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1.
Nat Commun ; 12(1): 2274, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33859196

RESUMO

Massive unemployment during the COVID-19 pandemic could result in an eviction crisis in US cities. Here we model the effect of evictions on SARS-CoV-2 epidemics, simulating viral transmission within and among households in a theoretical metropolitan area. We recreate a range of urban epidemic trajectories and project the course of the epidemic under two counterfactual scenarios, one in which a strict moratorium on evictions is in place and enforced, and another in which evictions are allowed to resume at baseline or increased rates. We find, across scenarios, that evictions lead to significant increases in infections. Applying our model to Philadelphia using locally-specific parameters shows that the increase is especially profound in models that consider realistically heterogenous cities in which both evictions and contacts occur more frequently in poorer neighborhoods. Our results provide a basis to assess eviction moratoria and show that policies to stem evictions are a warranted and important component of COVID-19 control.


Assuntos
/transmissão , Controle de Doenças Transmissíveis/métodos , Habitação/legislação & jurisprudência , Pandemias/prevenção & controle , Políticas , /economia , /virologia , Cidades/legislação & jurisprudência , Cidades/estatística & dados numéricos , Controle de Doenças Transmissíveis/legislação & jurisprudência , Simulação por Computador , Habitação/economia , Humanos , Modelos Estatísticos , Philadelphia/epidemiologia , Desemprego/estatística & dados numéricos , População Urbana/estatística & dados numéricos
2.
J Urban Health ; 98(2): 222-232, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33759068

RESUMO

Geographic inequalities in COVID-19 diagnosis are now well documented. However, we do not sufficiently know whether inequalities are related to social characteristics of communities, such as collective engagement. We tested whether neighborhood social cohesion is associated with inequalities in COVID-19 diagnosis rate and the extent the association varies across neighborhood racial composition. We calculated COVID-19 diagnosis rates in Philadelphia, PA, per 10,000 general population across 46 ZIP codes, as of April 2020. Social cohesion measures were from the Southeastern Pennsylvania Household Health Survey, 2018. We estimated Poisson regressions to quantify associations between social cohesion and COVID-19 diagnosis rate, testing a multiplicative interaction with Black racial composition in the neighborhood, which we operationalize via a binary indicator of ZIP codes above vs. below the city-wide average (41%) Black population. Two social cohesion indicators were significantly associated with COVID-19 diagnosis. Associations varied across Black neighborhood racial composition (p <0.05 for the interaction test). In ZIP codes with ≥41% of Black people, higher collective engagement was associated with an 18% higher COVID-19 diagnosis rate (IRR=1.18, 95%CI=1.11, 1.26). In contrast, areas with <41% of Black people, higher engagement was associated with a 26% lower diagnosis rate (IRR=0.74, 95%CI=0.67, 0.82). Neighborhood social cohesion is associated with both higher and lower COVID-19 diagnosis rates, and the extent of associations varies across Black neighborhood racial composition. We recommend some strategies for reducing inequalities based on the segmentation model within the social cohesion and public health intervention framework.


Assuntos
Afro-Americanos , Comportamento Cooperativo , Humanos , Philadelphia/epidemiologia , Características de Residência
3.
Pediatr Dermatol ; 38(2): 364-370, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33742457

RESUMO

BACKGROUND/OBJECTIVE: In spring 2020, high numbers of children presented with acral pernio-like skin rashes, concurrent with the coronavirus disease 2019 (COVID-19) pandemic. Understanding their clinical characteristics/ infection status may provide prognostic information and facilitate decisions about management. METHODS: A pediatric-specific dermatology registry was created by the Pediatric Dermatology COVID-19 Response Task Force of the Society for Pediatric Dermatology (SPD) and Pediatric Dermatology Research Alliance (PeDRA) and was managed by Children's Hospital of Philadelphia using REDCap. RESULTS: Data from 378 children 0-18 years entered into the registry between April 13 and July 17, 2020 were analyzed. Data were drawn from a standardized questionnaire completed by clinicians which asked for demographics, description of acral lesions, symptoms before and after acral changes, COVID-19 positive contacts, treatment, duration of skin changes, laboratory testing including SARS-CoV-2 PCR and antibody testing, as well as histopathology. 229 (60.6%) were male with mean age of 13.0 years (± 3.6 years). Six (1.6%) tested positive for SARS-CoV-2. Pedal lesions (often with pruritus and/or pain) were present in 96%. 30% (114/378) had COVID-19 symptoms during the 30 days prior to presentation. Most (69%) had no other symptoms and an uneventful course with complete recovery. CONCLUSIONS AND RELEVANCE: Children with acral pernio-like changes were healthy and all recovered with no short-term sequelae. We believe these acral changes are not just a temporal epiphenomenon of shelter in place during the spring months of the first wave of the COVID-19 pandemic and may be a late phase reaction that needs further study.


