Western Pennsylvania Research Articles

Clinical subgroup clustering analysis in a systemic lupus erythematosus cohort from Western Pennsylvania.

Systemic lupus erythematosus (SLE) is a complex heterogenous autoimmune disease that can affect multiple organs. We performed clinical clustering analysis to describe a lupus cohort from the University of Pittsburgh Medical Center. A total of 724 patients who met the American College of Rheumatology (ACR) classification criteria for SLE were included in this study. Clustering was performed using the ACR classification criteria and the partitioning around medoid method. Correlation analysis was performed using the Spearman's Rho test. Patients with SLE in our cohort identify three district clinical disease subsets. Patients in cluster 1 were significantly more likely to develop renal and hematologic involvement, and had overrepresentation in African-American and male lupus patients. Clusters 2 and 3 identified a milder disease, with a significantly less likelihood of organ complications. Patients in cluster 2 are characterized by malar rash and photosensitivity, while patients in cluster 3 are characterized by oral ulcers, which is present in ~90% of patients within this cluster. The presence of photosensitivity or oral ulcers appears to be protective against the development of lupus nephritis in our cohort. We describe a large cohort of SLE from Western Pennsylvania and identify three distinct clinical disease subgroups. Clustering analysis might help to better manage and predict disease complications in heterogenous diseases like lupus.

Kidney and Mortality Outcomes Associated with Ondansetron in Critically Ill Patients

Background: Ondansetron is a preferred anti-emetic in critical care to treat nausea and vomiting, and has historically been considered a largely safe option. A recent pharmacoepidemiology study reported that ondansetron may be associated with an increased risk for acute kidney injury (AKI). Methods: We interrogated the High-Density Intensive Care (HiDenIC-15) database containing intensive care data for 13 hospitals across Western Pennsylvania between Oct 2008-Dec 2014. AKI was defined using the Kidney Disease, Improving Global Outcomes 2012 guidelines. Ondansetron use was considered as receiving any form of ondansetron within 24 h of admission. The subsequent 48 h (hours 25-72 after admission) were analyzed for outcomes. Primary outcome was development of AKI; secondary outcomes included 90-day mortality and time to AKI. Propensity-matched, multivariate logistic regression was applied for both outcomes. Comparator groups were metoclopramide and prochlorperazine using the same exposure criteria. Results:AKI occurred in 965 (5.6%), 12 (3.0%), and 61 (6.5%) patients receiving ondansetron, prochlorperazine, and metoclopramide, respectively. In the adjusted analysis, no anti-emetic was associated with a significant change in the odds of developing AKI. Ondansetron was associated with a 5.48% decrease (CI -6.17--4.79) in death within 90 days of ICU-admission, which was independent of AKI status; an effect not seen with other anti-emetics. Anti-emetic usage was not associated with a change in the time to first AKI. Conclusion:Anti-emetic usage did not alter AKI risk. Ondansetron was associated with a significant decrease in 90-day mortality that was not seen by other anti-emetics, which requires further exploration.

Banished from Johnstown: Racist Backlash in Pennsylvania

Banished from Johnstown: Racist Backlash in Pennsylvania

The Ocean Floor

The Ocean Floor Carolyn Supinka (bio) Carolyn Supinka, strip, graphic, ocean floor, ocean, the deep sea Click for larger view View full resolution [End Page 73] Click for larger view View full resolution [End Page 74] Click for larger view View full resolution [End Page 75] Click for larger view View full resolution [End Page 76] Carolyn Supinka CAROLYN SUPINKA is a writer and visual artist from western Pennsylvania. She currently lives in Portland, Oregon, where she creates poems, comics, and prints, and works as an arts administrator. She is the author of the chapbook When I Interview Fire, published by Bottlecap Press in 2022, and the microchapbook Inside Voice, published by Ghost City Press in 2021. Her work has recently been published in Hobart, the West Review, Birdcoat Quarterly, and Sixth Finch, and is forthcoming in Passages North. She is the coeditor of Conjunction, a zine collaborative. Copyright © 2022 University of North Carolina Wilmington

From Captives to Consuls: Three Sailors in Barbary and Their Self-Making across the Early American Republic, 1770–1840 by Brett Goodin

