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1.
BMJ Open Respir Res ; 7(1)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32847947

RESUMO

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Associada a Assistência à Saúde/epidemiologia , Hipóxia/terapia , Intubação Intratraqueal/estatística & dados numéricos , Oxigenoterapia/métodos , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Corticosteroides/uso terapêutico , Afro-Americanos , Idoso , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus , Cânula , Comorbidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Cardiopatias/epidemiologia , Hispano-Americanos , Humanos , Hidroxicloroquina/uso terapêutico , Hipertensão/epidemiologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Viral/epidemiologia , Pulsoterapia , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fumar/epidemiologia
2.
Curr Opin Ophthalmol ; 31(5): 423-426, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740065

RESUMO

PURPOSE OF REVIEW: The aim of this study was to report characteristics of patients presenting with serious ocular injuries during the COVID-19 stay-at-home orders. RECENT FINDINGS: Of 1058 patients presenting for emergency evaluation during the stay-at-home order, 62 (5.9%) patients [mean (SD) age, 41.1 (19.2) years; 19 (31%) women; 31 (50%) white] presented with severe ocular trauma. The daily mean (SD) number of patients who presented for emergency evaluation decreased from 49.0 (9) to 36.4 (6) during the quarantine (P < 0.001). Patients presenting during the stay-at-home order were less likely to have health insurance [odds ratio (OR), 0.33; 95% confidence interval (95% CI), 0.13-0.90, P = 0.024], more likely to have a delayed presentation (difference, 22.7 h, 95% CI, 5.8-39.5, P < 0.001, more likely to travel farther to seek emergency care (difference, 10.4 miles, 95% CI, 2.6-18.2, P < 0.001) and more likely to have an injury occur at home (OR, 22.8; 95% CI, 9.6-54.2, P < 0.001). Of injuries occurring at home, there was a significant increase in injuries arising from home improvement projects during the stay-at-home order (28 vs. 0%, P = 0.02). SUMMARY: During the COVID-19 pandemic, patients with ocular trauma were more likely to have injuries sustained at home and have additional barriers to care. These changes underscore a need for targeted interventions to optimize emergent eye care during a pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Traumatismos Oculares/epidemiologia , Pneumonia Viral/epidemiologia , Quarentena , Adulto , Assistência à Saúde , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Philadelphia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
3.
Sci Immunol ; 5(49)2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727884

RESUMO

Limited data are available for pregnant women affected by SARS-CoV-2. Serological tests are critically important for determining SARS-CoV-2 exposures within both individuals and populations. We validated a SARS-CoV-2 spike receptor binding domain serological test using 834 pre-pandemic samples and 31 samples from COVID-19 recovered donors. We then completed SARS-CoV-2 serological testing of 1,293 parturient women at two centers in Philadelphia from April 4 to June 3, 2020. We found 80/1,293 (6.2%) of parturient women possessed IgG and/or IgM SARS-CoV-2-specific antibodies. We found race/ethnicity differences in seroprevalence rates, with higher rates in Black/non-Hispanic and Hispanic/Latino women. Of the 72 seropositive women who also received nasopharyngeal polymerase chain reaction testing during pregnancy, 46 (64%) were positive. Continued serologic surveillance among pregnant women may inform perinatal clinical practices and can potentially be used to estimate exposure to SARS-CoV-2 within the community.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Anticorpos Antivirais/imunologia , Betacoronavirus/imunologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Estudos de Coortes , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Pandemias , Philadelphia/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/virologia , Domínios Proteicos/imunologia , Estudos Soroepidemiológicos , Glicoproteína da Espícula de Coronavírus/imunologia , Adulto Jovem
4.
Ann Surg ; 272(2): e168-e169, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675529

RESUMO

: The spread of COVID-19 has challenged practices across the United States to dramatically change inpatient and outpatient practices to focus on containing spread of the virus and accommodate the anticipated increase in volume of acute illness. Despite this transition, practices will need to continue to accommodate evaluation of newly diagnosed malignancies, routine postoperative visits, and acute postoperative issues. Building on an existing telemedicine framework, we aim to describe rapid transition in our outpatient care to a telehealth model in a general thoracic surgery practice during COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Telemedicina/organização & administração , Cirurgia Torácica , Betacoronavirus , Humanos , Pandemias , Philadelphia/epidemiologia
5.
Stroke ; 51(9): e219-e222, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32684145

RESUMO

BACKGROUND AND PURPOSE: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States. METHODS: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals. RESULTS: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation. CONCLUSIONS: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.


