Reflections on Prolific Contributors to the Dental Literature and Dental History: Truman vs. Trueman.

Dental literature is rich in its historical evolution, which is extoled by key figures in the late 1800 and early 1900s. This paper will briefly highlight two of these individuals, both based in Philadelphia who had similar names, spelled differently, and who impacted greatly on this historical documentation.

"The new normal has become a nonstop crisis": a qualitative study of burnout among Philadelphia's harm reduction and substance use disorder treatment workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic worsened the ongoing overdose crisis in the United States (US) and caused significant mental health strain and burnout among health care workers (HCW). Harm reduction, overdose prevention, and substance use disorder (SUD) workers may be especially impacted due to underfunding, resources shortages, and chaotic working environments. Existing research on HCW burnout primarily focuses on licensed HCWs in traditional environments and fails to account for the unique experiences of harm reduction workers, community organizers, and SUD treatment clinicians. METHODS: We conducted a qualitative secondary analysis descriptive study of 30 Philadelphia-based harm reduction workers, community organizers, and SUD treatment clinicians about their experiences working in their roles during the COVID-19 pandemic in July-August 2020. Our analysis was guided by Shanafelt and Noseworthy's model of key drivers of burnout and engagement. We aimed to assess the applicability of this model to the experiences of SUD and harm reduction workers in non-traditional settings. RESULTS: We deductively coded our data in alignment with Shanafelt and Noseworthy's key drivers of burnout and engagement: (1) workload and job demands, (2) meaning in work, (3) control and flexibility, (4) work-life integration, (5) organizational culture and values, (6) efficiency and resources and (7) social support and community at work. While Shanafelt and Noseworthy's model broadly encompassed the experiences of our participants, it did not fully account for their concerns about safety at work, lack of control over the work environment, and experiences of task-shifting. CONCLUSIONS: Burnout among healthcare providers is receiving increasing attention nationally. Much of this coverage and the existing research have focused on workers in traditional healthcare spaces and often do not consider the experiences of community-based SUD treatment, overdose prevention, and harm reduction providers. Our findings indicate a gap in existing frameworks for burnout and a need for models that encompass the full range of the harm reduction, overdose prevention, and SUD treatment workforce. As the US overdose crisis continues, it is vital that we address and mitigate experiences of burnout among harm reduction workers, community organizers, and SUD treatment clinicians to protect their wellbeing and to ensure the sustainability of their invaluable work.

Lead exposure in childhood and historical land use: a geostatistical analysis of soil lead concentrations in South Philadelphia parks.

Elevated soil lead (Pb) concentrations in public parks and outdoor spaces continue to have a significant impact on the public health of urban communities. This study evaluated the geospatial and statistical relationships between soil Pb concentrations, the urban environment, and child blood lead levels (BLLs) in the neighborhood of South Philadelphia, PA. Soil samples (n = 240) were collected from forty (40) public parks and analyzed for Pb using a field portable X-ray fluorescence (XRF) analyzer. Geospatial mapping was used to investigate historical land use of each park, vehicular traffic on adjacent roadways, and density of residential/commercial development. Predicted child BLLs and BLL "high-risk areas" were identified using interpolation and biokinetic modeling. Childhood BLL data for South Philadelphia (n = 10,379) was provided by the Philadelphia Department of Public Health (2013-2015). Of the two hundred forty (240) soil samples collected, Pb levels for 10.8% of samples were ≥ 400 ppm. Two hundred sixty-nine of 10,379 children screened were identified with BLLs ≥ 5 µg/dL. Historical land use of each park was shown to be significantly correlated (p = 0.01) with soil Pb concentrations and child BLLs ≥ 5 µg/dL. Approximately 13.3% of the variance in child BLLs ≥ 5 µg/dL was attributed to historical site land use. Overall, undeveloped/greenspace historical land use exhibited the highest soil Pb concentrations in the study. Geospatial relationships were identified between census tracts with higher percentages of children with BLLs ≥ 5 µg/dL and interpolated BLL "high-risk" areas (≥ 3.5 µg/dL). The results of this study suggest soil accumulation time and historical land use may influence soil Pb concentrations and child BLLs in urban communities. Measured soil Pb concentrations were determined to effectively model community-wide contamination and childhood Pb exposure.

Measles Serostatus Among Parturient Patients at 2 Philadelphia Hospitals in 2021.

