Western Pennsylvania Research Articles

Opioid Overdoses and Take-Home Naloxone Interventions: Ethnographic Evidence for Individual-Level Barriers to Treatment of Opioid Use Disorders in Rural Appalachia

Introduction: Research indicates that take-home naloxone (THN) is saving lives across rural Appalachia, but whether it also results in treatment for opioid use disorders (OUDs) remains unclear. This study involves a detailed qualitative analysis of interviews with 16 individuals who had overdosed on opioids 61 times to understand why a THN intervention does not routinely lead to OUD treatment. Methods: This study builds upon a one-year (2018) qualitative study on community responses to opioid overdose fatalities in four adjacent rural counties in Western Pennsylvania. Using a semi-structured interview guide, 16 individuals who had experienced one or more overdoses were interviewed. Using NVivo, the transcribed audio-recorded interviews were coded, and a thematic analysis of the coded text was conducted. Findings: Findings reveal that of the 29 overdoses that included a THN intervention, only eight resulted in treatment. The analysis derives five individual-level barriers to treatment: (1) opioid dependence, (2) denial/readiness, (3) opioid withdrawal fears, (4) incarceration concerns, and (5) stigma and shame. These barriers impeded treatment, even though all the interviewees knew of treatment programs, how to access them, and in some cases had undergone treatment previously. Discussion and Conclusion: findings indicate that there is evidence that the five barriers make entering treatment after a THN intervention challenging and seemingly insurmountable at times. Recommendations based on the findings include increasing efforts to reduce stigma of OUDs in the community, including self-stigma resulting from misusing opioids, increasing informational efforts about Good Samaritan Laws, and increasing familiarity with medication-assisted treatments for OUDS.

AHN LifeFlight, 45 Years in the Making: Current Condition and Capabilities of Air Medical Transport.

In Pittsburgh, Pennsylvania, the skies have become a battleground against time in a world where every second counts. Since its inception in 1978, a revolution has occurred in emergency medical services, with LifeFlight Helicopters soaring to new heights in emergency treatment and transport. This article will explore the transformation of helicopter emergency medical services through the decades, where every rotor blade spins with a mission to save lives and rewrite the rules of survival. Allegheny Health Network's LifeFlight is a rotor-wing (helicopter) aeromedical transport service that provides rapid emergent transport for critically ill and injured persons. The program hub of operations is primarily in Western Pennsylvania. Since its inception in 1978, the program has grown and transformed into the sophisticated, highly technical, expanded scope of practice, critical care transport service it is today. The crews spend a significant portion of clinical care focusing on preparing the patient to survive the transport and ensure stability during transit; this phase of transport is equally crucial as the patient care during the actual flight. This article introduces the evolution and innovations that LifeFlight's medical crews and aviation practices have undergone since the program started.

Abstract 748: Impact of oral supplementation of sulforaphane for 12 months on lung cancer-related gene expression in former smokers at high risk for lung cancer: Results from a randomized placebo-controlled phase II clinical trial

