Central Pennsylvania Research Articles

Assessing bidirectional relations between infant temperamental negative affect, maternal anxiety symptoms and infant affect-biased attention across the first 24-months of life.

Developmental theories suggest affect-biased attention, preferential attention to emotionally salient stimuli, emerges during infancy through coordinating individual differences. Here we examined bidirectional relations between infant affect-biased attention, temperamental negative affect, and maternal anxiety symptoms using a Random Intercepts Cross-Lagged Panel model (RI-CLPM). Infant-mother pairs from Central Pennsylvania and Northern New Jersey (N = 342; 52% White; 50% reported as assigned female at birth) participated when infants were 4, 8, 12, 18 and 24 months of age. Infants completed the overlap task while eye-tracking data were collected. Mothers reported their infant's negative affect and their own anxiety symptoms. In an RI-CLPM, after accounting for between-person variance (random intercepts representing the latent average of a construct), it is possible to assess within-person variance (individual deviations from the latent average of a construct). Positive relations represent stability in constructs (smaller within-person deviations). Negative relations represent fluctuation in constructs (larger within-person deviations). At the between-person level (random intercepts), mothers with greater anxiety symptoms had infants with greater affect-biased attention. However, at the within-person level (deviations), greater fluctuation in maternal anxiety symptoms at 12- and 18 months prospectively related to greater stability in attention to angry facial configurations. Additionally, greater fluctuation in maternal anxiety symptoms at 18 months prospectively related to greater stability in attention to happy facial configurations. Finally, greater fluctuation in maternal anxiety symptoms at 4- and 12 months prospectively related to greater stability in infant negative affect. These results suggest that environmental uncertainty, linked to fluctuating maternal anxiety, may shape early socioemotional development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hydrogeologic and geomorphic processes in a karst landscape and seasonably-cold climate: Linking spatial distribution and morphometric dynamics of closed depressions to bedrock fractures in a wastewater spray irrigated agricultural and forest system located at the site of the Living Filter in Central Pennsylvania, United States

The Living Filter at Pennsylvania State University in Central Pennsylvania receives on average 1.5 million gallons per day (MGD) of secondary treated wastewater effluent year-round since 1962. The objective of this study was to identify and relate any bedrock fracture traces and surface depressions to any surficial or geomorphologic processes currently underway as a result of irrigation. The Living Filter is underlain by a massive dolomite with fractures trending near N-S that were previously documented using photogrammetry. A manual process was developed in order to determine the trend and location of several fracture traces within the Astronomy site section of the Living Filter. A semi-automated isolation scheme was next used to identify and correlate closed depressions to the location of fracture traces in the Living Filter. A predominant but slight NE-SW trend was observed among fractures at N5E in the area north of the Pennsylvania Furnace Anticline. A high occurrence of depressions was noted in the area of fractures compared to non-fractured bedrock. The depressions in this area were found to have a net gain of 8000 ft2, the result of which was from the net loss of 5000 ft2 within the agricultural portion of the site and a net gain of 13,000 ft2 within the forested portion of the site. Cross sections of several depressions within cropped areas indicated a lower angle slope corresponding to a V-shape while depressions within forested areas were characterized by a traditional U-shape and previously established steeper slope. These findings will enhance the current understanding of the different morphologic characteristics of both forested and agricultural depressions in karst topography. The workflows implemented here can be implemented in similar sites that display topographical variances from the bedrock fractures.

Living by the Symbolic River: Landscape Effects of Post-Industrial Water Narratives of the Susquehanna River

This paper examines ways in which human values toward surface water, especially large rivers, are relevant to land-use decisions in the watersheds. The study’s focus is the symbolic riverscape constructed by residents local to the Susquehanna River at the confluence of its branches in central Pennsylvania. The main analytical tool is the cultural landscape, a conceptualization of the ways in which alteration of the physical world is the product of human value systems. The paper traces the symbolic weights apparent in discourses about the Susquehanna River with regard to environmental use and abuse in the watershed, through qualitative analysis of public expressions of meaning and valuation. The conclusions emphasize an evolution of the meaning of the river toward a central role as an integral and intricate part of the human experience on the landscape, rather than its earlier role as one functional part of the economic system. Land-use actions consonant with that new value are now favored. This work is offered to suggest that land system science, which is highly effective in understanding altered natural systems and their consequences, can benefit from a fuller engagement with more-intimate human aspects of landscape such as symbols, meaning, and narrative.