This observational study explores whether rubella serostatus, which is routinely assessed during pregnancy, can serve as a proxy for measles serostatus in parturient persons.

Profiles of COVID-19 vaccine hesitancy by race and ethnicity in eastern Pennsylvania.

BACKGROUND: Throughout US history, chronic and infectious diseases have severely impacted minority communities due to a lack of accessibility to quality healthcare and accurate information, as well as underlying racism. These fault lines in the care of minority communities in the US have been further exacerbated by the rise of the COVID-19 pandemic. This study examined the factors associated with COVID-19 vaccine hesitancy by race and ethnicity, particularly among African American and Latinx communities in Eastern Pennsylvania (PA). METHODS: Survey data was collected in July 2021 in Philadelphia, Scranton, Wilkes-Barre, and Hazleton, PA. The 203 participants (38.7% Black, 27.5% Latinx) completed the 28-question survey of COVID-19 vaccination attitudes in either English or Spanish. RESULT: Out of the 203 participants, 181 participants met all the inclusion criteria, including completed surveys; of these participants, over three-fifths (63.5%) were acceptant of the COVID-19 vaccine whereas the remainder (36.5%) were hesitant. Binary logistic regression results showed that age, concern for vaccine efficacy, race, knowledge on the vaccine, and belief that the COVID-19 virus is serious significantly influenced COVID-19 vaccine hesitancy. Minorities were more likely to be hesitant toward vaccination (OR: 2.8, 95% CI: 1.1, 6.8) than non-Hispanic whites. Those who believed the COVID-19 vaccine was ineffective (OR: 8.3, 95% CI: 3.8, 18.2), and that the virus is not serious (OR: 8.3, 95% CI: 1.1, 61.8) showed the greatest odds of hesitancy. CONCLUSIONS: Minority status, age less than 45 years, misinformation about seriousness of COVID-19 illness, and concern about vaccine efficacy were contributing factors of COVID-19 vaccine hesitancy. Therefore, understanding and addressing the barriers to COVID-19 vaccination in minority groups is essential to decreasing transmission and controlling this pandemic, and will provide lessons on how to implement public health measures in future pandemics.

Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations.

We sought to explore the trust and influence community-based organizations have within the communities they serve to inform public health strategies in tailoring vaccine and other health messages. A qualitative study was conducted between March 15 - April 12, 2021 of key informants in community-based organizations serving communities in and around Philadelphia, Pennsylvania. These organizations serve communities with high Social Vulnerability Index scores. We explored four key questions including: (1) What was and continues to be the impact of COVID-19 on communities; (2) How have trust and influence been cultivated in the community; (3) Who are trusted sources of information and health messengers; and (4) What are the community's perceptions about vaccines, vaccinations, and intent to vaccinate in the context of the COVID-19 pandemic. Fifteen key informants from nine community-based organizations who serve vulnerable populations (e.g., mental health, homeless, substance use, medically complex, food insecurity) were interviewed. Five key findings include: (1) The pandemic has exacerbated disparities in existing social determinants of health for individuals and families and have created new concerns for these communities; (2) components of how to build the trust and influence (e.g., demonstrate empathy, create a safe space, deliver on results)resonated with key informants; (3) regardless of the source, presenting health information in a respectful and understandable manner is key to effective delivery; (4) trust and influence can be transferred by association to a secondary messenger connected to or introduced by the primary trusted source; and (5) increased awareness about vaccines and vaccinations offers opportunities to think differently, changing previously held beliefs or attitudes, as many individuals are now more cognizant of risks associated with vaccine-preventable diseases and the importance of vaccines. Community-based organizations offer unique opportunities to address population-level health disparities as trusted vaccine messengers to deliver public health messages.

Prevalence of Behavioral Flags in the Electronic Health Record Among Black and White Patients Visiting the Emergency Department.

