@article{rhea_camacho_amoriello_correa_lewbart_cruz_velez_castillo_pairis-garcia_2023, title={Assessing Livestock Production Practices on Small-Scale Multi-Species Farms Located on Floreana Island, Galapagos Islands}, volume={13}, ISSN={["2076-2615"]}, url={https://doi.org/10.3390/ani13040686}, DOI={10.3390/ani13040686}, abstractNote={Globally to date, established international standards for animal welfare, a priority of sustainable agriculture, have primarily focused on large-scale producers. However, across Latin America, including in Ecuador’s Galápagos Islands, smallholder farms play a critical role in food safety and security. We assessed five basic animal welfare measures (feed and water access, shelter availability and housing systems, animal health management, animal behavior, and timely euthanasia) for poultry, pigs, and cattle on Floreana Island, Galápagos. Utilizing assessment standards from multiple US sources and international standards, we developed a questionnaire and used it to conduct in-depth interviews during 4–5 July 2022 with eight participating producers, representing 75% of animal agriculture on Floreana. While we identified opportunities to enhance competencies in animal health management and timely euthanasia, farms performed well in the other assessed measures. Future work should promote knowledge transfer and in-country capacity building in farm biosecurity, access to veterinary care, antimicrobial resistance surveillance, and euthanasia methods. Efforts to positively impact smallholder farm livelihoods in Galápagos—one of the most biodiverse and protected ecosystems on the planet—will sustainably support human health through the interconnected realms of animal health and welfare, wildlife and environmental health, and food safety and security.}, number={4}, journal={ANIMALS}, author={Rhea, Sarah and Camacho, Blanca E. and Amoriello, Carrisa W. and Correa, Maria and Lewbart, Gregory A. and Cruz, Marilyn and Velez, Alberto and Castillo, Paulina and Pairis-Garcia, Monique}, year={2023}, month={Feb} }
 @article{bloch_rhea_2023, title={Assessing the impact of the early COVID-19 era on antibiotic resistant threats in inpatient settings: A mixed-Poisson regression approach}, volume={51}, ISSN={0196-6553}, url={http://dx.doi.org/10.1016/j.ajic.2023.04.159}, DOI={10.1016/j.ajic.2023.04.159}, abstractNote={During the COVID-19 pandemic, increased antibiotic prescribing and infection prevention challenges coincided with antibiotic-resistant (AR) infection increases. Clostridioides difficile (C difficile) and methicillin-resistant Staphylococcus aureus (MRSA) are serious, costly AR threats. Health inequities in pandemic-era AR infections are not well-characterized.North Carolina statewide inpatient admissions were used to determine monthly admission rates and admission rate ratios (RRs) for C difficile and MRSA infections comparing 2017-2019 (prepandemic) to 2020 (pandemic exposure) using mixed-model Poisson regression adjusted for age, sex, comorbidities, and COVID-19. We assessed effect measure modification by admissions... community-level income, county rurality, and race and ethnicity. Mean total costs by infection type were compared.With pandemic exposure, C difficile (adjusted RR.ß=.ß0.90 [95% confidence interval [CI] 0.86, 0.94]) and MRSA pneumonia (adjusted RR.ß=.ß0.97 [95% CI 0.91, 1.05]) decreased, while MRSA septicemia (adjusted RR.ß=.ß1.13 [95% CI 1.07, 1.19]) increased. Effect measure modification was not detected. C difficile or MRSA coinfection nearly doubled mean costs among COVID-19 admissions.Despite decreases in C difficile and most MRSA infections, the early COVID-19 pandemic period saw continued increases in MRSA septicemia admissions in North Carolina. Equitable interventions to curb increases and reduce health care costs should be developed.}, number={10}, journal={American Journal of Infection Control}, publisher={Elsevier BV}, author={Bloch, Rebecca and Rhea, Sarah}, year={2023}, month={Apr}, pages={1089–1094} }
 @article{bloch_faulkner_hilborn_wismer_martin_rhea_2023, title={Geographic Variability, Seasonality, and Increase in ASPCA Animal Poison Control Center Harmful Blue-Green Algae Calls-United States and Canada, 2010-2022}, volume={15}, ISSN={["2072-6651"]}, url={https://doi.org/10.3390/toxins15080505}, DOI={10.3390/toxins15080505}, abstractNote={Harmful cyanobacteria (blue-green algae) exposures can cause illness or death in humans and animals. We characterized American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center (APCC) harmful blue-green algae (HBGA) call data, compared it to a measure of harmful algal bloom public awareness, and considered its suitability as a public health information source. ASPCA APCC dog and cat “HBGA exposure” calls made 1 January 2010–31 December 2022 were included. We calculated annual HBGA call percentages and described calls (species, month, origin, exposure route). We characterized public awareness by quantifying Nexis Uni® (LexisNexis Academic; New York, NY, USA)-indexed news publications (2010–2022) pertaining to “harmful algal bloom(s)”. Call percentage increased annually, from 0.005% (2010) to 0.070% (2022). Of 999 HBGA calls, 99.4% (n = 993) were dog exposures. Over 65% (n = 655) of calls were made July–September, largely from the New England (n = 154 (15.4%)) and Pacific (n = 129 (12.9.%)) geographic divisions. Oral and dermal exposures predominated (n = 956 (95.7%)). Harmful algal bloom news publications increased overall, peaking in 2019 (n = 1834). Higher call volumes in summer and in the New England and Pacific geographic divisions drove HBGA call increases; public awareness might have contributed. Dogs and humans have similar exposure routes. ASPCA APCC HBGA call data could serve as a public health information source.}, number={8}, journal={TOXINS}, publisher={MDPI AG}, author={Bloch, Rebecca A. and Faulkner, Grace and Hilborn, Elizabeth D. and Wismer, Tina and Martin, Nicole and Rhea, Sarah}, year={2023}, month={Aug} }