Assuntos
Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Grupo com Ancestrais do Continente Africano , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Incidência , Pacientes Internados , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Trombose/complicações , Trombose/epidemiologia
6.
Gerodontology ; 37(3): 279-287, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32643211

RESUMO

OBJECTIVES: We conducted a trial to assess the treatment fidelity of an individual-based oral health education intervention utilising motivational interviewing (MI) techniques and its efficacy when compared to a group-based traditional oral health education intervention (TOHE) and a standard of care group (SC) in a sample from Philadelphia during a 12-month follow-up. BACKGROUND: There is lack of information on how different types of oral health educational interventions affect older adults on non-clinical outcomes including changes in oral health-related quality of life (OHRQoL), oral health self-efficacy (SE) and oral health knowledge (OHK). MATERIALS AND METHODS: One hundred and eighty patients were randomly allocated to TOHE, MI and SC groups. Treatment fidelity was measured in 16 non-study patients. The MI intervention was administered by a public health dental hygienist (PHDH). All interviews were audio-recorded and coded by an expert using the Motivational Interviewing Treatment Integrity (MITI) Code. Multivariable longitudinal regression analyses accounting for baseline demographics and correlated errors due to repeated measures via generalised estimating equation were conducted following an intention to treat approach. RESULTS: Over the 1-year follow-up, SE and OHRQoL scores significantly improved amongst the MI group whereas both outcomes worsened amongst the SC group. During the same period, SE and OHRQoL did not change in the TOHE group. CONCLUSION: Findings from the study support the fidelity of this intervention and the improvement of all non-clinical outcomes after 12 months amongst the MI group.


Assuntos
Entrevista Motivacional , Idoso , Educação em Saúde Bucal , Humanos , Saúde Bucal , Philadelphia , Qualidade de Vida
9.
BMC Med Res Methodol ; 20(1): 146, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: covidwho-549102

RESUMO

BACKGROUND: Despite widespread use, the accuracy of the diagnostic test for SARS-CoV-2 infection is poorly understood. The aim of our work was to better quantify misclassification errors in identification of true cases of COVID-19 and to study the impact of these errors in epidemic curves using publicly available surveillance data from Alberta, Canada and Philadelphia, USA. METHODS: We examined time-series data of laboratory tests for SARS-CoV-2 viral infection, the causal agent for COVID-19, to try to explore, using a Bayesian approach, the sensitivity and specificity of the diagnostic test. RESULTS: Our analysis revealed that the data were compatible with near-perfect specificity, but it was challenging to gain information about sensitivity. We applied these insights to uncertainty/bias analysis of epidemic curves under the assumptions of both improving and degrading sensitivity. If the sensitivity improved from 60 to 95%, the adjusted epidemic curves likely falls within the 95% confidence intervals of the observed counts. However, bias in the shape and peak of the epidemic curves can be pronounced, if sensitivity either degrades or remains poor in the 60-70% range. In the extreme scenario, hundreds of undiagnosed cases, even among the tested, are possible, potentially leading to further unchecked contagion should these cases not self-isolate. CONCLUSION: The best way to better understand bias in the epidemic curves of COVID-19 due to errors in testing is to empirically evaluate misclassification of diagnosis in clinical settings and apply this knowledge to adjustment of epidemic curves.


