employment; CAPhO: Honoraria; BIOGEN: Other: Licensing fee; Dana-Farber Cancer Institute: Other: Licencing fee; Gilead: Consultancy, Honoraria, Research Funding; Astra-Zeneca: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Roche: Honoraria, Licensing fee, Research Funding; Abbvie: Consultancy, Honoraria. Herishanu:Janssen: Honoraria; AbbVie: Honoraria; Roche: Honoraria. Munir:Gilead: Honoraria; Janssen: Honoraria; Novartis: Honoraria; Roche: Honoraria; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sunesis: Consultancy; Pharmacyclics: Other: TBC; Acerta: Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria; AbbVie: Honoraria. Walewska:Gilead: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: Travel grant, Speakers Bureau; Abbvie: Membership on an entity's Board of Directors or advisory committees, Other: Travel grant, Speakers Bureau; Takeda: Other: Travel grant; Novartis: Other: travel grant. Follows:Abbvie: Consultancy, Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; AstraZeneca: Consultancy, Honoraria, Speakers Bureau. Karlsson:Skane University Hospital: Employment. Ghia:AbbVie: Consultancy, Honoraria, Research Funding; Acerta/AstraZeneca: Consultancy, Honoraria; Juno/Celgene: Consultancy, Honoraria; Sunesis: Consultancy, Honoraria, Research Funding; Novartis: Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy; ArQule: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria; Dynamo: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding. Corbett:Celgene: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Tauranga Hospital: Employment; Pathlab Waikato: Equity Ownership. Walker:Peninsula Health (public hospital): Employment; Alfred health (public hospital): Employment; Roche: Other: Travel grant. Jurczak:Incyte: Research Funding; Takeda: Research Funding; Sandoz: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding; TG Therapeutics: Research Funding; Loxo: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Research Funding; Roche: Research Funding; Gilead: Research Funding; Celgene: Research Funding; MorphoSys: Research Funding; Celtrion: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Servier: Research Funding. Salles:Epizyme: Consultancy, Honoraria; BMS: Honoraria; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis, Servier, AbbVie, Karyopharm, Kite, MorphoSys: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Roche, Janssen, Gilead, Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Autolus: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Other: Educational events. Janssens:Novartis: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Sanofi: Consultancy, Speakers Bureau; Celgene: Speakers Bureau; abbvie: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; idem consultancy: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau. Cymbalista:AstraZeneca: Honoraria; Janssen: Honoraria; Sunesis: Research Funding; Roche: Research Funding; Gilead: Honoraria; Abbvie: Honoraria. Wierda:Juno Therapeutics: Research Funding; Janssen: Research Funding; Cyclcel: Research Funding; KITE pharma: Research Funding; Loxo Oncology Inc.: Research Funding; Genentech: Research Funding; Xencor: Research Funding; Acerta Pharma Inc: Research Funding; Pharmacyclics LLC: Research Funding; Sunesis: Research Funding; AbbVie: Research Funding; Miragen: Research Funding; Oncternal Therapeutics Inc.: Research Funding; Gilead Sciences: Research Funding; GSK/Novartis: Research Funding. Coutre:Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Astra Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Acerta: Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Research Funding; BeiGene: Other: Travel, Accommodations, Expenses & Data Safety Monitoring Committee; Genentech: Consultancy. Pagel:AstraZeneca: Consultancy; Gilead Sciences: Consultancy; Pharmacyclics: Consultancy. Skarbnik:Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Verastem Oncology: Honoraria, Research Funding, Speakers Bureau; Kite Pharma: Honoraria, Speakers Bureau; Gilead Sciences: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau; Acerta: Research Funding; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Genentech: Honoraria, Speakers Bureau; CLL Society: Consultancy, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Speakers Bureau; Novartis: Speakers Bureau. Kamdar:AstraZeneca: Consultancy; University of Colorado: Employment; Celgene: Consultancy; Seattle Genetics: Speakers Bureau; Pharmacyclics: Consultancy. Woyach:Janssen: Consultancy, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding; AbbVie: Research Funding; Karyopharm: Research Funding; Loxo: Research Funding; Morphosys: Research Funding; Verastem: Research Funding. Izumi:AstraZeneca: Equity Ownership; Acerta Pharma: Employment, Equity Ownership, Patents & Royalties: Acalabrutinib patents. Munugalavadla:Acerta Pharma: Employment; Gilead Sciences: Equity Ownership; AstraZeneca: Equity Ownership. Patel:Acerta Pharma: Employment, Equity Ownership; AstraZeneca: Equity Ownership. Wang:Acerta Pharma: Employment; AstraZeneca: Equity Ownership. Wong:Acerta Pharma: Employment. Byrd:Genentech: Research Funding; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; Novartis: Other: Travel Expenses, Speakers Bureau; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; Novartis: Other: Travel Expenses, Speakers Bureau; Novartis: Other: Travel Expenses, Speakers Bureau; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau; Ohio State University: Patents & Royalties: OSU-2S; Ohio State University: Patents & Royalties: OSU-2S; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; Genentech: Research Funding; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; Genentech: Research Funding; Acerta: Research Funding; Acerta: Research Funding; Acerta: Research Funding; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; Ohio State University: Patents & Royalties: OSU-2S; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; BeiGene: Research Funding; BeiGene: Research Funding; BeiGene: Research Funding; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau.

