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1.
J Emerg Manag ; 18(5): 411-424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174194

RESUMO

OBJECTIVE: To improve knowledge, skills, and confidence in mass casualty management through design and im-plementation of a formal educational curriculum. DESIGN: Observational study using a mixed-methods formal educational training curriculum. SETTING: Rural Emergency Medical Services (EMS) system in Pennsylvania. Subjects/participants: Convenience sample of 141 licensed EMS providers. INTERVENTIONS: Formal educational curriculum using a computerized mass casualty scenario, lectures, hands-on skill stations, post-intervention participant satisfaction survey, knowledge retention at three- and six-month post curriculum. RESULTS: The formal curriculum resulted in an improvement in scene size-up, incident command system (ICS) set-up, and medical management of 12 percent, 27 percent, and 26 percent, respectively. Average scores on the written component evaluating mass casualty incident (MCI) management and knowledge of test patient triage were 84 percent and 74 percent, respectively. Knowledge recall at three- and six-month post-training was highly retained as test scores were generally unchanged from the time of the educational session. Course and instructor evaluations by participants reflected a high degree of satisfaction (scoring five on a five-point Likert scale). CONCLUSIONS: The formal curriculum was effective in improving the knowledge, skills, and confidence of mass casualty management. Although traditional educational methods tend to show decreases in long-term knowledge retention, the mixed active learning strategies used in this curriculum resulted in high level retention since short and long-term test scores were similar and unchanged over time. Additionally, this curriculum was perceived by participants as highly satisfactory toward their knowledge and skill development.


Assuntos
Serviços Médicos de Emergência , Incidentes com Feridos em Massa , Currículo , Humanos , Pennsylvania , Ensino , Triagem
2.
PLoS One ; 15(11): e0242182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180868

RESUMO

BACKGROUND: Empirical data on conditions that increase risk of coronavirus disease 2019 (COVID-19) progression are needed to identify high risk individuals. We performed a comprehensive quantitative assessment of pre-existing clinical phenotypes associated with COVID-19-related hospitalization. METHODS: Phenome-wide association study (PheWAS) of SARS-CoV-2-positive patients from an integrated health system (Geisinger) with system-level outpatient/inpatient COVID-19 testing capacity and retrospective electronic health record (EHR) data to assess pre-COVID-19 pandemic clinical phenotypes associated with hospital admission (hospitalization). RESULTS: Of 12,971 individuals tested for SARS-CoV-2 with sufficient pre-COVID-19 pandemic EHR data at Geisinger, 1604 were SARS-CoV-2 positive and 354 required hospitalization. We identified 21 clinical phenotypes in 5 disease categories meeting phenome-wide significance (P<1.60x10-4), including: six kidney phenotypes, e.g. end stage renal disease or stage 5 CKD (OR = 11.07, p = 1.96x10-8), six cardiovascular phenotypes, e.g. congestive heart failure (OR = 3.8, p = 3.24x10-5), five respiratory phenotypes, e.g. chronic airway obstruction (OR = 2.54, p = 3.71x10-5), and three metabolic phenotypes, e.g. type 2 diabetes (OR = 1.80, p = 7.51x10-5). Additional analyses defining CKD based on estimated glomerular filtration rate, confirmed high risk of hospitalization associated with pre-existing stage 4 CKD (OR 2.90, 95% CI: 1.47, 5.74), stage 5 CKD/dialysis (OR 8.83, 95% CI: 2.76, 28.27), and kidney transplant (OR 14.98, 95% CI: 2.77, 80.8) but not stage 3 CKD (OR 1.03, 95% CI: 0.71, 1.48). CONCLUSIONS: This study provides quantitative estimates of the contribution of pre-existing clinical phenotypes to COVID-19 hospitalization and highlights kidney disorders as the strongest factors associated with hospitalization in an integrated US healthcare system.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Nefropatias/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Registros Eletrônicos de Saúde , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pennsylvania/epidemiologia , Diálise Renal , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
JMIR Mhealth Uhealth ; 8(10): e20419, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33006942

RESUMO

BACKGROUND: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19-related concerns. OBJECTIVE: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. METHODS: Screening algorithms for patients with SARS-CoV-2-related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. RESULTS: From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. CONCLUSIONS: Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs.


