Central Pennsylvania Research Articles

Abstract 4135127: Traveling more than a 20-mile radius to a Heart Failure Center can affect the quality of Heart Failure Care.

Introduction: We recognized the profound importance of access to care among patients with heart failure (HF). The geographical location of HF centers may significantly impact health outcomes, especially for those with limited transportation. This social determinant of health (SDOH) aspect is critical in bridging the gap in achieving HF care. Hypothesis/Methods: This was a single-center observational study conducted at a tertiary heart failure center in central Pennsylvania. We assessed the impact of travel distance by comparing patients who travel within a 20-mile radius to those who travel beyond a 20-mile radius. A total of 322 patients were referred to the HF clinic and enrolled in a guideline-directed medical therapy (GDMT) optimization program. Data collected included distance to Hershey Medical Center (HMC), health insurance coverage, HF etiology, onset, and echocardiogram. The distance was calculated based on the patient’s zip code. Results: Among patients enrolled in the HF-GDMT program, 194 travel within 20 miles, and 128 travel beyond a 20-mile radius to HMC. The mean travel distance to HMC was 9.1 miles (within) and 40.9 miles beyond 20 miles. The majority of patients were 81.3% white, 67% male, and the average age was 64. Most patients had heart failure with reduced ejection fraction (HFrEF) at 92.9%, 63% nonischemic, and 57.5% new onset. The comorbidities in both groups were similar, including hypertension, hyperlipidemia, and coronary artery disease (CAD). When comparing both groups, those who traveled beyond the 20-mile radius to HMC had more chronic HF at 55.5% vs. 34% in patients who traveled within the 20-mile radius. Upon enrollment, most patients were on suboptimal doses of either 1 or 2 of the four pillars of GDMT for HFrEF. Conclusions: The findings of this study revealed that patients with HF who travel beyond a 20-mile radius to HMC are more likely to have chronic HF, suggesting a delay in seeking care. A delay in referral may affect the timely initiation of appropriate GDMT and will likely lead to worse health outcomes. This underscores the urgent need for interventions to address barriers like transportation to improve HF care, offering a potential avenue for better patient outcomes.

Community responses and adaptations following the closure of a rural pharmacy and primary care facility.

This study investigates the experiences of one rural community in Central Pennsylvania following the closure of its singular pharmacy and primary health care facility. It aims to understand community members' responses and adaptations to declining health care accessibility and broader implications for rural health policy and practice. Employing a qualitative case study design, researchers conducted 26 in-depth interviews from May to December 2022. Interviews were grounded in a phenomenological approach and focused on participants' perceptions of their community and experiences accessing health care. Data were analyzed thematically following a coding reliability approach. The closure of the health care facilities resulted in significant social and economic impacts, particularly among vulnerable groups, such as older adults, people with disabilities, and working-class families. Participants reported increased reliance on their social support networks to access care, delays in seeking care due to the strain from longer travel distances, and loss of familiar and trusted care providers. We also found an over-reliance on local emergency medical services for routine care. Although the community demonstrated resilience through the use of social networks, some adaptations carried health risks, including delayed care and unmonitored use of alternative remedies. This study highligths theneed for health care policies that address the immediate loss of services and support the social networks and economic stability that rural communities rely on in the absence of local health care facilities. This research contributes insights for policymakers, health care providers, and community leaders working to support rural communities facing similar health care losses.

Neurally Adjusted Ventilatory Assist to Monitor Diaphragmatic Activity in Infantile Botulism.

Infantile botulism is a potentially life-threatening neuromuscular disorder. It presents with descending paralysis that can involve the diaphragm and cause respiratory failure. Neurally adjusted ventilatory assist (NAVA) provides synchronized bilevel positive pressure by using electrical diaphragmatic (Edi) signals. Diaphragmatic paresis is thought to be a contraindication for using NAVA. However, the use of a NAVA catheter allows continuous assessment of diaphragm activity in infantile botulism. We discuss a case of infantile botulism in an infant from central Pennsylvania who presented with poor oral feeding, hypothermia, and lethargy and progressed to develop apnea and acute respiratory failure. The infant was intubated and mechanically ventilated. A diagnosis of infantile botulism was confirmed through the detection of botulinum toxin in the infant's stool, and the infant was treated with botulism immune globulin neutralizing antibodies. During his recovery phase, a NAVA catheter was placed, which allowed monitoring of Edi signals to gauge the return of diaphragm activity and to assist with the assessment of extubation readiness. We describe the trends in this infant's Edi signals following administration of globulin neutralizing antibodies and the successful transition to invasive, and subsequently, noninvasive NAVA. Our report demonstrates the clinical utility of monitoring diaphragmatic activity using a NAVA catheter and that NAVA provided adequate respiratory support to an infant during the recovery phase of infantile botulism.