Background:Clostridioides difficile remains a pervasive issue throughout healthcare facilities in the United States. Currently, no national guidelines exist for healthcare facilities to notify public health about suspected C. difficile transmission. Identification of a threshold for public health notification is needed to improve efforts to target prevention in facilities and to contain the spread of C. difficile.Methods: We analyzed C. difficile data reported by acute-care hospitals (ACHs) during October 2017–September 2018 via the CDC NHSN in Colorado and Tennessee. Threshold levels of ≥2, ≥3, and ≥4 C. difficile infections per calendar month per unit were assessed to identify ACH units that would trigger facility reporting to public health. Values meeting thresholds were defined as “alerts.” Facilities were further stratified by size and medical teaching status. Recurrent alerts were defined as meeting the threshold at least twice within 12 months. Presence and recurrence of facility alerts were compared to facility-specific standardized infection ratios (SIRs) and cumulative attributable differences (CADs). Results: Of 105 ACHs in Tennessee and 50 in Colorado, 46 in Tennessee (44%) and 28 in Colorado (56%) had alerts with a threshold of ≥2 cases per calendar month per unit; 20 in Tennessee (19%) and 19 in Colorado (38%) had ≥3 cases per calendar month per unit; and 7 in Tennessee (7%) and 10 in Colorado (20%) had ≥4 cases per calendar month per unit. Most alerts with each threshold were in facilities with ≥400 beds and in major teaching hospitals. Using a threshold of ≥2, 64% of Tennessee and 79% of Colorado alerts were associated with recurrent alerting units. Using an alert threshold of ≥3, 85% of Tennessee facilities (17 of 20) and 75% of Colorado facilities (15 of 20) with the highest CAD values had at least 1 alert. Using state-based CAD values, 79% of the CAD value for Tennessee (356 of 449) and 91% of the CAD value for Colorado (309 of 340) were attributable to facilities with at least 1 alert. Facilities above a threshold of ≥3 had a pooled SIR of 0.92 in Tennessee (range, 0.46–7.94) and 1.07 in Colorado (range, 0.74–1.74). Conclusions: Using alert threshold levels identified ACHs with higher levels of C. difficile. Recurrent alerts account for a substantial proportion of the total alerts in ACHs, even as thresholds increased. Alerts were strongly correlated with high CAD values. Because NHSN C. difficile data are not available to public health departments until several months after cases are identified, public health departments should consider working with ACHs to implement a threshold model for public health notification, enabling earlier intervention than those prompted by SIR and CAD calculations.Disclosures: NoneFunding: None

