Philadelphia Metropolitan Area Research Articles

Green spaces and flood vulnerability in urbanising regions: a case study in the Philadelphia metropolitan area

ABSTRACT Flooding continues to be one of the most significant natural hazards, disproportionately impacting vulnerable populations in urbanising regions. This study aims to examine the relationship between green space density and flood vulnerability in the Philadelphia Metropolitan Area by integrating social and geophysical data. The research focuses on identifying areas where high flood vulnerability coincides with low green space availability, as these are critical regions for targeted intervention. Using social vulnerability indicators such as income, age, and housing characteristics, combined with geophysical factors like soil permeability and drainage density, the study assesses flood vulnerability across census block groups. Local Indicators of Spatial Association (LISA) and discriminant analysis were employed to detect spatial clusters with elevated flood risks and low green space density. Results reveal that these high-risk clusters are concentrated in densely urbanised areas such as Norristown, where lower-income and elderly populations are overrepresented. These findings reinforce broader environmental justice concerns, as socially vulnerable communities face compounded risks from both inadequate flood protection and limited access to green spaces. The study emphasises the need for integrated flood management, combining green infrastructure with structural interventions, to guide urban planners and policymakers in reducing flood risks and promoting environmental equity.

Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus.

Exogenous insulin therapy increases systemic exposure to insulin which may promote the development of colorectal neoplasia. We sought to evaluate the association between exogenous insulin therapy and the incidence of advanced adenoma in type 2 diabetes mellitus. A retrospective cohort study was conducted from January 1, 2007, to January 1, 2018, in a regional health system serving the United States Philadelphia metropolitan area, Central New Jersey, and South Central Pennsylvania. Study patients consisted of a random sample of patients with type 2 diabetes mellitus aged 40-80years who had undergone two rounds of colonoscopy examinations. The exposure was cumulative duration of insulin therapy (i.e., no use, 1-365days and > 365days). The outcome was time to incident advanced adenoma. Of the 975 eligible patients, 184 patients accumulated > 365days of insulin therapy before the follow-up colonoscopy. The mean (standard deviation) duration between the two rounds of colonoscopy examination was 5.1 (2.9) years among the insulin users and 5.3 (3.9) years among non-users. Compared to no insulin exposure, receiving > 365days of insulin therapy was associated with an increased incidence of advanced adenoma (adjusted hazard ratio [aHR] 4.84, 95% confidence interval [CI] 2.82-8.30), right-sided advanced adenoma (aHR 5.48, 95% CI 2.90-10.35), and 3 or more adenomas (aHR 2.61, 95% CI 1.46-4.69) at the follow-up colonoscopy examination. Insulin therapy is associated with an increased risk of advanced adenoma and may serve as a novel risk-stratification factor to enhance the efficiency of existing colorectal cancer screening and surveillance programs.

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19

Introduction: Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic. Methods: This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023. Results: The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to pre-pandemic levels (-3.6 pp in the late-pandemic period, p< 0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p< .001), controlling for sex, age, insurance type and clinic characteristics. Conclusions: Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.

To What Extent Have Nature-Based Solutions Mitigated Flood Loss at a Regional Scale in the Philadelphia Metropolitan Area?

Globally, floods are becoming more severe, lasting longer, and occurring more frequently because of changes in climate, rapid urbanization, and changing human demographics. Although traditional structural flood mitigation infrastructures (e.g., drainage systems, levees) are effective in urban areas, their functionalities in the face of extreme rainfall events and increased development largely depend on the capacity and location of such systems, making complementary solutions such as nature-based solutions (NBS) important. The concept of NBS within the context of flood mitigation has gained traction in the last decade; however, the success of NBS depends on their effectiveness and distribution over urban regions. This article seeks to examine the potential of NBS as a flood loss mitigation tool in one of the fastest-growing and flood-prone counties of Pennsylvania, Montgomery County, using Generalized Linear Model (GLR) and Geographically Weighted Regression (GWR) techniques. The analysis integrates the National Risk Index dataset for river flooding, a 100-year flood zone layer from National Flood Hazard Layer (NFHL) provided by FEMA, with land use and impervious surface percent data derived from National Land Cover Database (NLCD) for 2019 and socioeconomic data at the U.S. census tract level from the 2019 U.S. Census. This study’s findings partially contradict previous research by revealing an unexpected relationship between NBS quantity in floodplains and expected annual loss. Findings also suggest that small size and disconnected patches of NBS in floodplains in some dense urban areas effectively reduce total losses from flood events.