What does it take for rural-urban commuters to switch from driving to carpooling?

This study aims at identifying the potential ways to increase the willingness to carpool, particularly in rural–urban travel settings, where there is no/minimal public transit service (due to low population density) and purchasing a personal vehicle poses a significant financial burden for many households. To do so, we used time flexibility, defined as the tolerance for increased commute time (which can happen because of re-routing and picking up others when carpooling), as a proxy to willingness to carpool. Using structural equation modeling and survey responses from about 1000 workers and college students living in a rural county in Central Pennsylvania, we analyzed the sociodemographic, attitudinal, and situational factors that can lead to higher time flexibility when carpooling. We also investigated whether people’s time flexibility changes when they are offered monetary incentives (in terms of travel costs reimbursement). The results indicated that being a driving fan and seeking privacy when traveling reduces time flexibility, while being conscientious about environment and health leads to higher time flexibility. Moreover, females, people who had inconvenient past carpool experiences, and those living closer (within 20 min of driving) to their workplace/college showed lower time flexibility. On the other hand, people with lower income and higher driving costs were willing to tolerate longer commute times if reimbursed for a portion of their travel costs. We also found that if there is no initial level of willingness to carpool, reimbursement offers cannot do much to sway people’s decisions.

Complex interactions of deer herbivory, soil chemistry, and competing vegetation explain oak–hickory forest tree regeneration in central Pennsylvania, USA

The root causes of forest tree regeneration failure are difficult to resolve, although numerous studies show ungulate herbivory, soil conditions, and competition from undesirable vegetation as likely contributors. To better understand the relative importance of each issue, we conducted a 7-year manipulative experiment to assess the interactive effects of white-tailed deer ( Odocoileus virginianus) herbivory, soil acidity, and competing vegetation on tree regeneration in oak–hickory forests of central Pennsylvania, USA. Outcomes depended on initial tree seedling abundance, and all three factors had significant interactions. At low initial seedling abundance, fencing resulted in the greatest increase, but all treatments had a positive effect on seedling growth and abundance. At higher initial seedling abundance, abundance failed to recover 7 years after herbicide treatment and soil pH was an important predictor. When soil pH was >4.6 from lime application, seedling growth and abundance in unfenced controls with high initial abundance was comparable to the fenced-only treatment. Competing vegetation, assumed to be a symptom of excessive, long-term deer herbivory, does not seem to be the primary factor limiting tree regeneration in our study area. Ameliorating acid deposition warrants greater consideration as a management action because it could provide long-lasting benefits compared to short-term fence installations.