Quantifying detection probability of American woodcock (Scolopax minor) on transects sampled with thermal cameras

AbstractDeveloping effective monitoring techniques for sensitive wildlife populations is essential for improving conservation outcomes. The American woodcock (Scolopax minor; hereafter woodcock) is an upland migratory game bird traditionally surveyed by documenting displaying males in spring. Surveys of displaying males are limiting in a variety of important ways such as brief detection window and male‐centric observations. Thermal technology may overcome limitations of traditional monitoring techniques by increasing detections of non‐singing woodcock, however, the efficacy of thermal imaging for detecting woodcock remains unknown. To quantify woodcock detection probability using thermal imaging, we deployed and searched for heat‐emitting woodcock mounts along transects within early‐successional habitats in central Pennsylvania during 2020. We deployed 110 woodcock mounts and successfully detected 63 (57.2%). Detection rate declined as a function of increasing vegetation density and distance from transect. Although detection probability of woodcock was imperfect, thermal cameras may provide a solution for researchers aiming to assess presence or density of woodcock when coupled with analytical methods that account for imperfect detection.

Multistate model to estimate sex‐specific dispersal rates and distances for a wetland‐breeding amphibian population

AbstractHow animals move across space and time in heterogeneous landscapes has important implications for the conservation of imperiled and dispersal‐limited taxa, such as amphibians. Wetland‐breeding amphibians are thought to exhibit strong site fidelity, but there is growing evidence that many species are more vagile than previously assumed. Few studies have quantified breeding dispersal probabilities or distances while also accounting for observational uncertainty, which means that resultant estimates could be biased or confounded with sampling intensity and other demographic rates (e.g., site‐ and time‐specific detection and survival probabilities). Here, we analyze data from a 6‐year capture–mark–recapture study on adult spotted salamanders (Ambystoma maculatum) conducted at 12 wetlands in central Pennsylvania to estimate population dynamics and population structure at multiple scales. We used a multistate, hidden Markov estimator to quantify sex‐specific site fidelity and breeding dispersal as a function of Euclidean distance between wetlands while accounting for imperfect detection. We estimated short‐timescale movements (i.e., those that occur within a single breeding season) and longer timescale movements (i.e., those that occur among breeding seasons) to determine if dispersal rates and distances differed. We found that interannual site fidelity of males varied among wetlands and was positively associated with population density. Females exhibited higher interannual site fidelity and dispersed further than males between breeding seasons. Within breeding seasons, we found that up to 6% of males dispersed to a new wetland each day. Our study is the first to directly compare amphibian breeding dispersal probabilities and distances at multiple scales and provides a robust framework for improving inference on the spatial and temporal patterns of amphibian movement.

Exome Sequencing of a Clinical Population for Autosomal Dominant Polycystic Kidney Disease