Assuntos
Dermatologia/tendências , Pediatria/tendências , Dermatopatias/epidemiologia , Adolescente , Criança , Humanos , Masculino , Pandemias , Philadelphia , Sistema de Registros
4.
Environ Sci Technol ; 55(8): 4532-4541, 2021 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-33788543

RESUMO

Nitrogen oxides (NOX) and methane impact air quality through the promotion of ozone formation, and methane is also a strong greenhouse gas. Despite the importance of these pollutants, emissions in urban areas are poorly quantified. We present measurements of NOX, CH4, CO, and CO2 made at Drexel University in Philadelphia along with NOX and CO observations at two roadside monitors. Because CO2 concentrations in the winter result almost entirely from combustion with negligible influence from photosynthesis and respiration, we are able to infer fleet-averaged fuel-based emission factors (EFs) for NOX and CO, similar in some ways to how EFs are determined from tunnel studies. Comparison of the inferred NOX and CO fuel-based EF to the National Emissions Inventory (NEI) suggests errors in NEI emissions of either NOX, CO, or both. From the measurements of CH4 and CO2, which are not emitted by the same sources, we infer the ratio of CH4 emissions (from leaks in the natural gas infrastructure) to CO2 emissions (from fossil fuel combustion) in Philadelphia. Comparison of the CH4/CO2 emission ratios to emission inventories from the Environmental Protection Agency suggests underestimates in CH4 emissions by almost a factor of 4. These results demonstrate the need for the addition of long-term observations of CH4 and CO2 to existing monitoring networks in urban areas to better constrain emissions and complement existing measurements of NOX and CO.


Assuntos
Poluentes Atmosféricos , Monóxido de Carbono , Poluentes Atmosféricos/análise , Dióxido de Carbono/análise , Monóxido de Carbono/análise , Monitoramento Ambiental , Humanos , Metano/análise , Óxidos de Nitrogênio/análise , Philadelphia
5.
Health Aff (Millwood) ; 40(3): 536-539, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33646877

RESUMO

The demise of Hahnemann University Hospital demonstrates the need for health care and graduate medical education policy reform.


Assuntos
Falência/economia , Educação de Pós-Graduação em Medicina/economia , Hospitais Universitários/economia , Internato e Residência/economia , Humanos , Área Carente de Assistência Médica , Propriedade , Philadelphia , Estados Unidos
6.
Ann Biomed Eng ; 49(3): 950-958, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33638028

RESUMO

The purpose of this article is to demonstrate how a new cross-community leadership team came together, collaborated, coordinated across academic units with external community partners, and executed a joint mission to address the unmet clinical need for medical face shields during these unprecedented times. Key aspects of this success include the ability to forge and leverage new opportunities, overcome challenges, adapt to changing constraints, and serve the significant need across the Philadelphia region and healthcare systems. We teamed to design-build durable face shields (AJFlex Shields). This was accomplished by high-volume manufacturing via injection molding and by 3-D printing the key headband component that supports the protective shield. Partnering with industry collaborators and civic-minded community allies proved to be essential to bolster production and deliver approximately 33,000 face shields to more than 100 organizations in the region. Our interdisciplinary team of engineers, clinicians, product designers, manufacturers, distributors, and dedicated volunteers is committed to continuing the design-build effort and providing Drexel AJFlex Shields to our communities.