 @article{rhea_gensler_atlaw_pairis-garcia_lewbart_valentine_cruz_castillo_velez_trueba_et al._2023, title={Presence of Extended-Spectrum Beta-Lactamase-Producing <i>Escherichia coli</i> in Food-Producing and Companion Animals and Wildlife on Small-Holder Farms of Floreana Island, Galapagos Islands}, volume={11}, ISSN={["1557-7759"]}, url={https://doi.org/10.1089/vbz.2023.0044}, DOI={10.1089/vbz.2023.0044}, abstractNote={Background: Antimicrobial resistance (AR) has led to increasing human and animal morbidity and mortality and negative consequences for the environment. AR among Escherichia coli (EC) is on the rise, with serious concerns about extended-spectrum β-lactamase-producing E. coli (ESBL-EC). In the Galápagos Islands, where antimicrobials are available without a prescription, growing demands for food production can drive antimicrobial use. Food producing animals are at the interface of wildlife and environmental health on the smallest human-inhabited Galápagos Island, Floreana. We sought to determine if ESBL-EC were present in Floreana Island farm animal species and nearby wildlife and the relatedness of ESBL-EC isolates identified. Materials and Methods: During July 4-5, 2022, we visited 8 multispecies farms, representing 75% of food-producing animal production on Floreana, and collected 227 fecal samples from farm animals and wildlife. Each sample was plated on MacConkey agar supplemented with cefotaxime (4 μg/mL). Results: ESBL-EC was isolated from 20 (9%) fecal samples collected from pigs (N = 10), chickens (N = 6), wildlife (N = 3), and dog (N = 1). All ESBL-EC isolates were from samples taken at three (38%) of the eight farms. Fifteen (75%) of the ESBL-EC isolates were from a single farm. All ESBL-EC isolates were multidrug resistant. The most prevalent ESBL genes belonged to the blaCTX-M group. Among the typeable isolates from the farm with the largest proportion of ESBL-EC isolates (N = 14), we observed nine unique pulsed-field gel electrophoresis (PFGE) patterns, with identical patterns present across pig and chicken isolates. PFGE patterns in the three farms with ESBL-EC isolates were different. Conclusions: These results lend support for future routine AR monitoring activities at the livestock-wildlife interface in Galápagos to characterize potential interspecies transmission of AR bacteria and AR genes in this unique protected ecosystem, and the related human, animal, and environmental health impacts, and to formulate interventions to reduce AR spread in this setting.}, journal={VECTOR-BORNE AND ZOONOTIC DISEASES}, author={Rhea, Sarah and Gensler, Catherine and Atlaw, Nigatu and Pairis-Garcia, Monique and Lewbart, Gregory A. and Valentine, Alyssa and Cruz, Marilyn and Castillo, Paulina and Velez, Alberto and Trueba, Gabriel and et al.}, year={2023}, month={Nov} }
 @article{hadley_rhea_jones_li_stoner_bobashev_2022, title={Enhancing the prediction of hospitalization from a COVID-19 agent-based model: A Bayesian method for model parameter estimation}, volume={17}, ISSN={1932-6203}, url={http://dx.doi.org/10.1371/journal.pone.0264704}, DOI={10.1371/journal.pone.0264704}, abstractNote={Agent-based models (ABMs) have become a common tool for estimating demand for hospital beds during the COVID-19 pandemic. A key parameter in these ABMs is the probability of hospitalization for agents with COVID-19. Many published COVID-19 ABMs use either single point or age-specific estimates of the probability of hospitalization for agents with COVID-19, omitting key factors: comorbidities and testing status (i.e., received vs. did not receive COVID-19 test). These omissions can inhibit interpretability, particularly by stakeholders seeking to use an ABM for transparent decision-making. We introduce a straightforward yet novel application of Bayes’ theorem with inputs from aggregated hospital data to better incorporate these factors in an ABM. We update input parameters for a North Carolina COVID-19 ABM using this approach, demonstrate sensitivity to input data selections, and highlight the enhanced interpretability and accuracy of the method and the predictions. We propose that even in tumultuous scenarios with limited information like the early months of the COVID-19 pandemic, straightforward approaches like this one with discrete, attainable inputs can improve ABMs to better support stakeholders.}, number={3}, journal={PLOS ONE}, publisher={Public Library of Science (PLoS)}, author={Hadley, Emily and Rhea, Sarah and Jones, Kasey and Li, Lei and Stoner, Marie and Bobashev, Georgiy}, editor={de Sire, AlessandroEditor}, year={2022}, month={Mar}, pages={e0264704} }
 @article{jones_hadley_preiss_lofgren_rice_stoner_rhea_adams_2022, title={Estimate of undetected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in acute-care hospital settings using an individual-based microsimulation model}, volume={9}, ISSN={0899-823X 1559-6834}, url={http://dx.doi.org/10.1017/ice.2022.174}, DOI={10.1017/ice.2022.174}, abstractNote={Abstract}, journal={Infection Control & Hospital Epidemiology}, publisher={Cambridge University Press (CUP)}, author={Jones, Kasey and Hadley, Emily and Preiss, Sandy and Lofgren, Eric T. and Rice, Donald P. and Stoner, Marie C. D. and Rhea, Sarah and Adams, Joëlla W.}, year={2022}, month={Sep}, pages={1–10} }
 @article{stoner_angulo_rhea_brown_atwell_nguyen_mclaughlin_swerdlow_macdonald_2022, title={Estimates of Presumed Population Immunity to SARS-CoV-2 by State in the United States, August 2021}, volume={9}, ISSN={2328-8957}, url={http://dx.doi.org/10.1093/ofid/ofab647}, DOI={10.1093/ofid/ofab647}, abstractNote={Abstract}, number={2}, journal={Open Forum Infectious Diseases}, publisher={Oxford University Press (OUP)}, author={Stoner, Marie C D and Angulo, Frederick J and Rhea, Sarah and Brown, Linda Morris and Atwell, Jessica E and Nguyen, Jennifer L and McLaughlin, John M and Swerdlow, David L and MacDonald, Pia D M}, year={2022}, month={Jan} }
 @article{preiss_hadley_jones_stoner_kery_baumgartner_bobashev_tenenbaum_carter_clement_et al._2022, title={Incorporation of near-real-time hospital occupancy data to improve hospitalization forecast accuracy during the COVID-19 pandemic}, volume={7}, ISSN={2468-0427}, url={http://dx.doi.org/10.1016/j.idm.2022.01.003}, DOI={10.1016/j.idm.2022.01.003}, abstractNote={Public health decision makers rely on hospitalization forecasts to inform COVID-19 pandemic planning and resource allocation. Hospitalization forecasts are most relevant when they are accurate, made available quickly, and updated frequently. We rapidly adapted an agent-based model (ABM) to provide weekly 30-day hospitalization forecasts (i.e., demand for intensive care unit [ICU] beds and non-ICU beds) by state and region in North Carolina for public health decision makers. The ABM was based on a synthetic population of North Carolina residents and included movement of agents (i.e., patients) among North Carolina