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1.
J Environ Manage ; 263: 110333, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32883470

RESUMO

The Total Maximum Daily Load (TMDL) program established by the United States Environmental Protection Agency (US EPA) to improve America's water quality is being applied to the Chesapeake Bay watershed to mitigate the "dead zone" problem. Agricultural activities are the major nonpoint source of nitrogen (N), contributing 44% of total N to the Bay. Best Management Practices (BMPs) are recognized as an effective way to mitigate N loss of agricultural activities. However, because of physical and economic heterogeneity in agricultural regions, targeting BMPs to areas that produce disproportionate nutrient losses has the potential to reduce the costs of achieving water quality goals. The purpose of this study is to examine the potential to reduce costs of meeting a regional water quality goal by targeting N load reductions within- and across-counties. Based on TMDL developed by the US EPA in 2010 for the Chesapeake Bay watershed, the N reduction goal is 35% for Pennsylvania by 2025. We examine the effects of targeting the required reductions within counties, across counties, and both within and across counties for the Susquehanna watershed. Using the uniform strategy to meet 35% N reduction as the baseline, results show that costs of achieving a regional 35% N reduction goal can be reduced by 13%, 31% and 36% with cross-county targeting, within-county targeting and within and across county targeting, respectively. Cost effectiveness of government subsidy programs for water quality improvement in agriculture can be increased by targeting them to areas with lower N abatement costs.


Assuntos
Nitrogênio , Qualidade da Água , Agricultura , Análise Custo-Benefício , Pennsylvania
2.
Crit Care Nurs Q ; 43(4): 413-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833778

RESUMO

As the confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to grow with over 1 million documented infections in the United States alone, researchers and health care workers race to find effective treatment options for this potentially fatal disease. Mortality remains high in patients whose disease course requires mechanical ventilation and admission to intensive care units. While focusing on therapies to decrease mortality is essential, we must also consider the logistical hurdles faced with regard to safely and effectively delivering treatment while limiting the risk of harm to hospital staff and other noninfected patients. In this article, we discuss aspects of surge planning, considerations in limiting health care worker exposure, the logistics of medication delivery in a uniform and consolidated manner, protocols for delivering emergent care in a rapidly deteriorating coronavirus disease-2019 (COVID-19) patient, and safe practices for transporting infected patients.


Assuntos
Protocolos Clínicos , Infecções por Coronavirus/terapia , Hospitais Gerais/organização & administração , Exposição Ocupacional/prevenção & controle , Pneumonia Viral/terapia , Gestão da Segurança/organização & administração , Capacidade de Resposta ante Emergências/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pennsylvania/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
3.
Crit Care Nurs Q ; 43(4): 468-479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833781

RESUMO

The COVID-19 pandemic presented an unprecedented opportunity to test the emergency management plan of one large urban teaching hospital. In this article, a detailed description of the hospital's surge planning process with lessons learned has been provided.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitais de Ensino/organização & administração , Hospitais Urbanos/organização & administração , Enfermeiras Administradoras/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Capacidade de Resposta ante Emergências/organização & administração , Humanos , Pennsylvania/epidemiologia
4.
Crit Care Nurs Q ; 43(4): 480-483, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833782

RESUMO

The coronavirus pandemic has impacted global health care delivery within a short period of time and has spotlighted the needs of vulnerable patient populations. The recommended initiatives to prevent the viral spread have included strategies such as social distancing, hand hygiene, and wearing protective personal equipment. These activities are community-wide focused, however, may be difficult to achieve for those individuals with intellectual disabilities, thus making this population susceptible to viral spread of infection. This article discusses the experience at a large urban teaching hospital in regard to the care of intellectually disadvantaged patients with COVID-19 infection.