Assuntos
/prevenção & controle , Indústria Manufatureira , Equipamento de Proteção Individual/provisão & distribução , Impressão Tridimensional , Universidades , Desenho de Equipamento , Humanos , Colaboração Intersetorial , Philadelphia
8.
Vaccine ; 39(12): 1693-1700, 2021 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-33632563

RESUMO

BACKGROUND: Health care personnel have been identified by the ACIP as a priority group for COVID-19 vaccination. We conducted a survey in November-December 2020 at two large, academic hospitals in Philadelphia to evaluate the intention of hospital employees to be vaccinated. METHODS: The survey was sent electronically to all employees (clinical and nonclinical staff) at a children's hospital and an adult hospital. The survey was voluntary and confidential. Questions focused on plans to receive a COVID-19 vaccine when available, reasons why employees would/would not get vaccinated, when employees planned to be vaccinated, vaccine safety and efficacy features that would be acceptable, and past history of receipt of other vaccines by the employee and family. Responses were analyzed using univariate and multiple logistic regression methods. RESULTS: A total of 12,034 hospital employees completed the survey (a 34.5% response rate). Overall, 63.7% of employees reported that they planned to receive a COVID-19 vaccine, 26.3% were unsure, and 10.0% did not plan to be vaccinated. Over 80% of those unsure or unwilling to be vaccinated expressed concerns about vaccine side effects and the vaccines' newness. In multivariable logistic regression, persons planning to take a COVID-19 vaccine were more likely to be older, male, more educated, Asian or White, up-to-date on vaccinations, without direct patient contact, and tested for COVID-19 in the past. No significant difference in intention to be vaccinated was found between those with higher versus lower levels of exposure to COVID-19 patients or the number of previous exposures to patients with COVID-19. CONCLUSIONS: While the majority of hospital employees are planning to receive a COVID-19 vaccine, many are unsure or not planning to do so. Further education of hospital employees about the safety, efficacy, and value of the currently available COVID-19 vaccines is critical to vaccine acceptance in this population.


Assuntos
/administração & dosagem , Pessoal de Saúde/psicologia , Vacinação/psicologia , Adulto , Idoso , Feminino , Hospitais , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Philadelphia , Inquéritos e Questionários
10.
Artigo em Inglês | MEDLINE | ID: mdl-33435462

RESUMO

The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.


Assuntos
Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fumantes , Abandono do Hábito de Fumar/estatística & dados numéricos , Humanos , New York/epidemiologia , Pandemias , Philadelphia/epidemiologia , Inquéritos e Questionários
11.
mBio ; 12(1)2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468702

RESUMO

The severe acute respiratory coronavirus 2 (SARS-CoV-2) is the cause of the global outbreak of COVID-19. The epidemic accelerated in Philadelphia, PA, in the spring of 2020, with the city experiencing a first peak of infections on 15 April, followed by a decline through midsummer. Here, we investigate spread of the epidemic in the first wave in Philadelphia using full-genome sequencing of 52 SARS-CoV-2 samples obtained from 27 hospitalized patients collected between 30 March and 17 July 2020. Sequences most commonly resembled lineages circulating at earlier times in New York, suggesting transmission primarily from this location, though a minority of Philadelphia genomes matched sequences from other sites, suggesting additional introductions. Multiple genomes showed even closer matches to other Philadelphia isolates, suggestive of ongoing transmission within Philadelphia. We found that all of our isolates contained the D614G substitution in the viral spike and belong to lineages variously designated B.1, Nextstrain clade 20A or 20C, and GISAID clade G or GH. There were no viral sequence polymorphisms detectably associated with disease outcome. For some patients, genome sequences were determined longitudinally or concurrently from multiple body sites. In both cases, some comparisons showed reproducible polymorphisms, suggesting initial seeding with multiple variants and/or accumulation of polymorphisms after infection. These results thus provide data on the sources of SARS-CoV-2 infection in Philadelphia and begin to explore the dynamics within hospitalized patients.IMPORTANCE Understanding how SARS-CoV-2 spreads globally and within infected individuals is critical to the development of mitigation strategies. We found that most lineages in Philadelphia had resembled sequences from New York, suggesting infection primarily but not exclusively from this location. Many genomes had even nearer neighbors within Philadelphia, indicating local spread. Multiple genome sequences were available for some subjects and in a subset of cases could be shown to differ between time points and body sites within an individual, indicating heterogeneous viral populations within individuals and raising questions on the mechanisms responsible. There was no evidence that different lineages were associated with different outcomes in patients, emphasizing the importance of individual-specific vulnerability.