Assuntos
Técnicas de Laboratório Clínico/métodos , Serviços de Saúde Comunitária/organização & administração , Telemedicina , Infecções por Coronavirus/diagnóstico , Humanos , New Jersey/epidemiologia , Pennsylvania/epidemiologia
4.
Med Ref Serv Q ; 39(4): 406-410, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085947

RESUMO

Collaboration between several College of Medicine departments, including the library, resulted in a creation of a new service for faculty during the COVID-19 pandemic crisis. By combining efforts, support for teaching online became a united effort and much less daunting for faculty, who could consult one group for online teaching support, rather than three or four different entities. The resulting endeavor led to a website FAQ and consulting email address that is accessible to all faculty to provide focused and timely technology and education assistance to faculty.


Assuntos
Instrução por Computador/métodos , Infecções por Coronavirus , Educação a Distância/organização & administração , Tecnologia Educacional/organização & administração , Docentes de Medicina/educação , Bibliotecas Médicas/organização & administração , Pandemias , Pneumonia Viral , Faculdades de Medicina/organização & administração , Adulto , Betacoronavirus , Currículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Pennsylvania
5.
J Environ Qual ; 49(3): 613-627, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-33016388

RESUMO

Regulatory watershed mitigation programs typically emphasize widespread adoption of best management practices (BMPs) to meet total maximum daily load (TMDL) goals. To comply with the Chesapeake Bay TMDL, jurisdictions must develop watershed implementation plans (WIPs) to determine the number and type of BMPs to implement. However, the spatial resolution of the bay-level model used to determine these load reduction goals is so coarse that the regulatory plan cannot consider heterogeneity in local conditions, which affects BMP effectiveness. Using the Topo-SWAT modification of the Soil and Water Assessment Tool (SWAT), we simulated two BMP adoption scenarios in the Spring Creek watershed in central Pennsylvania to determine if leveraging fine-scale spatial heterogeneity to place BMPs could achieve the same (or better) nutrient and sediment reduction at a lower cost than the state-level WIP BMP adoption recommendations. Topo-SWAT was initialized with detailed land use and management practice information, systematically calibrated, and validated against 12 yr of observed data. After determining individual BMP cost effectiveness, results were ranked to design a cost-effective BMP adoption scenario that achieved equal or greater load reduction as the WIP scenario for 74% of the cost using eight management-based BMPs: no-till, manure injection, cover cropping, riparian buffers, land retirement, manure application timing, wetland restoration, and nitrogen management (15% less N input). Because watersheds of this size typically represent the smallest modeling unit in the Chesapeake Bay Model, results demonstrate the potential to use watershed models with finer inference scales to improve recommendations for BMP implementation under the Chesapeake Bay TMDL.


Assuntos
Nitrogênio/análise , Solo , Conservação dos Recursos Naturais , Pennsylvania , Áreas Alagadas
6.
J Environ Qual ; 49(3): 557-568, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-33016397