Most studies of autosomal dominant polycystic kidney disease (ADPKD) genetics have used kidney specialty cohorts, focusing on PKD1 and PKD2. These can lead to biased estimates of population prevalence of ADPKD-associated gene variants and their phenotypic expression. To determine the prevalence of ADPKD and contributions of PKD1, PKD2, and other genes related to cystic kidney disease in a large, unselected cohort. This retrospective observational study used an unselected health system-based cohort in central and northeast Pennsylvania with exome sequencing (enrolled from 2004 to 2020) and electronic health record data (up to October 2021). The genotype-first approach included the entire cohort and the phenotype-first approach focused on patients with ADPKD diagnosis codes, confirmed by chart and imaging review. Loss-of-function (LOF) variants in PKD1, PKD2, and other genes associated with cystic kidney disease (ie, ALG8, ALG9, DNAJB11, GANAB, HNF1B, IFT140, SEC61B, PKHD1, PRKCSH, SEC63); likely pathogenic missense variants in PKD1 and PKD2. Genotype-first analysis: ADPKD diagnosis code (Q61.2, Q61.3, 753.13, 753.12); phenotype-first analysis: presence of a rare variant in PKD1, PKD2, or other genes associated with cystic kidney disease. Of 174 172 patients (median age, 60 years; 60.6% female; 93% of European ancestry), 303 patients had ADPKD diagnosis codes, including 235 with sufficient chart review data for confirmation. In addition to PKD1 and PKD2, LOF variants in IFT140, GANAB, and HNF1B were associated with ADPKD diagnosis after correction for multiple comparisons. Among patients with LOF variants in PKD1, 66 of 68 (97%) had ADPKD; 43 of 43 patients (100%) with LOF variants in PKD2 had ADPKD. In contrast, only 24 of 77 patients (31.2%) with a PKD1 missense variant previously classified as "likely pathogenic" had ADPKD, suggesting misclassification or variable penetrance. Among patients with ADPKD diagnosis confirmed by chart review, 180 of 235 (76.6%) had a potential genetic cause, with the majority being rare variants in PKD1 (127 patients) or PKD2 (34 patients); 19 of 235 (8.1%) had variants in other genes associated with cystic kidney disease. Of these 235 patients with confirmed ADPKD, 150 (63.8%) had a family history of ADPKD. The yield for a genetic determinant of ADPKD was higher for those with a family history of ADPKD compared with those without family history (91.3% [137/150] vs 50.6% [43/85]; difference, 40.7% [95% CI, 29.2%-52.3%]; P < .001). Previously unreported PKD1, PKD2, and GANAB variants were identified with pedigree data suggesting pathogenicity, and several PKD1 missense variants previously reported as likely pathogenic appeared to be benign. This study demonstrates substantial genetic and phenotypic variability in ADPKD among patients within a regional health system in the US.

ENROLLING PARTICIPANTS WITH DEMENTIA IN A RURAL SETTING: GEISINGER RECRUITMENT STRATEGIES FOR D-CARE

Abstract Geisinger Health System serves a large, geographically stable population in central and northeast Pennsylvania and was chosen to participate in D-CARE due to its rural population, which is often under-represented. To reach potential participants, we used a multi-pronged recruitment approach including local radio, television, and newspaper advertisement; publication in a health system newsletter targeted to 55+; outreach to senior-care managers and primary care providers to encourage referrals; and leveraged an extensive electronic health record (EHR) database to identify a pool of almost 9,000 potential participants. Initial barriers to enrollment stemmed from geographic challenges and the dyad’s inability and/or unwillingness to travel long distances to lengthy in-clinic appointments. A post-pandemic transition to virtual visits helped ease the travel burden and increase study enrollment. Despite varied recruitment strategies, by far the most effective recruitment method remained direct referrals of patients and caregivers with whom the provider had discussed the D-CARE study.

Factors associated with ductal carcinoma in situ (DCIS) treatment patterns and patient-reported outcomes across a large integrated health network

PurposeTo examine associations between ductal carcinoma in situ (DCIS) patients’ characteristics, treating locations and DCIS treatments received and to pilot assessing quality-of-life (QoL) values among DCIS patients with diverse backgrounds.MethodsWe performed a retrospective tumor registry review of all patients diagnosed and treated with DCIS from 2018 to 2019 in the UPMC-integrated network throughout central and western Pennsylvania. Demographics, clinical information, and administered treatments were compiled from tumor registry records. We categorized contextual factors such as different hospital setting (academic vs. community), socioeconomic status based on the neighborhood deprivation index (NDI) as well as age and race. QoL survey was administered to DCIS patients with diverse backgrounds via QoL questionnaire breast cancer module 23 and qualitative assessment questions.ResultsA total of 912 patients were reviewed. There were no treatment differences noted for age, race, or NDI. Mastectomy rate was higher in academic sites than community sites (29 vs. 20.4%; p = 0.0045), while hormone therapy (HT) utilization rate was higher in community sites (74 vs. 62%; p = 0.0012). QoL survey response rate was 32%. Only HT side effects negatively affected in QoL scores and there was no significant difference in QoL domains and decision-making process between races, age, NDI, treatment groups, and treatment locations.ConclusionOur integrated health network did not show chronically noted disparities arising from social determinates of health for DCIS treatments by implementing clinical pathways and system-wide peer review. Also, we demonstrated feasibility in collecting QoL for DCIS women with diverse backgrounds and different socioeconomic statuses.