hospitals, nursing homes, and the community. We assigned SARS-CoV-2 infection to agents using county-level compartmental models and determined agents' COVID-19 severity and probability of hospitalization using synthetic population characteristics (e.g., age, comorbidities). We generated weekly 30-day hospitalization forecasts during May-December 2020 and evaluated the impact of major model updates on statewide forecast accuracy under a SARS-CoV-2 effective reproduction number range of 1.0-1.2. Of the 21 forecasts included in the assessment, the average mean absolute percentage error (MAPE) was 7.8% for non-ICU beds and 23.6% for ICU beds. Among the major model updates, integration of near-real-time hospital occupancy data into the model had the largest impact on improving forecast accuracy, reducing the average MAPE for non-ICU beds from 6.6% to 3.9% and for ICU beds from 33.4% to 6.5%. Our results suggest that future pandemic hospitalization forecasting efforts should prioritize early inclusion of hospital occupancy data to maximize accuracy.}, number={1}, journal={Infectious Disease Modelling}, publisher={Elsevier BV}, author={Preiss, Alexander and Hadley, Emily and Jones, Kasey and Stoner, Marie C.D. and Kery, Caroline and Baumgartner, Peter and Bobashev, Georgiy and Tenenbaum, Jessica and Carter, Charles and Clement, Kimberly and et al.}, year={2022}, month={Mar}, pages={277–285} }
 @article{evon_hurt_carpenter_rhea_hennessy_zule_2022, title={Substance use disorder treatment providers’ knowledge and opinions toward testing and treatment of chronic hepatitis C in rural North Carolina.}, url={https://doi.org/10.1037/rmh0000200}, DOI={10.1037/rmh0000200}, abstractNote={Poor access to care has made western North Carolina vulnerable to an outbreak of hepatitis C viral infection (HCV), particularly among persons who inject drugs (PWID). As substance use disorder (SUD) treatment providers could potentially improve linkage to HCV testing and treatment, we sought to understand SUD providers, clinic and client characteristics; referral patterns; HCV knowledge; willingness to participate in additional trainings; and local linkage-to-care pathways for treatment of substance use and HCV. Online survey data were collected from 78 SUD providers serving PWID in eight western rural North Carolina counties. Providers' attitudes toward working with HCV+ clients were very positive. One-third of providers reported a low fund of knowledge regarding HCV, HCV treatment, and financial assistance opportunities. Non-prescribing providers rarely initiated discussions about HCV testing/treatment, but were receptive to training. Respondents indicated that HCV testing and treatment were best delivered at local health departments or primary care clinics but were open to other venues where PWID access care. The vast majority of prescribing and non-prescribing providers expressed interest in obtaining training in HCV treatments, how to obtain HCV medications and topics on advanced liver disease. Data from prescribing and non-prescribing SUD providers suggest opportunities to develop or expand integrated care models for HCV testing/treatment in PWID in rural Appalachian North Carolina.}, journal={Journal of Rural Mental Health}, author={Evon, Donna M. and Hurt, Christopher B. and Carpenter, Delesha M. and Rhea, Sarah K. and Hennessy, Caitlin M. and Zule, William A.}, year={2022}, month={Jul} }
 @article{endres-dighe_jones_hadley_preiss_kery_stoner_eversole_rhea_2021, title={Lessons learned from the rapid development of a statewide simulation model for predicting COVID-19's impact on healthcare resources and capacity}, volume={16}, ISSN={["1932-6203"]}, url={http://dx.doi.org/10.1371/journal.pone.0260310}, DOI={10.1371/journal.pone.0260310}, abstractNote={The first case of COVID-19 was detected in North Carolina (NC) on March 3, 2020. By the end of April, the number of confirmed cases had soared to over 10,000. NC health systems faced intense strain to support surging intensive care unit admissions and avert hospital capacity and resource saturation. Forecasting techniques can be used to provide public health decision makers with reliable data needed to better prepare for and respond to public health crises. Hospitalization forecasts in particular play an important role in informing pandemic planning and resource allocation. These forecasts are only relevant, however, when they are accurate, made available quickly, and updated frequently. To support the pressing need for reliable COVID-19 data, RTI adapted a previously developed geospatially explicit healthcare facility network model to predict COVID-19’s impact on healthcare resources and capacity in NC. The model adaptation was an iterative process requiring constant evolution to meet stakeholder needs and inform epidemic progression in NC. Here we describe key steps taken, challenges faced, and lessons learned from adapting and implementing our COVID-19 model and coordinating with university, state, and federal partners to combat the COVID-19 epidemic in NC.}, number={11}, journal={PLOS ONE}, publisher={Public Library of Science (PLoS)}, author={Endres-Dighe, Stacy and Jones, Kasey and Hadley, Emily and Preiss, Alexander and Kery, Caroline and Stoner, Marie and Eversole, Susan and Rhea, Sarah}, editor={Villaverde, Alejandro FernándezEditor}, year={2021}, month={Nov} }
 @article{north carolina covid-19 agent-based model framework for hospitalization forecasting overview, design concepts, and details protocol_2021, year={2021}, month={Jun} }
 @article{parry_zule_hurt_evon_rhea_carpenter_2021, title={Pharmacist attitudes and provision of harm reduction services in North Carolina: an exploratory study}, volume={18}, url={http://dx.doi.org/10.1186/s12954-021-00517-0}, DOI={10.1186/s12954-021-00517-0}, abstractNote={Abstract}, number={1}, journal={Harm Reduction Journal}, publisher={Springer Science and Business Media LLC}, author={Parry, Rachel A. and Zule, William A. and Hurt, Christopher B. and Evon, Donna M. and Rhea, Sarah K. and Carpenter, Delesha M.}, year={2021}, month={Dec} }