PPL Foundation awards $1 million in community support for central Pennsylvania

PPL Foundation awards $1 million in community support for central Pennsylvania

8765 Assessment of the Social Vulnerability Index of a 10-Year Retrospective Cohort of Youth with Prediabetes

Abstract Disclosure: D. Somerville: None. R.H. Kolagani, MHS: None. C.E. McCrory: None. S. Budakoti: None. V.M. Chinchilli, PhD: None. J. Joseph: None. D.E. Hale: None. N. Raja-Khan: None. L.P. Huerta Saenz: None. Background: The incidence of prediabetes (preD) is rising among youth in the US. While there are known metabolic risk factors linked to preD development, we were interested in exploring the role of social determinants of health (SDoH) in the development of pediatric preD. The social vulnerability index (SVI) is a tool developed by the CDC to stratify SDoH risk for communities based on 14 factors such socioeconomic status (SES), household composition, race and transportation access. By understanding the role of SVI in the development of preD in youth, we may be able to plan interventions to prevent progression to Type 2 Diabetes (T2D). Objective: Our study goal was to determine the relationship between SVI and preD in youth receiving care at our institution, a large pediatric referral center in Central Pennsylvania. Methods: We conducted a 10-year retrospective chart review of electronic medical records (EMRs) to identify children/youth aged 6-17 years old diagnosed with preD at our pediatric health system between 01/2010 and 01/2020. We used the American Diabetes Association definitions of preD (one or more sub-type): 1) Impaired fasting glucose (IFG), 2) Impaired glucose tolerance (IGT), and 3) Elevated hemoglobin A1c (HA1C). ICD10 codes were used for initial chart identification (R73.01, R73.02, R73.03 and R73.09). The second phase of identification of youth with preD included the review of biological measures of glycemia of the initial identified charts to support the reported ICD10 diagnosis (either isolated subtypes or combinations). Social, demographic characteristics, and residence setting (urban vs. rural) were also investigated. SVI was assessed on a 0-1 scale, with high SVI (0.5-1) indicating greater social vulnerability and low SVI (0-0.49) indicating lower social vulnerability. Rurality was determined per the Health Resources and Services Administration Tool (HRSA). SAS frequencies were calculated. Fisher’s exact tests were applied to compare the frequencies of the aforementioned groups with respect to IFG, IGT, and HA1C. Results: We identified 2700 charts of youth with preD per ICD10 codes search, but only 552 had confirmed preD diagnosis supported by biological data registered in EMRs. The most common preD isolated subtype was HA1C (87.3%), while 12% and 4% had isolated IFG and IGT, respectively. Most youth had high SVI (66.9%) and only 5.8% were rural (p > 0.05). Neither SVI or rurality were associated with isolated preD subtypes, but 8.2% of low-SVI youth had composite [IFG +HA1C] subtypes compared to 3.5% of high-SVI youth (p=0.02). Conclusions: SVI was not significantly associated with any isolated preD subtype. However, youth with the combined preD subtypes [IFG + HA1C] had lower SVI. As T2D is more prevalent in youth from low SES, addressing SDoH at earlier stages of T2D (preD phase) is needed in the effort to prevent the progression of the disease. Presentation: 6/1/2024

Community profiles in northeastern and central Pennsylvania characterized by distinct social, natural, food, and physical activity environments and their relation to type 2 diabetes.

Understanding geographic disparities in type 2 diabetes (T2D) requires approaches that account for communities' multidimensional nature. In an electronic health record nested case-control study, we identified 15,884 cases of new-onset T2D from 2008 to 2016, defined using encounter diagnoses, medication orders, and laboratory test results, and frequency-matched controls without T2D (79,400; 65,069 unique persons). We used finite mixture models to construct community profiles from social, natural, physical activity, and food environment measures. We estimated T2D odds ratios (OR) with 95% confidence intervals (CI) using logistic generalized estimating equation models, adjusted for sociodemographic variables. We examined associations with the profiles alone and combined them with either community type based on administrative boundaries or Census-based urban/rural status. We identified four profiles in 1069 communities in central and northeastern Pennsylvania along a rural-urban gradient: "sparse rural," "developed rural," "inner suburb," and "deprived urban core." Urban areas were densely populated with high physical activity resources and food outlets; however, they also had high socioeconomic deprivation and low greenness. Compared with "developed rural," T2D onset odds were higher in "deprived urban core" (1.24, CI = 1.16-1.33) and "inner suburb" (1.10, CI = 1.04-1.17). These associations with model-based community profiles were weaker than when combined with administrative boundaries or urban/rural status. Our findings suggest that in urban areas, diabetogenic features overwhelm T2D-protective features. The community profiles support the construct validity of administrative-community type and urban/rural status, previously reported, to evaluate geographic disparities in T2D onset in this geography.

Outbreak-associated Salmonella Baildon found in wastewater demonstrates how sewage monitoring can supplement traditional disease surveillance.