Low-dose naltrexone reduced anxiety in persons with multiple sclerosis during the COVID-19 pandemic.

Persons with multiple sclerosis (PwMS) have been considered at high risk for vaccination and/or acquisition of COVID-19 related to their reduced immune systems and daily regimen of immune suppressing therapy. Substantiated and unsubstantiated reports on these unknown circumstances increased anxiety and depression. Low-dose naltrexone (LDN) is a potentially effective off-label therapy shown to be effective at controlling fatigue for several autoimmune disorders including MS. This study utilized a small population of PwMS from central Pennsylvania in order to determine whether LDN therapy altered their perceived anxiety or depression during the early months of COVID-19. Utilizing mailed surveys, self-reported anxiety and depression scores were found to be significantly lower for PwMS who were prescribed LDN either alone or as an adjuvant to a standard disease modifying therapy (DMT) in comparison to those on oral disease-modifying therapies (DMTs). The data suggest that the non-toxic, inexpensive biotherapeutic may be beneficial in lessening anxiety.

Automated recognition of ruffed grouse drumming in field recordings

AbstractRuffed grouse (Bonasa umbellus) populations are declining throughout their range, which has prompted efforts to understand drivers of the decline. Ruffed grouse monitoring efforts often rely on acoustic drumming surveys, in which a surveyor listens for the distinctive drumming sound that male ruffed grouse produce during the breeding season. Field‐based drumming surveys can fail to detect ruffed grouse when the birds drum infrequently or irregularly, making this species an excellent candidate for remote acoustic sensing with automated recording units (ARUs). An accurate automated recognition method for ruffed grouse drumming could enable effective and efficient use of ARU data for monitoring efforts; however, no such tool is currently available. Here we develop an automated method for detecting ruffed grouse drumming in audio recordings. Our detector uses a signal processing pipeline designed to recognize the accelerating pattern of drumming. We show that the automated recognition method accurately and efficiently detects drumming events in a set of labeled ARU field recordings. In a case study with 56 locations in Central Pennsylvania, we compared detections of ruffed grouse from 4 survey methods: field‐based acoustic drumming surveys, surveys conducted by humans listening to ARU recordings, and automated recognition for both a 1‐day and a 28‐day period. Field‐based surveys detected drumming at 9 of 56 locations (16%), while surveys conducted by humans listening to ARU recordings detected drumming at 8 locations (14%). Using automated recognition, the 1‐day recording period produced detections at 17 locations (30%) and the 28‐day recording period produced detections at 34 locations (61%). Our case study supports the idea that automated recognition can unlock the value of ARU datasets by temporally expanding the survey period. We provide an open‐source Python implementation of the recognition method to support further use in ruffed grouse monitoring efforts.

Alcohol, nicotine, and COVID-19: A retrospective study of health outcomes in central Pennsylvania

Individuals with substance abuse disorder are at increased risk for the development of severe disease following COVID-19 infection. Furthermore, individuals in rural populations where access to healthcare is limited and rates of substance abuse tend to be higher are at increased risk compared to other regions. The Penn State Health Network serves 29 counties in central Pennsylvania that are largely rural. The current study assessed the electronic medical records for individuals in this population that were reported as having alcohol dependence, nicotine dependence or both (co-users) in addition to individuals with no history of drug use and the rate of developing primary and secondary health outcomes following COVID-19 infection. All patients in this study were determined to be COVID+ while in care. We found that overall, risk for requiring ventilation, developing pneumonia, and mortality within 30 days of diagnosis all increased with any substance use history, across both males and females and across all age groups. Moreover, rates of these outcomes were considerably higher in patients that were both alcohol and nicotine dependent suggesting additive effects of co-use. Rates of secondary effects also increased substantially across all use categories with these patients showing greater risk of developing liver, kidney, and pancreas maladies compared to patients with no history of substance use. Taken together, these findings reinforce previous studies showing that substance use increases the risks of significant disease following COVID-19 infection, giving insights into the health disparities that exist in rural populations.

