Philadelphia Area Research Articles

Learning on a Limb: An outreach module to engage high school students in orthopaedics.

Orthopaedic researchers need new strategies for engaging underrepresented minority (URM) students. Our field has demonstrated noticeable gaps in racial, ethnic, and gender diversity, which inhibit our ability to innovate and combat the severe socioeconomic burden of musculoskeletal disorders. Towards this goal, we designed, implemented, and evaluated Learning on a Limb (LoaL), an orthopaedic research outreach module to teach URM high school students about orthopaedic research. During the 4-h module, students completed hands-on activities to learn how biomechanical testing, microcomputed tomography, cell culture, and histology are used in orthopaedic research. Over 3 years, we recruited 32 high school students from the Greater Philadelphia Area to participate in LoaL. Most participants identified as racial/ethnic or gender minorities in orthopaedic research. Using pre/post-tests, we found that students experienced significant learning gains of 51 percentage points from completing LoaL. In addition to teaching students about orthopaedic research, post-survey data demonstrated that participating in LoaL strongly influenced students' interest in orthopaedic research and scientific confidence. Several students acted on this interest by completing summer research experiences in the McKay Orthopaedic Research Laboratory at the University of Pennsylvania. LoaL instructors also benefited by having the opportunity to "pay it forward" to the next generation of students and build community within their department. Empowering institutions to host modules like LoaL would synergistically inspire URM high school students and strengthen community within orthopaedic departments to ultimately enhance orthopaedic research innovations.

The Role of Household Social Support and Undermining in Dietary Change.

US adults find it challenging to meet disease prevention dietary recommendations and may participate in interventions to improve dietary quality. Social influences outside of the intervention, including level of social support and undermining of healthy eating in the home, may affect an individual's dietary intake. This secondary analysis examined (1) changes in household social support and undermining of healthy eating across a dietary intervention with household member participation and (2) the relationship between changes in social influences and dietary intake. Adults (N = 62) with low adherence to cancer prevention dietary recommendations recruited from the Philadelphia area participated in a 20-week dietary intervention focused on psychoeducation about NCI dietary recommendations and skills for behavior change. Half of the participants were also randomized to have an adult household member participate in some intervention contacts with them. Participants completed measures of social support and undermining of healthy eating and dietary intake at baseline and post-treatment (20weeks). Fifty-two participants had available data for baseline and post-treatment (i.e., completers). Household social support of healthy eating increased more among participants randomized to have household involvement in the intervention with a medium effect (η2 = .11). Fruit and vegetable intake significantly increased among participants with meaningful increases in household social support with a large effect (η2 = .37). There were no significant interaction effects of change in household undermining and time on change in dietary intake. Dietary interventions with a household support component show promise for improving household social support and may impact magnitude of dietary change.

Associations of the Philadelphia sweetened beverage tax with changes in adult body weight: an interrupted time series analysis

Sweetened beverage taxes are associated with large decreases in sugar-sweetened beverage sales, but their effects on weight outcomes are unclear. We examined associations of the 2017 Philadelphia beverage tax with changes in adult weight outcomes. We obtained electronic health record data on adults 18-65 years old in Philadelphia (intervention) and other areas of Pennsylvania and New Jersey (control) from 2014 to 2019. Controlled interrupted time series models compared post-tax changes in trends of body mass index (BMI, primary outcome) and obesity prevalence (secondary outcome). A panel sample comprised 175,675 adults with at least one BMI measure in both the pre-tax (2014-2016) and post-tax (2017-2019) periods. A cross-sectional sample comprised 587,121 adults with at least one BMI measure from 2014 to2019. Before tax implementation, Philadelphia panel patients had a mean BMI of 30.4kg/m2 and an obesity prevalence of 44.5%. After implementation, in the panel sample, there was a-0.03kg/m2 (95% CI:-0.07, 0.02) per quarter decrease in BMI vs. control, implying a-0.32kg/m2 (-0.85, 0.20) change at the end of the 3-year study period. In the cross-sectional sample, there was a-0.05kg/m2 (95% CI:-0.09,-0.01) per quarter decrease in BMI vs. control, implying a-0.60kg/m2 (-1.04,-0.16) change at the end of the study period. Results for obesity prevalence were consistent with the BMI results. There was some limited evidence of a decrease in BMI and obesity prevalence in Philadelphia 3 years after beverage tax implementation. Replication of these results is needed. National Institutes of Health.