Reviewed by: From Captives to Consuls: Three Sailors in Barbary and Their Self-Making across the Early American Republic, 1770–1840 by Brett Goodin Konstantin Dierks From Captives to Consuls: Three Sailors in Barbary and Their Self-Making across the Early American Republic, 1770–1840. By Brett Goodin. Studies in Early American Economy and Society from the Library Company of Philadelphia. Baltimore: Johns Hopkins University Press, 2020. 224 pages. Cloth, ebook. Brett Goodin’s From Captives to Consuls presents a prehistory of the “self-made man” (1) in the era of the early American republic, before the symbol came to loom large in the nation’s cultural imagination. Though he credits Henry Clay with coining the phrase on the U.S. Senate floor in 1832, Goodin insists that “generations of American men had been inventing and reinventing themselves alongside the colonies’ own reinvention into a united nation” (1).1 Drawing inspiration from Linda Colley’s 2007 The Ordeal of Elizabeth Marsh, Goodin deploys a microhistorical approach “to chart an emergent United States in three lives and three lives in an emergent United States” (5).2 How, he asks, did individuals contribute their mite to the larger cultural project of American nation building? Goodin’s answer is that the pursuit of “self-making” (2) by nonelite white men was a crucial component in furthering American expansionary ambition in the first decades of the early republic. Goodin’s book weaves together three biographical studies of figures closely associated with geopolitical tensions between the United States and the Barbary States from 1784 to 1815: Richard O’Brien, James Cathcart, and James Riley. Each experienced captivity at the hands of the Barbary States, and the first two subsequently served as U.S. consuls in North Africa. Though they were united by this Barbary connection, their complete life histories were also remarkably similar: O’Brien, Cathcart, and Riley all worked as sailors in the 1770s before they became captives of the Barbary States, and in the 1830s, after their experiences in North Africa, all became involved in settlement of the “Old Northwest”—O’Brien in western Pennsylvania, Cathcart in Indiana, and Riley in Ohio. Though conceding that their experiences as captives and consuls were exceptional, Goodin maintains the full arcs of their lives were more typical of Americans during these formative years for the nation. [End Page 145] O’Brien, Cathcart, and Riley, Goodin argues, were confronted throughout their working lives by the same “forces of global conflict, commerce, and cultural exchange” faced by “many (if not most) Americans within the former colonies” (6). Indeed, Goodin sees the historical forces of the period spanning the “revolutionary era” and the “Jacksonian era” as converging especially “markedly” (6) in the cases of these three. Because of their roles, moreover, they produced a “trove of source material,” enabling Goodin to argue for the underappreciated contributions of these “non-elite” (6) historical figures to the national development of the young United States. Goodin recognizes from the long-standing lessons of social history that the three “(admittedly, white) American men” (6) cannot be treated as fully representative given the social diversity within the nation. But he views them as “exemplars of the era” (6) because of their circumstances—“volatility and insecurity in employment, finances, personal relationships, and safety”—and how they responded; they were “forced to cultivate a talent for adaptability and reinvention that was the hallmark of the self-made man” (1). This pattern of self-invention began for these men in the 1770s, Goodin maintains, when “early lessons in self-interested self-making at sea taught them to adapt to circumstances and routinely tack their identities and allegiances toward profit and security” (6). Building upon these experiences, he argues, they continued to find some measure of personal success “through their ability to adapt to circumstances beyond their control and to change and exploit identities and patrons while navigating a dizzying array of professions” (2). In their unexpected interactions with and then employment within the U.S. government, these nonelite men contributed to the international reach and western expansion of the United States. Moreover, in their claims to expertise about North Africa and then about the Old...

Appalachia North: A Memoir

Appalachia North: A Memoir

Von Willebrand Disease in Older Patients: A Retrospective Electronic Health Record Review.