 @inproceedings{jones_hadley_rhea_lofgren_2020, title={Assessing Strain On Hospital Capacity During A Localized Epidemic Using A Calibrated Hospitalization Microsimulation}, url={http://dx.doi.org/10.1109/wsc48552.2020.9384123}, DOI={10.1109/wsc48552.2020.9384123}, abstractNote={The ability of healthcare systems to provide patient care can become disrupted and overwhelmed during a major epidemic or pandemic. We adapted an existing hospitalization microsimulation of North Carolina to assess the impact of a localized epidemic of a fictitious pathogen on inpatient hospital bed availability in the same locale. As area hospital beds reach capacity, agents are turned away and seek treatment at different hospital locations. We explore how variability in the duration and severity of an epidemic affects hospital capacity in different North Carolina counties. We analyze various epidemic scenarios and provide insights into how many days counties and hospitals would have to prepare for a surge in capacity.}, booktitle={2020 Winter Simulation Conference (WSC)}, publisher={IEEE}, author={Jones, Kasey and Hadley, Emily and Rhea, Sarah and Lofgren, Eric}, year={2020}, month={Dec} }
 @article{grimes_ngoyi_stolka_hemingway-foday_lubula_mossoko_okitandjate_macdonald_nelson_rhea_et al._2020, title={Contextual, Social and Epidemiological Characteristics of the Ebola Virus Disease Outbreak in Likati Health Zone, Democratic Republic of the Congo, 2017}, volume={8}, ISSN={2296-2565}, url={http://dx.doi.org/10.3389/fpubh.2020.00349}, DOI={10.3389/fpubh.2020.00349}, abstractNote={While the clinical, laboratory and epidemiological investigation results of the Ebola outbreak in Likati Health Zone, Democratic Republic of the Congo (DRC) in May 2017 have been previously reported, we provide novel commentary on the contextual, social, and epidemiological characteristics of the epidemic. As first responders with the outbreak Surveillance Team, we explain the procedures that led to a successful epidemiological investigation and ultimately a rapid end to the epidemic. We discuss the role that several factors played in the trajectory of the epidemic, including traditional healers, insufficient knowledge of epidemiological case definitions, a lack of community-based surveillance systems and tools, and remote geography. We also demonstrate how a collaborative Rapid Response Team and implementation of community-based surveillance methods helped counter contextual challenges during the Likati epidemic and aid in identifying and reporting suspected cases and contacts in remote and rural settings. Understanding these factors can hinder or help in the rapid detection, notification, and response to future epidemics in the DRC.}, journal={Frontiers in Public Health}, publisher={Frontiers Media SA}, author={Grimes, Kathryn E. L. and Ngoyi, Bonaventure Fuamba and Stolka, Kristen B. and Hemingway-Foday, Jennifer J. and Lubula, Leopold and Mossoko, Mathias and Okitandjate, Antoine and MacDonald, Pia D. M. and Nelson, Amy and Rhea, Sarah and et al.}, year={2020}, month={Aug} }
 @article{hurt_carpenter_evon_hennessy_rhea_zule_2020, title={Mitigating the Risk of Infectious Diseases Among Rural Drug Users in Western North Carolina: Results of the Southern Appalachia Test, Link, Care (SA‐TLC) Health Care Provider Survey}, volume={36}, ISSN={0890-765X 1748-0361}, url={http://dx.doi.org/10.1111/jrh.12409}, DOI={10.1111/jrh.12409}, abstractNote={Abstract}, number={2}, journal={The Journal of Rural Health}, publisher={Wiley}, author={Hurt, Christopher B. and Carpenter, Delesha M. and Evon, Donna M. and Hennessy, Caitlin M. and Rhea, Sarah K. and Zule, William A.}, year={2020}, month={Mar}, pages={208–216} }
 @article{slayton_o’hagan_barnes_rhea_hilscher_rubin_lofgren_singh_segre_paul_2020, title={Modeling Infectious Diseases in Healthcare Network (MInD-Healthcare) Framework for Describing and Reporting Multidrug-resistant Organism and Healthcare-Associated Infections Agent-based Modeling Methods}, volume={3}, url={http://dx.doi.org/10.1093/cid/ciaa234}, DOI={10.1093/cid/ciaa234}, abstractNote={Abstract}, journal={Clinical Infectious Diseases}, publisher={Oxford University Press (OUP)}, author={Slayton, Rachel B and O’Hagan, Justin J and Barnes, Sean and Rhea, Sarah and Hilscher, Rainer and Rubin, Michael and Lofgren, Eric and Singh, Brajendra and Segre, Alberto and Paul, Prabasaj}, year={2020}, month={Mar} }
 @article{rhea_jones_endres-dighe_munoz_weber_hilscher_macfarquhar_sickbert-bennett_dibiase_marx_et al._2020, title={Modeling inpatient and outpatient antibiotic stewardship interventions to reduce the burden of Clostridioides difficile infection in a regional healthcare network}, volume={15}, url={https://doi.org/10.1371/journal.pone.0234031}, DOI={10.1371/journal.pone.0234031}, abstractNote={Antibiotic exposure can lead to unintended outcomes, including drug-drug interactions, adverse drug events, and healthcare-associated infections like Clostridioides difficile infection (CDI). Improving antibiotic use is critical to reduce an individual’s CDI risk. Antibiotic stewardship initiatives can reduce inappropriate antibiotic prescribing (e.g., unnecessary antibiotic prescribing, inappropriate antibiotic selection), impacting both hospital (healthcare)-onset (HO)-CDI and community-associated (CA)-CDI. Previous computational and mathematical modeling studies have demonstrated a reduction in CDI incidence associated with antibiotic stewardship initiatives in hospital settings. Although the impact of antibiotic stewardship initiatives in long-term care facilities (LTCFs), including nursing homes, and in outpatient settings have been documented, the effects of specific interventions on CDI incidence are not well understood. We examined the relative effectiveness of antibiotic stewardship interventions on CDI incidence using a geospatially explicit agent-based model of a regional healthcare network in North Carolina. We simulated reductions in unnecessary antibiotic prescribing and inappropriate antibiotic selection with intervention scenarios at individual and network healthcare facilities, including short-term acute care hospitals (STACHs), nursing homes, and outpatient locations. Modeled antibiotic prescription rates were calculated using patient-level data on antibiotic length of therapy for the 10 modeled network STACHs. By simulating a 30% reduction in antibiotics prescribed across all inpatient and outpatient locations, we found the greatest reductions on network CDI incidence among tested scenarios, namely a 17% decrease in HO-CDI incidence and 7% decrease in CA-CDI. Among intervention scenarios of reducing inappropriate antibiotic selection, we found a greater impact on network CDI incidence when modeling this reduction in nursing homes alone compared to the same intervention in STACHs alone. These results support the potential importance of LTCF and outpatient antibiotic stewardship efforts on network CDI burden and add to the evidence that a coordinated approach to antibiotic stewardship across multiple facilities, including inpatient and outpatient settings, within a regional healthcare network could be an effective strategy to reduce network CDI burden.}, number={6}, journal={PLOS ONE}, publisher={Public Library of Science (PLoS)}, author={Rhea, Sarah and Jones, Kasey and Endres-Dighe, Stacy and Munoz, Breda and Weber, David J. and Hilscher, Rainer and MacFarquhar, Jennifer and Sickbert-Bennett, Emily and DiBiase, Lauren and Marx, Ashley and et al.}, editor={Tizzoni, MicheleEditor}, year={2020}, month={Jun}, pages={e0234031} }