Abstract Introduction: Higher consumption of dietary sulforaphane (SFN), a phytochemical found in many cruciferous vegetables, has been shown to be associated with lower risk of lung cancer (LC). SF activates the NRF2-pathway, which initiates cellular detoxification, antioxidant, and anti-inflammatory responses. To date, no chemoprevention trial for LC has examined the impact of SFN on LC-related gene expression (GE) as an endpoint in nasal and bronchial tissue. The objective of our study was to examine whether oral intake of SF for 12 months impacts the GE of previously identified LC- and premalignant lesions (PML)-related genes in bronchial and nasal brushing samples. Methods: A randomized, placebo-controlled clinical trial (NCT03232138) was conducted in former smokers with ≥ 30 pack-years and quitting smoking for 1-10 years in Western Pennsylvania, USA. Forty-three subjects were randomly assigned to the SFN treatment (n = 21) or placebo group (n = 22) in 2018-2022. Each participant was instructed to take 4 Avmacol® or identical placebo capsules BID for 12 months. Each Avmacol® capsule contained 15 mg of glucoraphanin, which yielded a daily internal dose of 120 μmol SFN. Nasal swabs and bronchial brushings were obtained at baseline and after 12 months. Among the 37 participants who completed the study, RNA was extracted from their nasal swabs and bronchial brushings. We constructed single sample gene signature scores (GSS) using the GSVA algorithm for the following: 1) the NRF2-pathway, 2) genes associated with LC risk in bronchial biopsies, and 3) genes associated with PML. The genes in these sets were stratified by their up- or down-regulation in LC or PML. We evaluated the association between the interaction of SFN supplementation over time (pre-/post-treatment) on GSS using linear mixed models, adjusted for the fixed effects of age at baseline, RNA integrity number (RIN), packyears of smoking, and random effect of participant. Results: GE data was available for 31 participant pairs with bronchial and/or nasal samples. Within nasal tissue, SFN treatment increased both the GSSs of the NRF2-pathway (p=0.0089) and the downregulated LC-risk genes (p=0.0047), and decreased the upregulated LC-risk genes (p=0.012) over time, whereas SFN had no significant impact on GSSs of the NRF2-pathway and LC-risk genes in the bronchial tissue. No association between SFN treatment over time and the PML-related GSS was observed in nasal or bronchial tissue. Conclusion: Our initial analysis indicates that SFN treatment over 12 months impacted LC-associated GE in nasal tissue but not in bronchial tissue from former smokers. The discrepancy results may be due to small sample size and additional studies are warranted to confirm if SFN has direct impact on LC-risk related genes in bronchial tissue (NIH grant No. R01CA213123). Citation Format: Kathryn Demanelis, Avrum Spira, Yohana Kefella, Renwei Wang, Jennifer Adams-Haduch, Thomas W. Kensler, Jennifer E. Beane, David O. Wilson, Jian-Min Yuan. Impact of oral supplementation of sulforaphane for 12 months on lung cancer-related gene expression in former smokers at high risk for lung cancer: Results from a randomized placebo-controlled phase II clinical trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 748.

I’m still me, I’m still a person: war metaphor use and meaning making in women with metastatic breast cancer

PurposeThe war metaphor is one strategy used frequently in breast cancer to inspire individuals in a “fight” against cancer and assist patients in navigating their illness experience. Despite prominent use, the emotional impact of this language has not been examined in the context of meaning making among women with metastatic breast cancer (MBC).MethodsThis study involved a semi-structured interview considering the war metaphor’s impact on women’s illness experience with MBC. Participants (n = 22) had been diagnosed with MBC for at least 6 months or following 1 disease progression and were undergoing treatment at an NCI-designated cancer center in Western Pennsylvania at the time of interview. Each participant underwent an individual interview exploring the war metaphor’s impact on illness experience. Qualitative thematic analysis was performed to assess feelings about the war metaphor and emotional response to the lived experience of cancer.ResultsTwo themes were identified surrounding metaphor use and participants’ experiences with meaning making in cancer. First, women with MBC perceive the diagnosis as an “unfair fight” due to its incurable nature. Second, patients use alternative language of “living life” and communicate resistance to being defined by their cancer diagnosis.ConclusionWar metaphors are one collection of terminology people use to understand their diagnosis. However, their use may apply pressure to prioritize positivity in the face of diagnosis and treatment, in a unique clinical context where this may not be adaptive. These findings affirm a need to consider patients’ lived experiences to best facilitate psychological adjustment to illness.

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely

ObjectiveExamine the frequency and cost of procedural clearance tests and exams in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the US. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts post-surgical adverse events. DesignRetrospective health care claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania, USA. ParticipantsMembers aged ≥65 years who were continuously enrolled 6 months before and after having cataract surgery from 2018 through 2021 and had approved surgery claim(s). MethodsPreoperative exams or tests occurring in the 30 days prior to surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., CPT codes for blood panels and preprocedural ICD-10 CM codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. Main Outcome MeasuresTotal costs, prevalence, and strength of association as indicated by odds ratios. ResultsUp to 42% of members having cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed either in isolation or along with clearance visit(s). The combined costs for the preoperative visits and tests were $4.3M (approximately $107-114 per impacted member). There was little difference in member characteristics between those receiving and not receiving either preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member’s care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. ConclusionsRates of routine preoperative testing before cataract surgery have not declined despite intervening guidance from the Choosing Wisely campaign to reduce this utilization. Additionally, preoperative evaluations, many likely unnecessary, were very common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level.