Von Willebrand disease (VWD) is often diagnosed as a consequence of symptoms experienced with hemostatic stressors, such as menstruation and childbirth. Thus, patients seeking medical care for VWD are generally younger. As a result, the natural course of VWD in older adults has not been well described. A retrospective electronic health record review was performed to provide a descriptive analysis of older VWD patients with at least one clinic visit at the Hemophilia Center of Western Pennsylvania (HCWP) between June 1, 2015, and May 31, 2021, and age 45 or older at the time of the visit. Data collected included VWD-related information, multimorbidity, and medications. Age-related change in von Willebrand factor (VWF) levels and the influence of multimorbidity on VWF levels were assessed. Seventy patients had 131 HCWP clinic visits. Hypertension, 34.3%, and osteoarthritis, 32.3%, were the most common multimorbidity-associated conditions. More than 33% of patients were receiving at least one antihemostatic medication. The most common bleeding symptom was ecchymosis, 22.9%. VWF antigen levels, 0.76 IU/mL, and the proportion of patients with normal VWF levels, 54.5%, increased with age to 0.99 IU/mL, p < 0.001, and 78.8%, p < 0.001, respectively. Multimorbidity did not predict change in VWF levels, p = 0.84. Of 62 invasive procedures performed, bleeding occurred in one of nine where VWD-specific therapy was omitted. These findings underscore the importance of describing the natural course of VWD in older adults, especially the critical nature of determining bleeding risk to guide clinical decision-making with the use of antihemostatic drugs and periprocedural VWD-specific therapy.

The Autobiography of Daniel Parker, Frontier Universalist by Daniel Parker

Reviewed by: The Autobiography of Daniel Parker, Frontier Universalistby Daniel Parker David Komline (bio) Daniel Parker, Universalism, Religion, Halcyon Church, Abel Sarjent, Frontier history The Autobiography of Daniel Parker, Frontier Universalist. By Daniel Parker, edited by David Torbett. (Athens: Ohio University Press, 2020. Pp. 304. Cloth, $36.95.) David Torbett has performed a valuable service in making available the autobiography of Daniel Parker. Parker is, even to specialists, a practically unknown historical figure. Until now, his most lasting contribution had been a book published in 1844, Familiar Letters to a Brother in Two Series: On the Final Restoration of All Mankind to Holiness and Happiness; Through a Righteous Judgment, and an Equitable Retribution. But this work, though now widely available through Google Books, has rarely been cited, even in scholarship on Universalism. Richard Eddy's classic Universalism in America: A Historynotes that Parker "contributed no small amount of influence in spreading the knowledge and acceptance of Universalist views." Besides a paragraph in Eddy and a few other passing references, however, Parker has been almost lost to history. 1Torbett's edition of Parker's autobiography gives historians reason to revisit this frontier figure. Parker was born in 1781 in Massachusetts. As a child his family moved to western Pennsylvania, and when he was a young adult, they migrated to the Ohio frontier. Initially Parker worked with his father as a cabinetmaker. From 1809 to 1813 he went into business as an itinerant washing-machine [End Page 132]salesman. In 1816 he married Priscilla Mulloy Ring, and they settled near Cincinnati, Ohio. As their children reached adulthood the family established on their property Clermont Academy, perhaps the first racially integrated secondary school in Ohio. Parker touches on all these developments in his autobiography, which historians of the Ohio River Valley can now mine for anecdotes about daily life as well as for Parker's reflections on themes such as slavery, economics, and education. The most consistent theme in the autobiography is religion. Although born to Presbyterian parents, Parker followed his brother and joined the Halcyon Church. Torbett accurately notes that "Parker's most valuable contribution to the historical record may be his unique firsthand account of this mysterious group and its visionary leader, Abel Sarjent" (xxiii). Beyond this firsthand account, Torbett's introduction provides the most thorough overview of the Halcyon Church available. The Halcyon Church was founded by Abel Sarjent (sometimes spelled Sargent) in 1802. Sarjent published books, pamphlets, and periodicals that outlined his distinctive beliefs. He called himself a messenger sent by God to announce the imminent millennium. Additionally, Sarjent claimed to be a "universalist," although, technically speaking, contemporary theologians would label his views as annihilationist. Sarjent boasted that at the height of the Halcyon Church, 440 regular members and 2,200 other associates gathered in twenty locations. But the movement soon splintered and eventually disappeared, and Sarjent died in obscurity in 1839. Parker stood at the center of a controversy that may have contributed to the movement's demise. In 1807 he and a band of Halcyonists, convinced that the latter days were imminent, adopted an extreme ascetic lifestyle. Sarjent himself disapproved, but the group persisted. As they fasted and prayed, one of them, Amos Parkhurst, experienced mystical visions and performed miraculous deeds. Over several days he also frequently entered what Parker described as "a state resembling what is now called 'magnetic sleep,'" with "his pulse and breath suspended." His first such experience lasted nine hours. But on April 4, 1807, after four days like this, Parkhurst "was found to be actually dead" (38-39). Parker and the others left the Halcyonists, but the fallout brought scandal to the movement, which began to dwindle. Parker left behind this strong millennialism, but he retained other distinctive Halcyonist features. Most notable among these was a hermeneutical scheme involving symbolic interpretations of the Urim and Thummim [End Page 133]mentioned several times in the Old Testament. Additionally, he moved beyond Sarjent's annihilationism to affirm restorationism, the idea that all people would ultimately be saved. Eventually Parker took these ideas on the road, traveling regularly as an itinerant preacher. In editing the autobiography for publication, Torbett drew on a...