Non-typhoidal Salmonella is a common cause of gastroenteritis worldwide, but current non-typhoidal Salmonella surveillance is suboptimal. Here, we evaluated the utility of wastewater monitoring to enhance traditional surveillance for this foodborne pathogen. In June 2022, we tested raw sewage collected twice a week from two treatment plants in central Pennsylvania for non-typhoidal Salmonella and characterized isolates using whole-genome sequencing. We recovered 43 Salmonella isolates from wastewater samples, differentiated by genomic analysis into seven serovars: 16 Panama (37.2%), 9 Senftenberg (20.9%), 8 Baildon (18.6%), and 3 or fewer of four other serovars. We assessed genetic relatedness and epidemiologic links between these wastewater isolates with those from patients with salmonellosis. All S. Baildon isolates from wastewater were genetically similar to those associated with a known contemporaneous salmonellosis outbreak. S. Baildon from wastewater and 42 outbreak-related isolates in the national outbreak detection database had the same core genome multilocus sequence typing, and outbreak code differed by zero or one single polynucleotide polymorphism. One of the 42 outbreak-related isolates was obtained from a patient residing in the wastewater sample collection catchment area, which serves approximately 17000 people. S. Baildon is a rare serovar (reported in <1% cases nationally, over five years). Our study underscores the value of monitoring sewage from a defined population to supplement traditional surveillance methods for the evidence of Salmonella infections and to determine the extent of outbreaks.IMPORTANCEDuring the COVID-19 pandemic, monitoring for SARS-CoV-2 in wastewater was highly effective in identifying the variants of concern earlier than clinical surveillance methods. Here, we show that monitoring domestic sewage can also augment traditional reporting of foodborne illnesses to public health authorities. Our study detected multiple Salmonella enterica serovars in samples from two wastewater treatment plants in central Pennsylvania. Using whole-genome sequencing, we demonstrated that the isolates of variant S. Baildon clustered with those from a foodborne salmonellosis outbreak that occurred in a similar time frame. Cases were primarily from Pennsylvania, and one individual lived within the wastewater treatment catchment area. This study highlights the effectiveness of domestic sewage testing as a proactive public health strategy to track and respond to infectious disease outbreaks.

222 Validation of Brix for predicting sugar concentration of alfalfa and orchardgrass

Abstract The objective of this study was to evaluate the accuracy of Brix in predicting sugar concentrations in fresh alfalfa (Medicago sativa L.; ALF) and orchardgrass (Dactylis glomerata L.; OG) forages to be used as an inexpensive and rapid field-level assessment of relative energy in forages. In a 2-yr study, fresh forages samples from ALF and OG monoculture pastures in central Pennsylvania, U.S. were collected once monthly from May to September. Samples were immediately evaluated for Brix values with a hand-held digital refractometer, and the remaining biomass was frozen immediately with liquid N to halt cellular respiration. Samples were lyophilized and analyzed for individual sugars and wet chemistry nutritive analyses. Brix values were correlated with wet chemistry analyses using the PROC CORR procedure in SAS, with significance established at P &amp;lt; 0.05. Brix was positively correlated (P &amp;lt; 0.05) with total and individual sugars in ALF during late spring and late summer (0.49 to 0.93), but correlations were non-existent (P &amp;gt; 0.05) or negative (-0.55 to -0.73; P &amp;lt; 0.05) in mid-summer. Brix values had moderate to strong negative correlations (P &amp;lt; 0.05) to NDF and ADF in ALF (-0.57 to -0.71). Conversely, Brix values did not correlate (P &amp;gt; 0.05) to any notable sugar parameters in OG beyond the first sampling date (0.60 to 0.74; P &amp;lt; 0.05). Brix was not correlated (P &amp;gt; 0.05) to NDF and ADF in OG. In summary, Brix values did not consistently predict sugar concentrations in fresh ALF and OG forages. Because Brix measures dissolved solids in solution (not just sugars), Brix readings collected from crushed ALF or OG samples may be confounded by fibrous fractions found in the solution as well as decreased sugar concentrations compared with fruit crops. Brix accuracy may also be dependent on seasonal temperature patterns, plant growth stage, and daily weather patterns. Other solutions should be investigated that rapidly assess sugar profiles and nutritive values of fresh forages.