Importance: Behavioral flags in the electronic health record (EHR) are designed to alert clinicians of potentially unsafe or aggressive patients. These flags may introduce bias, and understanding how they are used is important to ensure equitable care. Objective: To investigate the incidence of behavioral flags and assess whether there were differences between Black and White patients and whether the flags were associated with differences in emergency department (ED) clinical care. Design, Setting, and Participants: This was a retrospective cohort study of EHR data of adult patients (aged ≥18 years) from 3 Philadelphia, Pennsylvania, EDs within a single health system between January 1, 2017, and December 31, 2019. Secondary analyses excluded patients with sickle cell disease and high ED care utilization. Data were analyzed from February 1 to April 4, 2022. Main Outcomes and Measures: The primary outcome of interest was the presence of an EHR behavioral flag. Secondary measures included variation of flags across sex, race, age, insurance status, triage status, ED clinical care metrics (eg, laboratory, medication, and radiology orders), ED disposition (discharge, admission, or observation), and length of key intervals during ED care. Results: Participating EDs had 195 601 eligible patients (110 890 [56.7%] female patients; 113 638 Black patients [58.1%]; 81 963 White patients [41.9%]; median [IQR] age, 42 [28-60] years), with 426 858 ED visits. Among these, 683 patients (0.3%) had a behavioral flag notification in the EHR (3.5 flags per 1000 patients), and it was present for 6851 ED visits (16 flagged visits per 1000 visits). Patient differences between those with a flag and those without included male sex (56.1% vs 43.3%), Black race (71.2% vs 56.7%), and insurance status, particularly Medicaid insurance (74.5% vs 36.3%). Flag use varied across sites. Black patients received flags at a rate of 4.0 per 1000 patients, and White patients received flags at a rate of 2.4 per 1000 patients (P < .001). Among patients with a flag, Black patients, compared with White patients, had longer waiting times to be placed in a room (median [IQR] time, 28.0 [10.5-89.4] minutes vs 18.2 [7.2-75.1] minutes; P < .001), longer waiting times to see a clinician (median [IQR] time, 42.1 [18.8-105.5] minutes vs 33.3 [15.3-84.5] minutes; P < .001), and shorter lengths of stay (median [IQR] time, 274 [135-471] minutes vs 305 [154-491] minutes; P = .01). Black patients with a flag underwent fewer laboratory (eg, 2449 Black patients with 0 orders [43.4%] vs 441 White patients with 0 orders [36.7%]; P < .001) and imaging (eg, 3541 Black patients with no imaging [62.7%] vs 675 White patients with no imaging [56.2%]; P < .001) tests compared with White patients with a flag. Conclusions and Relevance: This cohort study found significant differences in ED clinical care metrics, including that flagged patients had longer wait times and were less likely to undergo laboratory testing and imaging, which was amplified in Black patients.

Stakeholders' Perspectives on the Feasibility of Adopting a Healthy Nail Salon Recognition Program in Philadelphia: A Qualitative Study.

OBJECTIVES: The California Healthy Nail Salon Recognition Program is a statewide initiative to incentivize nail salons to adopt occupational health and safety best practices such as the use of safer nail products without certain harmful chemicals, ventilation systems upgrade, proper personal protective equipment use, and staff training. This public policy intervention is in response to the call to protect nail care workers, mostly women of color, who bear a disproportionate burden of chemical exposure at work. Because there is an interest to adopt a similar program in the Greater Philadelphia region, we conducted this formative research to document stakeholders' perspectives on the feasibility of adopting a Healthy Nail Salon Recognition Program in Philadelphia. METHODS: We conducted semi-structured interviews with a purposive sample of 31 stakeholders in Philadelphia in 2021. Using the Consolidated Framework for Implementation Science as our theoretical framework, we developed the interview guide and analysed the data using qualitative research methods to identify key facilitators and barriers. RESULTS: Key facilitating themes were perceived need and benefits of program to improve workers' health and working conditions, and willingness of stakeholders to leverage their organizational resources. Barriers included perceived high cost and time commitment from salon owners and employees, lack of funding and implementation leaders at the city government, community members' willingness to be visible and advocate for the program affected by the stigmas of being immigrant workers, and fear of interacting with authorities, as well as the impact of COVID-19 pandemic. CONCLUSIONS: Our results suggest successful adoption of a Healthy Nail Salon Recognition Program in Philadelphia will require outreach within the community to raise awareness of the benefits of the program and close partnership with community-based organizations to facilitate mutual understanding between the authorities and the ethnically diverse nail salon communities.

Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan.

Importance: In 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response. Objective: To evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan. Design, Setting, and Participants: In this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk. Main Outcomes and Measures: The relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting. Results: Of 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities' most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied. Conclusions and Relevance: In this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.

Excess Mortality From Non-COVID-19 Causes During the COVID-19 Pandemic in Philadelphia, Pennsylvania, 2020-2021.

