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1.
J Urol ; 203(1): 108-114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31430233

RESUMO

PURPOSE: Compared to urban populations, rural populations rank poorly on numerous health indicators, including cancer outcomes. We examined the relationship of rural residence with stage and treatment among patients with prostate cancer, the second most common malignancy in men. MATERIALS AND METHODS: Using the Pennsylvania Cancer Registry we identified all men diagnosed with prostate cancer between 2009 and 2015. Patients were classified as residing in a rural area, a large town or an urban area using the Rural-Urban Commuting Area classification. Our primary outcomes included indicators of prostate cancer treatment and treatment types but we also examined disease stage and mortality. We used the chi-square tests to assess differences between groups and estimated multivariable logistic regression models to assess the association between rural residence and treatment. RESULTS: We identified 51,024 men diagnosed with localized or metastatic prostate cancer between 2009 and 2015. The overall incidence of prostate cancer decreased during the study period from 416 to 304/100,000 men while the incidence of metastatic disease increased from 336 to 538/100,000. Rural residents were less likely to undergo treatment than urban residents even when stratified by low, intermediate and high risk disease (aOR 0.77, 95% CI 0.64-0.91; aOR 0.71, 95% CI 0.58-0.89; and aOR 0.68, 95% CI 0.53-0.89, respectively). Rural status did not affect the receipt of radiation therapy compared to other treatment types. CONCLUSIONS: Prostate cancer treatment differs between urban and rural residents. Rural residents are less likely to receive treatment even when stratified by disease risk.


Assuntos
Neoplasias da Próstata/terapia , População Rural , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pennsylvania/epidemiologia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Sistema de Registros
2.
Environ Monit Assess ; 191(12): 711, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31676989

RESUMO

Fine particulate matter (PM2.5) air pollution varies spatially and temporally in concentration and composition and has been shown to cause or exacerbate adverse effects on human and ecological health. Biomonitoring using airborne tree leaf deposition as a proxy for particulate matter (PM) pollution has been explored using a variety of study designs, tree species, sampling strategies, and analytical methods. In the USA, relatively few have applied these methods using co-located fine particulate measurements for comparison and relying on one tree species with extensive spatial coverage, to capture spatial variation in ambient air pollution across an urban area. Here, we evaluate the utility of this approach, using a spatial saturation design and pairing tree leaf samples with filter-based PM2.5 across Pittsburgh, Pennsylvania, with the goal of distinguishing mobile and stationary sources using PM2.5 composition. Co-located filter and leaf-based measurements revealed some significant associations with traffic and roadway proximity indicators. We compared filter and leaf samples with differing protection from the elements (e.g., meteorology) and PM collection time, which may account for some variance in PM source and/or particle size capture between samples. To our knowledge, this study is among the first to use deciduous tree leaves from a single tree species as biomonitors for urban PM2.5 pollution in the northeastern USA.


Assuntos
Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodos , Material Particulado/análise , Folhas de Planta/química , Poluição do Ar/análise , Humanos , Tamanho da Partícula , Pennsylvania , Árvores
3.
Am Surg ; 85(9): 961-964, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638507

RESUMO

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board-exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CT imaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs' performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.


Assuntos
Competência Clínica , Medicina de Emergência/normas , Cirurgia Geral/normas , Ferimentos e Lesões/cirurgia , Cuidados Críticos , Medicina de Emergência/educação , Cirurgia Geral/educação , Mortalidade Hospitalar , Humanos , Tempo de Internação , Duração da Cirurgia , Avaliação de Resultados da Assistência ao Paciente , Pennsylvania , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Estados Unidos
4.
Environ Entomol ; 48(6): 1452-1468, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31651025