RESUMO

Managing nonpoint sources of nutrients and sediments is the primary challenge for improving conditions in the Susquehanna-Chesapeake basin. Aquatic macroinvertebrates are widely used indicators of stream ecological integrity, but the relationship between nutrient runoff and macroinvertebrate response remains indistinct. Logistical and financial hurdles hinder collection of high-resolution empirical nutrient data, but landscape-based models like the Soil and Water Assessment Tool (SWAT) offer a more practical approach. Nutrient runoff was simulated with SWAT for a small, upland, agricultural Pennsylvania watershed. Three levels of ecological assessment were used to interpret SWAT results. Macroinvertebrate communities (intensive) were sampled at 14 sites and described using an Index of Biotic Integrity (IBI). Biological integrity was moderately degraded in many reaches. The Stream-Wetland-Riparian (SWR) Index (rapid) and landscape metrics (remote) also indicated prevalent agricultural stressors. Baseflow nitrate grab samples, collected once per season, showed no significant relationship with IBI score. Thirty spatiotemporal scales of nutrient data were extracted from SWAT for phosphorus, nitrate, and organic nitrogen. Best subsets regression was performed on IBI scores using SWAT, land cover, and SWR variables. Results were significant (p < .001) with high R2 values (84.8 and 86.2), signifying a negative relationship between instream nutrient concentration and IBI score. This study demonstrates the viability of SWAT as an alternative to in-field nutrient sampling, the value of spatiotemporal scale in model outputs, and the importance of site condition variables in relating nutrients to stream ecological health.


Assuntos
Rios , Solo , Nutrientes , Pennsylvania , Água
8.
Environ Res ; 191: 110189, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32919963

RESUMO

This study draws the link between COVID-19 and air pollution (ground ozone O3) from February 29, 2020 to July 10, 2020 in the top 10 affected States of the US. Utilizing quantile-on-quantile (QQ) estimation technique, we examine in what manner the quantiles of COVID-19 affect the quantiles of air pollution and vice versa. The primary findings confirm overall dependence between COVID-19 and air pollution. Empirical results exhibit a strong negative effect of COVID-19 on air pollution in New York, Texas, Illinois, Massachusetts, and Pennsylvania; especially at medium to higher quantiles, while New Jersey, Illinois, Arizona, and Georgia show strong negative effect mainly at lower quantiles. Contrarily, COVID-19 positively affects air pollution in Pennsylvania at extreme lower quantiles. On the other side, air pollution predominantly caused to increase in the intensity of COVID-19 cases across all states except lower quantiles of Massachusetts, and extreme higher quantiles of Arizona and New Jersey, where this effect becomes less pronounced or negative. Concludingly, a rare positive fallout of COVID-19 is reducing environmental pressure, while higher environmental pollution causes to increase the vulnerability of COVID-19 cases. These findings imply that air pollution is at the heart of chronic diseases, therefore the state government should consider these asymmetric channels and introduce appropriate policy measures to reset and control atmospheric emissions.


Assuntos
Poluição do Ar , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Poluição do Ar/efeitos adversos , Arizona , Betacoronavirus , Poluição Ambiental , Georgia , Humanos , Illinois , Massachusetts , New Jersey , New York , Pennsylvania , Texas
9.
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
12.
Emerg Med J ; 37(10): 637-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753392

RESUMO

Telehealth or using technology for a remote medical encounter has become an efficient solution for safe patient care during the severe acute respiratory syndrome coronavirus 2 or COVID-19 pandemic. This medium allows patient immediate healthcare access without the need for an in-person visit. We designed a time-sensitive, practical, effective and innovative scale-up of telehealth services as a response to the demand for COVID-19 evaluation and testing. As more patients made appointments through the institution's telehealth programme, we increased the number of clinicians available. JeffConnect, the acute care telehealth programme, was expanded to increase staffing from a standing staff of 37-187 doctors within 72 hours. Telehealth care clinicians primarily trained in emergency medicine, internal medicine and family medicine followed a patient decision pathway to risk stratify patients into three groups: home quarantine no testing, home quarantine with outpatient COVID-19 testing and referral for in-person evaluation in the ED, for symptomatic and potentially unstable patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Síndrome Respiratória Aguda Grave/diagnóstico , Telemedicina/organização & administração , Infecções por Coronavirus/epidemiologia , Delaware , Feminino , Hospitais Universitários , Humanos , Controle de Infecções/métodos , Masculino , New Jersey , Pennsylvania , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia
13.
PLoS One ; 15(8): e0237325, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810134