Association Between Lack of Access to a Neighborhood Park and High Blood Pressure in the Philadelphia Metropolitan Area

Association Between Lack of Access to a Neighborhood Park and High Blood Pressure in the Philadelphia Metropolitan Area

Interpretation of Probabilistic Surface Ozone Forecasts: A Case Study for Philadelphia

Abstract The use of probabilistic forecasting has been growing in a variety of disciplines because of its potential to emphasize the degree of uncertainty inherent in a prediction. Interpretation of probabilistic forecasts, however, is oftentimes difficult, deterring users who may benefit from such forecasts. To encourage broader use of probabilistic forecasts in the field of air quality, a process for interpreting forecasts from a statistical probabilistic air quality surface ozone model [the Regression in Self Organizing Map (REGiS)] is demonstrated. Four procedures to convert probabilistic to deterministic forecasts are explored for the Philadelphia, Pennsylvania, metropolitan area. These procedures calibrate the predicted probability of daily maximum 8-h-average ozone exceeding a standard value by 1) estimating climatological relative frequency, 2) establishing a probability of an exceedance threshold as 50%, 3) maximizing the threat score, and 4) determining the unit bias ratio. REGiS is trained using 2000–11 ozone-season (1 May–30 September) data, calibrated using 2012–14 data, and evaluated using 2015–18 data. Assessment of the calibration data with the Pierce skill score suggests an exceedance threshold based on climatological relative frequency for the conversion from probabilistic to deterministic forecasts. Calibrated REGiS generally compares well to predictions from the U.S. national air quality model and operational “expert” forecasts over the evaluation period. For other probabilistic models and situations, different procedures of converting probabilistic to deterministic forecasts may be more beneficial. The methods presented in this paper represent an approach for operational air quality forecasters seeking to use probabilistic model output to support forecasts designed to protect public health. Significance Statement Because probabilistic forecasting is becoming more prevalent in the field of air quality, the purpose of this article is to draw attention to the importance of defining a framework to accurately interpret these forecasts. This work shows that 1) probabilistic forecasts are potentially more useful to forecasters when converted into deterministic forecasts and 2) that some conversion methods are more skillful than others. It is recommended that, if it begins to produce probabilistic air quality products, the National Weather Service should implement some of the strategies presented herein to help with the interpretation of such forecasts.

Abstract C069: Reducing liver cancer risk through dietary change: Positive results from a community-based educational initiative in three racial/ethnic groups

Abstract Background: The existing body of literature suggests that modifiable lifestyle behaviors such as alcohol consumption and dietary behaviors were linked to viral hepatitis B/C and liver cancer. So far, most of the liver cancer awareness campaigns and behavioral interventions have focused on preventive behaviors such as screening, vaccination, and early diagnosis. Not enough efforts have been made to raise awareness of behavioral mechanism of liver cancer prevention, especially in the medically underserved populations. Methods: We used the community-based participatory research (CBPR) approach to implement an education initiative regarding the promotion of liver cancer among the African, Asian, and Hispanic populations within the Philadelphia metropolitan area and New York City. In this study, we used data from the pre-education surveys and follow-up assessments at 6 months post-education to assess the changes in dietary behaviors and alcohol consumption among participants. Results: The study sample includes 344 participants recruited through community-based organizations. The sample consists of 31 African Americans, 174 Asian Americans, and 139 Hispanic Americans. Among the African Americans participants, the consumption of scores such as fruits (2.710 to 3.581) and poultry (2.613 to 3.677) increased significantly, while vegetables and red meats decreased. In Asian Americans, the consumption of non-refined cereals (3.362 to 4.282), red meats (2.655 to 3.195), and dairy (2.851 to 3.701) products decreased. Lastly, among the Hispanic American participants poultry (2.173 to 3.554), dairy products (2.101 to 3.863), and olive oil (3.022 to 3.849) increased, as well as the consumption of alcohol. Conclusion: This community-based educational imitative generated different impacts in the three populations, further highlighting the needs for more targeted, culturally tailored efforts in health promotion among these underprivileged communities. Citation Format: Tamar Tertulien, Ellen J. Kim, Wenyue Lu, Steven Zhu, Nathaly Rubio-Torio, Evelyn González, Marilyn A. Fraser, Ming-Chin Yeh, Lin Zhu, Grace X. Ma, Olorunseun O. Ogunwobi, Yin Tan. Reducing liver cancer risk through dietary change: Positive results from a community-based educational initiative in three racial/ethnic groups [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C069.