Improving Access to Comprehensive Care for Pediatric Sickle Cell Patients through the Creation of Multispecialty Clinics

There are many barriers to health care for those in underserved populations such as the pediatric sickle cell population. Due to limitations of transportation, clinical availability, and lack of care coordination, pediatric sickle cell patients are at an increased risk of not receiving the extensive multi-subspecialty health care recommended to prevent potential sickle cell related complications that affect every organ system. To improve access to this multidisciplinary care, UPMC Children's Hospital of Pittsburgh (CHP) pediatric sickle cell program developed a multi-subspecialty collaborative clinic model to offer coordinated sickle cell and pulmonary care, which is critical for sickle cell patients due to the increased risk of pulmonary complications associated with sickle cell disease. By considering health care barriers experienced by our pediatric sickle cell population, we proposed that this coordinated subspecialty clinic model will increase compliance by offering patients and families the opportunity to receive synchronized care from two essential subspecialty groups in just one medical center trip. This increased access to preventative health care for the pediatric sickle cell population should contribute to decreased acute medical events that require critical care and other extensive resources within the health care system. Methods: Two adjacent clinic appointments within the sickle cell and pulmonology clinics were designated for sickle cell patients also requiring preventative pulmonary care to be seen consecutively by both clinical teams during the same half day (one in sickle cell clinic and one in pulmonary clinic). The effect of improving completed referrals using this multi-specialty clinic model was assessed by retrospective electronic medical record review comparing the number of pulmonology referrals made by SCD team and pulmonary visits completed pre- and post- coordinated multi-subspecialty clinic initiative. The studied time period prior to the multispecialty clinic creation was chosen to be calendar year 2019 in order to eliminate the variable of the COVID-19 pandemic affecting outpatient clinic participation. Post-intervention data were collected during calendar year 2022 soon after the creation of this multi-subspecialty initiative. Prior to the creation of this multi-subspecialty clinic model, coordinating CHP sickle cell and pulmonology care, only 24% of pediatric sickle cell patients referred for outpatient pulmonology consultation completed the clinical evaluation. Our program referred 53 of 168 total families during calendar year 2019, with only 17 patients completing their visit. Since beginning this multi-subspecialty clinic initiative, pulmonology evaluations completed by referred sickle cell patients increased to 55%. Thus, CHP's multispecialty clinic offering coordinated sickle cell and pulmonology care increased completed pulmonology referrals by 129%. Using Pearson's chi-square test to compare the relationship between the two categorical variables of prior- and post- multispecialty clinic formation with a null hypothesis of multispecialty clinics will not increase completed referrals, we found a value of 10.76, which is greater than the applied critical value of 9.21 (p=0.01). Therefore, these results are significant, and the null hypothesis was rejected. In summary, by establishing this multi-subspecialty coordinated care at CHP for our pediatric sickle cell population, our goal of improving compliance with critical preventive care was achieved. We hope that this type of intervention will enhance the quality of life for children with sickle cell disease currently, as well as contribute to better health in the patients' futures. We also predict that this improved preventive care will also contribute to decreased emergency care and extensive treatments required for patients cared by CHP. This multi-subspecialty care model also has the potential to benefit other pediatric patients with chronic diseases from underserved populations who experience similar barriers, both in CHP's Western Pennsylvania region as well as underserved populations and health care organizations beyond our region. By applying an approach to care focused on reducing health care barriers to underserved populations, impactful improvements may be seen not only in the pediatric sickle cell population, but in the health care system at large.