Assuntos
Infecções por Coronavirus/enfermagem , Deficiência Intelectual , Pandemias , Pneumonia Viral/enfermagem , Qualidade da Assistência à Saúde , Adulto , Infecções por Coronavirus/epidemiologia , Hospitais de Ensino , Hospitais Urbanos , Humanos , Pennsylvania/epidemiologia , Pneumonia Viral/epidemiologia , Populações Vulneráveis
5.
J Stroke Cerebrovasc Dis ; 29(8): 104988, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689650

RESUMO

BACKGROUND: The COVID-19 pandemic's impact on stroke care is two-fold direct impact of the infection and indirect impact on non-COVID-19 diseases. Anecdotal evidence and clinical observation suggest that there is a decrease in the number of patients presenting with stroke during the pandemic. We aim to understand the impact of the COVID-19 pandemic on the utilization of stroke emergency services on a single comprehensive stroke center (CSC). METHODS: We performed a retrospective analysis of a prospectively maintained database and compared all emergency department (ED) encounters, acute stroke admissions (including TIA), and thrombectomy cases admitted in March 2017-2019 to patients admitted in March 2020 at a comprehensive stroke center. RESULTS: Number of total ED encounters (22%, p=0.005), acute ischemic strokes (40%, p=0.001), and TIAs (60%, p=0.163) decreased between March of 2017-2019 compared to March of 2020. The number of patients undergoing EVT in March 2020 was comparable to March 2017-2019 (p=0.430). CONCLUSION: A pandemic-related stay-at-home policy reduces the utilization of stroke emergency services at a CSC. This effect appears to be more prominent for ED encounters, all stroke admissions and TIAs, and less impactful for severe strokes. Given the relatively low prevalence of COVID-19 cases in our region, this decrement is likely related to healthcare seeking behavior rather than capacity saturation.


Assuntos
Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Determinação de Necessidades de Cuidados de Saúde/tendências , Neurologia/tendências , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Interações entre Hospedeiro e Microrganismos , Humanos , Pandemias , Pennsylvania/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
7.
Med Care ; 58(8): 744-748, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692141

RESUMO

INTRODUCTION: Cancer patients' experience of care is an important component of quality that has not previously been used for comparing performance. We administered a new patient experience survey to cancer patients receiving outpatient chemotherapy treatment. We examined its measures for sensitivity to adjustment for case-mix and response tendency (level of general optimism/pessimism) and reliability for making performance comparisons between practices. METHODS: We surveyed 2304 cancer patients who received chemotherapy at 23 medical oncology practices in Southeastern Pennsylvania, receiving 715 responses (response rate 31%; 14 practices had 10 or more responses). We aggregated patient responses to calculate practice-level scores on 5 predefined composites: Affective Communication, Shared Decision-Making, Patient Self-Management, Exchanging Information, and Access. We then ranked the practices on each composite before and after adjustment for standard case-mix variables and supplemental adjustment for response tendency (measured via the Life Orientation Test-Revised). We calculated the reliability of practice scores on each composite using hierarchical linear models and calculated minimum sample sizes necessary to achieve reliabilities exceeding 0.7. RESULTS: After adjusting responses for case-mix and converting to a 0-100 scale, composite scores ranged from 77 for the Patient Self-Management composite to 92 for the Access composite. Adjustment for response tendency had an impact on practice rankings only for the Shared Decision-Making composite. The number of responses necessary to create reliable practice-level measurements ranged from 17 (Access composite) to 96 (Affective Communication composite). CONCLUSIONS: Patient experiences at oncology practices can be measured reliably using reasonable sample sizes. Standard case-mix adjustment is adequate for making comparisons on most composites.