8548 Breast Development in Infant Girls: Does Endogenous Estrogen Production During Minipuberty Play a Role?

Abstract Disclosure: M. Goldberg: None. S. Zhao: None. A. Kelly: None. V.A. Stallings: None. D.M. Umbach: None. W.J. Rogan: None. N. Shaw: None. D.P. Sandler: None. Background: Breast tissue, present at birth in most term infants, regresses during infancy but persists longer in girls than boys. In girls, this persistence is thought to be due in part to stimulation by estradiol (E2) produced during minipuberty, the postnatal activation of the hypothalamic-pituitary-gonadal axis. Empirical data are sparse, however. Because E2 concentrations in infant girls fluctuate, repeated E2 measures may be necessary to adequately characterize production across minipuberty and to detect effects on estrogen-sensitive breast tissue. Hypothesis: Higher average exposure to E2 during minipuberty is associated with larger breast bud diameter in late infancy in term females. Methods: We leveraged data from 136 girls from the Infant Feeding and Early Development (IFED) Study, a prospective cohort of reproductive development in term infants enrolled during 2010-2013 from the Philadelphia area. We measured E2 in serum samples collected at study visits every 2-4 weeks from age 2-32 weeks. We assessed breast bud diameter via ultrasound at the 32-week visit. For data analysis, we log2-transformed both E2 and breast bud diameter. For E2 concentrations below the limit of detection (2.99 pg/mL, 35% of samples), we applied multiple imputation. We first calculated the intraclass correlation coefficient (ICC) of repeated E2 to understand the relative magnitude of total variation from within subjects. We then calculated subject-specific mean of E2 across time and estimated associations with breast bud diameter at the 32-week visit using both age- and multivariable-adjusted linear regression models. We present results as percent change in breast bud diameter per doubling in average E2 concentration ([2β-1] x 100%). Results: Most infants were Black (71%) and formula-fed (76%). The median number of E2 measures per girl was 9 (range: 5-10). Most of the variation in E2 concentrations was due to within-individual variation (ICC=0.27). The geometric mean E2 concentration from 2-32 weeks of age was 5.1 pg/mL (95% confidence interval [CI]: 4.7-5.4). The median breast bud diameter at the 32-week visit was 13.7mm (range: 4.4-30.5). A doubling in average E2 concentration across minipuberty was associated with a 26% larger breast bud diameter (95% CI 10-43%). This association was similar after adjustment for feeding method, race, gestational age, neonatal weight, and breast bud diameter at the neonatal visit (percent change: 28%, 95% CI: 12-46%). Conclusions: Our results suggest that endogenous estrogen production in females during minipuberty stimulates the infant breast bud. More research is needed to investigate the potential biologic relevance of this hormonal stimulation of infant breast tissue to later breast development and risk of malignant and benign breast disorders. Presentation: 6/1/2024

Land use regression model to predict nitrogen dioxide in the greater Philadelphia area

Because of greater concern of nitrogen dioxide (NO2) pollution for urban residents, monitoring efforts are typically focused in urban areas. However, large populations in suburban areas near urban centers may also experience elevated NO2 levels. This study focuses on the application of a land use regression (LUR) model to predict NO2 pollution in the suburban and urban areas around the city of Philadelphia, Pennsylvania, USA. Air pollutant measurements used for the LUR were obtained from Ogawa™ passive samplers, which were deployed at several sites (n = 15) throughout the Greater Philadelphia area. Passive samplers were deployed for two weeks each during the fall, winter, and spring months between 2021 and 2022. Predictor data included various spatial buffers of land use, landcover, and traffic counts, as well as distances to various roadway types. The best LUR model based on regression statistics (F-statistic with 4 and 10 degrees of freedom = 5.111, p < 0.05) showed that mean NO2 concentrations increase within a 1000m buffer of annual average daily traffic. The model showed a patchwork of NO2 concentrations throughout the study area that could indicate regional and local emissions. The results highlight spatial variations of elevated concentrations influenced by a mix of land use, including roads, residential, and industrial areas.