RESUMO

Recent research has shown relationships between health outcomes and residence proximity to unconventional oil and natural gas development (UOGD). The challenge of connecting health outcomes to environmental stressors requires ongoing research with new methodological approaches. We investigated UOGD density and well emissions and their association with symptom reporting by residents of southwest Pennsylvania. A retrospective analysis was conducted on 104 unique, de-identified health assessments completed from 2012-2017 by residents living in proximity to UOGD. A novel approach to comparing estimates of exposure was taken. Generalized linear modeling was used to ascertain the relationship between symptom counts and estimated UOGD exposure, while Threshold Indicator Taxa Analysis (TITAN) was used to identify associations between individual symptoms and estimated UOGD exposure. We used three estimates of exposure: cumulative well density (CWD), inverse distance weighting (IDW) of wells, and annual emission concentrations (AEC) from wells within 5 km of respondents' homes. Taking well emissions reported to the Pennsylvania Department of Environmental Protection, an air dispersion and screening model was used to estimate an emissions concentration at residences. When controlling for age, sex, and smoker status, each exposure estimate predicted total number of reported symptoms (CWD, p<0.001; IDW, p<0.001; AEC, p<0.05). Akaike information criterion values revealed that CWD was the better predictor of adverse health symptoms in our sample. Two groups of symptoms (i.e., eyes, ears, nose, throat; neurological and muscular) constituted 50% of reported symptoms across exposures, suggesting these groupings of symptoms may be more likely reported by respondents when UOGD intensity increases. Our results do not confirm that UOGD was the direct cause of the reported symptoms but raise concern about the growing number of wells around residential areas. Our approach presents a novel method of quantifying exposures and relating them to reported health symptoms.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental/efeitos adversos , Fraturamento Hidráulico , Gás Natural/efeitos adversos , Campos de Petróleo e Gás , Adulto , Monitoramento Ambiental/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pennsylvania , Estudos Retrospectivos , Níveis Máximos Permitidos
14.
Popul Health Manag ; 23(5): 378-385, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32810418

RESUMO

Several months into the impact of the global COVID-19 pandemic, the authors use the framework of "radical uncertainty" and specific regional health care data to understand current and future health and economic impacts. Four key areas of discussion included are: (1) How did structural health care inequality manifest itself during the closure of all elective surgeries and visits?; (2) How can we really calculate the so-called untold burden that resulted from the closure, with a special emphasis on primary care?; (3) The Pennsylvania experience - using observations from the population of one major delivery ecosystem (Jefferson Health), a major accountable care organization (Delaware Valley ACO), and statewide data from Pennsylvania; and (4) What should be the priorities and focus of the delivery system of the future given the dramatic financial and clinical disruption of COVID-19?


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Planejamento em Saúde/métodos , Humanos , Masculino , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pennsylvania , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/métodos , Estados Unidos
15.
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
16.
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
17.
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
18.
Nutr Metab Cardiovasc Dis ; 30(9): 1500-1511, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32620337

RESUMO

BACKGROUND AND AIMS: Consumption of soy foods has been associated with protection against cardiometabolic disease, but the mechanisms are incompletely understood. We hypothesized that habitual soy food consumption associates with gut microbiome composition, metabolite production, and the interaction between diet, microbiota and metabolites. METHODS AND RESULTS: We analyzed dietary soy intake, plasma and stool metabolites, and gut microbiome data from two independent cross-sectional samples of healthy US individuals (N = 75 lean or overweight, and N = 29 obese). Habitual soy intake associated with several circulating metabolites. There was a significant interaction between soy intake and gut microbiome composition, as defined by gut enterotype, on metabolites in plasma and stool. Soy consumption associated with reduced systolic blood pressure, but only in a subset of individuals defined by their gut microbiome enterotype, suggesting that responsiveness to soy may be dependent on microbiome composition. Soy intake was associated with differences in specific microbial taxa, including two taxa mapping to genus Dialister and Prevotella which appeared to be suppressed by high soy intake We identified context-dependent effects of these taxa, where presence of Prevotella was associated with higher blood pressure and a worse cardiometabolic profile, but only in the absence of Dialister. CONCLUSIONS: The gut microbiome is an important intermediate in the interplay between dietary soy intake and systemic metabolism. Consumption of soy foods may shape the microbiome by suppressing specific taxa, and may protect against hypertension only in individuals with soy-responsive microbiota. CLINICAL TRIALS REGISTRY: NCT02010359 at clinicaltrials.gov.