Working Family Caregiver Well-Being: Work Impact, Workplace Supports, and Family Discord

A recent study by our team showed that family discord about care provision among multiple family caregivers was a significant predictor of caregiver burden, anxiety, depression, and activity restrictions. This study examined the combined effects of family discord, work impacts (missed work, caregiving affects work), and workplace supports (flexible hours, caregiver benefits) on caregiver well-being. We conducted a secondary analysis using cross-sectional survey data from the Western Pennsylvania Family Caregiving Project 2017-2018. Participants were family caregivers who worked outside the home and shared older adult (i.e. over age 50) caregiving responsibilities with family (n=364, mean age: 52.59 years, female: 71.7%, White: 79.7%, cared for a parent: 69.5%, mean work hours/week: 37.30). Hierarchical regression analyses were conducted testing for main effects of family discord, work impacts, and workplace supports; and interactions between discord and work impacts/workplace supports. The presence of family discord negatively impacted all caregiver well-being outcomes (p<0.05). Having more work impacts increased the risk for anxiety (p<0.04), activity restrictions (p<0.01) and burden (p<0.01). No main effects were found for workplace support. Moderating effects were found, such that anxiety was high when family discord and work impacts were higher (p=0.025). Additionally, more activity restrictions occurred when caregivers had low workplace support and higher family discord (p=0.020). Results suggest having less family discord, more workplace support, and less negative work impacts may improve caregiver well-being. Future work is needed to determine which work supports are most beneficial to this population and how family discord and negative work impacts can be reduced.

Primary care provider payment models and adherence to anticoagulation in patients with atrial fibrillation.

BACKGROUND: Oral anticoagulation (OAC) is recommended for the prevention of stroke in atrial fibrillation (AF). However, only 50%-60% of AF patients in the United States are treated with OAC, and 60% of them adhere to OAC therapy over time. OBJECTIVES: To (1) compare adherent use of OAC between AF patients who received primary care from practices involved in shared-savings models and patients who received care from practices not involved in shared savings and (2) examine the trend of adherence to OAC over time. Because OAC can save downstream medical costs associated with averted stroke events, we hypothesized that OAC adherence would be higher among patients receiving care from practices involved in shared savings. METHODS: Using 2014-2019 claims data from a health insurer in western Pennsylvania, we identified 20,637 AF patients from 2015-2018. Patients were followed from the first AF diagnosis (index date) for 12 months or until disenrollment. We categorized patients according to the payment model of the practice from which they received primary care: shared savings (n = 8,844) and no shared savings (n = 11,793). The primary outcome was adherent use of OAC therapy, which was defined as having at least 80% of the followup period covered with OAC. Secondary outcomes included adherent use of direct oral anticoagulants (DOACs) and adherent use of warfarin. We constructed logistic regression models to assess the association between involvement in shared savings and adherent use of OAC, while controlling for demographics, clinical characteristics, and index year. RESULTS: 34% of patients in the shared-savings group adhered to OAC, compared with 32.7% in the no shared-savings group (P = 0.04). After adjustment, adherence was higher for the shared-savings group for OAC (adjusted odds ratio [aOR] = 1.07, 95% CI = 1.01-1.14) and warfarin (aOR = 1.11, 95% CI = 1.02-1.20) compared with the no shared-savings group. However, the odds of adherent use of DOACs did not statistically differ between shared savings and no shared savings (aOR = 0.99, 95% CI = 0.91-1.08). The odds of adherent OAC use increased over time: the aOR of adherent use of OAC was 1.21 (95% CI = 1.09-1.34) for index year 2016; 1.50 (95% CI = 1.36-1.67) for 2017; and 1.78 (95% CI 1.60-1.98) for 2018, all compared with 2015. CONCLUSIONS: Receipt of primary care from a practice involved in shared savings was associated with a higher adherent use of OAC and warfarin for patients with atrial fibrillation. Furthermore, adherent use of OAC improved over time for both treatment groups. Our research demonstrates that the alignment of financial incentives between providers and insurers may improve the use of therapies with downstream cost-saving potential. DISCLOSURES: This project was funded by the National Heart, Lung and Blood Institute (grant number K01HL142847). Hernandez has received consulting fees from Pfizer and BMS, outside of the submitted work. The other authors have nothing to disclose.