Abstract A064: Patient-provider trust and immigration experiences and h. pylori knowledge among Asian Americans

Abstract Background: Asian Americans experience a disproportionately higher prevalence of Helicobacter pylori (H. pylori) infection. However, there persists limited awareness about H. pylori infection and the associated factors among this population. Methods: To assess the level of H. pylori-related knowledge and its association with immigration and provider-related factors, we conducted a cross-sectional pilot study involving 131 Asian American individuals aged 30-75 in the greater Philadelphia and NYC areas. Participants administered a questionnaire covering topics including migration experiences, provider characteristics, medical encounters, and other relevant covariates. Poisson regression was used to evaluate the relationship between these factors and H. pylori knowledge scores. Results: Among all participants, 78% (102/131) were not racially concordant with their PCP, and 39% (51/131) had limited English proficiency. Vietnamese participants had the highest mean H. pylori knowledge score (10.8, SD: 1.4), followed by Chinese (7.2, SD: 4.7) and Korean (5.7, SD: 4.4). In the crude model, racial concordance with PCPs showed a positive relationship (IRR: 1.33, 95% CI: 1.14–1.56) with knowledge scores, while length of immigration demonstrated a weak negative relationship (IRR: 0.98, 95% CI: 0.97–0.99). In the adjusted model, personal health experiences (aIRR: 1.3, 95% CI: 1.10–1.54) and patient-provider communication (aIRR: 1.71, 95% CI: 1.43–2.06) as key determinants of H. pylori knowledge. Conclusion: H. pylori knowledge in Asian Americans is influenced by immigration experiences and the trust between patients and providers, which affects information exchange, medical comprehension, and treatment adherence. Therefore, interventions aimed at improving H. pylori knowledge within the Asian American community should prioritize fostering trust between patients and their healthcare providers. This trust serves as a crucial foundation for facilitating informed decision-making and implementing preventive measures against gastric cancer. Citation Format: Zhiqing E. Liu, Jerry Kai-Chun Fu, Wenyue Lu, Phuong Do, Kathy Zhou, Ellen Kim, Yin Tan, Lin Zhu, Grace X. Ma. Patient-provider trust and immigration experiences and h. pylori knowledge among Asian Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A064.

Learning on a Limb: An outreach module to engage high school students in orthopaedics.

Orthopaedic researchers need new strategies for engaging diverse students. Our field has demonstrated noticeable gaps in racial, ethnic, and gender diversity, which inhibit our ability to innovate and combat the severe socioeconomic burden of musculoskeletal disorders. Towards this goal, we designed, implemented, and evaluated Learning on a Limb, an orthopaedic research outreach module to teach diverse high school students about orthopaedic research. During the 4-hr module, students completed hands-on activities to learn how biomechanical testing, microcomputed tomography, cell culture, and histology are used in orthopaedic research. Over three years, we recruited 32 high school students from the Greater Philadelphia Area to participate in Learning on a Limb. Most participants identified as racial/ethnic or gender minorities in orthopaedic research. Using pre/post-tests, we found that students experienced significant learning gains of 51 percentage points from completing Learning on a Limb. In addition to teaching students about orthopaedic research, post-survey data demonstrated that participating in Learning on a Limb strongly influenced students' interest in orthopaedic research. Several students acted on this interest by completing summer research experiences in the McKay Orthopaedic Research Laboratory at the University of Pennsylvania. Learning on a Limb instructors also benefited by having the opportunity to "pay it forward" to the next generation of students and build community within their department. Empowering institutions to host modules like Learning on a Limb would synergistically inspire diverse high school students and strengthen community within orthopaedic departments to ultimately enhance orthopaedic research innovations.

Addressing the Health Needs of Indian Americans in the Greater Philadelphia Region Through a Scoping Survey: Cancer Screening Assessment.