Assuntos
Pressão Sanguínea , Metabolismo Energético , Microbioma Gastrointestinal , Intestinos/microbiologia , Obesidade/dietoterapia , Alimentos de Soja , Adolescente , Adulto , Biomarcadores/sangue , Estudos Transversais , Fezes/química , Fezes/microbiologia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Masculino , Metabolômica , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/microbiologia , Obesidade/fisiopatologia , Pennsylvania , Ribotipagem , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
19.
Am J Public Health ; 110(9): 1386-1392, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673115

RESUMO

Objectives. To determine the impact of California's recreational marijuana legalization on marijuana use among justice system-involved (JSI) adolescents and young adults, and to distinguish whether any changes resulted from legalization (passing the law) or from implementation of the law.Methods. We compared changes in JSI youths' marijuana use in 2 states: California (n = 504), where recreational marijuana use was recently legalized, and Pennsylvania (n = 478), where recreational use is still prohibited. Furthermore, we examined changes in marijuana use across 3 key time periods (October 2015-June 2018): before legalization, after legalization but before implementation, and after implementation.Results. California JSI youths did not demonstrate a significant increase in marijuana use after legalization (b = -0.010; P = .950) or implementation (b = -0.046; P = .846). However, in Pennsylvania, rates of marijuana use increased significantly after legalization (b = 0.602; P = .001) but not after implementation (b = 0.174; P = .533).Conclusions. Although recreational marijuana legalization was not associated with changes in marijuana use among youths in California, we observed increased rates of use in Pennsylvania after legalization in California. Recreational marijuana laws may be indirectly related to youths' marijuana use by supporting more permissive national attitudes toward marijuana.


Assuntos
Comportamento do Adolescente , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Adolescente , California/epidemiologia , Criminosos/estatística & dados numéricos , Humanos , Legislação de Medicamentos , Masculino , Pennsylvania/epidemiologia , Adulto Jovem
20.
Environ Sci Technol ; 54(14): 8632-8639, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32603095

RESUMO

Chemical spills in streams can impact ecosystem or human health. Typically, the public learns of spills from reports from industry, media, or government rather than monitoring data. For example, ∼1300 spills (76 ≥ 400 gallons or ∼1500 L) were reported from 2007 to 2014 by the regulator for natural gas wellpads in the Marcellus shale region of Pennsylvania (U.S.), a region of extensive drilling and hydraulic fracturing. Only one such incident of stream contamination in Pennsylvania has been documented with water quality data in peer-reviewed literature. This could indicate that spills (1) were small or contained on wellpads, (2) were diluted, biodegraded, or obscured by other contaminants, (3) were not detected because of sparse monitoring, or (4) were not detected because of the difficulties of inspecting data for complex stream networks. As a first step in addressing the last problem, we developed a geospatial-analysis tool, GeoNet, that analyzes stream networks to detect statistically significant changes between background and potentially impacted sites. GeoNet was used on data in the Water Quality Portal for the Pennsylvania Marcellus region. With the most stringent statistical tests, GeoNet detected 0.2% to 2% of the known contamination incidents (Na ± Cl) in streams. With denser sensor networks, tools like GeoNet could allow real-time detection of polluting events.


Assuntos
Gás Natural , Poluentes Químicos da Água , Ecossistema , Monitoramento Ambiental , Humanos , Campos de Petróleo e Gás , Pennsylvania , Rios , Poluentes Químicos da Água/análise
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