Post-Immune Tolerance Induction Prophylactic FVIII Infusions May Not be Necessary for Tolerized Hemophilia a Patients on Emicizumab

Background: Hemophilia A is a hereditary bleeding disorder characterized by low factor VIII (FVIII) activity. Patients with severe bleeding phenotypes are at risk for significant bleeding-related morbidity and mortality including the development of hemophilic arthropathy. In recent years, prophylaxis with emicizumab, a bispecific monoclonal antibody, has supplanted prophylactic FVIII infusions due to its ease of self-administration, long half-life, and low annual bleeding rate (ABR), independent of tolerization status to alloantibodies against FVIII (inhibitors). However, it is unclear if emicizumab FVIII-mimic activity is sufficient to achieve hemostasis in moderate-severe bleeds, and therefore, FVIII replacement may still be necessary. Despite its well-established benefits, the use of emicizumab in previously untreated patients (PUPs), and patients with under 20 exposures to FVIII is still not well understood due to a lack of long-term experience and understanding of its impact on the pathophysiology of FVIII inhibitors. Further investigation is also needed regarding the risk of inhibitor recurrence in patients with previous inhibitors and the concomitant use of emicizumab. At our institution, patients on emicizumab with a history of inhibitors do not continue post-immune tolerance induction prophylactic FVIII infusions. We also initiate emicizumab before 20 exposures to FVIII, and sometimes before immune tolerance induction (ITI). We explored our patient population to understand inhibitor incidence and recurrence amidst emicizumab prophylaxis. Methods: We performed a single center retrospective analysis of patients served by the Hemophilia Center of Western Pennsylvania. We identified patients with Hemophilia A on emicizumab prophylaxis. Relevant data was collected including demographics, inhibitor status at time of transition to emicizumab and in the available follow-up period, bleeding events after transition, and number of FVIII exposures before and after transition. Inhibitor recurrence was defined as laboratory evidence of inhibitor using chromogenic Bethesda assay and/or unexplained breakthrough bleeding events despite on-demand FVIII infusions. Results: Data was reviewed for 36 patients on emicizumab prophylaxis. Three patients were lost to follow-up. Median age was 15.3 years (range 1.2 - 82). Median follow-up time on emicizumab was 3.5 years (range 0.5 - 5). Two patients had < 20 FVIII exposures prior to emicizumab, and one of those had an inhibitor before emicizumab. In total, 15 patients (45%) were diagnosed with an inhibitor prior to emicizumab. Of these, 8 patients (53%) were tolerized prior to emicizumab, and 7 patients (47%) were not tolerized prior to emicizumab. Median peak inhibitor titer was 4.2 Bethesda units (range 0.7 - 281 Bethesda units). After transition to emicizumab, no tolerized patients for which inhibitor status was tested during the follow-up period had inhibitor recurrence, and 1 non-tolerized patient's inhibitor became undetectable after 4 years of emicizumab therapy (the same patient who had developed an inhibitor with < 20 FVIII exposures prior to emicizumab). Mean ABR was 0.33 events/year for tolerized patients (median 0, range 0 - 3); 0.17 events/year for non-tolerized patients (median 0, range 0 - 1); and 0.60 events/year for patients with no history of inhibitor (median 0, range 0 - 4). Mean number of FVIII exposures per year was 0.09 for tolerized patients (median 0, range 0 - 1); 0.07 for non-tolerized patients (median 0, range 0 - 1); and 1.2 for patients with no history of inhibitor (median 0, range 0 - 20). Conclusion: In our small cohort, no patient who was tolerized prior to emicizumab had recurrence of clinical or laboratory evidence of inhibitor while on emicizumab therapy, despite infrequent exposure to FVIII infusion. We did not have enough power to determine whether patients with < 20 FVIII exposures before emicizumab developed inhibitors, though one such patient had inhibitor resolution on emicizumab without ITI. Consistent with other works, overall ABRs in all patients on emicizumab therapy were low. These findings add to other studies on the safety of emicizumab and its impact on the natural history of FVIII inhibitors. Our study also suggests that continuing post-ITI prophylactic FVIII infusions in tolerized patients on emicizumab may not be necessary. Larger-scale studies are required to substantiate our findings.