Assuntos
Institutos de Câncer/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Relações Profissional-Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
8.
J Endod ; 46(9): 1167-1184, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32553878

RESUMO

INTRODUCTION: The purpose of this randomized controlled trial was to evaluate the role of platelet-rich plasma (PRP) in the healing of through-and-through periapical lesions using both 2-dimensional periapical radiographs and 3-dimensional (3D) cone-beam computed tomographic imaging. METHODS: Thirty-four patients after confirmation of a through-and-through periapical lesion were enrolled and randomly assigned to either the control or PRP group. Periapical surgery was performed, and grafting of the bone defect with PRP was done in the PRP group before suturing. Follow-up was scheduled at 12 months for clinical and radiographic analysis based on Molven's criteria; modified Penn 3D criteria; and resected plane, apical area, and cortical plate indexes. The absolute area and volume of the lesions were measured preoperatively and at follow-up using CorelDRAW X7 (64-bit) (Corel Corporation, Ottawa, Canada) and ITK Snap software (free software under the GNU General Public License developed by the National Institutes of Health, the US National Institute of Biomedical Imaging and BioEngineering, the US National Library of Medicine, the Universities of Pennsylvania and North Carolina, and an independent developer group), respectively. RESULTS: Thirty-two patients were available at follow-up. A success rate of 93.7% was observed for both the control and PRP groups on 2-dimensional evaluation, whereas the PRP group exhibited a significantly higher success rate (87.5%) than the control (50%) on 3D assessment. A significantly higher percentage reduction in the lesion volume was documented in the PRP group (92.30 ± 4.72) than the control group (83.04 ± 12.82). Resected plane, apical area, and cortical plate indexes revealed a significantly higher scoring at the resected plane and cortical plate parameter in the PRP group. Overall analysis documented the faster re-establishment of the palatal cortical plate than the buccal cortical plate in through-and-through lesions. CONCLUSIONS: These results suggest that PRP improves the healing outcome in through-and-through lesions. CBCT imaging provides better healing assessment after periapical surgery over periapical radiographs in such lesions.


Assuntos
Plasma Rico em Plaquetas , Canadá , Tomografia Computadorizada de Feixe Cônico , Humanos , North Carolina , Pennsylvania , Cicatrização
9.
Head Neck ; 42(7): 1681-1689, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32476228

RESUMO

BACKGROUND: In light of the COVID-19 pandemic, there has been a rapid increase in telemedicine visits. Otolaryngology patient satisfaction with these visits has not yet been extensively studied using a validated survey. METHODS: All patients who had telemedicine visits with three head and neck surgeons, by phone or video-based platform, between March 25, 2020 and April 24, 2020. Retrospective chart reviews were conducted to determine demographic, disease, and treatment information. Patients who had a video visit were contacted by telephone and, if they could be reached and consented, were administered the telehealth usability questionnaire (TUQ). RESULTS: Hundred surveys were completed. The average score across all questions was 6.01 on a scale from 1 to 7, where 7 indicated the highest level of patient agreement. The highest scores were for questions related to satisfaction with telehealth (6.29), while the lowest were related to reliability (4.86). CONCLUSIONS: Patients are generally highly satisfied with telemedicine.


Assuntos
Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Otorrinolaringopatias/epidemiologia , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Telemedicina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pennsylvania/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
10.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32584447

RESUMO

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/terapia , Controle de Infecções/normas , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Ambulatorial/normas , Terapia Combinada , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Sistemas Multi-Institucionais , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Cuidados Paliativos/normas , Segurança do Paciente , Pennsylvania , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Assistência Terminal/normas , Centros de Atenção Terciária
11.
Ann Thorac Surg ; 110(2): 622-629, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32380059