Seasonal gut contents of introduced Allegheny Crayfish (Faxonius obscurus) in an eastern Pennsylvania stream

Abstract Crayfish are important components of many freshwater ecosystems and play key roles as detritivores and/or carnivores. However, dietary studies are lacking for many species. Few data are available on the diet of Allegheny Crayfish (Faxonius obscurus), a common species native to western Pennsylvania and historically introduced into the central and eastern portions of the commonwealth. We collected Allegheny Crayfish from a site in eastern Pennsylvania from April to October and dissected specimens to evaluate the seasonal diet of this species. We found that gut contents in all months sampled primarily consisted of organic detritus (e.g., dead leaves and woody debris) and inorganic detritus (e.g., sand and silt), with small quantities of macroinvertebrate material and negligible vegetal material (macrophytes or algae). Generally, the diet of this species is similar those of other crayfish in the genus Faxonius.

Aspects of rare earth element enrichment in Allegheny Plateau coals, Pennsylvania, USA

The Allegheny Plateau in western Pennsylvania, western Maryland, and northern West Virginia has relatively flat-lying strata with southwest-northeast-trending anticlines cored by splay faults originating from the thrust faults and southeast-northwest-trending lineaments. The lineaments define both the structural relief of the anticlines and the coal rank. Coal rank in the Pennsylvanian Allegheny Group coals is medium volatile bituminous in the region of less-prominent structural relief and low volatile bituminous in the region with more pronounced anticlines.Zinc and Cl exhibit high values in coals in the vicinity of the lineaments. Although coal rank was not a parameter in the Principal components analysis, the highest rank coals clustered together in a quadrant defined, in part, by the Zn concentration. Zinc was selected as a parameter due to its possible link with hydrothermal mineralization and Zr and TiO2/Al2O3 were selected based on their presumed association with detrital mineral influences. The highest rare earths + Y values in benches of the Lower Kittanning coal were found at sites close to the lineaments.Negative or negligible Ce anomalies (δCe) and strongly positive Gd anomalies (δGd) suggest marine or hydrothermal influences and negative Eu anomalies (δEu) along with high TiO2/Al2O3 values suggest a terrestrial input. The plots of δCe vs. δGd and δCe vs. δEu show that the low volatile bituminous coals are segregated from the other coals, suggesting that the factors that influenced coal rank also influenced the distribution of the rare earth elements.

Abstract 11652: Long-Term Outcomes in Post-Cardiac Arrest Patients With Severe Functional Disability at Hospital Discharge