 @article{collins_rhea_diallo_bah_yattara_keleba_macdonald_2020, title={Surveillance system assessment in Guinea: Training needed to strengthen data quality and analysis, 2016}, volume={15}, url={https://doi.org/10.1371/journal.pone.0234796}, DOI={10.1371/journal.pone.0234796}, abstractNote={The 2014–2016 Ebola virus disease outbreak revealed the fragility of the Guinean public health infrastructure. As a result, the Guinean Ministry of Health is collaborating with international partners to improve compliance with the International Health Regulations and work toward the Global Health Security Agenda goals, including enhanced case- and community-based disease surveillance. We assessed the case-based disease surveillance system during October 1, 2015–March 31, 2016, in the Boffa prefecture of Guinea. We conducted onsite interviews with public health staff at the peripheral (health center), middle (prefectural), and central (Ministry of Health) levels of the public health system to document leadership structure; methods for maintaining case registers and submitting weekly case reports; disease surveillance feedback; data analysis; and baseline surveillance information on four epidemic-prone diseases (cholera, meningococcal meningitis, measles, and yellow fever). The surveillance system was simple and paper-based at health centers and computer spreadsheet–based at the prefectural and central levels. Surveillance feedback to stakeholders at all levels was infrequent. Data analysis activities were minimal at the peripheral levels and progressively more robust at the prefectural and central levels. Reviewing the surveillance reports from Boffa during the study period, we observed zero reported cases of the four epidemic-prone diseases in the weekly reporting from the peripheral to the central level. Similarly, the national District Health Information System 2 had no reported cases of the four diseases in Boffa but did indicate reported cases among all four neighboring prefectures. Based on the assessment findings, which suggest low sensitivity of the case-based disease surveillance system in Boffa, we recommend additional training and support to improve surveillance data quality and enhance Guinean public health workforce capacity to use these data.}, number={6}, journal={PLOS ONE}, publisher={Public Library of Science (PLoS)}, author={Collins, Doreen and Rhea, Sarah and Diallo, Boubacar Ibrahima and Bah, Mariama Boubacar and Yattara, Facinet and Keleba, Rachelle Goman and MacDonald, Pia D. M.}, editor={Schieffelin, JohnEditor}, year={2020}, month={Jun}, pages={e0234796} }
 @article{rhea_hilscher_rineer_munoz_jones_endres-dighe_dibiase_sickbert-bennett_weber_macfarquhar_et al._2019, title={Creation of a Geospatially Explicit, Agent-based Model of a Regional Healthcare Network with Application to Clostridioides difficile Infection}, volume={17}, ISSN={2326-5094 2326-5108}, url={http://dx.doi.org/10.1089/hs.2019.0021}, DOI={10.1089/hs.2019.0021}, abstractNote={Agent-based models (ABMs) describe and simulate complex systems comprising unique agents, or individuals, while accounting for geospatial and temporal variability among dynamic processes. ABMs are increasingly used to study healthcare-associated infections (ie, infections acquired during admission to a healthcare facility), including Clostridioides difficile infection, currently the most common healthcare-associated infection in the United States. The overall burden and transmission dynamics of healthcare-associated infections, including C difficile infection, may be influenced by community sources and movement of people among healthcare facilities and communities. These complex dynamics warrant geospatially explicit ABMs that extend beyond single healthcare facilities to include entire systems (eg, hospitals, nursing homes and extended care facilities, the community). The agents in ABMs can be built on a synthetic population, a model-generated representation of the actual population with associated spatial (eg, home residence), temporal (eg, change in location over time), and nonspatial (eg, sociodemographic features) attributes. We describe our methods to create a geospatially explicit ABM of a major regional healthcare network using a synthetic population as microdata input. We illustrate agent movement in the healthcare network and the community, informed by patient-level medical records, aggregate hospital discharge data, healthcare facility licensing data, and published literature. We apply the ABM output to visualize agent movement in the healthcare network and the community served by the network. We provide an application example of the ABM to C difficile infection using a natural history submodel. We discuss the ABM's potential to detect network areas where disease risk is high; simulate and evaluate interventions to protect public health; adapt to other geographic locations and healthcare-associated infections, including emerging pathogens; and meaningfully translate results to public health practitioners, healthcare providers, and policymakers.}, number={4}, journal={Health Security}, publisher={Mary Ann Liebert Inc}, author={Rhea, Sarah and Hilscher, Rainer and Rineer, James I. and Munoz, Breda and Jones, Kasey and Endres-Dighe, Stacy M. and DiBiase, Lauren M. and Sickbert-Bennett, Emily E. and Weber, David J. and MacFarquhar, Jennifer K. and et al.}, year={2019}, month={Aug}, pages={276–290} }