Despite higher income and education, there are profound health disparities among Asian Americans. These disparities are highlighted in particular by screening behaviors for cancer. Between 1998 and 2008, cancer rates increased threefold among Indian Americans, raising concern that cancer screening in this group may be especially low. To better understand cancer screening behavior, we collected data from a total of 157 self-identifying Indian Americans residing in the greater Philadelphia area. Nearly all participants reported having health insurance (98.7%), and most had received a physical exam within a year (87.3%). Only17.4% of the participants were referred for mammography, while 30% of participants over age 30 were referred for ovarian cancer screening. Just 4 participants were recommended for pancreatic cancer screening. The findings contribute new information to the understanding of health needs of Indian Americans residing in the greater Philadelphia region and reveal a need for greater focus on preventive care.

A comparison of ultrasound-based testis volume with Prader orchidometry and stability of testis size relative to peers from birth to 28weeks.

Testis volume, an indicator of the reproductive development during minipuberty, is commonly measured by Prader orchidometer, despite ultrasound being the gold standard. Data are lacking on the longitudinal relationship between these two measures and on the stability of boys' relative testis size across infancy. To examine the relationship between ultrasound-based and orchidometer-based testis volume measurements and to assess the stability of relative testis size among individual boys in the study. The Infant Feeding and Early Development study is a longitudinal cohort of healthy infants recruited from hospitals in the Philadelphia area during 2010-2013. We measured testis size from birth to 28weeks in 147 infants using Prader orchidometry (nine study visits) and ultrasound (five study visits). We modeled testis growth, extracted predicted volumes for each boy on each day of the study, and ranked these volumes from smallest to largest. The average testis volume trajectory exhibited linear growth over the first 16weeks followed by slower growth and then a plateau. Prader orchidometry overestimated testis size by almost 3-fold, compared to ultrasound. A range of ultrasound volumes corresponded to each bead size (e.g., bead size of 1 cm3 corresponded to an ultrasound-based volume between 0.11 and 0.87 cm3). Infants changed rankings of median of 22 positions (of 147) across the entire 6-month follow-up. Infants' ranks near birth were highly correlated with their ranks at the end of the study. Consistent with other studies, we found wide variability in testis size during infancy and that Prader orchidometry overestimates testis size. When compared to ultrasound, orchidometry only crudely estimates testis size in this age group. Ultrasound-based volumes generally showed stability in relative testis size across infancy. Accurate measurement of testis size is difficult using orchidometry in infants. This highlights the need for ultrasound for accurate measurement, with a one-time measurement likely sufficient to determine relative testis size across the first 6 months of infancy.

From Laggard to Innovator: Barbara Fruchter and the 1970s-Era Movement to Deinstitutionalize Pennsylvania Juvenile Justice

Abstract: Using diverse archival sources and oral history interviews, this essay examines how volunteer activist women in the 1970s galvanized support to pass major legislative reforms that made Pennsylvania a model for how to implement the federal Juvenile Justice and Delinquency Prevention Act (JJDPA) of 1974 at the state level. Horrified by conditions they witnessed on a tour of a nearby juvenile detention center, three Philadelphia area women created a broad-based coalition—centered in the Juvenile Justice Center (JJC) of Pennsylvania—to improve local conditions of confinement and spearhead novel policies to transform juvenile justice statewide. Focusing on Barbara Fruchter, JJC cofounder and de facto leader of the state’s deinstitutionalization campaign, this essay probes how a now well-accepted idea in juvenile justice—treating the great majority of delinquent youth in small community-based rather than large institutional programs—was first envisioned and introduced into American juvenile justice a half-century ago.

Promoting healthful and diverse eating behaviours through an extracurricular culinary skills intervention in Philadelphia.