Assuntos
Teorema de Bayes , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral , Alberta/epidemiologia , Betacoronavirus/patogenicidade , Viés , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Philadelphia/epidemiologia , Sensibilidade e Especificidade , Incerteza
10.
BMC Med Res Methodol ; 20(1): 146, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-32505172

RESUMO

BACKGROUND: Despite widespread use, the accuracy of the diagnostic test for SARS-CoV-2 infection is poorly understood. The aim of our work was to better quantify misclassification errors in identification of true cases of COVID-19 and to study the impact of these errors in epidemic curves using publicly available surveillance data from Alberta, Canada and Philadelphia, USA. METHODS: We examined time-series data of laboratory tests for SARS-CoV-2 viral infection, the causal agent for COVID-19, to try to explore, using a Bayesian approach, the sensitivity and specificity of the diagnostic test. RESULTS: Our analysis revealed that the data were compatible with near-perfect specificity, but it was challenging to gain information about sensitivity. We applied these insights to uncertainty/bias analysis of epidemic curves under the assumptions of both improving and degrading sensitivity. If the sensitivity improved from 60 to 95%, the adjusted epidemic curves likely falls within the 95% confidence intervals of the observed counts. However, bias in the shape and peak of the epidemic curves can be pronounced, if sensitivity either degrades or remains poor in the 60-70% range. In the extreme scenario, hundreds of undiagnosed cases, even among the tested, are possible, potentially leading to further unchecked contagion should these cases not self-isolate. CONCLUSION: The best way to better understand bias in the epidemic curves of COVID-19 due to errors in testing is to empirically evaluate misclassification of diagnosis in clinical settings and apply this knowledge to adjustment of epidemic curves.


Assuntos
Teorema de Bayes , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral , Alberta/epidemiologia , Betacoronavirus/patogenicidade , Viés , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Philadelphia/epidemiologia , Sensibilidade e Especificidade , Incerteza
12.
PLoS One ; 15(5): e0230856, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379776

RESUMO

To analyze types and patterns of greening trends across a city, this study seeks to identify a method of creating very high-resolution urban vegetation maps that scales over space and time. Vegetation poses unique challenges for image segmentation because it is patchy, has ragged boundaries, and high in-class heterogeneity. Existing and emerging public datasets with the spatial resolution necessary to identify granular urban vegetation lack a depth of affordable and accessible labeled training data, making unsupervised segmentation desirable. This study evaluates three unsupervised methods of segmenting urban vegetation: clustering with k-means using k-means++ seeding; clustering with a Gaussian Mixture Model (GMM); and an unsupervised, backpropagating convolutional neural network (CNN) with simple iterative linear clustering superpixels. When benchmarked against internal validity metrics and hand-coded data, k-means is more accurate than GMM and CNN in segmenting urban vegetation. K-means is not able to differentiate between water and shadows, however, and when this segment is important GMM is best for probabilistically identifying secondary land cover class membership. Though we find the unsupervised CNN shows high degrees of accuracy on built urban landscape features, its accuracy when segmenting vegetation does not justify its complexity. Despite limitations, for segmenting urban vegetation, k-means has the highest performance, is the simplest, and is more efficient than alternatives.


Assuntos
Planejamento de Cidades/métodos , Modelos Estatísticos , Redes Neurais de Computação , Parques Recreativos/organização & administração , Cidades , Planejamento de Cidades/economia , Análise por Conglomerados , Confiabilidade dos Dados , Humanos , Distribuição Normal , Parques Recreativos/economia , Philadelphia , Poaceae , Solo , Árvores , Recursos Hídricos
13.
Sci Total Environ ; 724: 138353, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32408469