Characterizing Equity of Intensive Care Unit Admissions for Sepsis and Acute Respiratory Failure.

Rationale: Patients who identify as from racial or ethnic minority groups who have sepsis or acute respiratory failure (ARF) experience worse outcomes relative to nonminority patients, but processes of care accounting for disparities are not well-characterized. Objectives: Determine whether reductions in intensive care unit (ICU) admission during hospital-wide capacity strain occur preferentially among patients who identify with racial or ethnic minority groups. Methods: This retrospective cohort among 27 hospitals across the Philadelphia metropolitan area and Northern California between 2013 and 2018 included adult patients with sepsis and/or ARF who did not require life support at the time of hospital admission. An updated model of hospital-wide capacity strain was developed that permitted determination of relationships between patient race, ethnicity, ICU admission, and strain. Results: After adjustment for demographics, disease severity, and study hospital, patients who identified as Asian or Pacific Islander had the highest adjusted ICU admission odds relative to patients who identified as White in both the sepsis and ARF populations (odds ratio, 1.09; P = 0.006 and 1.26; P < 0.001). ICU admission was also elevated for patients with ARF who identified as Hispanic (odds ratio, 1.11; P = 0.020). Capacity strain did not modify differences in ICU admission for patients who identified with a minority group in either disease population (all interactions, P > 0.05). Conclusions: Systematic differences in ICU admission patterns were observed for patients that identified as Asian, Pacific Islander, and Hispanic. However, ICU admission was not restricted from these groups, and capacity strain did not preferentially reduce ICU admission from patients identifying with minority groups. Further characterization of provider decision-making can help contextualize these findings as the result of disparate decision-making or a mechanism of equitable care.

Psychotherapy Caucus Creates Program to Increase Use of Psychotherapy

Psychotherapy Caucus Creates Program to Increase Use of Psychotherapy

Impacts of Road Deicing Application on Sodium and Chloride Concentrations in Philadelphia Region Drinking Water.

Historical application of roadway deicing agents (e.g., road salt and brines) has led to an increase in sodium and chloride concentrations in surface water over time. Numerous studies have explored the impacts of road salt on freshwater aquatic organisms such as amphibians and benthic macroinvertebrates; however, the public health risk associated with consuming drinking water with elevated sodium has been largely unexplored in the literature. Yet, sodium ingestion, primarily through diet, has been linked to adverse human health conditions, such as hypertension. This study documents weekly sodium and chloride concentrations in municipal tap water from three municipalities within the Philadelphia metropolitan area during winter 2018–2019 (November through March). A late winter peak in sodium and chloride concentrations was observed for all three municipalities immediately following successive snow events coupled with daily high temperatures above 0°C. Among municipalities, mean and peak sodium and chloride concentrations were associated with relatively higher development in upstream areas. Observed sodium concentrations ranged from 1 to 6.4x the USEPA recommended guideline of 20 mg/L for individuals restricted to a total sodium intake of 500 mg/day. Additionally, the contribution of sodium ingestion from water consumption to the recommended daily sodium intake limits for adults ranged from 3.5% to 18.8% for non‐restricted and 4.2%–33.3% for “low salt” (i.e., <1,500 mg/day) diets, respectively. The study results coupled with a records review for 40 U.S. municipalities in snow affected regions indicate the need for real‐time communication between water utilities and the general public regarding sodium exposure risk during winter months.