RESUMO

BACKGROUND: Contradictory data exist regarding timing of stage 2 palliation (S2P). Prolonged interstage hospitalizations and home surveillance programs have contributed to a more rapid progression to S2P. Our goal is to describe the S2P population and explore the relationships of clinical outcomes and S2P timing at our institution over the last 14 years. METHODS: S2P procedures from 2004 to 2018 at a single institution were included in a retrospective analysis. The analysis was stratified by S2P timing and clinical variables. The primary outcome was Fontan completion, and secondary outcomes included mortality and orthotopic heart transplantation rate, as well as perioperative clinical variables. RESULTS: A total of 114 patients who underwent S2P were included. The median age and weight at S2P were 100 days (interquartile range [IQR], 87-119) and 5.1 (IQR, 4.6-5.5) kg, respectively. The median age in the early group was 79 (IQR, 73-87) days and in the nonearly group was 107 (IQR, 100-124) days. Ninety percent of cavopulmonary anastomoses were augmented with an ePTFE (expanded polytetrafluoroethylene) patch. The overall Fontan completion rate was 76%, without differences in Kaplan-Meier estimates. There were no operative mortalities and no differences in late mortality rate (P = .30). CONCLUSIONS: The interstage period continues to be high risk for those undergoing single-ventricle palliation. In our experience, S2P performed at less than 90 days seems to be a viable and safe procedure when indicated, resulting in comparable Fontan completion rates.


Assuntos
Técnica de Fontan/métodos , Previsões , Ventrículos do Coração/cirurgia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Cuidados Paliativos , Feminino , Seguimentos , Humanos , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Lactente , Masculino , Pennsylvania/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento
12.
Head Neck ; 42(7): 1668-1673, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32420631

RESUMO

The 2019 Coronavirus Pandemic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services, which include surveillance for recurring cancer and prevention of second primaries. The application of evidence-based approaches to the identification and management of treatment and tumor-related toxicities has embraced the use of validated patient-reported outcomes instruments, health promotion, and care coordination. In this manuscript, we describe how our multidisciplinary team of survivorship providers has accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.


Assuntos
Betacoronavirus , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Sobrevivência , Quimiorradioterapia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/reabilitação , Assistência Odontológica , Diagnóstico por Imagem , Humanos , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Avaliação Nutricional , Exposição Ocupacional/prevenção & controle , Pandemias , Medidas de Resultados Relatados pelo Paciente , Pennsylvania/epidemiologia , Equipamento de Proteção Individual , Exame Físico , Modalidades de Fisioterapia , Garantia da Qualidade dos Cuidados de Saúde , Qualidade de Vida , Fonoterapia , Inquéritos e Questionários , Avaliação de Sintomas , Telemedicina
13.
Am J Respir Crit Care Med ; 202(2): 230-240, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32374177

RESUMO

Rationale: Complement is crucial for host defense but may also drive dysregulated inflammation. There is limited understanding of alternative complement function, which can amplify all complement activity, during critical illness.Objectives: We examined the function and key components of the alternative complement pathway in a series of critically ill patients and in a mouse pneumonia model.Methods: Total classical (CH50) and alternative complement (AH50) function were quantified in serum from 321 prospectively enrolled critically ill patients and compared with clinical outcomes. Alternative pathway (AP) regulatory factors were quantified by ELISA (n = 181) and examined via transcriptomics data from external cohorts. Wild-type, Cfb-/-, and C3-/- mice were infected intratracheally with Klebsiella pneumoniae (KP) and assessed for extrapulmonary dissemination.Measurements and Main Results: AH50 greater than or equal to median, but not CH50 greater than or equal to median, was associated with decreased 30-day mortality (adjusted odds ratio [OR], 0.53 [95% confidence interval (CI), 0.31-0.91]), independent of chronic liver disease. One-year survival was improved in patients with AH50 greater than or equal to median (adjusted hazard ratio = 0.59 [95% CI, 0.41-0.87]). Patients with elevated AH50 had increased levels of AP factors B, H, and properdin, and fewer showed a "hyperinflammatory" subphenotype (OR, 0.30 [95% CI, 0.18-0.49]). Increased expression of proximal AP genes was associated with improved survival in two external cohorts. AH50 greater than or equal to median was associated with fewer bloodstream infections (OR, 0.67 [95% CI, 0.45-0.98). Conversely, depletion of AP factors, or AH50 less than median, impaired in vitro serum control of KP that was restored by adding healthy serum. Cfb-/- mice demonstrated increased extrapulmonary dissemination and serum inflammatory markers after intratracheal KP infection compared with wild type.Conclusions: Elevated AP function is associated with improved survival during critical illness, possibly because of enhanced immune capacity.