Background: In patients resuscitated from out of hospital cardiac arrest (OHCA) with severe functional disability, life support is often limited. However, long-term outcomes in such patients are largely unknown, leaving little data to guide this decision. Methods: We performed a retrospective cohort study of OHCA survivors ≥ 18 years of age, treated at a single center in Western Pennsylvania from 01/01/2010-05/20/2021, with a modified Rankin scale (mRS) of 5 and cerebral performance category (CPC) of 4 at hospital discharge. We recorded demographics, arrest characteristics, and neurological exam at hospital discharge. We reviewed records from index hospitalization to the present to determine the date and type of subsequent healthcare encounters and whether or not subjects followed commands in subsequent neurological exams. National Death Index query and internet search for obituary until 5/20/2021. Survival time and hazard ratios were estimated using Kaplan-Meier curves. Results: Among 2,460 OHCA patients treated, 857 (35%) survived to hospital discharge. Of survivors, 83 (9.6%) had mRS 5 and CPC 4, and 69 (85%) did not follow commands. One year mortality was 59% (n=48) with median survival time of 166 days (IQR 77-1083). Age ≥ 65 years was not associated with survival [HR 1.51, 95%CI 0.79 - 2.89]. We found 361 subsequent medical encounters (median per patient =1, IQR 0-4), most often ED visits (n=131, 41%). Visits comprised 87 (28%) well patient visit/medication refills, 60 (22%) infections, and 38 (12%) tracheostomy/feeding tube issues. Average frequency of healthcare encounters was about once every 3 months (.30 encounters per month, SD .799). Of subjects who did not follow commands at hospital discharge, 4 (6%) followed commands on subsequent encounters. Conclusions: About 10% of OHCA survivors were discharged from the hospital with severe functional disability. They had a 59% 1-year mortality and frequent visits to the ED. Few (6%) patients regained the ability to follow commands.

The Von Willebrand Disease Aging and Bleeding Correlation (VWD ABC) Study

The Von Willebrand Disease Aging and Bleeding Correlation (VWD ABC) Study

Review of the distribution and new occurrences of Lacunicambarus&amp;nbsp;thomai (Jezerinac, 1993) (Decapoda, Cambaridae) in Pennsylvania&amp;nbsp;and its possible introduction outside of its native range

Recent investigations into the distributions of western Pennsylvania, USA, crayfishes have yielded 30 new occurrences of Lacunicambarus thomai (Jezerinac, 1993). The discovery of a population of L. thomai in Crawford County is the furthest north population in the state. Two populations of L. thomai were discovered outside of its historic range in Fayette and Somerset counties in southwestern Pennsylvania. These populations are in recreational fishing destinations and may have been introduced by bait bucket or construction fill. Additional surveys for Pennsylvania L. thomai should occur in areas lacking recent, thorough searches.

The distribution of beech leaf disease and the causal agents of beech bark disease (Cryptoccocus fagisuga, Neonectria faginata, N. ditissima) in forests surrounding Lake Erie and future implications

Over the past century, beech bark disease has dramatically altered the composition and structure of stands containing American beech (Fagus grandifolia). Management of beech bark disease has focused on reducing beech thickets and identifying resistant trees in aftermath forests. Beech leaf disease is a recently detected invasive disease, now also affecting beech forests. In 2019, a plot network was established in central North America to examine the extent of beech leaf disease spread and the severity of effects on trees and forests. Here, data from this plot network was used to determine the extent to which American beech is exposed to beech leaf disease, beech scale (Cryptococcus fagisuga), and beech bark disease (C. fagisuga and Neonectria spp. complex) in forests surrounding the Great Lakes in southwestern Ontario, northeastern Ohio, western Pennsylvania, and western New York. Beech leaf disease and scale were found to be well established, not only among sites but also in the different canopy layers. Beech bark disease was present, but occurrence was low. Pest accumulation differed between overstory and sapling layers. Beech leaf disease was the primary pest of saplings while both beech leaf disease and beech scale dominated in the overstory. Forest composition was similar throughout the study range; American beech, sugar maple, red maple, and white ash were abundant and common in the sapling and seedling layer. Few invasive plants were evident among saplings and seedlings. Sugar maple and red maple will likely fill small canopy gaps following beech decline or mortality. Intervention should be considered in stands with potential for increasing tree diversity or promoting beech leaf disease-resistant American beech trees to the overstory. New strategies are needed for beech conservation along with research to determine the extent of beech leaf disease resistance in American beech.

Cohort Study of Cannabis Use History and Perinatal Cigarette Use Among Overweight and Obese Women.