RESUMO

Microorganisms are abundant in the near surface atmosphere and make up a significant fraction of organic aerosols with implications on both human health and ecosystem services. Despite their importance, studies investigating biogeographical patterns of the atmospheric microbiome between urban and suburban areas are limited. Urban and suburban locations (including their microbial communities) vary considerably depending on climate, topography, industrial activities, demographics and other socio-economic factors. Hence, we need more location-specific data to make informed decision affecting air quality, human health, and the implication of a changing climate and policy decisions. The objective of this study was to describe how the atmospheric microbiome varies in composition and function between urban and suburban sites. We used high-throughput sequencing to analyze microbial communities collected at different times from PM2.5 samples collected by active sampling method (using a pump and an impactor) and dust settling of TSP collected by passive sampling method (no pump and no impactor) from an urban and suburban site. We found diverse communities unique in composition at both sites with equivalent functional potential. Taxonomic composition varied significantly with Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, and Other phyla in greater relative abundance at the urban site. In contrast, Cyanobacteria, Tenericutes, Fusobacteria, and Deinococcus, were enriched at the suburban site. Community diversity also demonstrated a high degree of temporal variation within site. We identified over one-third of the communities as potentially pathogenic taxa (urban: 47.52% ± 14.40%, suburban: 34.53% ± 14.60%) and determined the majority of organisms come from animal-associated host or are environmental non-specific. Potentially pathogenic taxa and source environments were similar between active- and passive- sampling method results. Our research is novel it adds to the underrepresented set of studies on atmospheric microbial structure and function across land types and is the first to compare suburban and urban atmospheric communities.


Assuntos
Microbiota , Animais , Atmosfera , Humanos , Philadelphia , Proteobactérias , RNA Ribossômico 16S
14.
Otolaryngol Head Neck Surg ; 163(1): 25-37, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32423296

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic requires clinicians to explore alternatives to routine patient management. Otolaryngologists caring for children commonly depend on physical examination, laboratory data, and ambulatory surgical procedures. Limiting patient care, mindful allocation of resources, and concern for safety have challenged all aspects of our health care system. This evidence-based clinical consensus is designed to guide practitioners of pediatric otolaryngology for common scenarios during this time. DATA SOURCES: Peer-reviewed literature, published reports, institutional guidelines, and expert consensus. REVIEW METHODS: A clinical consensus on 6 common scenarios in pediatric otolaryngology developed with evidence-based strategies. CONCLUSIONS: Providers should suspend all in-person nonessential office visits and elective surgical procedures. An emphasis on medical management and caregiver education will provide reasonable approaches to many of the common outpatient concerns. Surgery for chronic otitis media, obstructive sleep apnea, and acute rhinosinusitis should occur only in response to severe complications or failure of medical regimens. The approach to the pediatric neck mass focuses on timely management for oncologic etiologies and cautious surgical intervention for abscess drainage or tissue sampling. Finally, epistaxis and otorrhea must be triaged and addressed without the usual ambulatory procedures. IMPLICATIONS FOR PRACTICE: Adaptation of practice patterns during this unprecedented moment for our health care system requires thoughtful planning. The strategies described allow for safe handling of common pediatric otolaryngology diagnoses. Ultimately, otolaryngologists must be stewards of our global health community while advocating for the care of individual pediatric patients.


Assuntos
Algoritmos , Betacoronavirus , Consenso , Infecções por Coronavirus/complicações , Hospitais Pediátricos , Otolaringologia/normas , Otorrinolaringopatias/terapia , Pneumonia Viral/complicações , Criança , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Saúde Global , Humanos , Otorrinolaringopatias/complicações , Pandemias , Philadelphia , Pneumonia Viral/epidemiologia
15.
Radiology ; 296(3): E156-E165, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32339081