RESUMO

Oviposition substrate selection, egg mass characteristics, host preference, and life history of Lycorma delicatula (White) (Hemiptera: Fulgoridae) were studied in Pennsylvania between 2016 and 2017. Twenty-four substrate types (trees, shrubs, and nonliving materials) were selected by females for oviposition. Tree-of-heaven, black cherry, black birch, and sweet cherry were favored at 62.5% of the types and accounted for 68.5% of the egg masses based on survey results 200 cm above ground. Egg mass density ranged between 0.2 and 75.2 egg masses/m2 with no significant difference among substrate types. Egg mass size ranged between 0 and 192 eggs/egg mass, with 91.8% containing <50 eggs. Significantly larger egg masses were found on sweet and black cherry compared with tree-of-heaven, with significantly higher hatch success on black locust. Eggs hatched between May 2 and June 5 and peaked on 18 May 2017. Tree-of-heaven and summer grape were preferred by nymphs and adults, while multiflora rose and black walnut were favored by the first, second, and the fourth instar nymphs, respectively. The first, second, third, fourth instars and adults lasted for 62 (2 May-3 July), 42 (8 June-20 July), 35 (26 June-31 July), 39 (10 July-18 Aug.), and 114 (24 July-15 Nov.) days, with peaks on 25 May, 22 June, 6 July, 31 July, and 22 Aug., respectively. Adult feed for 2 months before laying eggs in early October. Cumulative degree-days were 0-325, 153-652, 340-881, 567-1,020, 738-1,227, and 942-1,795 for the egg, first, second, third, fourth instar, and adult stage, respectively. Oviposition strategies and development patterns were discussed.


Assuntos
Hemípteros , Animais , Feminino , América do Norte , Oviposição , Óvulo , Pennsylvania
5.
Environ Entomol ; 48(6): 1270-1276, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31603497

RESUMO

The spotted lanternfly, Lycorma delicatula White (1845) (Hemiptera: Fulgoridae), is an invasive insect that was first reported in North America in Berks County, Pennsylvania, in 2014. It is a polyphagous phloem feeder that attacks over 70 plant species, threatening the agricultural, lumber, and ornamental industries of North America. Infestations of the pest have been reported in several U.S. counties, and a lack of endemic predators and parasitoids feeding on L. delicatula suggests a release from natural enemies in the invaded range. An egg-parasitoid Anastatus orientalis (Hymenoptera: Eupelmidae) was reported attacking L. delicatula at high rates in its native range and may play a key role in reducing its populations there. To better understand the foraging behavior of A. orientalis, a series of behavioral experiments were conducted to determine successful parasitism and behavioral responses to traces left by adult L. delicatula and to the oothecae which cover their eggs. Our results suggest that wasps detected chemical traces left by L. delicatula adults while walking on surfaces and exhibited a strong arrestment response. Moreover, wasps preferred to oviposit in egg masses with intact oothecae. The implications of these findings are herein discussed with regard to the exploitation of host kairomones by foraging wasps, as well as to its ability to overcome host structural defenses.


Assuntos
Besouros , Hemípteros , Vespas , Animais , Interações Hospedeiro-Parasita , América do Norte , Pennsylvania
6.
BMC Health Serv Res ; 19(1): 703, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619229

RESUMO

BACKGROUND: In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS: We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS: Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS: In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/economia , Medicaid/economia , Medicare/economia , Padrões de Prática Médica/economia , Fosfato de Sitagliptina/economia , Administração Oral , Idoso , Diabetes Mellitus Tipo 2/economia , Planos de Pagamento por Serviço Prestado , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pennsylvania , Fosfato de Sitagliptina/administração & dosagem , Estados Unidos
7.
J Environ Qual ; 48(4): 1057-1066, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31589682