In non-pregnant populations, cannabis use and cannabis use disorder (CUD) have been linked to tobacco use and less successful quit attempts. We compared perinatal cigarette use in women across 3 groups: never used cannabis (No CU group); used cannabis but did not meet CUD criteria (CU group); history of CUD (CUD group). Interviews with 257 pregnant women with overweight/obesity (M age = 28years; 52% white) were conducted for a study of eating behavior in Western Pennsylvania from 2012-2016. Tobacco use was assessed early in pregnancy (< 20weeks gestation), late in pregnancy (34-38weeks gestation) and 6months postpartum. CUD was measured with the Structured Clinical Interview for DSM-IV (SCID). Data relevant to the proposed analyses were available for 252 women. Generalized mixed effect models were used to predict perinatal cigarette use based on cannabis use group, time and their interaction, adjusting for age, race, education, income, parity, and mood/anxiety disorder. Forty-eight percent of participants reported prior cannabis use and 15% were diagnosed with lifetime CUD. History of cannabis use predicted cigarette smoking in early pregnancy (OR 11.12, CI 3.27-37.85), late pregnancy (OR 6.55, CI 1.70-25.27), and 6months postpartum (OR 7.57, CI 2.72-21.07), regardless of CUD. A history of CUD did not appear to confer additional risk for perinatal cigarette use. Given increasing rates of cannabis use among pregnant women, these results highlight the importance of addressing history of cannabis use in conjunction with tobacco use to improve smoking cessation efforts.

VOICE-BASED MONITORING OF COPD

TOPIC: Pulmonary Rehabilitation TYPE: Original Investigations PURPOSE: COPD is a common, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation with a projected increase in prevalence over the coming decades. Periodic assessment of COPD is needed to determine the level of airflow limitation and assess impact on a patient’s health status, risk of future exacerbations, hospital admissions, mortality and to help guide therapy. Previously, COPD was viewed as a disease mostly characterized by dyspnea, now it is recognized that COPD impacts patients beyond this. As a result, a comprehensive assessment of symptoms is recommended. The COPD assessment test (CAT) is an 8 item measure of health status impairment and is commonly used to assess symptoms. Voice is an important biomarker of many medical conditions including diseases of the respiratory system which leave signatures in breath and speech. We build on our previous work of voice-based prediction of FEV1 and FVC (Ashraf, Obaid, et al. Chest 158.4 (2020): A1687, Walter, Kristin. JAMA 325.12 (2021): 1130-1131) to create a voice based early warning system for COPD exacerbation utilizing the CAT score. METHODS: We present the results of a prospective cohort study correlating voice and breath samples to CAT scores. We collected a total of 418 sessions from 9 participants aged 42 to 75 at a large suburban general hospital in Western Pennsylvania over the course of a year. Each participant provided biweekly voice and breath samples, along with self-reported CAT scores. We recorded audio samples on a commodity smart tablet using a proprietary software and analyzed recorded data off-line on the secure Telling.ai cloud. Based on input from health care providers, we weighted CAT questions pertaining to cough, sputum, wheezing and tightness of the chest more heavily than other questions. We extracted audio features from the recordings and developed a regression algorithm using k fold cross validation to predict deviation in the weighted CAT score from a baseline, and a binary classification retrospective prediction algorithm to predict a clinically important weighted CAT score increase (2 point or more) upto 7 days in advance. RESULTS: Our weighted CAT deviation from baseline regressor and retrospective exacerbation classification models had the following results, averaged across all folds, for all participants:(R squared = 0.972, Mean absolute error =0.449, Mean squared error = 0.572, Pearson Coefficient Correlation r = 0.998, two-tailed p-value < 0.0000001)and(Accuracy = 94.086%, Sensitivity = 94.229%, Specificity = 94.414%)respectively. CONCLUSIONS: We demonstrate that changes in voice and breath correlate strongly with changes in symptoms scores 0.97 R^2and MAE = 0.45 and furthermore, that signatures in voice can be detected even before the symptoms present themselves (2 point or more weighted CAT score increase upto 7 days in advance) with 94.23% sensitivity and 94.41% specificity . This technology requires no additional custom-built hardware, is cost effective, non-invasive and practical for ubiquitous and frequent use on mobile phones. CLINICAL IMPLICATIONS: The solution is ideally suited for personalized, predictive and frequent monitoring to enable the development of clinical decision support systems. This technique offers the promise of early interventions to reduce exacerbation frequency and severity, advancing personalized medicine for chronic and acute respiratory care. DISCLOSURES: Employee relationship with Telling.ai Please note: $20001 - $100000 by Mir Mohammed Daanish Ali Khan, source=Web Response, value=Salary Employee relationship with Telling.ai Please note: $20001 - $100000 by Rajat Kulshreshtha, source=Web Response, value=Salary Employee relationship with Telling.ai Please note: >$100000 by Prakhar Pradeep Naval, source=Web Response, value=Salary Speaker/Speaker's Bureau relationship with boeringer Ingleheim Please note: 2019-2020 Added 04/29/2021 by Anil Singh, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with astra zeneca Please note: 2019-2020 Added 04/29/2021 by Anil Singh, source=Web Response, value=Honoraria Chief Technical Officer relationship with Telling.ai Please note: >$100000 by Satya Venneti, source=Web Response, value=Salary