Assuntos
Via Alternativa do Complemento/imunologia , Estado Terminal/terapia , Pneumonia/imunologia , Pneumonia/terapia , Análise de Sobrevida , Idoso , Animais , Feminino , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Pneumonia/epidemiologia , Julgamento Moral Retrospectivo
14.
West J Emerg Med ; 21(3): 633-639, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32421512

RESUMO

INTRODUCTION: Urinary tract infections (UTI) are a common indication for antibiotic use in the emergency department (ED). With antibiotic resistance on the rise, it is essential that antibiotics be prescribed appropriately for UTIs. Our objective was to evaluate the appropriateness of antibiotic prescriptions by ED providers for uncomplicated cystitis and pyelonephritis. METHODS: We conducted a retrospective study of females ages 2-50 years seen in an academic ED from January 2017 to April 2018 diagnosed with UTI. We assessed the appropriateness of discharge antibiotic prescriptions, as determined by adherence to clinical practice guidelines, best evidence for the particular indication (cystitis vs pyelonephritis for children and adults), and the local antibiogram. RESULTS: A total of 421 patients were included in this study. Of these, 60 children and 198 adults were diagnosed with cystitis, and 47 children and 116 adults were diagnosed with pyelonephritis. Treatment in the absence of true infection was common, with culture-confirmed UTI occurring in only 17/50 (34%) of children and 60/129 (47%) of adults diagnosed with cystitis, and 23/40 (58%) of children and 58/87 (67%) of adults diagnosed with pyelonephritis, among patients who had urine cultures. The type of antibiotic prescribed was appropriate in 53/60 (88%) of children and 135/198 (68%) of adults with cystitis, and 38/47 (81%) of children and 53/116 (46%) of adults with pyelonephritis. The most common inappropriate antibiotic types were beta-lactams in adults (n = 92), nitrofurantoin for pyelonephritis (n = 16), and amoxicillin (n = 15). Dosing and duration errors were also common, occurring in 122/279 (44%) of prescriptions of an appropriate antibiotic type. The frequency of errors in the type of antibiotic prescribed was similar among provider types (attending physician, resident physician, and advanced practice clinician; p = 0.926). CONCLUSION: This study reveals room for improvement in antibiotic prescription practices across provider cohorts in the ED for the management of uncomplicated cystitis and pyelonephritis in females.


Assuntos
Antibacterianos/uso terapêutico , Cistite , Serviço Hospitalar de Emergência/estatística & dados numéricos , Uso Excessivo de Medicamentos Prescritos , Pielonefrite , Criança , Cistite/tratamento farmacológico , Cistite/epidemiologia , Cistite/microbiologia , Resistência Microbiana a Medicamentos , Feminino , Humanos , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Padrões de Prática Médica/normas , Uso Excessivo de Medicamentos Prescritos/prevenção & controle , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , Pielonefrite/tratamento farmacológico , Pielonefrite/epidemiologia , Pielonefrite/microbiologia , Estudos Retrospectivos
15.
Sci Total Environ ; 731: 138497, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434096