RESUMO

Over-the-counter and prescription medications are routinely present at detectable levels in surface and groundwater bodies. The presence of these emerging contaminants has raised both environmental and public health concerns, particularly when the water is used for drinking either directly or with additional treatment. However, the frequency of occurrence, range of concentrations, and potential human health risks are not well understood, especially for groundwater supplies. Private wells are often not tested for contaminants regulated by drinking water standards and are even less frequently tested for emerging contaminants. By partnering with the Pennsylvania Master Well Owner Network, water samples were collected from 26 households with private wells in the West Branch of the Susquehanna River basin in central Pennsylvania in winter 2017. All samples were analyzed for six pharmaceuticals (acetaminophen, ampicillin, naproxen, ofloxacin, sulfamethoxazole, and trimethoprim) and one over-the-counter stimulant (caffeine). At least one compound was detected at each site. Ofloxacin and naproxen were the most and least frequently detected compounds, respectively. Concentrations from the groundwater wells were higher than those of nearby surface water samples. However, risk calculations revealed that none of the concentrations measured in groundwater samples posed significant human health risk. A simple, physicochemical-based modeling approach was used to predict pharmaceutical transport from septic absorption field to groundwater and further elucidate variations in detection frequencies. Findings indicate that although septic tanks may act as contaminant sources for groundwater wells, the human health impacts from trace-level pharmaceuticals that may be present are likely minimal.


Assuntos
Água Subterrânea , Poluentes Químicos da Água , Monitoramento Ambiental , Humanos , Pennsylvania , Rios
8.
J Hist Med Allied Sci ; 74(4): 440-466, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31592527

RESUMO

This manuscript explores the history of the Freedom House Enterprises Ambulance Service, a social and medical experiment that trained "unemployable" black citizens during the late 1960s and early 1970s to provide then state of the art prehospital care. Through archives, newspapers, personal correspondence, university memoranda, and the medical literature, this paper explores the comparable, yet different roles of the program's two leaders, Drs. Peter Safar and Nancy Caroline. Despite its success in demonstrating national standards for paramedic training and equipment, the program ended abruptly in 1975. And though Pittsburgh's city administration cited economic constraints for its fledgling support of Freedom House, black and majority newspapers and citizens alike understood the city's diminishing support of the program in racial terms. The paper discusses Safar and Caroline's well-intentioned efforts in developing this novel program, while confronting the racial, social, and structural constraints on the program and the limits of racial liberalism.


Assuntos
Ambulâncias/história , Grupos de Populações Continentais , Política , Saúde Pública/história , Cidades , História do Século XX , Humanos , Pennsylvania
9.
Dis Colon Rectum ; 62(11): 1336-1343, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567930