New route, new faces? Measuring opportunities for exposure to sociodemographic diversity on transit using social interaction potential

IntroductionMeasuring the effect that transportation interventions have on accessibility can be broadened by incorporating potential opportunities for social exposure, particularly with diverse others. MethodsIn this paper, we employ a modified social interaction potential (SIP) approach to measure changes in exposure to diverse populations based on the addition of new bus services to the transit network. SIP is a metric employed in transportation geography research to measure opportunities for engagement by describing the theoretical potential for colocation. DataIndividual-level, origin-destination data from a survey of passengers on a newly added bus to the Southeastern Pennsylvania Transportation Authority’s (SEPTA; Philadelphia metropolitan area) network is analyzed. ResultsA SIP-based index of opportunities for exposure to sociodemographic diversity are demonstrated and changes to SIP around the addition of the new bus route are measured. The results of paired t-tests signal that the addition of this new route to the network is associated with a statistically significant increase in the opportunities for exposure to income and age diversity, as compared to index values measured using likely transit travel patterns utilized before the addition of the new route. ConclusionTransportation planning efforts meant to promote greater accessibility to material opportunities through new transit alignments may also expand accessibility to social opportunities. We advance a methodological approach that crafts a nuanced portrait of accessibility that can help to orient future transportation planning policy. Future analyses employing this approach will benefit from larger, administratively provided, individual-level datasets that describe greater segments of the population.

Abstract PO-161: A community-based liver cancer education initiative led to healthier dietary and alcohol use behaviors among racial/ethnic minority community members

Abstract Background: There is an increasing body of literature that suggests a relationship between modifiable dietary behaviors and alcohol use and liver cancer. We designed and implemented a culturally tailored community-based education program to promote liver cancer prevention. Methods: Through NCI funded U54 TUFCCC/HC Cancer Partnership Community Outreach Core program, using CBPR approach, we engaged community-based organizations and community stakeholders serving underserved African, Asian, and Hispanic American communities in the Philadelphia metropolitan area and New York City. The community-based education incorporated in-person and virtual hybrid education workshops to address COVID-19 pandemic barriers. We conducted pre-education surveys and follow-up assessments at 6 months post-education. Participants' dietary behaviors, alcohol use, and sociodemographic characteristics were examined at both time points. Results: 526 participants were recruited including 92 African Americans, 247 Asian Americans, and 187 Hispanic Americans, with an average age of 59. We found that at 6-month follow-up assessment, participants had average decreased intake of red meat (3.148/6 vs. 2.685/6, p &amp;lt; 0.001), and average increased intake of vegetables (4.484/6 vs. 5.044/6, p &amp;lt; 0.001) and fruits (4.327/6 vs. 4.877/6, p &amp;lt; 0.001), compared to their intake at pre-education assessment. Additionally, average change in beer (-0.252) and spirit (-0.905) consumption substantively decreased from pre-intervention to 6-month follow-up assessment. Conclusion: This community-based education showed significant effects in improving healthy dietary behaviors and reducing alcohol intake among community members through CBPR community engagement from the two metropolitan areas. Future efforts are needed to sustain the positive changes in modifiable lifestyle behaviors and liver cancer prevention in these medically underserved communities. Citation Format: Tiffany Li, Wenyue Lu, Lin Zhu, Ellen Kim, Kerry Traub, Steven Zhu, Nathaly Rubio-Torio, Evelyn Gonzalez, Marilyn A. Fraser, Ming-Chin Yeh, Grace X. Ma, Olorunseun O. Ogunwobi, Yin Tan. A community-based liver cancer education initiative led to healthier dietary and alcohol use behaviors among racial/ethnic minority community members [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-161.

Empowering Low-Income Asian American Women to Conduct Human Papillomavirus Self-Sampling Test: A Community-Engaged and Culturally Tailored Intervention.

BackgroundAsian American women face disproportionate burden of cervical cancer (CC) than non-Hispanic white women in the U.S. The goal of this study was to assess the feasibility and impact of a culturally tailored intervention to promote Human papillomavirus (HPV) self-sampling test among hard-to-reach Asian American women.MethodsWe adopted the community-based participatory research (CBPR) approach to conduct this efficacy study. A total of 156 female participants (56 Chinese, 50 Korean, and 50 Vietnamese) were recruited from community-based organizations (CBOs) in the greater Philadelphia metropolitan area. The intervention components included HPV-related education, HPV self-sampling test kit and instructions, group discussions, and patient navigations, all available in Asian languages. We examined several outcomes, including the completion of HPV self-sampling, HPV-related knowledge, perceived social support, self-efficacy, and comfort with the self-sampling test at post-intervention assessment.ResultsThe majority of Asian American women had low annual household income (62.3% earned less than $20,000) and low educational attainment (61.3% without a college degree). We found significant increase in participants’ knowledge on HPV (baseline: 2.83, post: 4.89, P <.001), social support (baseline: 3.91, post: 4.09, P < .001), self-efficacy (baseline: 3.05, post: 3.59, P < .001), and comfortable with HPV self-sample test (baseline: 3.62, post: 4.06, P < .001).ConclusionTo the best of our knowledge, this is the first intervention study that promoted HPV self-sampling test among Asian American women. Our findings showed that CBPR culturally tailored intervention of self-sampling was highly effective in empowering low-income Asian American women to conduct HPV self-sampling tests.