Stakeholder perspectives on six identified interpersonal communication components of patient navigation in breast cancer care.

Although identified as a key competency domain and a needed area of professional development, interpersonal communication in breast cancer care patient navigation is understudied. Moreover, the patient-navigator relationship may be influenced by the interpersonal communication skills and behaviors of the patient navigator. This paper reports on the interpretation step of a concept mapping study, where key stakeholders shared their perspectives on six identified interpersonal communication components of breast cancer care patient navigation. This study utilized concept mapping, a community-engaged mixed method approach. After conducting brainstorming, sorting, and concept mapping analysis, a six-cluster concept map of interpersonal communication in breast cancer care patient navigation was identified. Interpretation sessions with each participant group (patients, patient navigators, administrators) allowed both naming and more in-depth exploration of the six clusters. The sessions were led by a facilitator, the PI, and were audio recorded and transcribed. Six 2-h interpretation sessions were conducted with 21 participants, including patients with breast cancer, breast cancer patient navigators (lay or medically trained), and patient navigation administrators from Western Pennsylvania. Through a group consensus process, the six clusters were named. Participants identified that all six identified components were essential to patient navigation, but the ability to build patient-centered trust and relationships and maintain professional communication were the most impactful components of the patient-navigator relationship. These findings validate the importance of interpersonal skills and behaviors of patient navigators in breast cancer care. These findings can inform the patient navigation role description, competencies, and the development of curriculum for training and metrics for evaluation.

Mapping the Environmental Risk of Beech Leaf Disease in the Northeastern United States.

The recently emerged beech leaf disease (BLD) is causing the decline and death of American beech in North America. First observed in 2012 in northeast Ohio, U.S.A., BLD had been documented in 10 northeastern states and the Canadian province of Ontario as of July 2022. A foliar nematode has been implicated as the causal agent, along with some bacterial taxa. No effective treatments have been documented in the primary literature. Irrespective of potential treatments, prevention and prompt eradication (rapid responses) remain the most cost-effective approaches to the management of forest tree disease. For these approaches to be feasible, however, it is necessary to understand the factors that contribute to BLD spread and use them in estimation of risk. Here, we conducted an analysis of BLD risk across northern Ohio, western Pennsylvania, western New York, and northern West Virginia, U.S.A. In the absence of symptoms, an area cannot necessarily be deemed free of BLD (i.e., absence of BLD cannot be certain) due to its fast spread and the lag in symptom expression (latency) after infection. Therefore, we employed two widely used presence-only species distribution models (SDMs), one-class support vector machine (OCSVM), and maximum entropy (Maxent) to predict the spatial pattern of BLD risk based on BLD presence records and associated environmental variables. Our results show that both methods work well for BLD environmental risk modeling purposes, but Maxent outperforms OCSVM with respect to both the quantitative receiver operating characteristics (ROC) analysis and the qualitative evaluation of the spatial risk maps. Meanwhile, the Maxent model provides a quantification of variable contribution for different environmental factors, indicating that meteorological (isothermality and temperature seasonality) and land cover type (closed broadleaved deciduous forest) factors are likely key contributors to BLD distribution. Moreover, the future trajectories of BLD risk over our study area in the context of climate change were investigated by comparing the current and future risk maps obtained by Maxent. In addition to offering the ability to predict where the disease may spread next, our work contributes to the epidemiological characterization of BLD, providing new lines of investigation to improve ecological or silvicultural management. Furthermore, this study shows strong potential for extension of environmental risk mapping over the full American beech distribution range so that proactive management measures can be put in place. Similar approaches can be designed for other significant or emerging forest pest problems, contributing to overall management efficiency and efficacy.