RESUMO

BACKGROUND: Surgery remains the standard of care in rectal cancer. Select patients will not undergo surgery for reasons such as medical inoperability or a watch-and-wait approach and instead are managed with definitive chemoradiation. OBJECTIVE: We used the National Cancer Database to identify overall survival and predictors thereof in the nonoperative management of patients with rectal cancer. DESIGN: This was a retrospective review. SETTINGS: This study used deidentified data from the National Cancer Database. PATIENTS: We queried the national cancer database from 2004 to 2014 for stage 1 to 3 rectal adenocarcinoma treated with only chemotherapy and radiation to definitive doses. Dose escalated therapy was defined as >54 Gy. MAIN OUTCOME MEASURES: Univariable and multivariable analyses were performed to identify sociodemographic, treatment, and tumor characteristics predictive of dose escalation and overall survival. Propensity-adjusted Cox proportional hazard ratios for survival were used to account for indication bias. RESULTS: Among the 6311 patients eligible for the study, 11% were treated with doses >54 Gy. Earlier stage and increased age/comorbidity patients were more likely to receive dose escalation, and patients with more recent treatment and treatment at an academic facility were less likely. The median follow-up time was 31 months (range, 2-154 mo). Three- and 5-year overall survival rates for all patients were 60% and 46%. Patients treated with dose escalation had a median survival of 33 months compared with 56 months for those treated with ≤54 Gy (p < 0.0001). LIMITATIONS: The main limitation is the inherent selection bias present in National Cancer Database studies. Important treatment details and outcomes as they relate to a definitive chemoradiation approach in rectal cancer are lacking. Salvage therapy was also not recorded, which in this population could be surgery. CONCLUSIONS: In this analysis, dose escalation in the nonoperative management of rectal cancer was associated with a lower overall survival compared with more conventional doses. Careful patient selection and enrollment on appropriate clinical trials may be warranted in the nonoperative setting. See Video Abstract at http://links.lww.com/DCR/B15. LA QUIMIORRADIACIÓN DEFINITIVA PARA EL CÁNCER RECTAL: ¿HAY LUGAR PARA EL AUMENTO DE LA DOSIS? UN ESTUDIO DE BASE DE DATOS NACIONAL DEL CÁNCER:: La cirugía sigue siendo el estándar en el tratamiento del cáncer rectal. Algunos pacientes no son quirúrgicos por razones como, no ser operables o con el enfoque de ver y esperar, y en su lugar son tratados con la quimiorradiación definitiva.Utilizamos la base de datos nacional del cáncer para identificar la supervivencia general y los factores predictivos de la misma, en el tratamiento no quirúrgico de pacientes con cáncer rectal.Esta fue una revisión retrospectiva.Utilizamos los datos identificados en la base de datos nacional del cáncer.Se consultó la base de datos nacional del cáncer del 2004-2014, para adenocarcinoma rectal en estadio 1-3, tratada únicamente con quimioterapia y radiación hasta la dosis definitiva. La terapia de aumento de la dosis se definió como >54 Gy.Se realizaron análisis univariables y multivariables para identificar características sociodemográficas, de tratamiento y predictivas del aumento de la dosis y supervivencia en general. Los índices de riesgo proporcionales de Cox ajustados a la propensión para la supervivencia, se utilizaron para tener en cuenta el sesgo de indicación.Entre los 6311 pacientes elegibles para el estudio, el 11% fue tratado con dosis >54 Gy. Los pacientes en estadios tempranos y con mayor edad/comorbilidad, tenían más probabilidades de recibir aumento de la dosis, y menos propensos los pacientes con tratamientos recientes y de centros académicos. El tiempo medio de seguimiento fue de 31 meses (2-154 meses). Las tasas de supervivencia global de tres y cinco años para todos los pacientes, fueron respectivamente del 60% y 46%. Los pacientes tratados con aumento de la dosis, tuvieron una supervivencia media de 33 meses, en comparación con los 56 meses para los pacientes tratados con ≤54 Gy (p < 0,0001).La principal limitación es el inherente sesgo en la selección, presente en los estudios de la base de datos nacional del cáncer. Faltan los detalles importantes del tratamiento y los resultados en relación con el enfoque definitivo de quimiorradiación en cáncer rectal. Tampoco se registró la terapia de rescate, que en esta población podría ser la cirugía.En este análisis, el aumento de la dosis en el manejo no quirúrgico del cáncer rectal, se asoció con una menor supervivencia global, en comparación con la dosis más convencional. La cuidadosa selección del paciente y la inscripción en los apropiados ensayos clínicos, pueden estar justificados en el entorno no quirúrgico. Vea el Resumen del Video en http://links.lww.com/DCR/B15.


Assuntos
Adenocarcinoma , Tratamento Conservador , Neoplasias Retais , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Quimiorradioterapia/métodos , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Seleção de Pacientes , Pennsylvania/epidemiologia , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Estudos Retrospectivos , Análise de Sobrevida , Conduta Expectante/métodos , Conduta Expectante/estatística & dados numéricos
11.
J Environ Manage ; 250: 109484, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31487601

RESUMO

Over 4000 km of Pennsylvania's flowing waters and attendant ecosystems have been degraded by mine drainage to the exclusion of multiple designated uses. Both Acid Mine Drainage (AMD) and Net Alkaline Mine Drainage (NAMD) may result from coal extraction depending on the underlying geology. Acid Mine Drainage is characterized as an acidic mixture of toxic heavy metals in solution, while NAMD is circumneutral in pH with metals forming oxidized precipitates. The ecological impacts of AMD have been well documented but NAMD-impacted streams have received considerably less attention. We selected 10 low-order tributaries of the Ohio and Youghiogheny rivers in southwestern Pennsylvania impacted by point-source inputs of NAMD for assessment of water quality and benthic macroinvertebrate communities. Levels of pH, total iron (Fe), and sulfate (SO4) were significantly elevated in the impacted stream reaches when compared with upstream reference sites while total alkalinity and specific conductance were equivalent. Macroinvertebrate abundance declined by 92% in the impacted stream reaches, but community structure in terms of taxonomic composition and species richness was similar. Total iron, total sulfate, and specific conductance were significantly linked to macroinvertebrate community impairment. The presence of resident macroinvertebrate communities in the unimpacted reaches suggests that remediation would result in a rapid recolonization and establishment of viable downstream ecosystems.