Objectives. To estimate excess mortality from non-COVID-19 causes during the COVID-19 pandemic in Philadelphia, Pennsylvania, and understand disparities by race/ethnicity, age, and sex. Methods. We used Poisson regression models of weekly deaths using data from Pennsylvania's vital registration system (2018-2021). Results. There was significant excess mortality as a result of heart disease, homicide, diabetes, drug overdoses, traffic crashes, and falls in 2020-2021; the burden of this excess non-COVID-19 mortality fell on non-Hispanic Black Philadelphians. Among younger non-Hispanic Black men, homicide and drug overdoses were responsible for 54% and 18% of excess deaths-more than COVID-19 (17%). For younger non-Hispanic Black women, drug overdoses accounted for 51% of excess deaths, whereas COVID-19 accounted for 40%. Conclusions. Excess mortality was not solely caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; the causative agent of COVID-19), particularly at younger ages. Indirect pandemic mortality exacerbated prepandemic disparities by race/ethnicity. Public Health Implications. Excess mortality as a result of non-COVID-19 causes may reflect indirect pandemic mortality. National cause-of-death data lag behind local cause-of-death data; local data should be examined as an early indication of trends and disparities. Public health practitioners must center health equity in pandemic response and planning. (Am J Public Health. 2022;112(12):1800-1803. https://doi.org/10.2105/AJPH.2022.307096).

Thomas Dent Mütter, M.D. (1811 to 1859): Exemplar of Expertise.

Thomas Dent Mütter, a Philadelphia plastic surgeon in the 1840s, boldly championed anesthesia when few physicians were convinced of its virtues. He was an early advocate of handwashing and hygienic wound care and helped pioneer the concept of postoperative recovery units. A leader in education, Mütter used a highly interactive style of teaching and restructured medical school classes to raise the caliber of clinical training. He supplemented his lectures with a myriad of specimens that he amassed over 24 yr. In 1863, this vast collection would serve as the basis for the Mütter Museum, which remains active today. Mütter exemplified expertise by tirelessly pursuing new knowledge and methods for the benefit of his patients and students.

Comparison of Maternal and Neonatal Antibody Levels After COVID-19 Vaccination vs SARS-CoV-2 Infection.

Importance: Pregnant persons are at an increased risk of severe COVID-19 from SARS-CoV-2 infection, and COVID-19 vaccination is currently recommended during pregnancy. Objective: To ascertain the association of vaccine type, time from vaccination, gestational age at delivery, and pregnancy complications with placental transfer of antibodies to SARS-CoV-2. Design, Setting, and Participants: This cohort study was conducted in Pennsylvania Hospital in Philadelphia, Pennsylvania, and included births at the study site between August 9, 2020, and April 25, 2021. Maternal and cord blood serum samples were available for antibody level measurements for maternal-neonatal dyads. Exposures: SARS-CoV-2 infection vs COVID-19 vaccination. Main Outcomes and Measures: IgG antibodies to the receptor-binding domain of the SARS-CoV-2 spike protein were measured by quantitative enzyme-linked immunosorbent assay. Antibody concentrations and transplacental transfer ratios were measured after SARS-CoV-2 infection or receipt of COVID-19 vaccines. Results: A total of 585 maternal-newborn dyads (median [IQR] maternal age, 31 [26-35] years; median [IQR] gestational age, 39 [38-40] weeks) with maternal IgG antibodies to SARS-CoV-2 detected at the time of delivery were included. IgG was detected in cord blood from 557 of 585 newborns (95.2%). Among 169 vaccinated persons without SARS-CoV-2 infection, the interval from first dose of vaccine to delivery ranged from 12 to 122 days. The geometric mean IgG level among 169 vaccine recipients was significantly higher than that measured in 408 persons after infection (33.88 [95% CI, 27.64-41.53] arbitrary U/mL vs 2.80 [95% CI, 2.50-3.13] arbitrary U/mL). Geometric mean IgG levels were higher after vaccination with the mRNA-1273 (Moderna) vaccine compared with the BNT162b2 (Pfizer/BioNTech) vaccine (53.74 [95% CI, 40.49-71.33] arbitrary U/mL vs 25.45 [95% CI, 19.17-33.79] arbitrary U/mL; P < .001). Placental transfer ratios were lower after vaccination compared with after infection (0.80 [95% CI, 0.68-0.93] vs 1.06 [95% CI, 0.98-1.14]; P < .001) but were similar between the mRNA vaccines (mRNA-1273: 0.70 [95% CI, 0.55-0.90]; BNT162b2: 0.85 [95% CI, 0.69-1.06]; P = .25). Time from infection or vaccination to delivery was associated with transfer ratio in models that included gestational age at delivery and maternal hypertensive disorders, diabetes, and obesity. Placental antibody transfer was detectable as early as 26 weeks' gestation. Transfer ratio that was higher than 1.0 was present for 48 of 51 (94.1%) births at 36 weeks' gestation or later by 8 weeks after vaccination. Conclusions and Relevance: This study found that maternal and cord blood IgG antibody levels were higher after COVID-19 vaccination compared with after SARS-CoV-2 infection, with slightly lower placental transfer ratios after vaccination than after infection. The findings suggest that time from infection or vaccination to delivery was the most important factor in transfer efficiency.