Priority screening of contaminants of emerging concern (CECs) in surface water: Comparing cell-based bioassays and exposure-activity ratios (EARs)

In this study, we compared a wide range of cell-based bioassays to the use of chemical analysis followed by exposure-activity ratio (EAR) and Toxicological Prioritization index (ToxPi) for prioritizing chemicals, sites, and hazard concerns in water samples. Surface water samples were collected from nine sites in three Central Pennsylvania streams and analyzed for a forty-six contaminants of emerging concern (CECs), including pesticides, personal care products, and pharmaceuticals. Cell-based reporter assays evaluated human and zebrafish molecular initiating events (MIEs) in endocrine and metabolic disruption, altered lipid metabolism, and oxidative stress. Bioassays showed that 12 out of 40 assays had at least one site with activity over the effect-based trigger (EBT) values. The receptors that exhibited the highest number of samples above the EBT that would be expected to cause toxicity were Aryl hydrocarbon receptor (AhR, human and zebrafish), Pregnane X Receptor (PXR), Estrogen Receptor-beta (ERB), and Androgen Receptor (AR). Characterizing the collection sites by their bioactivity aligned closely with the stream in which samples were collected. The sum of all EARs for each chemical indicated that the pharmaceutical Carbamazepine and the pesticides Carbaryl and Atrazine posed the greatest concern. However, predicted activity and site prioritization based on individual chemical analysis and calculated EAR were different than those measured by bioassay, indicating that biologically active chemicals are present in the samples that were not included in the targeted analytes. Taken together, these data show that chemical analysis and EAR analysis are beneficial for prioritization of chemicals, whereas mechanism-based bioassays are more inclusive of known as well as unknown chemical contaminants and thus of more use for overall water quality analysis and site prioritization.

Abstract P337: Impact of a population health approach using smartphone-enabled home albuminuria testing to improve screening in patients with hypertension or diabetes

Background: Screening for albuminuria with urine albumin/creatinine ratio (ACR) testing among at risk patients is critical as guideline-based therapies can be used to decrease the risk of cardiovascular and kidney disease. However, adherence to testing remains very low, especially for hypertension. Here, we report the results from a prospective pilot study involving a smartphone-enabled home albuminuria testing quality improvement. Methods: We randomly selected 4000 adult individuals (50% with hypertension but no diabetes and 50% with diabetes +/- hypertension) receiving primary care at a large healthcare system in Central and Northeastern Pennsylvania who had not undergone ACR testing in the past 12 months to receive Minuteful Kidney, an FDA-cleared, smartphone-enabled home urine albuminuria screening kit using the vendor’s (Healthy.io) standard workflow. The home testing group was matched 1:1 to 4000 controls who received usual care using propensity score matching addressing imbalances in sociodemographics and comorbidities. The primary outcome was completion of ACR test (either laboratory based ACR or Minuteful Kidney) within 100 days of the index date. Results shown are as of May 1, 2024 (86 days after the index date). Results: Overall, completion of any ACR test was higher in the home testing group than matched controls (50.2% vs. 19.1%; p&lt;0.001). The impact on ACR testing was higher for the hypertension subgroup (50.4% vs. 11.2%; p&lt;0.001) than the diabetes subgroup (49.9% vs. 26.9%; p&lt;0.001). Among the home testing group, 1542/4000 (38.7%) completed the smartphone ACR test, with a higher proportion of completions in non-diabetic hypertension (848/2000 [42.4%] than the diabetes subgroup (663/2000 [33.2%]). Adherence rates were similar across age groups and geographic location. Satisfaction was high among individuals in the home testing group (53+ Net Promoter Score; 94% rated the test as easy or very easy to complete; 88% stated preference for at home testing). Home-based albuminuria screening detected mild to moderate albuminuria (30-300 mg/g) in 33.2% and severe albuminuria (&gt;300 mg/g) in 8.1%. Abnormal results were fairly similar for the diabetes subgroup (33.8% 30-300 mg/g, 10.8% &gt;300 mg/g) and the hypertension subgroup (32.6% 30-300 mg/g, 5.9% &gt;300 mg/g). Conclusions: A population health approach using smartphone-enabled home albuminuria testing is effective in increasing albuminuria screening among individuals with hypertension or diabetes.