Identifying Psychosocial Risk Factors in Maternal Substance Use in Western Pennsylvania

Identifying Psychosocial Risk Factors in Maternal Substance Use in Western Pennsylvania

Association between trauma triage and time-to-vaso-occlusive events in patients with sickle cell disease after traumatic injury: a retrospective study

IntroductionSickle cell disease (SCD) is associated with vaso-occlusive events (VOEs) that can lead to disease complications, including early mortality. Given that similar inflammatory responses characterize VOE and traumatic injury, injured...

Examining oncologist involvement in a nurse-led primary palliative care intervention.

264 Background: Patients with advanced cancer are recommended to receive palliative care (PC) early, but a limited PC specialty workforce limits feasibility. Primary PC, administered by providers outside the PC specialty, has been proposed as a way to increase access to PC. However, prior studies of primary PC have not demonstrated benefit, possibly due to lack of collaboration within the care team. We examine oncologist involvement in the largest primary PC study to date, where primary PC was delivered by oncology nurses. Methods: CONNECT (NCT02712229) was a cluster-randomized controlled trial of a primary PC intervention conducted at 17 community oncology clinics in Western Pennsylvania from 2016-2020. Selected clinic nurses (N=23) were trained to deliver up to 3 monthly primary PC visits, formulating a care plan after each visit. Nurses were asked to update the patient’s oncologist after each visit and to document this communication. We use descriptive statistics to examine level of oncologist involvement in these primary PC visits, based on nurse documentation. Results: Of 336 patients randomized to receive the primary PC intervention, 266 completed at least one study visit, and 233 (87.6%) had at least one visit where the nurse reported updating the oncologist afterwards. Of 674 total study visits, nurses reported updating the oncologist in 553 (82.0%) of them, most commonly in person (77.0%), followed by email (13.4%) and phone (9.6%). For in person or phone exchanges, mean length of interaction was 8.3 (SD 5.7) minutes, with a median of 5.0 minutes. For visits where communication occurred between the nurse and oncologist, the nurse reported presenting their specific care plan only 29.5% of the time (163/553 visits). In 96.9% (158/163) of cases, the oncologist was reported as receptive to the presented care plan, with no further details given in the 5 instances where the oncologist was reported as not receptive. When the oncologist was receptive to the care plan, it was reported that no changes were made by the oncologist in 94.3% (149/158) of cases. In the handful of cases where changes were made, changes involved ordering additional tests (3), changes to non-oncologic medications or therapeutics (2), involving other providers (1), changing oncologic treatment (1), and modifying the patient’s visit schedule (1). Conclusions: In a large trial of oncology nurse-led primary PC, oncologist involvement in care plans was not robust. More extensive team collaboration may be required in future primary PC interventions to increase the efficacy of primary PC. Clinical trial information: NCT02712229 .

Rurality and Atrial Fibrillation: Patient Perceptions of Barriers and Facilitators toCare.

Background Patients experience atrial fibrillation (AF) as a complex disease given its adversity, chronicity, and necessity for long-term treatments. Few studies have examined the experience of rural individuals with AF. We conducted qualitative assessments of patients with AF residing in rural, western Pennsylvania to identify barriers and facilitators to care. Methods and Results We conducted 8 semistructured virtual focus groups with 42 individuals living in rural western Pennsylvania using contextually tailored questions to assess participant perspectives. We inductively analyzed focus group transcripts using paragraph-by-paragraph and focused coding to identify themes with the qualitative description approach. We used Krippendorff α scoring to determine interreviewer reliability. We harnessed investigator triangulation to augment the reliability of our findings. We reached thematic saturation after coding 8 focus groups. Participants were 52.4% women, with a median age of 70.9 years (range, 54.5-82.0 years), and most were White race (92.9%). Participants identified medication costliness, invisibility of AF to others, and lack of emergent transportation as barriers to care. Participants described interpersonal support and use of technology as important for AF self-care, and expressed ambivalence about how relationships with health care providers affected AF care. Conclusions Focus group participants described multiple social and structural barriers to care for AF. Our findings highlight the complexity of the experience of individuals with AF residing in rural western Pennsylvania. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04076020.

