Evolution of multi-well pad development and influence of well pads on environmental violations and wastewater volumes in the Marcellus shale (USA).

A majority of well pads for unconventional gas wells that are drilled into the Marcellus shale (northeastern USA) consist of multiple wells (in some cases as many as 12 wells per pad), yet the influence of the evolution of well pad development on the extent of environmental violations and wastewater production is unknown. Although the development of multi-well pads (MWP) at the expense of single well pads (SWP) has been mostly driven by economic factors, the concentrated nature of drilling activities from hydraulic fracturing and horizontal drilling operations on MWP suggests that MWP may create less surface disturbance, produce more volumes of wastewater, and generate more environmental violations than SWP. To explore these hypotheses, we use geospatial techniques and statistical analyses (i.e., regression and Mann-Whitney tests) to assess development of unconventional shale gas wells, and quantify environmental violations and wastewater volumes on SWP and MWP in Pennsylvania. The analyses include assessments of the influence of different types of well pads on potential, minor and major environmental events. Results reveal that (a) in recent years, a majority of pads on which new wells for unconventional gas were drilled are MWP, (b) on average, MWP have about five wells located on each pad and thus, had the transition to MWP not occurred, between two and four times as much land surface disturbance would have occurred per year if drilling was relegated to SWP, (c) there were more environmental violations on MWP than SWP, but when the number of wells were taken into account, fewer environmental violations per well were observed on MWP than on SWP, (d) there were more wastewater and recycled wastewater volumes per pad and per well produced on MWP than on SWP, and (e) the proportion of wastewater that was recycled was higher on MWP than SWP. This study sheds light on how the evolution from SWP to MWP has influenced environmental violations and wastewater production in a field that has undergone rapid development in recent years.

Multidisciplinary Management of Menopause: Symposium Proceedings.

This proceeding summarizes a symposium on multidisciplinary management of menopause held on July 30, 2021 as part of the Health of Women 2021 conference. The workshop featured presentations by national experts who provided insights into multidisciplinary approaches to the management of menopause, vasomotor symptoms and genitourinary syndrome of menopause, bone health (including osteoporosis, muscular strength, and mobility), as well as sexual and psychological health during menopause. In this study, we highlight the major points of each presentation and the resultant discussion.

Preschool Vision Screening Collaborative: Successful Uptake of Guidelines in Primary Care.

Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment. METHODS: Thirty-nine Ohio primary care providers interested in preschool vision screening self-selected to participate in an Institute for Healthcare Improvement Breakthrough Series learning collaborative that spanned 18 months. Charts of patients attending 3-, 4-, and 5-year well-child visits were randomly selected and reviewed for documentation of vision screening attempts, referrals, and need for rescreening. RESULTS: Practitioners improved evidenced-based screening attempts for distance visual acuity and stereopsis of 3-5-year-old patients from 18% at baseline to 87% (P < 0.001) at 6 months; improved screening rates were sustained through completion of the collaborative. Baseline referral rates (26%) of abnormal vision screens improved by 59% (P < 0.001) during the first 6 months and were maintained through month 18. Rates for children with incomplete screens that were scheduled for a repeated screening increased during the first 6 months. However, changes in this metric did not reach statistical significance (P = 0.265), nor did it change during the remainder of the collaborative. CONCLUSIONS: Rapid integration and maintenance of preschool vision screening guidelines are feasible across primary care settings utilizing a structured learning collaborative. Challenges with the rescreening processes for children with incomplete vision screens remain, with the 3-year age group having the greatest room for improvement.

Advancing Women's Health and Women's Leadership With Endowed Chairs in Women's Health.

Gender-based bias and conflation of gender and status are root causes of disparities in women's health care and the slow advancement of women to leadership in academic medicine. More than a quarter of women physicians train in internal medicine and its subspecialties, and women physicians almost exclusively constitute the women's health focus within internal medicine. Thus, internal medicine has considerable opportunity to develop women leaders in academic medicine and promote women's health equity.To probe whether holding an endowed chair-which confers status-in women's health may be an effective way to advance women leaders in academic medicine and women's health, the authors explored the current status of endowed chairs in women's health in internal medicine. They found that the number of these endowed chairs in North America increased from 7 in 2013 to 19 in 2015, and all were held by women. The perceptions of incumbents and other women's health leaders supported the premise that an endowed chair in women's health would increase women's leadership, the institutional stature of women's health, and activities in women's health research, education, and clinical care.Going forward, it will be important to explore why not all recipients perceived that the endowed chair enhanced their own academic leadership, whether providing women's health leaders with fundraising expertise fosters future success in increasing the number of women's health endowed chairs, and how the conflation of gender and status play out (e.g., salary differences between endowed chairs) as the number of endowed chairs in women's health increases.