RESUMO

Background Coronavirus disease 2019 (COVID-19) and pneumonia of other diseases share similar CT characteristics, which contributes to the challenges in differentiating them with high accuracy. Purpose To establish and evaluate an artificial intelligence (AI) system for differentiating COVID-19 and other pneumonia at chest CT and assessing radiologist performance without and with AI assistance. Materials and Methods A total of 521 patients with positive reverse transcription polymerase chain reaction results for COVID-19 and abnormal chest CT findings were retrospectively identified from 10 hospitals from January 2020 to April 2020. A total of 665 patients with non-COVID-19 pneumonia and definite evidence of pneumonia at chest CT were retrospectively selected from three hospitals between 2017 and 2019. To classify COVID-19 versus other pneumonia for each patient, abnormal CT slices were input into the EfficientNet B4 deep neural network architecture after lung segmentation, followed by a two-layer fully connected neural network to pool slices together. The final cohort of 1186 patients (132 583 CT slices) was divided into training, validation, and test sets in a 7:2:1 and equal ratio. Independent testing was performed by evaluating model performance in separate hospitals. Studies were blindly reviewed by six radiologists without and then with AI assistance. Results The final model achieved a test accuracy of 96% (95% confidence interval [CI]: 90%, 98%), a sensitivity of 95% (95% CI: 83%, 100%), and a specificity of 96% (95% CI: 88%, 99%) with area under the receiver operating characteristic curve of 0.95 and area under the precision-recall curve of 0.90. On independent testing, this model achieved an accuracy of 87% (95% CI: 82%, 90%), a sensitivity of 89% (95% CI: 81%, 94%), and a specificity of 86% (95% CI: 80%, 90%) with area under the receiver operating characteristic curve of 0.90 and area under the precision-recall curve of 0.87. Assisted by the probabilities of the model, the radiologists achieved a higher average test accuracy (90% vs 85%, Δ = 5, P < .001), sensitivity (88% vs 79%, Δ = 9, P < .001), and specificity (91% vs 88%, Δ = 3, P = .001). Conclusion Artificial intelligence assistance improved radiologists' performance in distinguishing coronavirus disease 2019 pneumonia from non-coronavirus disease 2019 pneumonia at chest CT. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Inteligência Artificial , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Radiologistas , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , China , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia , Pneumonia/diagnóstico por imagem , Radiografia Torácica , Radiologistas/normas , Radiologistas/estatística & dados numéricos , Estudos Retrospectivos , Rhode Island , Sensibilidade e Especificidade , Adulto Jovem
16.
Am J Public Health ; 110(6): 863-867, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298172

RESUMO

Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle.Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle.Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually.Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Automóveis/estatística & dados numéricos , Ciclismo/estatística & dados numéricos , Transportes , Acidentes de Trânsito/prevenção & controle , Humanos , Análise de Séries Temporais Interrompida , Philadelphia/epidemiologia , Transportes/métodos , Transportes/estatística & dados numéricos
17.
Am J Public Health ; 110(6): 836-839, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298174

RESUMO

Safe Start is a community health worker program representing a partnership between a high-volume, inner-city, hospital-based prenatal clinic; a community-based organization; a large Medicaid insurer; and a community behavioral health organization to improve perinatal outcomes among publicly insured pregnant women with chronic health conditions in Philadelphia, Pennsylvania. As of June 2019, 291 women participated in the program. Relative to a comparison group (n = 300), Safe Start participants demonstrate improved engagement in care, reduced antenatal inpatient admissions, and shorter neonatal intensive care unit stays.


Assuntos
Doença Crônica/terapia , Serviços de Saúde Comunitária , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Adolescente , Adulto , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde , Feminino , Promoção da Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Philadelphia , Pobreza , Gravidez , Adulto Jovem
20.
Am J Public Health ; 110(4): 540-546, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078356

RESUMO

Objectives. To identify the effect of a Breakfast in the Classroom (BIC) initiative on the foods and drinks students consume in the morning.Methods. Sixteen public schools in Philadelphia, Pennsylvania, that provide universal breakfast participated in a group randomized trial to examine the effects of BIC with complementary nutrition promotion between 2013 and 2016. Control schools (n = 8) offered breakfast in the cafeteria before school. Baseline data were collected from 1362 students in grades 4 to 6. Endpoint data were collected after 2.5 years. Students self-reported the foods and drinks they consumed in the morning.Results. At endpoint, there was no effect of the intervention on breakfast skipping. Nearly 30% of intervention students consumed breakfast foods or drinks from multiple locations, as compared with 21% of control students. A greater proportion of intervention students than control students consumed 100% juice, and a smaller proportion consumed sugar-sweetened beverages and foods high in saturated fat and added sugar.Conclusions. A BIC initiative led to improvements in the types of foods and drinks students consumed in the morning. However, the program did not reduce breakfast skipping and increased the number of locations where students ate.


Assuntos
Desjejum , Serviços de Alimentação/organização & administração , Instituições Acadêmicas , Bebidas/classificação , Criança , Feminino , Alimentos/classificação , Assistência Alimentar , Humanos , Masculino , Philadelphia , Avaliação de Programas e Projetos de Saúde
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