Aversion to pragmatic randomised controlled trials: three survey experiments with clinicians and laypeople in the USA

ObjectivesPragmatic randomised controlled trials (pRCTs) are essential for determining the real-world safety and effectiveness of healthcare interventions. However, both laypeople and clinicians often demonstrate experiment aversion: preferring to implement either...

Individual differences in developmental trajectories of affective attention and relations with competence and social reticence with peers.

This study examined individual differences in affective attention trajectories in infancy and relations with competence and social reticence at 24 months. Data collection spanned 2017 to 2021. Infants (N = 297, 53% White, 49% reported as assigned male at birth) recruited in South Central and Central Pennsylvania and Northern New Jersey provided eye-tracking data at five assessments. Caregivers self-reported anxiety symptoms, infant temperamental negative affect, and infant competence at the final assessment. A subgroup of infants participated in a peer social dyad at the final assessment. Using group-based trajectory modeling, we found three groups of infants with different affective attention trajectories: affective attention increasers (n = 73), affective attention shifters (n = 156), and affective attention decreasers (n = 50). Affective attention increasers exhibited low intercepts with steep attention increases, particularly to angry facial configurations. Affective attention shifters exhibited middle intercepts with attention decreases to facial configurations but an attention increase to angry facial configurations. Affective attention decreasers exhibited high intercepts with steep attention decreases. Infants in the affective attention increasers group exhibited more competence when accounting for caregiver anxiety symptoms and infant temperamental negative affect. Group membership was not related to social reticence during the peer social dyad. Infants higher in temperamental negative affect exhibited more social reticence, particularly as the social dyad continued. Our results provide evidence for individual differences in developmental trajectories of affective attention and relations with toddler social behavior. Our results are primarily generalizable to rural and urban populations in the Midatlantic United States. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Radar-Based 10-Year Climatology of Convective Snow Events in Central Pennsylvania

Abstract Convective snow (CS) presents a significant hazard to motorists and is one of the leading causes of weather-related fatalities on Pennsylvania roadways. Thus, understanding environmental factors promoting CS formation and organization is critical for providing relevant and accurate information to those impacted. Prior research has been limited, mainly focusing on frontal CS bands often called “snow squalls”; thus, these studies do not account for the diversity of CS organizational modes that is frequently observed, highlighting a need for a robust climatology of broader CS events. To identify such events, a novel, radar-based CS detection algorithm was developed and applied to WSR-88D radar data from 10 cold seasons in central Pennsylvania, during which 159 cases were identified. Distinct convective organization modes were identified: linear (frontal) snow squalls, single cells, multicells, and streamer bands. Each algorithm-flagged radar scan containing CS was manually classified as one of these modes. Interestingly, the most-studied frontal mode only occurred &lt;5% of the time, whereas multicellular modes dominated CS occurrence. Using the times associated with each CS mode, synoptic and local environmental information from model analyses was investigated. Key characteristics of CS environments compared to null cases include a 500-hPa trough in the vicinity, lower-tropospheric conditional instability, and sufficient moisture. Environments favorable for the different CS modes featured statistically significant differences in the 500-hPa trough axis position, surface-based CAPE, and the unstable layer depth, among others. These results provide insights into forecasting CS mode, explicitly presented in a forecasting decision tree. Significance Statement Convective snow events such as snow squalls are a leading cause of weather-related deaths on Pennsylvania roads. Research into these events is limited, thus negatively impacting forecast skill. To better understand convective snow event frequency of occurrence, inter- and intra-annual variability, and their supporting environments, we performed a 10-yr radar-based climatology of these events. We report the results of this climatology and on the statistically significant differences in their supporting environments. The latter are used to propose a forecasting framework for convective snow, which may improve the predictability of convective snow in an operational setting.

Food availability aligns with contrasting demographics in populations of an at-risk songbird.