Assuntos
Invertebrados , Poluentes Químicos da Água , Animais , Ecossistema , Monitoramento Ambiental , Ohio , Pennsylvania
12.
Environ Pollut ; 254(Pt B): 113103, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31479809

RESUMO

Sealcoat is an emulsified coating product applied to asphalt to protect against surface weathering. Sealcoat products contain coal-tar (CT) or petroleum-derived residues and are a recognized source of polycyclic aromatic hydrocarbons (PAHs) in urban areas. Although the toxicity of urban runoff from CT-sealed asphalt is established, chemical characterization has focused more on PAHs and alkylated derivatives and less on polar transformation products. In this study, solid-phase extraction (SPE) was used to concentrate dissolved (<0.2 µm) species in runoff collected from asphalt surfaces sealed with CT pitch or steam-cracked petroleum (SCP) residues. CT-sealed surfaces released a 20-fold greater concentration of SPE-extractable compounds in runoff compared to SCP-sealed surfaces. Representative compounds were sorted into four groups: nitrogen heterocycles (azaarenes) and other oxygen- and sulfur-containing species (N HET); hydroxylated N heterocycles (hydroxylated N HET); the nonionic surfactant 2,4,7,9-tetramethyl-5-decyne-4,7-diol (TMDD); and styrene-acrylonitrile polymer byproducts (SAN Trimer). Species concentrations and weathering-related disappearance behavior differed among the four subgroups. While hydroxylated N HET concentrations decreased by 94% in runoff from CT-sealed surfaces 60 h after sealcoat application, SAN Trimer concentrations in CT and SCP runoff increased over time as polymerization progressed, illustrating the complex changes the chemicals in sealcoat undergo as it cures under environmentally-relevant conditions. Overall, this study shows that urban runoff collected from CT-sealed and SCP-sealed asphalt surfaces is a potential source of water-soluble contaminants with unknown long-term ecotoxicological effects to aquatic systems.


Assuntos
Alcatrão/análise , Monitoramento Ambiental , Hidrocarbonetos/química , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Químicos da Água/análise , Pennsylvania , Hidrocarbonetos Policíclicos Aromáticos/química , Poluentes Químicos da Água/química , Poluição da Água/análise
13.
J Stroke Cerebrovasc Dis ; 28(11): 104315, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31409537

RESUMO

INTRODUCTION: Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) can prevent severe disability and mortality. There is currently limited data on the epidemiology of LVO strokes and ET eligibility. We aim to determine the incidence of intracranial vessel occlusion (IVO) strokes eligible for ET per 2018 American Heart Association (AHA) guidelines and characteristics of an AHA ineligible population at a comprehensive stroke center (CSC). METHODS: Retrospective chart review of all consecutive AISs at a CSC between November 2014 and February 2017. Demographic, clinical, and radiographic data were analyzed to determine ET eligibility per AHA guidelines and characteristics of ineligible patients were investigated. RESULTS: Twenty-four percent of AIS harbor an IVO. Thirty percent of IVO strokes and 47% of anterior circulation LVO strokes are thrombectomy eligible per AHA guidelines. Most common reasons for thrombectomy ineligibility among IVO strokes are presence of IVO other than anterior circulation LVO (35%, n = 224), presence of large stroke burden (15%, n = 93), baseline modified Rankin scale greater than or equal to 2 (14%, n = 89), and NIHSS score less than 6 (15%, n = 96). CONCLUSIONS: At a CSC, 1 in 4 AISs harbor an IVO. Seven in 100 acute ischemic strokes, 3 in 10 strokes with vessel occlusion, and 1 in 2 strokes with internal carotid or middle cerebral artery M1 occlusion are thrombectomy eligible per AHA 2018 guidelines. These data highlight that current guidelines render a majority of strokes thrombectomy ineligible and a large window of opportunity exists for clinical investigation.