A public health partnership was established between a state Medicare Regional Care Collaborative Organization (RCCO), the state health department, a pharmacy school and three community pharmacies located in rural Colorado to optimize the utilization of a free public health service provided through each pharmacy. Fourth-year pharmacy students were allocated year-round by the University of Colorado to support disease management and medication therapy management (MTM) services offered to patients in three rural towns served by the RCCO. Faculty from the school of pharmacy reviewed data provided by the RCCO to identify patients who could benefit from MTM or disease state management (DSM) services. These patients were contacted and encouraged to take advantage of these free pharmacy-based services. Additionally, a number of targeted interventions were performed within these populations to optimize their health. Concerted efforts were made to improve information flow and communication between these pharmacy sites and partnering medical offices. Additionally, pharmacy students were successfully integrated in to medical offices to work alongside medical providers in these communities. This manuscript describes the implementation and coordination of this project as well as the impact these pharmacies had on the communities they served.
 
 Topic: Original Research

The National Board of Public Health Examiners (NBPHE, the Board) is the result of many years of intense discussion about the importance of credentialing within the public health community. The Board is scheduled to begin credentialing graduates of programs and schools of public health accredited by the Council on Education for Public Health (CEPH) in 2008. Among the many activities currently underway to improve public health practice, the Board views credentialing as one pathway to heighten recognition of public health professionals and increase the overall effectiveness of public health practice. The process underway includes developing, preparing, administering, and evaluating a voluntary certification examination that tests whether graduates of CEPH-accredited schools and programs have mastered the core knowledge and skills relevant to contemporary public health practice. This credentialing initiative is occurring at a time of heightened interest in public health education, and an anticipated rapid turnover in the public health workforce. It is fully anticipated that active discussion about the credentialing process will continue as the Board considers the many aspects of this professional transition. The Board wishes to encourage these discussions and welcomes input on any aspects relating to implementation of the credentialing process.

Cannabis-infused “edibles” are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention. We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events. It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.

People infected with HIV who persist in exposing others to infection through negligent, reckless, or criminal activity create a legal and ethical dilemma for public officials. Protection of the public health requires balancing the rights of infected people with the expectations of society. When reasonable efforts fail to obtain the voluntary cooperation of infected individuals, Colorado law permits health officers to restrict their behaviour. Since 1986, at least 20 people who were aware of their infection are known to have exposed others to HIV in Colorado Springs, Colorado. Restrictive measures have been initiated in 14 cases to date. Presented here is an overview of Colorado law, selected case studies, and a summary of its strengths and shortcomings.

The legalization of cannabis has necessitated a debate about the specific public or private places in which the consumption of cannabis should be lawfully allowed. Relevant federal, and state or provincial, laws governing the public consumption of cannabis as of April 2020 were retrieved through primary legal research in LexisNexis and official government websites. Across various states and provinces within the United States and Canada, three types of cannabis-related regulatory regimes have emerged. Quebec has adopted the most restrictive type of regulatory framework. Quebec generally prohibits the smoking or vaping of cannabis in both indoor and outdoor public places, by extending the restrictions on the use of tobacco and alcohol products to cannabis consumption. Slightly less restrictive are jurisdictions such as Ontario and British Columbia, which allow cannabis consumption in most outdoor public spaces, such as streets or parks. Certain local-level jurisdictions within the US states of California and Colorado have adopted the least restrictive local-level regulatory regime, by authorizing the operation of indoor cannabis consumption sites at certain fixed locations or within mobile spaces. The degree to which private consumption is allowed or prohibited also varies widely. An individual who lives or works in a jurisdiction such as Quebec that has prohibited the smoking or vaping of cannabis in almost all public places will be left with limited spaces in which to consume inhalable cannabis products. By contrast, a non-medical cannabis user who lives in Colorado, which authorizes on-site consumption at certain licensed establishments, has far more options to consume inhalable cannabis outside of the home. In this article, we will examine a range of federal-, state- or provincial-, and local-level laws that regulate cannabis consumption in certain public and private places and consider some of the potential public health and safety implications of these laws.