Assuntos
/virologia , /genética , Células A549 , Adulto , Idoso , Idoso de 80 Anos ou mais , /epidemiologia , Feminino , Genoma Viral , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Philadelphia/epidemiologia , Filogenia , Polimorfismo Genético , Glicoproteína da Espícula de Coronavírus/genética
13.
JAMA Netw Open ; 4(1): e2034868, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33492375

RESUMO

Importance: Police in Philadelphia, Pennsylvania, routinely transport patients with penetrating trauma to nearby trauma centers. During the past decade, this practice has gained increased acceptance, but outcomes resulting from police transport of these patients have not been recently evaluated. Objective: To assess mortality among patients with penetrating trauma who are transported to trauma centers by police vs by emergency medical services (EMS). Design, Setting, and Participants: This cohort study used the Pennsylvania Trauma Outcomes Study registry and included 3313 adult patients with penetrating trauma from January 1, 2014, to December 31, 2018. Outcomes were compared between patients transported by police (n = 1970) and patients transported by EMS (n = 1343) to adult level I and II trauma centers in Philadelphia. Exposures: Police vs EMS transport. Main Outcomes and Measures: The primary end point was 24-hour mortality. Secondary end points included death at multiple other time points. After whole-cohort regression analysis, coarsened exact matching was used to control for confounding differences between groups. Matching criteria included patient age, injury mechanism and location, Injury Severity Score (ISS), presenting systolic blood pressure, and Glasgow Coma Scale score. Subgroup analysis was performed among patients with low, moderate, or high ISS. Results: Of the 3313 patients (median age, 29 years [interquartile range, 23-40 years]) in the study, 3013 (90.9%) were men. During the course of the study, the number of police transports increased significantly (from 328 patients in 2014 to 489 patients in 2018; P = .04), while EMS transport remained unchanged (from 246 patients in 2014 to 281 patients in 2018; P = .44). On unadjusted analysis, compared with patients transported by EMS, patients transported by police were younger (median age, 27 years [interquartile range, 22-36 years] vs 32 years [interquartile range, 24-46 years]), more often injured by a firearm (1741 of 1970 [88.4%] vs 681 of 1343 [50.7%]), and had a higher median ISS (14 [interquartile range, 9-26] vs 10 [interquartile range, 5-17]). Patients transported by police had higher mortality at 24 hours than those transported by EMS (560 of 1970 [28.4%] vs 246 of 1343 [18.3%]; odds ratio, 1.86; 95% CI, 1.57-2.21; P < .001) and at all other time points. After coarsened exact matching (870 patients in each transport cohort), there was no difference in mortality at 24 hours (210 [24.1%] vs 212 [24.4%]; odds ratio, 0.95; 95% CI, 0.59-1.52; P = .91) or at any other time point. On subgroup analysis, patients with severe injuries transported by police were less likely to be dead on arrival compared with matched patients transported by EMS (64 of 194 [33.0%] vs 79 of 194 [40.7%]; odds ratio, 0.48; 95% CI, 0.24-0.94; P = .03). Conclusions and Relevance: For patients with penetrating trauma in an urban setting, 24-hour mortality was not different for those transported by police vs EMS to a trauma center. Timely transport to definitive trauma care should be emphasized over medical capability in the prehospital management of patients with penetrating trauma.