 @inproceedings{jones_munoz_rineer_bobashev_hilscher_rhea_2019, title={On Calibrating a Microsimulation of Patient Movement Through a Healthcare Network}, url={http://dx.doi.org/10.1109/wsc40007.2019.9004765}, DOI={10.1109/wsc40007.2019.9004765}, abstractNote={Hospital admission and discharge dynamics facilitate pathogen transmission among individuals in communities, hospitals, nursing homes, and other healthcare facilities. We developed a microsimulation to simulate this movement, as patients are at increased risk for healthcare-associated infections, antibiotic exposure, and other health complications while admitted to healthcare facilities. Patients can also serve as a source of infection throughout the healthcare network as they move locations. This microsimulation is a base model that can be enhanced with various disease-specific agent-based health modules. We calibrated the model to simulate patient movement in North Carolina, where over 1 million hospital admissions occur annually. Each patient originated from a unique starting location and eventually transferred to another healthcare facility or returned home. Here, we describe our calibration efforts to ensure an accurate patient flow and discuss the necessary steps to replicate this model for other healthcare networks.}, booktitle={2019 Winter Simulation Conference (WSC)}, publisher={IEEE}, author={Jones, Kasey and Munoz, Breda and Rineer, James and Bobashev, Georgiy and Hilscher, Rainer and Rhea, Sarah}, year={2019}, month={Dec} }
 @article{stolka_ngoyi_grimes_hemingway-foday_lubula_magazani_bikuku_mossoko_kitoto_bashilebo_et al._2018, title={Assessing the Surveillance System for Priority Zoonotic Diseases in the Democratic Republic of the Congo, 2017}, volume={16}, url={http://dx.doi.org/10.1089/hs.2018.0060}, DOI={10.1089/hs.2018.0060}, abstractNote={High-functioning communicable disease surveillance systems are critical for public health preparedness. Countries that cannot quickly detect and contain diseases are a risk to the global community. The ability of all countries to comply with the International Health Regulations is paramount for global health security. Zoonotic diseases can be particularly dangerous for humans. We conducted a surveillance system assessment of institutional and individual capacity in Kinshasa and Haut Katanga provinces in the Democratic Republic of the Congo for nationally identified priority zoonotic diseases (eg, viral hemorrhagic fever [VHF], yellow fever, rabies, monkeypox, and influenza monitored through acute respiratory infections). Data were collected from 79 health workers responsible for disease surveillance at 2 provincial health offices, 9 health zone offices, 9 general reference hospitals, and 18 health centers and communities. A set of questionnaires was used to assess health worker training in disease surveillance methods; knowledge of case definitions; availability of materials and tools to support timely case detection, reporting, and data interpretation; timeliness and completeness of reporting; and supervision from health authorities. We found that health workers either had not been recently or ever trained in surveillance methods and that their knowledge of case definitions was low. Timeliness and completeness of weekly notification of epidemic-prone diseases was generally well performed, but the lack of available standardized reporting forms and archive of completed forms affected the quality of data collected. Lessons learned from our assessment can be used for targeted strengthening efforts to improve global health security.}, number={S1}, journal={Health Security}, publisher={Mary Ann Liebert Inc}, author={Stolka, Kristen B. and Ngoyi, Bonaventure Fuamba and Grimes, Kathyrn E. L. and Hemingway-Foday, Jennifer J. and Lubula, Leopold and Magazani, Alain Nzanzu and Bikuku, Joseph and Mossoko, Mathias and Kitoto, Leonie Manya and Bashilebo, Sylvie Mpangi and et al.}, year={2018}, month={Dec}, pages={S-44-S-53} }
 @article{zhang_rhea_hurt_mobley_swygard_seña_mckellar_2018, title={HIV Preexposure Prophylaxis Implementation at Local Health Departments: A Statewide Assessment of Activities and Barriers}, volume={77}, url={http://dx.doi.org/10.1097/qai.0000000000001546}, DOI={10.1097/qai.0000000000001546}, abstractNote={
            Background:
            Expanding access to HIV preexposure prophylaxis (PrEP) could help reduce rates of HIV infection in the United States. This study characterizes activities and barriers to PrEP implementation at local health departments (LHDs) in North Carolina (NC), which contains a large rural population.
          }, number={1}, journal={JAIDS Journal of Acquired Immune Deficiency Syndromes}, publisher={Ovid Technologies (Wolters Kluwer Health)}, author={Zhang, Helen L. and Rhea, Sarah K. and Hurt, Christopher B. and Mobley, Victoria L. and Swygard, Heidi and Seña, Arlene C. and McKellar, Mehri S.}, year={2018}, month={Jan}, pages={72–77} }
 @article{rhea_seña_hilton_hurt_wohl_fleischauer_2018, title={Integrated Hepatitis C Testing and Linkage to Care at a Local Health Department Sexually Transmitted Disease Clinic: Determining Essential Resources and Evaluating Outcomes}, volume={45}, ISSN={1537-4521 0148-5717}, url={http://dx.doi.org/10.1097/OLQ.0000000000000748}, DOI={10.1097/olq.0000000000000748}, abstractNote={Abstract}, number={4}, journal={Sexually Transmitted Diseases}, publisher={Ovid Technologies (Wolters Kluwer Health)}, author={Rhea, Sarah and Seña, Arlene C. and Hilton, Alison and Hurt, Christopher B. and Wohl, David and Fleischauer, Aaron}, year={2018}, month={Apr}, pages={229–232} }
 @article{fleischauer_ruhl_rhea_barnes_2017, title={Hospitalizations for Endocarditis and Associated Health Care Costs Among Persons with Diagnosed Drug Dependence — North Carolina, 2010–2015}, volume={66}, url={http://dx.doi.org/10.15585/mmwr.mm6622a1}, DOI={10.15585/mmwr.mm6622a1}, abstractNote={Opioid dependence and overdose have increased to epidemic levels in the United States. The 2014 National Survey on Drug Use and Health estimated that 4.3 million persons were nonmedical users of prescription pain relievers (1). These users are 40 times more likely than the general population to use heroin or other injection drugs (2). Furthermore, CDC estimated a near quadrupling of heroin-related overdose deaths during 2002-2014 (3). Although overdose contributes most to drug-associated mortality, infectious complications of intravenous drug use constitute a major cause of morbidity leading to hospitalization (4). In addition to infections from hepatitis C virus (HCV) and human immunodeficiency virus (HIV), injecting drug users are at increased risk for acquiring invasive bacterial infections, including endocarditis (5,6). Evidence that hospitalizations for endocarditis are increasing in association with the current opioid epidemic exists (7-9). To examine trends in hospitalizations for endocarditis among persons in North Carolina with drug dependence during 2010-2015, data from the North Carolina Hospital Discharge database were analyzed. The incidence of hospital discharge diagnoses for drug dependence combined with endocarditis increased more than twelvefold from 0.2 to 2.7 per 100,000 persons per year over this 6-year period. Correspondingly, hospital costs for these patients increased eighteenfold, from $1.1 million in 2010 to $22.2 million in 2015. To reduce the risk for morbidity and mortality related to opioid-associated endocarditis, public health programs and health care systems should consider collaborating to implement syringe service programs, harm reduction strategies, and opioid treatment programs.