The objective was to evaluate trends in marijuana exposures reported to the Colorado regional poison centre (RPC). Human exposures cases from the Colorado RPC obtained from 1 January 2000 through 31 December 2018 using generic marijuana exposure codes. There were 2221 marijuana exposures, with an increase in exposures by 11.2 cases per year (p<0.0001). Annual cases remained steady since 2014 (p=0.22), with a 19.4% increase in 2018 compared with 2017. Since 2014, the largest increase was in children age 0–8 years (p<0.0001). Edible marijuana exposures increased by 9.6 exposures per year from 2015 to 2018 (p=0.04). After observing an increase in Colorado RPC marijuana exposure cases in 2010 and 2014, annual exposures have been stable through 2017, with the first increase in legalised recreational sales era in 2018. There are specific concerns for the paediatric population and exposures involving edibles, as these cases continue to increase.

BackgroundComprehensive background check (CBC) policies are hypothesised to reduce firearm-related violence because they extend background checks to private party firearm sales, but no study has determined whether these policies actually increase background checks, an expected intermediary outcome. We evaluate the association between CBC policies and the rates of firearm background checks in three states that recently implemented these policies: Delaware (July 2013), Colorado (July 2013) and Washington (December 2014).MethodsWe used the synthetic control group method to estimate the difference from estimated counterfactual postintervention trends in the monthly rate of background checks per 1 00 000 people for handguns, long guns and both types combined, using data for January 1999 through December 2016. Inference was based on results from permutation tests. We conducted multiple sensitivity analyses to assess the robustness of our results.ResultsBackground check rates increased in Delaware, by 22%–34% depending on the type of firearm, following enactment of its CBC law. No overall changes were observed in Washington and Colorado. Our results were robust to changes in the comparison group and statistical methods.ConclusionsThe enactment of CBC policies was associated with an overall increase in firearm background checks only in Delaware. Data external to the study suggest that Washington experienced a modest, but consistent, increase in background checks for private party sales, and Colorado experienced a similar increase in checks for sales not at gun shows. Non-compliance may explain the lack of an overall increase in background checks in Washington and Colorado.

States are required to provide a public health screening for all newly arrived refugees in the United States. In 1997, a comprehensive program was created to include both a physical examination and a mental health screening. This article provides a complete description of the mental health screening process, including two illustrative cases, and reports information about the refugees who participated in the program. Ten percent of screened refugees were offered mental health referrals; of those, 37% followed up. Refugees who presented for treatment reported a higher number of symptoms upon screening compared with those who were offered referrals but did not follow up. Psychiatric evaluation confirmed that those who screened positive and presented for treatment were experiencing a high level of suffering and qualified for mental health diagnoses. The findings support inclusion of a mental health screening as part of the public health screening.

WaterborneEscherichia coliare a major reservoir of antimicrobial resistance (AMR), including but not limited to extended-spectrum beta-lactamase (ESBL) andKlebsiella pneumoniaecarbapenemase (KPC) mechanisms. This study quantified and described ESBL- and KPC-producingE. coliin Northern Colorado from sewer water, surface water, and influent and effluent wastewater treatment sources. Total detected bacteria andE. coliabundances, and the percentages that contain ESBL and/or KPC, were compared between water sources. SeventyE. coliisolates from the various waters had drug resistance validated with a panel of 17 antibiotics using a broth microdilution assay. The diverse drug resistance observed acrossE. coliisolates was further documented by polymerase chain reaction of common ESBL genes and functional relatedness by PhenePlate assay-generated dendrograms (n=70). The totalE. coliabundance decreased through the water treatment process as expected, yet the percentages ofE. coliharboring ESBL resistance were increased (1.70%) in surface water. Whole-genome sequencing analysis was completed for 185 AMR genes in wastewaterE. coliisolates and confirmed the presence of diverse AMR gene classes (e.g., beta-lactams and efflux pumps) in isolate genomes. This study completed surveillance of AMR patterns inE. colithat reside in environmental water systems and suggests a role for integrating both phenotypic and genotypic profiling beyond ESBL and KPC mechanisms. AMR screening via multiple approaches may assist in the prevention of drug-resistantE. colispread from waters to animals and humans.