Assuntos
Serviços Médicos de Emergência , Polícia , Transporte de Pacientes , Ferimentos Penetrantes/mortalidade , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Philadelphia , Centros de Traumatologia
14.
Am J Emerg Med ; 41: 51-54, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33387928

RESUMO

INTRODUCTION: Since the beginning of the novel coronavirus (COVID-19) pandemic in the United States, there have been concerns about the potential impact of the pandemic on persons with opioid use disorder. Shelter-in-place (SIP) orders, which aimed to reduce the spread and scope of the virus, likely also impacted this patient population. This study aims to assess the role of the COVID-19 pandemic on the incidence of opioid overdose before and after a SIP order. METHODS: A retrospective review of the incidence of opioid overdoses in an urban three-hospital system was conducted. Comparisons were made between the first 100 days of a city-wide SIP order during the COVID-19 pandemic and the 100 days during the COVID-19 pandemic preceding the SIP order (Pre-SIP). Differences in observed incidence and expected incidence during the SIP period were evaluated using a Fisher's Exact test. RESULTS: Total patient visits decreased 22% from 46,078 during the Pre-SIP period to 35,971 during the SIP period. A total of 1551 opioid overdoses were evaluated during the SIP period, compared to 1665 opioid overdoses during the Pre-SIP period, consistent with a 6.8% decline. A Fisher's Exact Test demonstrated a p < 0.0001, with a corresponding Odds Ratio of 1.20 with a 95% confidence interval (1.12;1.29). CONCLUSION: The COVID-19 pandemic and the associated SIP order were associated with a statistically and clinically significant increase in the proportion of opioid overdoses in relation to the overall change in total ED visits.


Assuntos
/epidemiologia , Pandemias , Quarentena , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Humanos , Incidência , Philadelphia/epidemiologia , Estudos Retrospectivos
15.
AIDS Patient Care STDS ; 35(1): 15-22, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400589

RESUMO

Prior sexually transmitted infections (STIs) are associated with higher rates of subsequent human immunodeficiency virus (HIV) infection, but the influence of prior STIs on perceived vulnerability to HIV remains unclear. We aimed to assess this relationship, hypothesizing that a prior STI diagnosis is associated with higher self-assessed vulnerability to HIV. We performed a cross-sectional study of men and transgender individuals who have sex with men screening for HIV prevention trials in Philadelphia. An unadjusted regression analysis found no significant association between prior STI and HIV risk perception (p = 0.71) or HIV anxiety (p = 0.32). Multivariate logistic regression models that controlled for predetermined potential cofounders known to impact HIV risk-such as condom use, preexposure prophylaxis use, and demographics-also failed to show statistically significant associations between prior STI and HIV risk perception (p = 0.87) or HIV anxiety (p = 0.10). Furthermore, there was no effect modification by HIV preventive behaviors on the relationship between prior STI and HIV vulnerability. These data suggest that a gap exists between how clinicians may attribute individual HIV risk and how individuals view their own vulnerability at a given moment in time. Future research should focus on the dynamic relationship between perceived HIV vulnerability, STI diagnosis, and adoption of preventive behavior to determine better, individualized targets for HIV prevention interventions.


Assuntos
Ansiedade/psicologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Profilaxia Pré-Exposição/métodos , Doenças Sexualmente Transmissíveis/epidemiologia , Pessoas Transgênero , Adulto , Preservativos , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Percepção , Philadelphia/epidemiologia , Comportamento Sexual , Minorias Sexuais e de Gênero
16.
Spat Spatiotemporal Epidemiol ; 36: 100401, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33509436

RESUMO

Surveillance data obtained by public health agencies for COVID-19 are likely inaccurate due to undercounting and misdiagnosing. Using a Bayesian approach, we sought to reduce bias in the estimates of prevalence of COVID-19 in Philadelphia, PA at the ZIP code level. After evaluating various modeling approaches in a simulation study, we estimated true prevalence by ZIP code with and without conditioning on an area deprivation index (ADI). As of June 10, 2020, in Philadelphia, the observed citywide period prevalence was 1.5%. After accounting for bias in the surveillance data, the median posterior citywide true prevalence was 2.3% when accounting for ADI and 2.1% when not. Overall the median posterior surveillance sensitivity and specificity from the models were similar, about 60% and more than 99%, respectively. Surveillance of COVID-19 in Philadelphia tends to understate discrepancies in burden for the more affected areas, potentially misinforming mitigation priorities.