}, number={22}, journal={MMWR. Morbidity and Mortality Weekly Report}, publisher={Centers for Disease Control MMWR Office}, author={Fleischauer, Aaron T. and Ruhl, Laura and Rhea, Sarah and Barnes, Erin}, year={2017}, month={Jun}, pages={569–573} }
 @article{rhea_moorman_pace_mobley_macfarquhar_robinson_hayden_thai_drobeniuc_brooks_et al._2016, title={Hepatitis B Reverse Seroconversion and Transmission in a Hemodialysis Center: A Public Health Investigation and Case Report}, volume={68}, url={http://dx.doi.org/10.1053/j.ajkd.2016.03.424}, DOI={10.1053/j.ajkd.2016.03.424}, abstractNote={In March 2013, public health authorities were notified of a new hepatitis B virus (HBV) infection in a patient receiving hemodialysis. We investigated to identify the source and prevent additional infections. We reviewed medical records, interviewed the index patient regarding hepatitis B risk factors, performed HBV molecular analysis, and observed infection control practices at the outpatient hemodialysis facility where she received care. The index patient's only identified hepatitis B risk factor was hemodialysis treatment. The facility had no other patients with known active HBV infection. One patient had evidence of a resolved HBV infection. Investigation of this individual, who was identified as the source patient, indicated that HBV reverse seroconversion and reactivation had occurred in the setting of HIV (human immunodeficiency virus) infection and a failed kidney transplant. HBV whole genome sequences analysis from the index and source patients indicated 99.9% genetic homology. Facility observations revealed multiple infection control breaches. Inadequate dilution of the source patient's sample during HBV testing might have led to a false-negative result, delaying initiation of hemodialysis in isolation. In conclusion, HBV transmission occurred after an HIV-positive hemodialysis patient with transplant-related immunosuppression experienced HBV reverse seroconversion and reactivation. Providers should be aware of this possibility, especially among severely immunosuppressed patients, and maintain stringent infection control.}, number={2}, journal={American Journal of Kidney Diseases}, publisher={Elsevier BV}, author={Rhea, Sarah and Moorman, Anne and Pace, Robert and Mobley, Victoria and MacFarquhar, Jennifer and Robinson, Edward and Hayden, Tonya and Thai, Hong and Drobeniuc, Jan and Brooks, John T. and et al.}, year={2016}, month={Aug}, pages={292–295} }
 @article{rhea_fleischauer_foust_davies_2016, title={Hepatitis C in North Carolina: Two Epidemics With One Public Health Response}, volume={77}, url={http://dx.doi.org/10.18043/ncm.77.3.190}, DOI={10.18043/ncm.77.3.190}, abstractNote={Hepatitis C virus (HCV) infection, the most common blood-borne infection in the United States, is most frequently transmitted through injection drug use [1]. Although HCV infection can be acute and self-limiting, approximately 75%–85% of infected persons will develop chronic illness. Of the estimated 3.5 million persons in the United States with chronic HCV infection, approximately 75% were born during the period 1945–1965 (ie, baby boomers) [1-3]. Chronic HCV infection has been referred to as a silent epidemic. Approximately 50% of those with chronic infection are unaware of their status and do not receive recommended medical care and treatment, increasing the possibility of progression to liver disease, cirrhosis, liver cancer, and death [1, 2]. Concurrent with the ongoing epidemic of chronic HCV infection, an emerging epidemic of acute HCV infection has been recognized among young persons who inject drugs and live in rural, resource-poor areas [4]. Opioid injection is on the rise in the United States, with a 200% increase in injection drug use fatalities since 2000 [5]. In North Carolina, opioid- and heroin-related hospitalizations and fatalities have increased 3-fold during the past 10 years [6]. New hot spots of acute HCV infection have been identified in central Appalachian states among persons who injection drugs who are aged 30 years and younger and from nonurban areas [4]. Acute cases of HCV infection are reportable by law to the North Carolina Department of Health and Human Services (NC DHHS) as part of statewide communicable disease surveillance [7]. Through public health investigations, reports…}, number={3}, journal={North Carolina Medical Journal}, publisher={North Carolina Institute of Medicine}, author={Rhea, S. and Fleischauer, A. and Foust, E. and Davies, M.}, year={2016}, month={May}, pages={190–192} }
 @article{notes from the field: atypical pneumonia in three members of an extended family - south carolina and north carolina, july-august 2013._2014, url={https://europepmc.org/articles/PMC5779437}, journal={MMWR. Morbidity and mortality weekly report}, year={2014}, month={Aug} }
 @article{rhea_weber_poole_cairns_2014, title={Risk Factors for Hospitalization After Dog Bite Injury: A Case-cohort Study of Emergency Department Visits}, volume={21}, url={http://dx.doi.org/10.1111/acem.12312}, DOI={10.1111/acem.12312}, abstractNote={Abstract}, number={2}, journal={Academic Emergency Medicine}, publisher={Wiley}, author={Rhea, Sarah and Weber, David J. and Poole, Charles and Cairns, Charles}, editor={Mello, Michael J.Editor}, year={2014}, month={Feb}, pages={196–203} }