Golden-winged Warblers (Vermivora chrysoptera) have become rare across much of their historic breeding range and response to conservation efforts is variable. Evidence from several recent studies suggests that breeding output is a primary driver explaining responses to conservation and it is hypothesized that differences in food availability may be driving breeding output disparity between two subpopulations of the warbler's Appalachian breeding range. Herein, we studied two subpopulations: central Pennsylvania ("central subpopulation"), where breeding productivity is relatively low, and eastern Pennsylvania ("eastern subpopulation"), where breeding productivity is relatively high. To test the food-availability hypothesis in this system, we measured density of caterpillars, plasma lipid metabolites (triglycerides [TRIG; fat deposition] and glycerol [GLYC; fat breakdown]), body mass of adults males, and acquired body mass data for fledglings at 38 sites managed for nesting habitat. Consistent with our prediction, leaf-roller caterpillar density, the group upon which Golden-winged Warblers specialize, was 45× lower in the central subpopulation than the eastern subpopulation. TRIG concentrations were highest within the eastern subpopulation during breeding grounds arrival. The change in TRIG concentrations from the breeding-grounds-arrival stage to the nestling-rearing stage was subpopulation dependent: TRIG decreased in the eastern subpopulation and was constant in the central subpopulation, resulting in similar concentrations during the nestling-rearing stage. Furthermore, GLYC concentrations were higher in the eastern subpopulation, which suggests greater energy demands in this region. Despite this, adult male warblers in the eastern subpopulation maintained a higher average body mass. Finally, fledgling body mass was 16% greater in the eastern subpopulation than the central subpopulation before and after fledging. Collectively, our results suggest that poor breeding success of Golden-winged Warblers in the central subpopulation could be driven by lower availability of primary prey during the breeding season (leaf-roller caterpillars), and this, in turn, limits their response to conservation efforts.

Air pollution and incident sarcoidosis in central Pennsylvania

ABSTRACT Sarcoidosis is a chronic granulomatous disease predominantly affecting the lungs and inducing significant morbidity and elevated mortality rate. The etiology of the disease is unknown but may involve exposure to an antigenic agent and subsequent inflammatory response resulting in granuloma formation. Various environmental and occupational risk factors have been suggested by previous observations, such as moldy environments, insecticides, and bird breeding. Our study investigated the association of air pollution with diagnosis of sarcoidosis using a case-control design. Penn State Health electronic medical records from 2005 to 2018 were examined for adult patients with (cases) and without (controls) an International Classification of Disease (ICD)-9 or −10 code for sarcoidosis. Patient addresses were geocoded and 24-hr residential-level air pollution concentrations were estimated using spatio-temporal models of particulate matter <2.5 μm (PM2.5), ozone, and PM2.5 elemental carbon (EC) and moving averages calculated. In total, 877 cases and 34,510 controls were identified. Logistic regression analysis did not identify significant associations between sarcoidosis incidence and air pollution exposure estimates. However, the odds ratio (OR) for EC for exposures occurring 7–10 years prior did approach statistical significance, and ORs exhibited an increasing trend for longer averaging periods. Data suggested a latency period of more than 6 years for PM2.5 and EC for reasons that are unclear. Overall, results for PM2.5 and EC suggest that long-term exposure to traffic-related air pollution may contribute to the development of sarcoidosis and emphasize the need for additional research and, if the present findings are substantiated, for public health interventions addressing air quality as well as increasing disease surveillance in areas with a large burden of PM2.5 and EC.

Quantifying the Enhanced Performance of Multifamily Residential Passive House over Conventional Buildings in Terms of Energy Use

In response to escalating energy demands and global warming concerns, the Passive House Standard has emerged as a solution in residential construction, aiming to drastically reduce energy consumption and operational costs primarily through high-performance building envelopes. While a considerable volume of the literature has focused on the Passivhaus Institute (PHI) standards, predominantly in European contexts, there is a gap in research on the Passive House Institute US (Phius) standards, particularly in North American climates. This study conducts a quantitative comparative analysis of two adjacent multifamily residential buildings in Central Pennsylvania, Climate Zone 5A—one built using conventional construction methods and the other following Passive House (PHIUS+ 2015) certification standards—to validate the energy efficiency improvements attributed to Passive House designs. A comparative analysis of the whole building energy use over two years reveals that the Passive House building consumes approximately 50% less energy than its conventional counterpart in terms of whole building energy use and the national median recommended benchmark metric defined by the Energy Star Portfolio Manager. These findings emphasize the potential for significant energy savings and greenhouse gas reductions in residential buildings, highlighting the necessity for policymakers and governments to incentivize the adoption of Passive House standards to achieve environmental sustainability and reduce energy costs for society.