In the current study we evaluated an afterschool nutrition education programme, called Vetri Cooking Lab (VCL), for promoting healthy and diverse eating habits among at-risk children in the Greater Philadelphia area. To understand potential programme impacts, we conducted a longitudinal analysis of survey data collected before and after participation in VCL. Main study included cooking confidence, cooking knowledge, changes in dietary consumption behaviours, and changes in vegetable preferences. Participants included students in grades 3-11 enrolled in VCL during the 2018-19 school year at VCL sites (n = 60) throughout Philadelphia, PA, and Camden, NJ. Eligible participants completed surveys both before and after participating in the programme. We found that students' confidence and knowledge increased (P < 0.001) after the cooking intervention. Knowledge and confidence were positively associated (r = 0.55; P < 0.001). Confidence was correlated with consumption behaviour changes (r = 0.18; P = 0.022). Confidence was positively associated with consumption changes in both our adjusted (OR = 1.81; P < 0.001) and unadjusted models (aOR = 1.88; P = 0.013). Compared to Black students, White students were more likely to report consumption changes (aOR = 5.83; P = 0.013). Hispanic/Latino participants and participants who spoke Spanish had nearly three times higher odds of consumption behaviour changes (Hispanic/Latino OR = 2.55; P = 0.007; Spanish OR = 3.04; P = 0.005). Student age and gender were not associated with behaviour changes. Our research demonstrates that programmes integrating practical cooking skills education along with nutrition, food, and cooking education can improve confidence and knowledge about healthy food choices amongst children driving an overall improvement in children's eating habits.

Abstract A040: Examining the geographical distribution of a colorectal cancer awareness community outreach program

Abstract Background: Colorectal cancer (CRC) is a significant health issue in the United States, ranking as the third most diagnosed cancer and the second leading cause of cancer-related deaths. The incidence of CRC varies across the east coast of the United States due to multiple factors, including disparities in lifestyle, healthcare accessibility, and environmental exposures. Community-based participatory research plays a vital role in identifying effective interventions to enhance awareness of cancer risk and prevention in specific communities. Methods: This study focused on Asian Americans, Blacks, and Hispanics residing in the Greater Philadelphia (PA), New Jersey (NJ), and New York City (NYC) areas. The Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH) collaborated with community-based organizations' leaders and staff to streamline recruitment, workshop delivery, and survey data collection. The workshop curriculum covered essential CRC information, including facts, dietary habits, and screening guidelines. Pre- and post-workshop surveys were used to assess changes in CRC knowledge and screening intention. The distribution of participants was analyzed using Arc GIS. Results: [GXM1] The study population consisted of 212 Asian, 172 Hispanic/Latino, and 126 African American/Black participants. Geographical data was obtainable for 486 participants, primarily from New York (n=286, 58.8%), Pennsylvania (n=150, 30.9%), and New Jersey (n=49, 10.1%). These states form the Pennsylvania, New Jersey, and New York City (PNN) region, which is known for its high concentrations of neighborhoods experiencing persistent poverty, especially in areas densely populated by minorities. Distinct examples include neighborhoods within the Bronx borough of New York City and Philadelphia County in Pennsylvania. Alarmingly, in some counties within the PNN region, as many as 26% of the census tracts are categorized as persistently impoverished. This pattern of concentrated poverty is supported by several existing studies and research reports. Conclusions: The distribution of participants aligned with the study area of SPEECH and areas characterized by persistent poverty. These findings provide valuable insights to guide efforts in improving cancer health equity in the identified regions. Citation Format: Thoin F. Begum, Ellen Kim, Lin Zhu, Yin Tan, Evelyn T. González, Marilyn A. Fraser, Yingzhang Lin, Nathaly Rubio-Torio, Tenya Blackwell, Carolyn Martin, Safa Ibrahim, Ming-Chin Yeh, Grace X. Ma. Examining the geographical distribution of a colorectal cancer awareness community outreach program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A040.

Abstract C100: An effective intervention toolkit to promote medication adherence among Asian Americans living with chronic hepatitis B