Community-Based COVID-19 Vaccine Clinics in Medically Underserved Neighborhoods to Improve Access and Equity, Philadelphia, 2021-2022.

Vaccination remains key to reducing the risk of COVID-19-related severe illness and death. Because of historic medical exclusion and barriers to access, Black communities have had lower rates of COVID-19 vaccination than White communities. We describe the efforts of an academic medical institution to implement community-based COVID-19 vaccine clinics in medically underserved neighborhoods in Philadelphia, Pennsylvania. Over a 13-month period (April 2021-April 2022), the initiative delivered 9038 vaccine doses to community members, a majority of whom (57%) identified as Black. (Am J Public Health. 2022;112(12):1721-1725. https://doi.org/10.2105/AJPH.2022.307030).

Key determinants to school breakfast program implementation in Philadelphia public schools: Implications for the role of SNAP-Ed.

Background: Policies addressing food insecurity are only effective if they are implemented successfully, serving those most at risk. Universal school meals provide a key intervention to schools that serve predominantly low-income families by providing free school breakfast and lunch to all. Unfortunately, low uptake of such provisions among students is concerning especially regarding school breakfast, warranting key implementation support for schools to ensure student nutrition needs are met. Thus, the purpose of this study was to evaluate the determinants of implementing two different school breakfast programs and pragmatic strategies for serving breakfast in ways that maximize student participation. Methods: A qualitative study was conducted between 2018 and 2020 within the School District of Philadelphia (SDP) comprising surveys, interviews, and observations to assess contextual determinants of two distinctive breakfast models: Breakfast in the Classroom (BIC) and Cafeteria after the Bell (CAB). Principals and lead kitchen staff completed surveys to assess determinants of breakfast model adoption. Principals, lead kitchen staff, classroom teachers, climate (i.e., social emotional wellbeing), and facilities staff subsequently participated in interviews to discuss implementation determinants (i.e., facilitators and challenges) and strategies for maximizing student participation. Observations provided rich data to triangulate interviews and survey data. Survey data were analyzed using frequency analysis, and observation and interview data were analyzed through thematic analysis. Presentation of themes was framed by the Consolidated Framework for Implementation Research. Results: Results highlighted several positive determinants to participation including addressing student and family needs, making data-informed decisions, and providing hot meals and fruit based on student tastes. Negative determinants to implementation comprised challenges to SNAP-Ed-funded policy changes to promote student breakfast participation, lack of communication between administration, and staff and turnover among food service staff. Strategies included modifying school entrance procedures and combining breakfast with other education-related tasks to minimize instructional time lost through breakfast after the bell schedules. Discussion: Data highlight the need to include implementation partner expertise when designing interventions for increasing reach and effectiveness of school meal programs. Future research that directly tests implementation strategies and key outcomes of reach/participation, among others, is critical to bridging the policy to practice gap in school nutrition programs.

End-stage renal disease incidence in a cohort of US firefighters from San Francisco, Chicago, and Philadelphia.

BACKGROUND: Firefighters perform strenuous work in hot environments, which may increase their risk of chronic kidney disease. The purpose of this study was to evaluate the risk of end-stage renal disease (ESRD) and types of ESRD among a cohort of US firefighters compared to the US general population, and to examine exposure-response relationships. METHODS: ESRD from 1977 through 2014 was identified through linkage with Medicare data. ESRD incidence in the cohort compared to the US population was evaluated using life table analyses. Associations of all ESRD, systemic ESRD, hypertensive ESRD, and diabetic ESRD with exposure surrogates (exposed days, fire runs, and fire hours) were examined in Cox proportional hazards models adjusted for attained age (the time scale), race, birth date, fire department, and employment duration. RESULTS: The incidence of all ESRD was less than expected (standardized incidence ratio (SIR) = 0.79; 95% confidence interval = 0.69-0.89, observed = 247). SIRs for ESRD types were not significantly increased. Positive associations of all ESRD, systemic ESRD, and hypertensive ESRD with exposed days were observed: however, 95% confidence intervals included one. CONCLUSIONS: We found little evidence of increased risk of ESRD among this cohort of firefighters. Limitations included the inability to evaluate exposure-response relationships for some ESRD types due to small observed numbers, the limitations of the surrogates of exposure, and the lack of information on more sensitive outcome measures for potential kidney effects.