Assuntos
Isquemia Encefálica/terapia , Assistência Integral à Saúde , Definição da Elegibilidade , Trombose Intracraniana/terapia , Seleção de Pacientes , Acidente Vascular Cerebral/terapia , Trombectomia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Tomada de Decisão Clínica , Humanos , Incidência , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/epidemiologia , Pennsylvania/epidemiologia , Prevalência , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-31426341

RESUMO

Parole decision-the decision to release an incarcerated individual from prison conditionally-is one of the most critical decisions across justice systems around the world. The decision carries with it significant consequences: for the freedom of the individual awaiting release (the parolee); for the safety of the community in which they will return; and for the correctional system overall, especially its organizational capacity. The current study attempts to add to the parole decision-making literature by specifically analyzing the role that mental health factors may play in explaining parole decisions. Research to date is inconclusive on whether or not mental illness is a risk factor for criminal behavior; despite this, individuals with mental health problems generally fare worse on risk assessment tools employed in justice decisions. The study relies on a 1000+ representative sample of parole-eligible individuals in Pennsylvania, United States. To increase reliability, the analyses test for several mental health factors based on information from different sources (i.e., self-reported mental health history; risk assessment tool employed by the Parole Board; and risk assessment tool employed by the Department of Corrections). To address validity concerns, the study controls for other potential correlates of parole decisions. Although the multivariate models explained a considerable amount of variance in parole decisions, the inclusion of mental health variables added relatively little to model fit. The results provide insights into an understudied area of justice decision making, suggesting that despite the stigmatization of mental illness among criminal justice populations, parole board members in Pennsylvania, United States, appear to follow official guidelines rather than to consider more subjective notions that poor mental health should negate parole release.


Assuntos
Tomada de Decisões , Saúde Mental , Prisioneiros/psicologia , Nível de Saúde , Humanos , Pennsylvania , Prisões , Medição de Risco , Fatores de Risco , Autorrelato
15.
Artigo em Inglês | MEDLINE | ID: mdl-31452436

RESUMO

Various exposure estimates have been used to assess health impact of unconventional natural gas development (UNGD). The purpose of this study was to (1) use an air pollution dispersal screening model and wind direction to characterize the air emissions from UNGD facilities at each residence and (2) assess association of this exposure estimate with respiratory symptoms. Respiratory symptoms were abstracted from health records of a convenience sample of 104 adults from one county in southwestern PA who had completed a standard clinical interview with a nurse practitioner. Using publicly available air emission data, we applied a "box" air pollution dispersion screening model to estimate the median ambient air level of CO, NOx, PM 2.5, VOCs, and formaldehyde at the residence during the year health symptoms were reported. Sources and median emissions were categorized as north, south, east, or west of the residence to account for the effect of wind direction on dispersion. Binary logistic regression was performed for each respiratory symptom. Number of sources had varying magnitudes of association with some symptoms (i.e., cough, shortness of breath, and "any respiratory symptom") and no association with others (i.e., sore throat, sinus problems, wheezing). Air emissions were not associated with any symptom.