Utilizing student-led contact tracing initiative to alleviate COVID-19 disease burden in central Pennsylvania

Contact tracing elicits probable contacts from COVID-19 cases. Our student-led contact tracing initiative promoted isolation of both confirmed and probable cases and quarantine of contacts to reduce disease in Central Pennsylvania. Close contacts of COVID-19 cases were contacted by tracers, advised to quarantine, and monitored for 14 days for symptoms. Symptomatic contacts were classified as probable cases and advised to isolate. Data was collected from March 24, 2020 to May 26, 2020. Poisson regression and linear regression were utilized to examine the relationships between case and number of contacts and proportion of symptomatic contacts. Study sample comprised of 346 confirmed and 157 probable cases. Our results indicate a significant difference in percent of household contacts who became symptomatic between confirmed and probable cases (22% vs. 3%; adjusted P<.01). Similarly, probable cases had significantly fewer non-household contacts compared to confirmed cases (0.87 vs. 0.55; adjusted P<.01). Timely notification of exposure to a COVID-19 positive individual by student contact tracers allowed for probable cases to quarantine early in the disease process. Our data suggests that early quarantine and/or isolation may have directly contributed to probable cases having fewer non-household contacts and a smaller proportion of symptomatic household-contacts compared to confirmed cases.

Integrated weed management with strategic tillage can maintain soil quality in continuous living cover systems

Maximizing living cover and minimizing soil disturbance with no-till are key strategies in regenerative row-crop production. Although living cover and no-till can increase beneficial soil carbon and water stable aggregates (WSA), annual crops in rotation with perennials often rely on herbicides to control weeds and terminate perennials. Integrated weed management (IWM) reduces reliance on herbicides by employing multiple weed control strategies including tillage and/or cultivation. However, many no-till growers are reluctant to implement some soil disturbance due to concerns about negative impacts on soil health. For that reason, we hypothesized that compared to continuous no-till and standard herbicides (NT-SH), a strategic inversion tillage in IWM (ST-IWM) would result in lower soil carbon and WSA in the year following the tillage event. We also hypothesized that soil carbon and WSA would not differ between the two systems when sampled after cover cropping and 2 years of perennials. We tested these hypotheses within a 6-year, diverse, dairy crop rotation initiated in 2010 in central Pennsylvania in a channery silt loam soil. The systems were compared in split-plots in a full crop entry experiment, where the six phases of the crop rotation were planted every year in a randomized complete block design, replicated four times. We compared the soil health indicators in spring 2010 prior to the start of the experiment and in 2013 and 2019 following inversion tillage (ST-IWM) or herbicide termination (NT-SH) of the perennial forage in the first year of the rotation. We also compared these indicators in the sixth year of the rotation after 3 years of annual and cover crops and 2 years of perennial forage. We sampled at two depths: 0–5 and 5–15 cm for total carbon and bulk density, 0–5 cm for labile carbon and 0–15 cm for WSA. Results indicate that despite initial smaller soil health values in the ST-IWM system following inversion tillage, all properties except labile carbon were similar to the NT-SH system in the sixth year of the rotation.

Implementing Locally Tailored Strategies to Promote Redemption of Farmers' Market Nutrition Program Vouchers Among WIC Participants in Central Pennsylvania.