Factors and Outcomes Associated With Viral Suppression Trajectory Group Membership Among Youth Transitioning From Pediatric to Adult HIV Care.

PURPOSE: Youth experiencing healthcare transition (HCT) from pediatric to adult HIV care are at risk for poor viral suppression (VS). We have a limited understanding of VS trajectory groups (VSTGs) pre- and post-HCT and factors associated with these trajectories. METHODS: We analyzed Philadelphia HIV surveillance data of youth diagnosed with HIV at least 2 years pre-HCT. We used group-based trajectory analysis to characterize VS trends pre- and post-HCT. We compared baseline sociodemographic characteristics across the different VSTGs and care continuum outcomes in the year post-HCT. Generalized estimating equations evaluated the association between VSTG and HIV care continuum outcomes measured 2 years post-HCT. RESULTS: Between 2012 and 2019, 232 eligible youth underwent HCT: 69.4% were aged 24-25, 75.4% male, and 76.7% non-Hispanic Black. Three VSTGs were identified: low (30.6%), increasing (26.7%), and high probability (42.7%) for VS. Younger age was associated with high-probability VSTG membership: 59.2% of those aged 18-23 versus 35.4% of those aged 24-25 were in the high-probability VSTG (p < .001). Demographics found to be associated with linkage to care post-HCT included younger age (p = .018), female sex at birth (p = .038), and perinatal acquisition (p = .012). Perinatal acquisition was also associated with retention in care in the year post-HCT (p = .029). For those transitioning between 2012 and 2018, those in the high-probability VSTG had greater odds of being retained (adjusted odds ratio 1.68, 95% confidence interval 1.03-2.71) and VS (adjusted odds ratio 6.95, interval 3.74-12.95) 2 years post-HCT, compared to those in the low VSTG. DISCUSSION: We identified distinct VSTGs that informed long-term trends post-HCT. VSTG membership may allow for tailoring of appropriate HCT support.

Coming in hot: Police transport and prehospital time after firearm injury.

BACKGROUND: In Philadelphia, PA, police and emergency medical services (EMS) transport patients with firearm injuries. Prior studies evaluating this system have lacked reliable prehospital times. By linking police and hospital data sets, we established a complete timeline from firearm injury to outcome. We hypothesized that police-transported patients have shorter prehospital times that, in turn, are associated with improved survival and increased unexpected survivorship at 6 and 24 hours. METHODS: This retrospective study linked patient-level data from OpenDataPhilly Shooting Victims and the Pennsylvania Trauma Systems Foundation. All adults transported to a Level I or II trauma center after firearm injury in Philadelphia from 2015 to 2018 were included. Patient-level characteristics were compared between cohorts; unexpected survivors were identified using Trauma Score-Injury Severity Score. Multiple regression estimated risk-adjusted associations between transport method, prehospital time, and outcomes. RESULTS: Police-transported patients (n = 977) had significantly shorter prehospital times than EMS-transported patients (n = 320) (median, 9 minutes [interquartile range, 7-12 minutes] vs. 21 minutes [interquartile range, 16-29 minutes], respectively; p < 0.001). Police-transported patients were more often severely injured than those transported by EMS (60% vs. 50%, p = 0.002). After adjusting for confounders, police-transported patients had improved survival relative to EMS on hospital arrival (87% vs. 84%, respectively, p = 0.035), but not at 6 hours (79% vs. 78%, respectively, p = 0.126) or 24 hours after arrival (76% vs. 76%, respectively, p = 0.224). Compared with EMS, police-transported patients were significantly more likely to be unexpected survivors at 6 hours (6% vs. 2%, respectively, p < 0.001) and 24 hours (3% vs. 1%, respectively, p = 0.021). CONCLUSION: Police-transported patients had more severe injuries, shorter prehospital times, and increased likelihood of unexpected survival compared with EMS-transported patients. After controlling for confounders, patient physiology and injury severity represent meaningful determinants of mortality in our mature trauma system, indicating an ongoing opportunity to optimize in-hospital care. Future studies should investigate causes of death among unexpected early survivors to mitigate preventable mortality. LEVEL OF EVIDENCE: Prognostic/Epidemiological, Level III.