Digital hypertension management: clinical and cost outcomes of a pilot implementation of the OMRON hypertension management platform.

Home monitoring of blood pressure (BP) in hypertensive patients can improve outcomes, but challenges to both patient compliance and the effective transmission of home BP readings to physicians can limit the extent to which physicians can use this information to improve care. The OMRON Hypertension Management Platform (OMRON HMP) pairs a home BP cuff with a digital product that tracks data, provides reminders to improve patient compliance, and provides a streamlined source of information to physicians. The primary objective of the quality improvement (QI) project was to test the hypothesis that use of the OMRON HMP could reduce the number and cost of hypertension related claims, relative to a retrospectively matched cohort of insured members. A secondary objective was to demonstrate improvement in control of BP among patients. Eligible members were recruited to the QI project between December 1, 2018 and December 30, 2020 and data collected for six months following recruitment. All members received the OMRON HMP intervention. Enrollment and data collection were coordinated on-site at selected PCP partner providers in Western Pennsylvania. Eligible members were identified from insurance claims data as those receiving care for primary hypertension from participating primary care physicians and/or cardiologists. Eligible members were between the ages of 35 and 85, with a diagnosis of primary hypertension. The retrospective cohort was selected from electronic medical records of Highmark-insured patients with hypertension who received care at Allegheny Health Network (AHN), a subsidiary of Highmark Health. Members were matched on baseline BP and lipid measures, age, smoking status, diabetes status, race and sex. Daily home BP readings were recorded by the OMRON HMP app. Patient data was reviewed by clinical staff on a weekly basis and treatment plans could be adjusted in response to this data. OMRON HMP users showed a significant increase in the number and cost of hypertension-related claims, contrary to the hypothesis, but did display improvements in control of BP. The use of a digital platform to facilitate at-home BP monitoring appeared to improve BP control but led to increased hypertension-related costs in the short-term.

Mapping the Gap: Understanding the Need for Occupational Therapy Among Older Adults With Visual Impairment.

Visual impairment (VI) affects more than 9 million Americans age 65 yr and older, and it limits meaningful participation in daily living. Occupational therapy can have a considerable impact on the functional performance of those with VI; however, information is limited on the existing occupational therapy services available for older adults with VI across the United States. To calculate the prevalence of VI by U.S. county and quantify and locate the existing occupational therapy practitioners with certification in vision rehabilitation. Synthetic estimation was used to calculate the prevalence of VI among those age 65 yr and older in the United States by county. Geographic Information Systems mapping was used to illustrate the prevalence of VI and availability of occupational therapy practitioners with specialized training in vision rehabilitation by U.S. town. Communities with high concentrations of older adults with VI were more prevalent in the center of the United States, whereas occupational therapy practitioners with specialty training in vision rehabilitation were concentrated primarily on the east coast of the United States, on both Florida coasts, in selected cities in Texas and California, in western Pennsylvania, and in Alabama. The availability of occupational therapy practitioners with specialty training in vision rehabilitation does not match the visual rehabilitation needs of older adults in the United States. These findings can be used to prioritize efforts for new service provision, provide outreach to underserved populations, and guide occupational therapy education to improve access to vision rehabilitation throughout the United States. What This Article Adds: The data provided in this study can inform resource allocation, workforce development, and entry-level occupational therapy education to address the ongoing needs of older adults with VI.

Environmental exposures and mismatch repair status in a western Pennsylvania endometrial cancer cohort (155)

Environmental exposures and mismatch repair status in a western Pennsylvania endometrial cancer cohort (155)

Odds of COVID-19-associated asthma exacerbations in children higher during Omicron wave.