Abstract Introduction: Asian Americans is a Hepatitis B (HBV) disparity population who only account for 7% of the US population but experience nearly 60% burden of chronic HBV, which is associated with 75% of hepatocellular carcinoma (HCC). Adherence to HBV medication guideline is a practical approach to preventing liver cancer. However, limited studies have been conducted on promoting HBV medication adherence among underserved Asian American HBV patients. Methods: This study utilized 18-month follow-up data from a randomized controlled clinical trial aimed at improving long-term adherence to HBV medication adherence. Eligible Asian American HBV patients were recruited in the Greater Philadelphia and New York City areas from community-based organizations and clinics that serving the targeted population. Guided by Community-based Participatory Research (CBPR) approach, we developed and implemented Virtual Patient Navigation Toolkit and Text Messaging (VPN Toolkit+TM) to promote HBV pill-taking among the targeted population. HBV medication adherence was assessed using the Morisky 8-Item Medication Adherence Scale with a score ranges from 0 to 8, depression was measured with Patient Health Questionnaire-9, and knowledge of HBV was evaluated with a 10-item scale. A p-value that is smaller than 0.5 is considered statistically significant. Results: Among 149 participants (108 Chinese and 41 Vietnamese) who were prescribed HBV medication, 44.97% were female. Bivariate analysis showed that medication adherence was significantly higher in the intervention group than in the control (7.25 vs. 5.57, p&amp;lt;0.001 ) group at the 18-month follow-up. Results from the multivariable analysis revealed that compared with their control group counterparts, intervention group participants had significantly higher Morisky medication score (Coef.= 0.66, p=0.044), controlling for demographics, depression level, and HBV knowledge score. The results indicated that there was a significant intervention effect in medication adherence at 18-month follow-up. In addition, we found that a lower depression score (Coef.=-0.11, p&amp;lt;0.001) and a higher level of HBV related knowledge (Coef.=0.40, p&amp;lt;0.001) were significant predictors of better HBV medication adherence at 18-month follow-up assessment, with other variables held constant. Conclusion: The findings imply the necessity of promoting VPN Toolkit+ TM intervention among medically underserved HBV pill-taking patients. Moreover, targeted interventions addressing psychosocial barriers and promoting HBV-related knowledge would effectively promote HBV medication adherence among Asian Americans with chronic HBV infection. Citation Format: Wenyue Lu, Lin Zhu, Thoin Begum, Yin Tan, Minhhuyen T. Nguyen, Xiaoli Ma, Sarah Lai, Tam Tran, Phuong Do, Elizabeth Handorf, Ming-Chin Yeh, Grace X. Ma. An effective intervention toolkit to promote medication adherence among Asian Americans living with chronic hepatitis B [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C100.

Primary Care Provider Receptivity to Multi-Cancer Early Detection Test Use in Cancer Screening.

Multi-cancer early detection tests (MCEDs) are blood-based tests that detect biomarkers released or induced by cancer cells. If MCED tests are shown to be safe and effective in cancer screening, they are likely to be ordered and managed in primary care. To understand primary care providers' support for and concerns about the implementation and management of MCED testing, the research team developed a cross-sectional survey that was sent to 939 primary care providers (physicians, residents/fellows, and advanced practice providers) in a large academic health system in the greater Philadelphia area. The survey included standard items used to assess provider background characteristics and to measure provider awareness of challenges related to MCED test use (7 items), perceived competence in MCED testing (5 items), and receptivity to MCED test use in the future (4 items). A total of 351 (37.4%) primary care providers completed the survey. Among respondents, the awareness of challenges in MCED testing (mean = 3.95, sd = 0.64), perceived competence (3.67, sd = 0.85), and receptivity to MCED use in practice (mean = 3.62, 0.75) were moderately high. Multiple regression was performed to identify factors associated with receptivity to MCED testing. We found that provider number of years in practice (DATA), awareness of challenges related to MCED testing (DATA), and perceived competence in MCED test use (DATA) were positively and significantly associated with receptivity to MCED test use in practice. An exploratory factor analysis extracted two components: receptivity to MCEDs and awareness of challenges. Surprisingly, these factors had a positive correlation (r = 0.124, p = 0.024). Providers' perceived competence in using MCED tests and providers' experience level were significantly associated with receptivity to MCED testing. While there was strong agreement with potential challenges to implementing MCEDs, PCPs were generally receptive to using MCEDs in cancer screening. Keeping PCPs updated on the evolving knowledge of MCEDs is likely critical to building receptivity to MCED testing.