Determinants and health implications of individuals' activity space experiences

AbstractPrevious research on the health impact of activity space assumed that individuals conduct daily activities outside residential neighborhoods. Little is known about whether and for whom this assumption holds, let alone whether neighborhood effects vary by individual activity space experiences. Using data in the Philadelphia metropolitan area, we identify four types of activity space experiences—individuals with extended activity space, confined activity space, no activity space, and unidentified activity space—and analyze the determinants of them. We then investigate how activity space experiences alter the relationship between neighborhood characteristics and self‐rated health. The findings suggest that (1) approximately 15% of respondents do not have activity space, (2) individual characteristics, such as gender, age, race, and poverty status, are associated with activity space experiences, and (3) for middle‐aged (35–64) and older adults (65+), neighborhood social capital matters less for the health of people with no activity space than for those with extended activity space.

Reconstruction of the Spring Hill Wildfire and Exploration of Alternate Management Scenarios Using QUIC-Fire

New physics-based fire behavior models are poised to revolutionize wildland fire planning and training; however, model testing against field conditions remains limited. We tested the ability of QUIC-Fire, a fast-running and computationally inexpensive physics-based fire behavior model to numerically reconstruct a large wildfire that burned in a fire-excluded area within the New York–Philadelphia metropolitan area in 2019. We then used QUIC-Fire as a tool to explore how alternate hypothetical management scenarios, such as prescribed burning, could have affected fire behavior. The results of our reconstruction provide a strong demonstration of how QUIC-Fire can be used to simulate actual wildfire scenarios with the integration of local weather and fuel information, as well as to efficiently explore how fire management can influence fire behavior in specific burn units. Our results illustrate how both reductions of fuel load and specific modification of fuel structure associated with frequent prescribed fire are critical to reducing fire intensity and size. We discuss how simulations such as this can be important in planning and training tools for wildland firefighters, and for avenues of future research and fuel monitoring that can accelerate the incorporation of models like QUIC-Fire into fire management strategies.

Harnessing electronic health records to study emerging environmental disasters: a proof of concept with perfluoroalkyl substances (PFAS)

Environmental disasters are anthropogenic catastrophic events that affect health. Famous disasters include the Seveso disaster and the Fukushima-Daiichi nuclear meltdown, which had disastrous health consequences. Traditional methods for studying environmental disasters are costly and time-intensive. We propose the use of electronic health records (EHR) and informatics methods to study the health effects of emergent environmental disasters in a cost-effective manner. An emergent environmental disaster is exposure to perfluoroalkyl substances (PFAS) in the Philadelphia area. Penn Medicine (PennMed) comprises multiple hospitals and facilities within the Philadelphia Metropolitan area, including over three thousand PFAS-exposed women living in one of the highest PFAS exposure areas nationwide. We developed a high-throughput method that utilizes only EHR data to evaluate the disease risk in this heavily exposed population. We replicated all five disease/conditions implicated by PFAS exposure, including hypercholesterolemia, thyroid disease, proteinuria, kidney disease and colitis, either directly or via closely related diagnoses. Using EHRs coupled with informatics enables the health impacts of environmental disasters to be more easily studied in large cohorts versus traditional methods that rely on interviews and expensive serum-based testing. By reducing cost and increasing the diversity of individuals included in studies, we can overcome many of the hurdles faced by previous studies, including a lack of racial and ethnic diversity. This proof-of-concept study confirms that EHRs can be used to study human health and disease impacts of environmental disasters and produces equivalent disease-exposure knowledge to prospective epidemiology studies while remaining cost-effective.

The influence of sea breeze on mold spore dispersion.