The Pennsylvania Farmers' Market Nutrition Program (FMNP) provides vouchers to participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to purchase locally grown fruits, vegetables (F&V), and herbs every year from June to November. Voucher redemption is suboptimal among WIC participants in Lebanon County, a community with high numbers of low-income and Hispanic families. Supported by a Racial and Ethnic Approaches to Community Health (REACH) award, our community-academic coalition partnered with the local WIC provider to implement locally tailored strategies to promote redemption of FMNP vouchers. In 2019, we surveyed FMNP participants (n = 100) to examine opportunities for improved voucher redemption. Increasing sites for voucher use (47%) and a larger variety of F&V (27%) were the most commonly selected improvements participants identified. Participants also supported improvements to increase awareness of available seasonal produce (14%), text/phone reminders to redeem vouchers (13%), and having recipes to cook meals with FMNP-approved F&V (12%). These findings led us to implement a weekly, Farm-to-WIC "grab bag" program in 2020/2021. We partnered with a local farmer to offer a variety of FMNP-approved produce in $3 and $6 grab bags at the local WIC provider. Each grab bag included healthy recipes using the included produce. In 2021, we launched a text/phone reminder intervention to encourage voucher redemption among FMNP participants (n = 57). Our work demonstrates the value of community-academic partnerships to identify and implement feasible strategies that are responsive to local needs as well as supporting existing programs providing greater access to affordable produce.

Spatiotemporal patterns of PFAS in water and crop tissue at a beneficial wastewater reuse site in central Pennsylvania.

Per- and polyfluoroalkyl substances (PFAS) are a collective name for thousands of synthetic compounds produced to enhance consumer and industrial products since the 1940s. They do not easily degrade, and some are known to pose serious ecological and human health concerns at trace concentrations (ng L-1 levels). Per- and polyfluoroalkyl substances persist in treated wastewater and are inadvertently introduced into the environment when treated wastewater is reused as an irrigation source. The Pennsylvania State University (PSU) has been spray-irrigating its wastewater at a 2.45 km2 mixed-use agricultural and forested site known as the "Living Filter" since the 1960s. To understand the spatiotemporal patterns of 20 PFAS at the Living Filter, water samples were collected bimonthly from fall 2019 through winter 2021 from the PSU's wastewater effluent and from each of the site's 13 monitoring wells. Crop tissue was collected at the time of harvest to assess PFAS presence in corn silage and tall fescue grown at the study site. Total measured PFAS concentrations in the monitoring wells ranged from nondectable to 155ng L-1 , with concentrations increasing with the direction of groundwater flow. Concentrations within each well exhibited little temporal variability across sampling events, with mixed relationships between PFAS and groundwater elevation observed between wells. Further, >84% of the PFAS present in livestock feed crops were short-chain compounds, with PFAS consumed annually by livestock fed crops harvested from the site estimated to be 2.46-7.67mg animal-1 yr-1 . This research provides insight into the potential impacts of long-term beneficial reuse of treated wastewater on groundwater and crop tissue quality.

Congenital Nephrotic Syndrome in the Amish and Mennonite Population of Central Pennsylvania

Congenital Nephrotic Syndrome in the Amish and Mennonite Population of Central Pennsylvania

Effect of age and rural residency on perceptions about SARS-CoV-2 pandemic and vaccination in kidney transplant recipients.

BackgroundTransplant patients have poor outcomes in coronavirus‐disease 2019 (COVID‐19). The pandemic's effects on rural patients’ overall care experience, attitudes to telemedicine, and vaccination are poorly understood.MethodsWe administered a cross‐sectional survey to adult kidney transplant recipients in central Pennsylvania across four clinical sites between March 29, 2021 and June 2, 2021. We assessed the pandemic's impact on care access, telemedicine experience, attitudes toward preventive measures, vaccination, and variation by sociodemographic variables.ResultsSurvey completion rate was 51% (303/594). Of these, 52.8% were rural residents. The most common impact was use of telemedicine (79.2%). Predominant barriers to telemedicine were lack of video devices (10.9%), perceived complexity (5.6%), and technical issues (5.3%). On a 0–10 Likert scale, the mean positive impression for telemedicine was 7.7; lower for patients with telephone‐only versus video visits (7.0 vs. 8.2; p < .001), and age ≥60 years (7.4 vs. 8.1; p = .01) on univariate analyses. Time/travel savings were commonly identified (115/241, 47.7%) best parts of telemedicine and lack of personal connection (70/166, 42.2%) the worst. Only 68.9% had received any dose of COVID vaccination. The vaccinated group members were older (58.4 vs. 53.5 years; p = .007), and less likely rural (47.8% vs. 65.2%; p = .005). Common themes associated with vaccine hesitancy included concerns about safety (27/59, 46%), perceived lack of data (19/59, 32%), and distrust (17/59, 29%). At least one misconception about the vaccines or COVID‐19 was quoted by 29% of vaccine‐hesitant patients.ConclusionsAmong respondents, the pandemic significantly impacted healthcare experience, especially in older patients in underserved communities. COVID‐19 vaccination rate was relatively low, driven by misconceptions and lack of trust.