Quantifying soil moisture and evapotranspiration heterogeneity within a solar farm: Implications for stormwater management

As solar energy becomes a cheap source of renewable energy, the number of major utility-scale ground solar panel installations, often called ‘solar farms,’ are growing. With these solar farms often covering hundreds of acres, there is potential for impacts on natural hydrologic processes, including runoff generation and erosion. There is still limited research in this area, and best management practices to address these impacts are variable and not well understood. To fill this gap, we conducted a field investigation of soil moisture patterns, solar radiation, and vegetation at two solar farms in central Pennsylvania, USA that are representative of the complex terrain in the region (e.g., high or variable slopes). Both solar farms also included engineered infiltration basins or trenches that were investigated. Analysis of soil moisture patterns reveals redistribution of water relative to panels, with dripline soil moisture 19 % higher than the reference, and underpanel moisture 25 % lower than the reference, on average at both solar farms over a year. There are also the greatest periods of saturation and runoff generation at the panel driplines. However, an open interspace between panel rows and existing infiltration basins and trenches are playing a critical role in managing runoff. Micrometeorological monitoring indicates reduced evapotranspiration (ET) under panels, with potential underpanel ET 37–67 % lower in summer, and minimal difference in winter. However, a survey of vegetation revealed almost complete ground coverage under panels, which is critical for supporting infiltration and reducing erosion. As solar farms expand to meet important renewable energy goals, it is essential that care be taken to design the landscape to minimize runoff generation and erosion. This work demonstrates that healthy vegetation and well-draining soils can help manage runoff on solar farms; where necessary on more challenging landscapes, engineered stormwater controls can manage any unmitigated runoff.

Geospatial analysis of the distribution of uveal melanoma patients at a referral center in the United States.

e21566 Background: Approximately 2500 new uveal melanoma (UM) cases (5.2 cases per million population) are diagnosed yearly in the United States. We previously identified three unique geospatial accumulations of UM in North Carolina, Alabama, and New York based on our clinical experience. Such unexpected findings prompted us to conduct a more systematic evaluation of geospatial accumulations of UM patients at our institution. Methods: Through the electronic medical record system, we identified patients seen at our institution with a diagnosis of UM. Identified living patients and family of deceased patients were either sent an e-mail or paper letter with an internet link to a survey. The survey asked for the patient’s name, date of birth, sex, date of primary UM diagnosis, address at time of UM diagnosis and number of years at that address, and all previous addresses and dates of residence prior to the UM diagnosis. Using these addresses, ArcGIS and R software was used to analyze the geospatial distribution of our UM patients. The data was supplemented with 2020 American Community Survey census estimates at the state, county, and census tract level to estimate population-based rates of UM. Results: We identified 2718 UM patients in our clinical database, and a total of 726 participants completed the survey with a total of 2939 US addresses. The majority of addresses were precise to the street address level (77.9%). At the time of UM diagnosis, patients had lived at their current address for a median of 16 years. Pennsylvania and the neighboring states expectedly made up the majority (63.6%) of our patients, but about 1/3 of our patients resided in other states at the time of their UM diagnosis (total of 42 different states). Several counties presented elevated rates of UM with ≥5 case per 100,000 persons. We observed a group of counties in central Pennsylvania, at the border of Pennsylvania and New York, and in upper New York by the Finger Lakes with notably elevated rates of UM, which was consistent with our clinical observations at our institution. Several neighboring counties in Kentucky and Virginia also presented elevated rates. Conclusions: Through this pilot project, we have demonstrated that it is possible to collect lifetime residency information from UM patients in order to map their geospatial distribution in the US. Furthermore, although institutional bias toward referring physicians should be considered, our geospatial analysis identified accumulations of UM in areas similar to our clinical concerns. The results of our study warrant further investigations into environmental influences on UM development. Our future goal is to extend our approach through national and international collaborations to increase the number of participants in the analysis and to minimize institutional bias.