Monitoring gaseous pollutants using passive sampling in the Philadelphia region

ABSTRACT Air pollution can have deleterious impacts on human health and the environment. Historically, air pollution studies have focused more on cities. However, it is also important to consider the impact on large suburban populations living closer to the major cities. In this study, nitrogen oxides (nitrogen dioxide and nitric oxide), sulfur dioxide, ozone, and ammonia concentrations were measured from fifteen sites in the Greater Philadelphia area, Pennsylvania, USA using Ogawa passive samplers from September 2021 to May 2022. The fall season had the highest mean NOx concentrations (11.03 ± 4.51 ppb), and spring had the highest mean O3 concentration (18.65 ± 6.71 ppb) compared to other seasons. NOx concentrations were higher at suburban (30.43 ± 33.79 ppb) and urban sites (22.49 ± 12.54 ppb) compared to semi-rural sites (11.08 ± 9.20 ppb). SO2 was not detected in most of the measurements. The positive statistically significant correlation between NO and NH3 in urban (R2 = 0.33, p-value <0.05) and suburban sites (R2 = 0.37, p-value <0.05) during winter and spring, respectively, suggests a high attribution of traffic emissions to NH3 at urban and suburban sites. Influence of traffic emissions on air pollutant values for the study region is also supported by similar NOx concentrations between suburban and urban sites as well as decreasing NO2/NOx ratios with increased distance from expressways. This study shows that passive sampling can be effectively used for assessing spatial and seasonal variations in air pollutants within an area of diverse land use. Implications: This study presents the findings of temporal and seasonal patterns for nitrogen dioxide, nitric oxide, tropospheric ozone, and ammonia at urban, suburban, and semi-rural areas of the greater Philadelphia region. The main objective of the study is to monitor air pollution in suburban and semi-rural areas which are not monitored for air pollution. We monitored from a total of fifteen sites in three seasons to assess air pollution in suburban and semi-rural areas near the major city in the United States – Philadelphia. The findings are important to learn how air quality is affected in suburban and semi-rural areas near the major city. The study also shows the useful application of inexpensive passive sampling technique for measuring air pollution.

Rethinking building envelope design: Machine learning approaches to evaluate its impact on indoor ozone exposures

Ozone is widely recognized as an ambient air contaminant that causes acute and chronic health effects. However, there is a limited number of studies investigating indoor exposures to ozone in occupied houses and linking design variables to the predictive power of indoor ozone levels. This study focuses on typical envelope airflow paths used in residences in the Philadelphia area in the United States. The model development draws from the field data, including indoor and outdoor ozone concentration, environmental parameters, and building characteristics from four building envelopes. Five machine learning algorithms (i.e., support vector machine, lasso regression, random forest, Bayesian bridge regression, and gradient boosting) are employed, with indoor ozone concentration as the dependent variable, as it indicates how the hot and sunny weather that might lead to the possibility of indoor air quality (IAQ) alerts due to ozone. The results showed that gradient boosting model based on all field measurements had the highest R-squared value of 0.974 and low enough root mean square error (RMSE) and mean absolute error (MAE) which are 1.182 and 0.788, respectively. We conclude that indoor ozone forecasting model based on inputting environmental survey (ES) in addition to either design variables or indoor environment characteristics can effectively predict and can therefore be used at the building design phase to improve healthy living environments.

"I had become fed up": A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout.

Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery. To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so. We conducted focus groups and interviews of Black NPs ( N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis. Emergent themes included: Strategies Utilized to Address Health Inequities ; Burnout & the Minority Tax ; Risks & Rewards of Taking a Stance ; and Uneven Promises of Organizational Engagement . Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles. Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care. The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.

32 Associations between Childhood Attention Deficit Hyperactivity Disorder and Learning Disabilities and Cognition in Late Adulthood.