Filth Fly Parasitoid (Hymenoptera: Pteromalidae) Monitoring Techniques and Species Composition in Poultry Layer Facilities.

Muscid flies, especially house flies (Musca domestica L.) (Diptera: Muscidae), are a major pest of poultry layer facilities. Augmentative biological control of muscid flies with pteromalid wasps has gained increased attention in recent years. Knowing which pteromalid species are present in a specific area could produce more effective filth fly control. The purpose of this project was to survey parasitoid populations in poultry layer facilities in central and southeastern Pennsylvania from June through September. Two genera of parasitoids, Spalangia and Trichomalopsis, were collected over the course of the survey. Overall, out of 3,724 parasitized pupae the species collected in order of most to least common were Spalangia cameroni Perkins, Spalangia nigroaenea Curtis, Trichomalopsis spp., and Spalangia endius Walker. House fly parasitism overall and by each parasitoid species varied by location and over the four study months. A second objective was to evaluate a new parasitoid trap for surveying parasitoid wasp populations. This device uses a combination of house fly third instars and development media. This was compared to a more traditional method, the sentinel bag, which uses only fly pupae. A higher proportion of Spalangia spp. emerged from the new trap design and more Trichomalopsis spp. emerged from the sentinel bag. This suggests that using this new device alongside the traditional collection method may result in more accurate sampling of pteromalid populations.

The influence of patriarchy on Nepali-speaking Bhutanese women's diabetes self-management.

The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women's status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women's diabetes self-management employing a conceptual framework based on Walby's structures of patriarchy. An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework. Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women's patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women's access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy. Patriarchal practices that start early on within women's lives, such as child marriage, religious restrictions as well as women's access to education and autonomy impacted NSB women's access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.

Patients’ opinions on participation in patient-centered outcomes research in community pharmacies: A qualitative study

BackgroundPatient-centered outcomes research (PCOR) often brings patient voices, thoughts, and opinions into the research process, allowing patients to have a say in the research process from project inception to dissemination of results. Community pharmacy teams are well-situated to engage patients in their own health and in research, given their trusting relationships with patients and access in communities. ObjectiveTo gather patients’ opinions on participation in PCOR at their local community pharmacy. MethodsFour regional focus groups representing western, central, northeastern, and southeastern Pennsylvania were conducted. A single community pharmacy in each region recruited patients to participate in each focus group. A focus group discussion guide was developed and reviewed by a Stakeholder Advisory Board that consisted patients, pharmacists, and researchers. Questions focused on patients’ relationships with their pharmacy and pharmacist, perceptions of research occurring at their local pharmacy, and patient engagement methods. Focus group sessions were audio-recorded, transcribed verbatim, and independently coded by 2 investigators. Coding discrepancies were reconciled through discussion, and a qualitative inductive thematic analysis was conducted by the research team. ResultsA total of 44 patients participated in one of 4 focus groups. Patients provided insights into what would make them more likely to participate in PCOR at their local community pharmacy. Four themes emerged from the discussions: (1) Understanding the impact to one’s health or community affects participation; (2) Patients prefer to schedule research activities at times outside of prescription pick-up or drop-off; (3) Trusted relationships can be leveraged for recruitment; and (4) Face-to-face engagement is preferred for participant recruitment. ConclusionPatients want to engage in research in a way that is respectful of their time and matters to them. Strong patient-pharmacist relationships are essential for patient engagement in and acceptance of PCOR opportunities in community pharmacies. Community pharmacies may be rich locations to engage patients in PCOR.