Sex and Gender Medical Education Summit: a roadmap for curricular innovation.

The Sex and Gender Medical Education Summit: a roadmap for curricular innovation was a collaborative initiative of the American Medical Women's Association, Laura W. Bush Institute for Women's Health, Mayo Clinic, and Society for Women's Health Research (www.sgbmeducationsummit.com). It was held on October 18-19, 2015 to provide a unique venue for collaboration among nationally and internationally renowned experts in developing a roadmap for the incorporation of sex and gender based concepts into medical education curricula. The Summit engaged 148 in-person attendees for the 1 1/2-day program. Pre- and post-Summit surveys assessed the impact of the Summit, and workshop discussions provided a framework for informal consensus building. Sixty-one percent of attendees indicated that the Summit had increased their awareness of the importance of sex and gender specific medicine. Other comments indicate that the Summit had a significant impact for motivating a call to action among attendees and provided resources to initiate change in curricula within their home institutions. These educational efforts will help to ensure a sex and gender basis for delivery of health care in the future.

The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination.

The purpose of this study is to determine whether the inclusion of known positive patients to the practical portion of a Focused Assessment Sonogram in Trauma (FAST) training course improves overall training and increases FAST accuracy. This is a prospective double-blind design. Original course participants (PRE) underwent a 2-hour didactic session and practicum with ten normal volunteers. Modified course participants (POST) additionally imaged five peritoneal dialysis (PD) patients to simulate positive examinations. The practitioners (six PRE and five POST) were compared as to their ability to detect and quantify intraperitoneal fluid (0-2000 cc) in nine PD patients during a double-blind prospective examination. Test results were reported as positive or negative. Positive results were further quantified by volume. Each practitioner performed ten examinations. Data for inexperienced clinicians are presented. Sensitivity for detecting < or = 750 cm3 was 45 per cent PRE and 87 per cent POST (P = 0.02). Accuracy in quantifying volume within 250 cm3 was 38 per cent PRE and 44 per cent POST (not significant). FAST accuracy for inexperienced sonographers--particularly in diagnosing smaller volumes--can be improved significantly by including positive studies in training. Exposure to positive FAST examinations during training improves the learning curve. With the growing dependency on FAST to accurately triage blunt abdominal trauma safe and effective FAST training should consist of didactic education and a practical portion that includes positive studies. When screened properly PD patients can be used effectively to demonstrate positive FAST studies.

Rheumatic disease among Oklahoma tribal populations: a cross-sectional study.

OBJECTIVE: Rheumatic diseases cause significant morbidity within American Indian populations. Clinical disease presentations, as well as historically associated autoantibodies, are not always useful in making a rapid diagnosis or assessing prognosis. The purpose of our study was to identify autoantibody associations among Oklahoma tribal populations with rheumatic disease. METHODS: Oklahoma tribal members (110 patients with rheumatic disease and 110 controls) were enrolled at tribal-based clinics. Patients with rheumatic disease (suspected or confirmed diagnosis) were assessed by a rheumatologist for clinical features, disease criteria, and activity measures. Blood samples were collected and tested for common rheumatic disease autoantibodies [antinuclear antibody (ANA), anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), anti-Ro, anti-La, anti-Sm, anti-nRNP, anti-ribosomal P, anti-dsDNA, and anticardiolipins]. RESULTS: In patients with suspected systemic rheumatic diseases, 72% satisfied American College of Rheumatology classification criteria: 40 (36%) had rheumatoid arthritis (RA), 16 (15%) systemic lupus erythematosus, 8 (7%) scleroderma, 8 (7%) osteoarthritis, 4 (4%) fibromyalgia, 2 (2%) seronegative spondyloarthropathy, 1 Sjögren's syndrome, and 1 sarcoidosis. Compared to controls, RA patient sera were more likely to contain anti-CCP (55% vs 2%; p < 0.001) or RF IgM antibodies (57% vs 10%; p < 0.001); however, the difference was greater for anti-CCP. Anti-CCP positivity conferred higher disease activity scores (DAS28 5.6 vs 4.45; p = 0.021) while RF positivity did not (DAS28 5.36 vs 4.64; p = 0.15). Anticardiolipin antibodies (25% of rheumatic disease patients vs 10% of controls; p = 0.0022) and ANA (63% vs 21%; p < 0.0001) were more common in rheumatic disease patients. CONCLUSION: Anti-CCP may serve as a more specific RA biomarker in American Indian patients, while the clinical significance of increased frequency of anticardiolipin antibodies needs further evaluation.