Objective:There has been relatively little research on the effect of childhood attention difficulties/weaknesses and learning disabilities/differences on cognitive aging. This study examined associations between self-reported symptoms and diagnoses/concerns of childhood attention deficit hyperactivity disorder (ADHD) and reading or math learning disabilities (LD) and cognitive abilities in older adulthood. We hypothesized that cognitive weaknesses in childhood would be associated with cognitive abilities later in life.Participants and Methods:The 25 individuals with healthy cognition or MCI were recruited from the greater Philadelphia area (Mage= 74.4; SD= 5.34; 40% men; 84%white) and completed a self-report questionnaire of childhood ADHD and LD. Specifically, participants rated their experience of ADHD symptoms of inattention and hyperactivity/impulsivity and indicated whether they had a past diagnosis of (or concerns regarding past) ADHD, math LD or language/reading LD Participants also completed tests of language, attention, episodic memory, executive function, and processing speed. Pearson or point-biserial correlation coefficients (r-values) indicating a medium effect size (.30 or greater) were interpreted as meaningful.Results:On average, participants reported 3.48 symptoms of inattention and 2.56 symptoms of hyperactivity/impulsivity (i.e., at least six symptoms from either category are consistent with diagnostic criteria for ADHD). 16% of the sample reported childhood ADHD/attention difficulties, 48% reported childhood math LD/math difficulties, and 32% reported childhood language LD/difficulties. On cognitive tests, the sample performed in the average range, with considerable variability (i.e., norm-based, demographically adjusted T-scores ranged from 20-74). The relation between cognitive scores and report of childhood ADHD symptoms was weak and non-significant correlation (r&lt;.18). By contrast, report of childhood ADHD/attention difficulties was associated with lower scores attention tests (r=.33). Report of childhood language LD/difficulties was associated with a worse overall cognitive composite (r=-.35) and executive function ability (r=-.35). Childhood math LD/difficulties was not meaningfully associated with lower scores on any of the cognitive tests administered. Unexpectedly, report of childhood cognitive difficulties also were associated with higher scores on cognitive tests, such that childhood ADHD/attention difficulties was associated with better performance on tests of episodic memory (r=.39), and childhood math LD/difficulties were associated with better performance on tests of language (r=-.37).Conclusions:Current cognitive abilities in older adults may be influenced by lifelong cognitive weakness and academic difficulties. A history of ADHD and LD/difficulties should be considered in clinical neuropsychological assessment and future research on cognitive aging should consider ADHD/LD from a lifespan, developmental framework.

Three methods of characterizing climate-induced changes in extreme rainfall: a comparison study

Abstract (1) Three practical and easily implementable methods are provided to estimate percent increases in extreme rainfall due to climate change for the period 2020–2090 using Global Climate Model (GCM) output. (2) Methods are designed to bracket the expected range of extreme rainfall intensification for 1–24-h events with return intervals of 1 year to 100 years. (3) One method is based on the 20 largest wet days produced by an ensemble of GCMs, and the other two use GCM projections of temperature and Clausius–Clapeyron assumptions. (4) The results of the case study for the Philadelphia area show that, by the end-of-century, extreme rain event volumes might increase from a low of 18% to a high of 61%, depending on the duration and return interval under consideration. (5) Methods have been benchmarked against existing, publicly available projected rainfall intensities to show the methods that provide an accurate range of extreme rainfall intensification due to climate change.

A Health Belief Model Examination of Factors Related to Hepatitis B Screening Among African Immigrants in Philadelphia.

Chronic hepatitis B infection is a leading cause of liver cancer worldwide. In the USA, African immigrants (AI) have high hepatitis B virus (HBV) infection rates but low HBV knowledge and screening rates. Research about HBV among AI living in Philadelphia is particularly limited. This study aims to assess barriers to and factors influencing HBV screening in the Philadelphia AI population. African and Caribbean-born adults in Greater Philadelphia were recruited for phone interviews at community health fairs hosted by the African Cultural Alliance of North America (ACANA) and the African Family Health Organization (AFAHO) in partnership with the Hepatitis B Foundation. Seventeen interviews were recorded, transcribed, and coded independently by two members of the research team using NVivo software. Themes and subthemes were created by analysis of the codes and arranged under Health Belief Model (HBM) concepts. Major perceived barriers included lack of HBV knowledge and awareness and cultural challenges related to health care access, preventive care, fear, and stigma. Participants recommended using community organizations and programs to spread awareness about HBV and serve as cues to action. In-person education was emphasized due to lack of access to and knowledge of technology such as Zoom. While HBV educational sessions have been implemented in this population, they have not been consistent or far-reaching. The results of this study can contribute to the implementation of a comprehensive AI-specific HBV education and screening program through partnerships with community organizations to ensure that all high-risk individuals in the Philadelphia area are screened.