Assuntos
Teorema de Bayes , Vigilância da População , Análise Espacial , Viés , Humanos , Philadelphia/epidemiologia , Prevalência , Sensibilidade e Especificidade
18.
Artigo em Inglês | MEDLINE | ID: mdl-33352953

RESUMO

This study investigated the geographic variation and the clustering of lung cancer incidence rates in Philadelphia and the surrounding areas using addresses at the time of diagnosis. Using 60,844 cases from Pennsylvania Cancer Registry, we calculated and mapped the age-adjusted incidence rates for five Pennsylvania (PA) counties near Philadelphia between 1998-2007 and 2008-2017. We identified ZIP codes with significantly higher incidence rates than the state rates and examined their demographic and exposure characteristics. Further, we tested for spatial autocorrelation and identified spatial clusters using Moran's I statistic. Our results showed that approximately one in four ZIP codes had an incidence rate that was significantly higher than the PA state rate in each period studied. Clusters of higher incidences were detected in the southeastern part of PA bordering New Jersey. These areas tended to be more populated, of lower socioeconomic status, and closer to manufacturing facilities and major highways. Possibly driven by the community and environmental factors, the observed differences in disease incidence suggest the importance of including residential location in risk assessment tools for lung cancer.


Assuntos
Neoplasias Pulmonares , Análise por Conglomerados , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , New Jersey/epidemiologia , Philadelphia/epidemiologia
19.
Am J Orthod Dentofacial Orthop ; 158(5): 674-683, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33008712

RESUMO

INTRODUCTION: This study aimed to assess the accuracy of virtual surgical planning (VSP) performed by Dolphin Imaging software (version 11.9; Dolphin Imaging and Management Solutions, Chatsworth, Calif). METHODS: Ten people requiring bimaxillary surgery and genioplasty were followed up prospectively. All patients had preoperative cone-beam computed tomography, plaster models, and photographs allowing for VSP. Interocclusal intermediate surgical splints were produced using a 3-dimensional (3D) printer. Postoperative images were acquired 15 days after surgery using cone-beam computed tomography. ITK-Snap (version 3.6; Cognitica, Philadelphia, Pa) allowed the segmentation of reliable 3D models. Geomagic Qualify 2013 (3D Systems, Rock Hill, SC) and MeshValmet (version 3.0) were used to identify the differences between VSP and actual surgical results through the root mean square values and the 3D translational displacement (3-axes) of the 3D centroid of each model. RESULTS: Discrepancies between the VSP and the actual result were found at the mandible (P = 0.013) and the chin (P = 0.013) when considering the root mean square values. In addition, 3D centroid differences were found in the transverse and sagittal direction of the right ramus (P = 0.034 and P = 0.005, respectively) and the sagittal aspect of the left ramus (P = 0.025). Considering 2 mm as a threshold of clinical relevance, almost all the bone fragments (maxilla, proximal, and distal mandibular segments) were accurately corrected by surgery, although not in the chin. CONCLUSIONS: On the basis of the obtained values, it is possible to consider the Dolphin Imaging software as clinically acceptable for performing virtual orthognathic surgical planning.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cirurgia Assistida por Computador , Tomografia Computadorizada de Feixe Cônico , Humanos , Imageamento Tridimensional , Philadelphia
20.
Health Aff (Millwood) ; 39(10): 1792-1798, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33017232

RESUMO

Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children's Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment system. The system, a computer-based virtual driving test, exposes drivers to common serious crash scenarios to identify critical skill deficits and is delivered in testing centers immediately before the on-road examination. A pilot study of license applicants who completed it showed that the virtual driving assessment system accurately predicted which drivers would fail the on-road examination and provided automated feedback that informed drivers on their skill deficits. At this time, the partnership's work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the coronavirus disease 2019 pandemic has introduced to driver testing and training.


Assuntos
Condução de Veículo/legislação & jurisprudência , Infecções por Coronavirus/prevenção & controle , Licenciamento/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gestão da Segurança/organização & administração , Interface Usuário-Computador , Adolescente , Infecções por Coronavirus/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Veículos Automotores/estatística & dados numéricos , Ohio , Pandemias/estatística & dados numéricos , Philadelphia , Projetos Piloto , Pneumonia Viral/epidemiologia , Transportes/métodos , Adulto Jovem
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