 @article{rhea_weber_poole_waller_ising_williams_2014, title={Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina}, volume={244}, url={http://dx.doi.org/10.2460/javma.244.5.597}, DOI={10.2460/javma.244.5.597}, abstractNote={Abstract}, number={5}, journal={Journal of the American Veterinary Medical Association}, publisher={American Veterinary Medical Association (AVMA)}, author={Rhea, Sarah K. and Weber, David J. and Poole, Charles and Waller, Anna E. and Ising, Amy I. and Williams, Carl}, year={2014}, month={Mar}, pages={597–603} }
 @article{rhea_ising_waller_haskell_weber_2012, title={Using ICD-9-CM E-Codes in Addition to Chief Complaint Keyword Searches for Identification of Animal Bite-Related Emergency Department Visits}, volume={127}, url={http://dx.doi.org/10.1177/003335491212700603}, DOI={10.1177/003335491212700603}, number={6}, journal={Public Health Reports}, publisher={SAGE Publications}, author={Rhea, Sarah and Ising, Amy and Waller, Anna and Haskell, Marilyn Goss and Weber, David J.}, year={2012}, month={Nov}, pages={561–562} }
 @article{rhea_ising_fleischauer_deyneka_vaughan-batten_waller_2012, title={Using Near Real-Time Morbidity Data to Identify Heat-Related Illness Prevention Strategies in North Carolina}, volume={37}, url={http://dx.doi.org/10.1007/s10900-011-9469-0}, DOI={10.1007/s10900-011-9469-0}, abstractNote={Timely public health interventions reduce heat-related illnesses (HRIs). HRI emergency department (ED) visit data provide near real-time morbidity information to local and state public health practitioners and may be useful in directing HRI prevention efforts. This study examined statewide HRI ED visits in North Carolina (NC) from 2008-2010 by age group, month, ED disposition, chief complaint, and triage notes. The mean number of HRI ED visits per day was compared to the maximum daily temperature. The percentage of HRI ED visits to all ED visits was highest in June (0.25%). 15-18 year-olds had the highest percentage of HRI visits and were often seen for sports-related heat exposures. Work-related HRI ED visits were more common than other causes in 19-45 year-olds. Individuals ≥65 years were more likely admitted to the hospital than younger individuals. The mean daily number of HRI ED visits increased by 1.4 for each 1°F (degree Fahrenheit) increase from 90°F to 98°F and by 15.8 for each 1°F increase from 98°F to 100°F. Results indicate that HRI prevention efforts in NC should be emphasized in early summer and targeted to adolescents involved in organized sports, young adults with outdoor occupations, and seniors. At a maximum daily temperature of 98°F, there was a substantial increase in the average daily number of HRI ED visits. ED visit data provide timely, sentinel HRI information. Analysis of this near real-time morbidity data may assist local and state public health practitioners in identification of HRI prevention strategies that are especially relevant to their jurisdictions.}, number={2}, journal={Journal of Community Health}, publisher={Springer Science and Business Media LLC}, author={Rhea, Sarah and Ising, Amy and Fleischauer, Aaron T. and Deyneka, Lana and Vaughan-Batten, Heather and Waller, Anna}, year={2012}, month={Apr}, pages={495–500} }
 @article{rhea_glickman_waller_williams_glickman_2011, title={Association of Doxycycline Prescriptions and Tick-Related Emergency Department Visits in North Carolina}, volume={104}, url={http://dx.doi.org/10.1097/smj.0b013e3182245fe9}, DOI={10.1097/smj.0b013e3182245fe9}, abstractNote={Objectives: To compare the seasonal frequency of doxycycline prescriptions with tick-related emergency department (ED) visits in North Carolina, and to determine if doxycycline prescriptions are associated in time with an increase in the number of ED visits for a tick-related patient complaint or a subsequent diagnosis of a tick-borne infection. Methods: Aggregate monthly counts of total dispensed doxycycline prescriptions for each North Carolina Piedmont Metropolitan Statistical Area (MSA) were compared with the proportions of tick-related ED visits from August 2007 through July 2009. Results: Epidemic curves of tick-related ED visits for each of the 6 MSAs were characterized by increased frequency in the spring and summer months followed by a decline in the fall. However, the pattern of doxycycline prescriptions varied by MSA. Doxycycline prescriptions in Durham-Chapel Hill and Raleigh-Cary MSAs increased in the spring and summer, while for the 4 other Piedmont MSAs there was no consistent or pronounced spring-summer increase. Conclusion: Doxycycline prescription use did not always correlate well with suspected tick activity in North Carolina. Therefore, doxycycline prescription use cannot necessarily be used as a surrogate measure of tick activity for infectious disease surveillance until the reasons for this variability are better understood.}, number={9}, journal={Southern Medical Journal}, publisher={Southern Medical Association}, author={Rhea, Sarah and Glickman, Seth and Waller, Anna and Williams, Carl and Glickman, Larry}, year={2011}, month={Sep}, pages={653–658} }
 @article{rhea_glickman_waller_ising_maillard_lund_glickman_2011, title={Evaluation of Routinely Collected Veterinary and Human Health Data for Surveillance of Human Tick-Borne Diseases in North Carolina}, volume={11}, url={http://dx.doi.org/10.1089/vbz.2009.0255}, DOI={10.1089/vbz.2009.0255}, abstractNote={Tick-borne diseases are an important cause of human morbidity in North Carolina. This study evaluated the use of routinely collected veterinary hospital and human hospital emergency department (ED) data for earlier signal detection compared with routine reporting of tick-borne diseases to the North Carolina Division of Public Health in 2006 and 2007. The Early Aberration Reporting System was used to detect the earliest indication of an increase in number of dogs infested with ticks that were brought to veterinary hospitals and in number of people presenting to EDs with a tick-related chief complaint or who had an ED International Classification of Diseases diagnosis code of tick-borne disease. Results indicate that systematic monitoring of veterinary hospital and human ED data can detect increases in tick activity 4 weeks earlier than the current surveillance method, which would facilitate timely initiation of tick prevention and increased clinical awareness among veterinarians and physicians.}, number={1}, journal={Vector-Borne and Zoonotic Diseases}, publisher={Mary Ann Liebert Inc}, author={Rhea, Sarah K. and Glickman, Seth W. and Waller, Anna and Ising, Amy and Maillard, Jean-Marie and Lund, Elizabeth M. and Glickman, Larry T.}, year={2011}, month={Jan}, pages={9–14} }