RESUMO

Studies of neonatal health risks of unconventional natural gas development (UNGD) have not included comprehensive assessments of environmental chemical exposures. We investigated a clustering of dysphagic cases in neonatal foals born between 2014 and 2016 in an area of active UNGD in Pennsylvania (PA),USA. We evaluated equine biological data and environmental exposures on the affected PA farm and an unaffected New York (NY) farm owned by the same proprietor. Dams either spent their entire gestation on one farm or moved to the other farm in late gestation. Over the 21-month study period, physical examinations and blood/tissue samples were obtained from mares and foals on each farm. Grab samples of water, pasture soil and feed were collected; continuous passive sampling of air and water for polycyclic aromatic hydrocarbons was performed. Dysphagia was evaluated as a binary variable; logistic regression was used to identify risk factors. Sixty-five foals were born, 17 (all from PA farm) were dysphagic. Odds of dysphagia increased with the dam residing on the PA farm for each additional month of gestation (OR = 1.4, 95% CI 1.2, 1.7, p = 6.0E-04). Males were more likely to be born dysphagic (OR = 5.5, 95% CI 1.2, 24.5, p = 0.03) than females. Prior to installation of a water filtration/treatment system, PA water concentrations of 3,6-dimethylphenanthrene (p = 6.0E-03), fluoranthene (p = 0.03), pyrene (p = 0.02) and triphenylene (p = 0.01) exceeded those in NY water. Compared to NY farm water, no concentrations of PAHs were higher in PA following installation of the water filtration/treatment system. We provide evidence of an uncommon adverse health outcome (dysphagia) in foals born near UNGD that was eliminated in subsequent years (2017-2019) following environmental management changes. Notably, this study demonstrates that domestic large animals such as horses can serve as important sentinels for human health risks associated with UNGD activities.


Assuntos
Monitoramento Ambiental , Gás Natural , Animais , Animais Recém-Nascidos , Feminino , Cavalos , Humanos , Recém-Nascido , Masculino , New York , Avaliação de Resultados em Cuidados de Saúde , Pennsylvania , Gravidez
16.
J Agric Saf Health ; 26(1): 31-43, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-32429618

RESUMO

This article presents data for agricultural work-related fatal injuries to non-working youth (> 18 years old) in Pennsylvania. Cases were identified from the Pennsylvania Farm Fatality (PA-FF) database for the period 2000-2018. The circumstances of the death in each incident were reviewed from news clippings, death certificates, and other reports available to determine the victim's status as a bystander, passenger, or other non-working child. The study identified 69 agricultural work-related fatalities to non-working youth in Pennsylvania. Incidents were coded as non-working accomplice (26), non-working accomplice extra rider (14), non-working attendant (25), and ambiguous (4). Fatalities to children > 5 years old accounted for 74% of the non-working youth fatalities, and most (75%) of the victims were male. Plain Sect community members (Anabaptists) comprised 78% of the cases. Children contribute significantly to the overall burden of agricultural work-related fatal injuries in Pennsylvania, especially as bystanders. From the review of the data, we conclude that fatal injuries to non-working children on farms are preventable. The process of identifying different injury patterns associated with non-work-related child activity has increased our understanding of how safety professionals and community members may help prevent these fatalities. Many researchers have noted a variety of intervention efforts that show potential for providing safer farm and home environments but will need long-term commitments in various capacities.


Assuntos
Acidentes de Trabalho/mortalidade , Agricultura , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Fazendas , Feminino , Humanos , Masculino , Pennsylvania
17.
Head Neck ; 42(6): 1243-1247, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-125248

RESUMO

The 2019 novel coronavirus (COVID-19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to the providers, patients, and families.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Centros Médicos Acadêmicos , Tomada de Decisão Clínica , Infecções por Coronavirus/prevenção & controle , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Comunicação Interdisciplinar , Masculino , Esvaziamento Cervical/métodos , Saúde do Trabalhador , Pandemias/prevenção & controle , Segurança do Paciente , Seleção de Pacientes , Pennsylvania , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Medição de Risco , Retalhos Cirúrgicos/transplante
18.
Head Neck ; 42(6): 1310-1316, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-116760

RESUMO

Multidisciplinary conferences (MDC) are an important component of head and neck oncologic care including diagnosis, treatment, and survivorship. Virtual MDC allows for improved collaboration between providers at distant sites and proper allocation of health care resources in a time of crisis. When approached systematically, a virtual MDC is feasible to design and implement in a large academic medical center with multiple satellite hospitals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Oncologia/organização & administração , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Telemedicina/organização & administração , Centros Médicos Acadêmicos , Infecções por Coronavirus/epidemiologia , Humanos , Pennsylvania , Pneumonia Viral/epidemiologia
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