Assuntos
Poluentes Atmosféricos/análise , Exposição Ambiental/análise , Monitoramento Ambiental/métodos , Gás Natural/análise , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Pennsylvania/epidemiologia , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/fisiopatologia , Vento
16.
Accid Anal Prev ; 132: 105275, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31465933

RESUMO

Negative binomial (NB) regression is among the most common statistical modeling methods used to model crash frequencies due to its simple functional form and ability to handle over-dispersion commonly found in crash data. However, a drawback of this approach is that regression parameters are assumed to be the same across observations, which could contribute to biased parameter estimates. To alleviate this concern, the random parameters negative binomial (RPNB) model was recently proposed, which allows regression parameters to differ across observations following some known distribution. The resulting coefficients should be less biased, and thus the RPNB approach is believed to provide a more accurate relationship between independent variables and expected crash frequency. However, the prediction accuracy of the RPNB model relative to the standard NB model has not been thoroughly evaluated, particularly with respect to out-of-sample observations for which unique random parameters cannot be estimated. In this paper, the predictive power of the RPNB and NB models are examined using two-lane rural highway data from three engineering Districts in Pennsylvania. Multiple evaluation metrics are applied-root-mean-square error (RMSE) and mean absolute error (MAE), coefficients from calibration functions and cumulative residual (CURE) plots-to assess each model type. The results show that the RPNB model outperforms the NB model when applied to within sample observations (i.e., those used to estimate the model) by making use of the observation-specific coefficients. However, the predictive power of the RPNB model appears to be similar to or slightly less precise than the traditional NB model when applied to out-of-sample observations. Since the RPNB model is estimated using a simulation-based approach, sensitivity tests were also performed to see how the parameter estimates change with the number of Halton draws used to perform the simulation. For the sample sizes used in this paper, the estimates were fairly insensitive when more than 50 Halton draws were used. The findings suggest that the RPNB model is more reliable when applied to the same set of sites that were used to estimate the model but might not be as robust as the traditional NB model when applied to other sites.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ambiente Construído/estatística & dados numéricos , Medição de Risco/métodos , Acidentes de Trânsito/prevenção & controle , Distribuição Binomial , Humanos , Pennsylvania , População Rural , Segurança
17.
J Nurs Adm ; 49(9): 418-422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436739

RESUMO

The need for continuous observation (1:1) of patients for safety precautions, including fall risk, elopement risk, confusion, and aggressive behavior, is highly variable, and it is therefore difficult to plan accurate staffing levels. The high variability in determining when 1:1 staffing for safety is indicated, and for how long, leads to resource strain and high cost to the hospital. A multidisciplinary team analyzed current processes for assigning, monitoring, and discontinuing safety 1:1 care for nonsuicidal patients using Six Sigma methodologies. The team implemented a standardized weaning process to reduce the duration of time on continuous observation and a standardized 4-hour reassessment using a behavior observation-tracking tool to validate the continued need for 1:1 coverage. The interventions resulted in reducing average monthly safety 1:1 staffing hours by 25.6% and saving an estimated $142 000 annually across 6 units. Phase 2 of the project integrated the observation-tracking tool and reassessment check-in into the hospital's electronic medical record for improved tracking and documentation.


Assuntos
Monitoramento Ambiental/economia , Monitoramento Ambiental/métodos , Segurança do Paciente/economia , Gestão da Segurança/economia , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração , Eficiência Organizacional , Humanos , Pennsylvania , Projetos Piloto
18.
Accid Anal Prev ; 132: 105274, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31446099

RESUMO

Count regression models have been applied widely in traffic safety research to estimate expected crash frequencies on road segments. Data mining algorithms, such as classification and regression trees, have recently been introduced into the field to overcome some of the assumptions associated with statistical models. However, these data-driven algorithms usually provide non-parametric output, making it difficult to draw statistical inference or to evaluate how independent variables are associated with expected crash frequencies. In this paper, the model-based recursive partitioning (MOB) algorithm is applied in a crash frequency application. The algorithm incorporates the concept of recursive partitioning data in tree models and develops user-defined statistical models as outputs. The objective of this paper is to explore the potential of the MOB algorithm as a methodological alternative to parametric modeling methods in crash frequency analysis. To accomplish the objective, a standard negative binomial (NB) regression model, a NB model developed using the MOB algorithm, adjusted NB models which incorporate variables identified by the MOB algorithm, and a random parameters NB model are compared using 8 years of data collected from two-lane rural highways in Pennsylvania. The models are compared in terms of data fitness, sign and magnitude of statistical association between the independent and dependent variables, and predictive power. The results show that the MOB-NB model yields better data fitness than other NB models, and provides similar performance to the RPNB model, suggesting that the MOB-NB model may be capturing unobserved heterogeneity by dividing the data into subgroups. The presence of a passing zone and posted speed limit are two covariates identified by the MOB algorithm that differentiate variable effects among subgroups. In addition, the MOB-NB model provides the highest prediction accuracy based on the training and test data sets, although the difference among models is small. The comparison results reveal that the MOB algorithm is a promising alternative to identify covariates, evaluate variable associations and instability, and make predictions in a crash frequency context.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Algoritmos , Distribuição Binomial , Ambiente Construído/estatística & dados numéricos , Humanos , Modelos Estatísticos , Pennsylvania , Medição de Risco/métodos
19.
Artigo em Inglês | MEDLINE | ID: mdl-31443587