Association between race, shooting hot spots, and the surge in gun violence during the COVID-19 pandemic in Philadelphia, New York and Los Angeles.

Gun violence rates increased in U.S. cities in 2020 and into 2021. Gun violence rates in U.S. cities is typically concentrated in racially segregated neighborhoods with higher poverty levels. However, poverty levels and demographics alone do not explain the high concentration of violence or its relative change over time. In this paper, we examine the extent to which the increase in shooting victimization in Philadelphia, New York, and Los Angeles during the 2020-2021 pandemic was concentrated in gun violence hot spots, and how the increase impacted race and ethnic disparities in shooting victimization rates. We find that 36% (Philadelphia), 47% (New York), and 55% (Los Angeles) of the increase in shootings observed during the period 2020-2021 occurred in the top decile of census block groups, by aggregate number of shootings, and that the race/ethnicity of victims in these gun violence hot spots were disproportionately Black and Hispanic. We discuss the implications of these findings as they relate to racial disparities in victimization and place-based efforts to reduce gun violence.

Low-income parents' perceptions of a sweetened beverage tax in Philadelphia.

Objective: To characterise perceptions of the Philadelphia Beverage Tax among low-income parents. Design: We conducted semi-structured interviews and administered demographic questions via telephone. We based the interview guide and initial codebook on a conceptual model illustrating perceived fairness and effectiveness as essential for successfully adopting food policies. We performed thematic analysis using NVivo 12. Setting: We recruited from a primary care paediatrics clinic in Philadelphia, Pennsylvania from July to August 2020. Participants: Philadelphia parents/caregivers of 2- to 11-year-old children with Medicaid insurance. Results: Participants were predominantly African American (97 %), female (100 %), and had annual household incomes <$50 000 (80 %). Participants were 26- to 72-years old, with an average aged child of 5 years (range 7 months to 20 years). Themes emerged regarding tax perceptions, revenue use and behaviour change due to the tax. Using revenue for highly valued programmes and accountability of city government to use revenue as promised were critical elements in perceptions of tax fairness. Some parents avoided the tax through cross-border shopping and buying drink powders or concentrates, influencing perceptions of tax effectiveness. The tax signalled the health dangers of sweetened beverage consumption to most parents. Conclusion: Our findings bring to light four key takeaways for policymakers designing sweetened beverage taxes. (1) Dedication of tax revenue to programmes highly valued by parents and (2) transparency in revenue spending may improve acceptability. (3) State or national taxes may be more effective at decreasing consumption due to cross-border shopping. (4) Pairing taxes with health promotion campaigns may enhance behaviour change.

J. J. Woodward, the Philadelphia Centennial, and Medical Imaging in 19th Century America.

In his travelogue of the 1876 Philadelphia Centennial, What Ben Beverly Saw at the Great Exposition, James L. Dale described an exhibit that impressed him with both wonder and horror: a set of photographs documenting the outcomes of surgical operations that suggested procedures "of the most fearful character, which would seem impossible to perform, and the poor patient survive." What Dale described was the US Army Medical pavilion, where the displays were designed to convince domestic and international visitors of the professionalism and innovation of American medicine and in particular to highlight the contributions of military medicine. The medical building included a full-size model of an army field hospital and multiple exhibits constituting a representative sampling of collections from the US Army Medical Museum: photographic portraits of famous surgeons; enlarged microphotographs of blood, bone, and tissue samples; images of Civil War wounds and their treatments; artifacts and supplies for surgical procedures; and a painting, Thomas Eakins's The Gross Clinic. Together, this collection of artifacts presented viewers with a narrative of the current American medical field, with special focus on the Civil War as a catalyst for new medical discoveries. While Eakins's painting became the most famous image from the pavilion, it was not part of the original display, which was explicitly designed to demonstrate how surgeons and medical researchers used healing knowledge to transcend the devastation of the Civil War. This essay examines the exhibit's roots in wartime medicine and research and studies how Dr. Joseph Janvier Woodward planned and developed the exhibit to communicate with the public about current medical and surgical practice.