Background: Many allergists consider the ocean breeze to be free of allergens and recommend visits to the coast for relief; however, the coast may perpetuate an allergenic environment. Objective: This study investigated the sea breeze's impact on spore dispersion between coastal and inland sites, and the potential implications of sea breeze on human health and coastal resources. Methods: Spore sampling occurred during 2006 by using pollen samplers. Samplers were located at the Rutgers University Institute of Marine and Coastal Sciences Marine Field Station and the Rutgers University Pinelands Field Station. Statistical analysis was performed on the spore data to compare concentrations from the various locations. The effect of sea breeze circulation on particulate matter was analyzed from meteorological data collected in 2006. Sea breeze data were collected from simulations, Doppler radar, and meteorological towers at varying heights. Results: There was no significant difference between the total spore concentration at the New Jersey coast and the New Jersey Pinelands canopy. Conclusion: Sea breeze has been shown to favor aerobiologic transfers from coastal seawater to land, but the immediate environment (floor) still remains a primary determinant of affecting an individual's allergic airway disease. Results of some studies have shown that coastal environments may favor the onset allergic airway, but in our study this seemed to be equivalent to the floor (or immediate locale) of an individual affected with allergy. However, the sea breeze effect seemed to have the ability to impact allergic airway disease (AAD) populations not only living along the coasts but of those living up to 130 km inland and potentially those living in the Philadelphia metropolitan area.

126 Survey of equine pasture best management practices and soil fertility in southeast Pennsylvania

Proper pasture and grazing management can increase nutritive forage yield, decrease operational costs, and reduce nutrient and sediment runoff. However, management can be challenging in suburban areas where pastures may be small and overstocked. This study assessed pasture health and best management practices (BMPs) on suburban Pennsylvania horse farms. Participant farms (n = 28) in counties adjacent to the Philadelphia metropolitan area were recruited via social media, and 2–3 pastures/farm (72 in total; primarily used for grazing) were evaluated between November, 2019 and January, 2020 via soil testing, the USDA-NRCS Pasture Condition Score Sheet (PCSS), and the Penn State Equine Pasture Evaluation Disc (EPED). Farm managers were also surveyed about their pasture management practices. Pasture soil pH, soil nutrient, PCSS, and EPED data were transformed to normality and analyzed with linear models, with p-values adjusted for multiple comparisons by Monte Carlo simulation. Fixed effects included farm purpose (private or commercial); lime, fertilizer, and/or manure application; and whether the farm practiced rotational grazing. Covariates included total number of horses, number of hectares per farm, stocking rate, and farm. Mean ± s.e. pasture size was 0.68 ± 0.07 ha and mean stocking rate was 3.6 horses/hectare. Only 14% of farms had performed a soil test in the last 3yr, and less than 20% applied lime or fertilizer in that period. Three quarters of farm managers allowed horses to graze pastures to under 7.6 cm in height, and 54% reported using rotational grazing. Mean pasture soil pH was 6.18 ± 0.04, with 86% of pastures below optimum range. Soil pH was lower for pastures on private farms ( P = 0.06), and on fields where no lime ( P = 0.05) or fertilizer ( P < 0.01) was applied in the last 3yr. Mean soil P was 41.7 ± 4.0 ppm, with 50% of pastures below and 20% above optimum levels. Soil P was higher for pastures on personal farms ( P < 0.01), and fields with spread manure ( P < 0.01). Mean percent desirable and total vegetative cover scored via EPED were 56.0 ± 2.3 and 66.1 ± 2.8, respectively. Pasture health scored using PCSS was greatest for pastures where rotational grazing was used ( P = 0.03), although this effect did not influence percent desirable cover ( P = 0.68). Both PCSS and EPED scores were positively correlated (r = 0.571; P < 0.01) and both increased with decreasing stocking rate (r = −0.424; P < 0.01 and r = −0.294; P = 0.01, respectively). In summary, there appears to be low-to-moderate adoption of pasture BMPs among surveyed horse farms. Results of this study may be used to target educational programming for horse owners in suburban areas.

Presence of SARS-CoV-2 on the Surface of Fruits and Vegetables.

There is no information about whether the SARS-CoV-2 virus is present on the surface of fruits and vegetables obtained from grocery stores. The goal of this study is to determine if SARS-CoV-2 was present on the surfaces of produce in grocery stores in the Philadelphia metropolitan area during the peak pandemic period. Produce from 10 stores was swabbed and then analyzed for the presence of the virus. Of the 140 fruits and vegetables tested, only one fruit sample contained SARS-CoV-2 on its surface. The results indicate that the spread of the virus through contact with produce is highly unlikely.