We aimed to determine the association of COVID-19 variant wave with asthma exacerbations in children with asthma. We conducted a retrospective cross-sectional study of children in the Western Pennsylvania COVID-19 Registry (WPACR). We extracted data for all children in the WPACR with asthma and compared their acute clinical presentation and outcomes during the Pre-Delta (7/1/20-6/30/21), Delta (8/1/21-12/14/21), and Omicron (12/15/21-8/30/22) waves. We conducted multivariable logistic regression analyses of SARS-CoV-2-associated asthma exacerbations, adjusting for characteristics that have been associated with COVID-19 outcomes in prior studies. Among 573 children with asthma in the WPACR during the study period, the proportion of children with COVID-19 who had an asthma exacerbation was higher during the Omicron wave than during the prior two variant waves (40.2% vs. 22.6% vs. 26.2%, p = 0.002; unadjusted OR = 2.12 [95% confidence interval (CI) = 1.39-3.22], p < 0.001). In our multivariable regression models, the odds of an asthma exacerbation were 2.8 times higher during the Omicron wave than during prior waves (adjusted OR = 2.80 [95% CI = 1.70-4.61]). Results were similar after additionally adjusting for asthma severity but were no longer significant after additionally adjusting for poor asthma control. The proportion of children with asthma experiencing an asthma exacerbation during SARS-CoV-2 infection was higher during Omicron than prior variant waves, adding to the body of evidence that COVID-19-associated respiratory symptoms vary by variant. These findings provide additional support for vaccination and prevention.

A multisite, quasiexperimental trial of a college course to support student mental health during the COVID-19 pandemic.

The purpose of this study was to investigate the acceptability, appropriateness, feasibility, and preliminary effectiveness of a three-credit college Wellness and Resilience Course (WRC) for improving student mental health and well-being outcomes in the context of the coronavirus disease 2019 (COVID-19) pandemic. Undergraduate students aged 18-24 years old on five campuses in Western Pennsylvania or West Virginia who had either enrolled in the WRC (n = 81) or were attending university as usual (i.e., not enrolled in the WRC; n = 171) participated in surveys at baseline (beginning of semester), end of semester, and 3-month follow-up during the Spring and Fall 2020 semesters. Overall, students rated the WRC as acceptable, appropriate, and feasible. From baseline to the end of semester, students who received the WRC reported significant improvements in psychological flexibility (d = 0.30), mindfulness (d = 0.42), distress tolerance (d = 0.36), and use of dysfunctional and adaptive coping skills (d = 0.32), compared with students who did not receive the WRC. At follow-up, all gains remained statistically significant and students who received the WRC additionally reported significant improvements in stress (d = 0.44) and life satisfaction (d = 0.35) compared with students who did not receive the WRC. These findings offer preliminary evidence that college courses focused on mental wellness may be an important component of campus strategies to increase universal access to mental health support and skills. This study was registered on clinicaltrials.gov on April 8, 2020.

Hysong v. Gallitzin Borough School District: Industrialization, Immigration, and Nativism Converge in Gallitzin, Pennsylvania

ABSTRACT This article examines the convergence of industry, immigrants, and nativists in a public school in the Western Pennsylvania town of Gallitzin in the mid-1890s. In the court system, the Junior Order of the United American Mechanics, a nativist group, challenged the Gallitzin School District’s employment of the Sisters of St. Joseph as teachers in the public schools. This article explores the events leading up to the initial county trial; public school life in Gallitzin at the time as portrayed in the witnesses’ testimony at the trial; and its aftermath.

The role of relatedness: Applying a developmental-relational view of compassion in adolescence

Developmental-relational theories of adolescence suggest that receiving compassion from others promotes an internalized sense of relatedness with others, which in turn can support extending compassion toward others. Given that adolescence is marked by an expanding social environment, this may be a particularly salient time for a young person's social-ecology to impact their motivation to express compassion. We explore this hypothesis using a yearlong, three-wave longitudinal dataset from 599 adolescents (Mage = 16.3 years; 49% girls; 80% White) who attended high school in a suburban area of western Pennsylvania. Autoregressive, cross-lagged panel analyses indicated that adolescents' perceptions of receiving compassion from others at the beginning of the school year was associated with an increased sense of relatedness in the middle of the year, which in turn predicted greater extending compassion for others at the end of the year. Implications for applying a developmental-relational view to research and intervention efforts on compassion in adolescence are discussed.