Ohio Department of Health

During out-of-hospital cardiac arrest (OHCA), initial airway device choice as well as final device choice in the event of failure may both influence overall procedural success and patient outcomes. Understanding national practice patterns in airway device placement may inform resuscitation strategies and system-level quality improvement. To assess patterns in the order of advanced airway device use for adults in the United States receiving OHCA treatment during emergency medical service (EMS) activations. This retrospective cross-sectional study used data from the National EMS Information System (NEMSIS) database from January 2018 to December 2023. During this period, NEMSIS included more than 256 million EMS activations from nearly 14 000 agencies across 54 states and territories. Activations for 911 responses during adult OHCA with advanced airway device attempts after EMS arrival, with documented success (yes or no) and number of attempts, were included. Advanced airway devices documented by EMS clinicians. Order of advanced airway device use, measured by EMS clinician documentation. From 2018 to 2023, EMS reported 2 365 224 activations involving adults having an OHCA, with 650 440 patients (0.3%) receiving either endotracheal intubation (ETI) and/or supraglottic airway (SGA). Most patients received a successful initial airway device attempt (503 774 [77.4%]). Although ETI was the most common initial airway device (458 546 [70.5%]), SGA had a higher first-pass success rate (93.0% vs 71.0%). Among patients whose first ETI attempt failed (133 177 of 458 546 [29.0%]), the final documented device remained ETI in 72 167 cases (72.3%) and changed to SGA in 27 651 (27.7%). Among patients whose first SGA attempt failed, 13 480 (61.9%) remained with SGA and 3388 (38.1%) were switched to ETI. In this cross-sectional study, most patients with OHCA received ETI as the first advanced airway procedure, despite higher SGA first-pass success. Among patients whose initial attempt failed, most continued with the same device. However, switching from ETI to SGA had a higher final success rates. These findings highlight the importance of airway device sequence in prehospital care and may inform training and protocols for airway management.

Wastewater surveillance gained popularity as a tool supporting public health decision-making during the COVID-19 pandemic. In this study, we monitored four distinct socially vulnerable communities in Cincinnati, Ohio, by monitoring four subsewersheds using 15 upstream locations over two time periods: spring/summer (2023) and fall/winter (2023–2024). The goal of our study was to evaluate the feasibility and effectiveness of monitoring wastewater in socially and economically diverse subsewersheds. A number of 24 h composite samples were collected twice a week and analyzed for SARS-CoV-2 viral loads in the four subsewersheds and two wastewater treatment plants (WWTPs). Wastewater quality parameters (electric conductivity, pH, temperature, ORP) were also measured continuously. During the fall/winter period, increased clinical cases were correlated with high SARS-CoV-2 viral concentrations indicated by both subsewershed and WWTP monitoring. In our study, subsewershed monitoring did not provide early warning of SARS-CoV-2 levels in wastewater and cases compared to WWTP wastewater monitoring during the fall/winter period when outbreaks with higher pathogen levels often occur. This was possibly due to the proximity of the selected subsewersheds to the WWTPs. Although two socially vulnerable subsewersheds had higher SARS-CoV-2 viral concentrations in wastewater, the most vulnerable subsewershed had the lowest wastewater concentrations and the lowest number of reported cases during our study. Therefore, social vulnerability is not always the best predictor of the community COVID-19 burden since other factors may play a role in community infection, including transiency and population age distribution. This study presents some challenges and important findings from subsewershed SARS-CoV-2 wastewater monitoring during two seasons in Ohio.

The United States Food and Drug Administration (FDA) has now linked acetaminophen use in pregnancy to risk of offspring autism and has recommended leucovorin as a possible therapeutic for ASD [...].

Bipolar disorder is a severe mental illness, and rates of diagnosis have risen in recent years. Accurately diagnosing bipolar disorder can be difficult when a patient is not actively manic, as screening questionnaires are not reliable diagnostic tools, patient self-report can be unreliable, and bipolar symptoms overlap with other psychiatric conditions. Much has been written about the overlap between bipolar disorder and borderline personality disorder, but many other disorders present with similar symptoms, including unipolar depression. Accurate diagnosis is important to ensure optimal treatment and patient outcomes. The goal of this article is to provide an evidence-based approach to diagnosing bipolar disorder and distinguishing it from other psychiatric disorders in clinical settings. Using the mnemonic "DIGFAST" (distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleeplessness, talkativeness), we review the DSM-5-TR diagnostic criteria for mania. Distinguishing features include the episodic nature of elevated/irritable moods, severity of symptoms, and the simultaneous occurrence of multiple manic symptoms. Insight is typically impaired in bipolar disorder, and collateral information can help improve diagnostic clarity. Hypomanic symptoms can be distinguished from other conditions by their duration and accompanying changes in functioning. A thorough clinical interview is the most important asset in making an accurate diagnosis of bipolar disorder.