What was the Prevalence of COVID-19 in Asymptomatic Patients Undergoing Orthopaedic Surgery in One Large United States City Mid-pandemic?

Many patients with coronavirus disease 2019 (COVID-19) are asymptomatic. The prevalence of COVID-19 in orthopaedic populations will vary depending on the time and place where the sampling is performed. The idea that asymptomatic carriers play a role is generalizable but has not been studied in large populations of patients undergoing elective orthopaedic surgery. We therefore evaluated this topic in one large, metropolitan city in a state that had the ninth-most infections in the United States at the time this study was completed (June 2020). This work was based on a screening and testing protocol that required all patients to be tested for COVID-19 preoperatively. (1) What is the prevalence of asymptomatic COVID-19 infection in patients planning to undergo orthopaedic surgery in one major city, in order to provide other surgeons with a framework for assessing COVID-19 rates in their healthcare system? (2) How did patients with positive test results for COVID-19 differ in terms of age, sex, and orthopaedic conditions? (3) What proportion of patients had complications treated, and how many patients had a symptomatic COVID-19 infection within 30 days of surgery (recognizing that some may have been missed and so our estimates of event rates will necessarily underestimate the frequency of this event)? All adult patients scheduled for surgery at four facilities (two tertiary care hospitals, one orthopaedic specialty hospital, and one ambulatory surgery center) at a single institution in the Philadelphia metropolitan area from April 27, 2020 to June 12, 2020 were included in this study. A total of 1295 patients were screened for symptoms, exposure, temperature, and oxygen saturation via a standardized protocol before surgical scheduling; 1.5% (19 of 1295) were excluded because they had COVID-19 symptoms, exposure, or recent travel based on the initial screening questionnaire, leaving 98.5% (1276 of 1295) who underwent testing for COVID-19 preoperatively. All 1276 patients who passed the initial screening test underwent nasopharyngeal swabbing for COVID-19 via reverse transcription polymerase chain reaction before surgery. The mean age at the time of testing was 56 ± 16 years, and 53% (672 of 1276) were men. Eighty-seven percent (1106), 8% (103), and 5% (67) were tested via the Roche, Abbott, and Cepheid assays, respectively. All patients undergoing elective surgery were tested via the Roche assay, while those undergoing nonelective surgery received either the Abbott or Cepheid assay, based on availability. Patients with positive test results undergoing elective surgery had their procedures rescheduled, while patients scheduled for nonelective surgery underwent surgery regardless of their test results. Additionally, we reviewed the records of all patients at 30 days postoperatively for emergency room visits, readmissions, and COVID-19-related complications via electronic medical records and surgeon-reported complications. However, we had no method for definitively determining how many patients had complications, emergency department visits, or readmissions outside our system, so our event rate estimates for these endpoints are necessarily best-case estimates. A total of 0.5% (7 of 1276) of the patients tested positive for COVID-19: five via the Roche assay and two via the Abbott assay. Patients with positive test results were younger than those with negative results (39 ± 12 years versus 56 ± 16 years; p = 0.01). With the numbers available, we found no difference in the proportion of patients with positive test results for COVID-19 based on subspecialty area (examining the lowest and highest point estimates, respectively, we observed: trauma surgery [3%; 2 of 68 patients] versus hip and knee [0.3%; 1 of 401 patients], OR 12 [95% CI 1-135]; p = 0.06). No patients with negative preoperative test results for COVID-19 developed a symptomatic COVID-19 infection within 30 days postoperatively. Within 30 days of surgery, 0.9% (11 of 1276) of the patients presented to the emergency room, and 1.3% (16 of 1276) were readmitted for non-COVID-19-related complications. None of the patients with positive test results for COVID-19 preoperatively experienced complications. However, because some were likely treated outside our healthcare system, the actual percentages may be higher. Because younger patients are more likely to be asymptomatic carriers of disease, surgeons should emphasize the importance of taking proper precautions to prevent virus exposure preoperatively. Because the rates of COVID-19 infection differ based on city and time, surgeons should monitor the local prevalence of disease to properly advise patients on the risk of COVID-19 exposure. Further investigation is required to assess the prevalence in the orthopaedic population in cities with larger COVID-19 burdens. Level III, therapeutic study.