RESUMO

Recent studies of unconventional resource development (URD) and adverse health effects have been limited by distance-based exposure surrogates. Our study compared exposure classifications between air pollutant concentrations and "well activity" (WA) metrics, which are distance-based exposure proxies used in Marcellus-area studies to reflect variation in time and space of residential URD activity. We compiled Pennsylvania air monitoring data for benzene, carbon monoxide, nitrogen dioxide, ozone, fine particulates and sulfur dioxide, and combined this with data on nearly 9000 Pennsylvania wells. We replicated WA calculations using geo-coordinates of monitors to represent residences and compared exposure categories from air measurements and WA at the site of each monitor. There was little agreement between the two methods for the pollutants included in the analysis, with most weighted kappa coefficients between -0.1 and 0.1. The exposure categories agreed for about 25% of the observations and assigned inverse categories 16%-29% of the time, depending on the pollutant. Our results indicate that WA measures did not adequately distinguish categories of air pollutant exposures and employing them in epidemiology studies can result in misclassification of exposure. This underscores the need for more robust exposure assessment in future analyses and cautious interpretation of these existing studies.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Exposição Ambiental/análise , Monitoramento Ambiental/métodos , Campos de Petróleo e Gás , Monóxido de Carbono/análise , Estudos Epidemiológicos , Humanos , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Pennsylvania
20.
Parasitol Res ; 118(10): 2767-2772, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31388786

RESUMO

For two decades, the incidence and range of sarcoptic mange in black bears (Ursus americanus) in Pennsylvania has increased. The causative agent, Sarcoptes scabiei, can be directly or indirectly transmitted; therefore, data on environmental persistence is important for guiding management and public communications. The objective of this study was to determine the survival of S. scabiei at different temperatures. Full section skin samples and superficial skin scrapes were collected from bears immediately after euthanasia due to severe mange. After ~ 24 h on ice packs (shipment to lab), samples were placed in dishes at 0, 4, 18, or 30 °C and 60, 20, 12, and 25% relative humidity, respectively, and the percentage of mites alive, by life stage, was periodically determined. Humidity was recorded but not controlled. Temperature significantly affected mite survival, which was shortest at 0 °C (mostly ≤ 4 h) and longest at 4 °C (up to 13 days). No mites survived beyond 8 days at 18 °C or 6 days at 30 °C. Mites from full-thickness skin sections survived significantly longer than those from superficial skin scrapes. Adults typically survived longer than nymphs and larvae except at 30 °C where adults survived the shortest time. These data indicate that at cooler temperatures, S. scabiei can survive for days to over a week in the environment, especially if on host skin. However, these data also indicate that the environment is unlikely to be a long-term source of S. scabiei infection to bears, other wildlife, or domestic animals.


Assuntos
Sarcoptes scabiei/crescimento & desenvolvimento , Escabiose/veterinária , Ursidae/parasitologia , Animais , Animais Selvagens/parasitologia , Umidade , Larva/crescimento & desenvolvimento , Ninfa/crescimento & desenvolvimento , Pennsylvania , Escabiose/parasitologia , Pele/parasitologia , Temperatura Ambiente , Ursidae/fisiologia
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