The COVID antivaccination dilemma

So much has been written about this that I have hesitated (no pun intended) to address it. However, the consequences are so huge as to public health that I feel a moral imperative to write. The Greeks got this right with their word dilemma, δίλημμα, two sides or even “two horns” (a meaning that was adopted even to the uterus). Most of us in the biomedical field are stunned by the position of the antivaxers. However, it is always best to try and understand the opposition's belief system. As to those who are suspicious of medical advice and “technology,” I think of my late father-in-law, a western Pennsylvania steel mill foreman. He was not college-educated and yet intelligent in many ways (meaning he sought to understand, as the word intelligent means). He never saw a doctor or took a pill but had his own pharmacopeia of natural herbs. He died from a condition that could have been treated. His loss was a poignant lesson, to me, of the power of one's thinking as to medical science. The various causes of COVID vaccination hesitancy or resistance have been widely discussed. For African Americans in particular, a factor has been the history of unethical medical experimentation and now an irresolute suspicion about vaccination among many in this community. This situation is a shameful reflection, among many, of enduring racism in America and also resonates with horrific disparities in healthcare access.1 Sadly, there are many in America who may now be moving toward COVID vaccination and yet lack easy access. For those diehard antivaccinationists, I ask if we in the biomedical profession could have done a better job in educating the public. I think we could have. The recent authorization of the Pfizer vaccine is a case in point, where I think we were at fault for not making it clearer that “emergency use” is a term than does not mean “unsafe” or “unproven.” It is heartening to see that a large proportion of COVID-vaccine-hesitant Americans have now agreed to move forward. Another example of where we, and the media, may not have been clear enough is the use of the term “encapsulation” to describe the packaging of the mRNA vaccines (necessary to enhance delivery). I had not realized this until recently, when it became apparent that this word is why some people think the term “capsule” means that a chip will be put into their body. In some extreme forms of this angst, it is believed this “chip” will enter the brain and allow the government control over the person. We should never laugh at this. It is our fault if we have not done a better job of reaching the public.2 The remaining opponents hold firm beliefs about their rights to their bodies as well as passionate views on the limits of government on their lives. Another group holds certain religious beliefs. For the former, I would stress the importance of our continued efforts to educate the lay public, as we can try.2 For the latter, I think that religious beliefs are outside the bounds of science, and we should respect these. However, in many religions, there is the sanctity of life, whether believed as a gift from a god and/or something so cherished as to be never put at risk. For example, in Judaism, this is codified in a doctrine, whereby certain laws can be overlooked if their deployment might impair saving a life. The legal stalemate over vaccination brings us to the US Constitution, whose principles we adopted from a Frenchman, Montesquieu. Thanks to the architects James Madison, Alexander Hamilton, and others, it grants to the states considerable autonomy. This is why the governors of several states have not supported mask mandates and think they will prevail. The courts will see these cases now, and we can only hope medical science weighs in, as it always should. Some ardent constitutional scholars have argued for the Constitution's amendment, while others hold that it is a sacrosanct structure that should not be brought before the forum of changing times. We shall see how this debate ends up.

“This Is a Good Neighborhood. This Ain’t No Pittsburgh!”: Conflicting Narratives of Opioid Misuse within Rural School Districts and Communities

Purpose: This study examines the local and institutional factors that shape how educators and educational leaders in western Pennsylvania have understood and responded to rapid growth in opioid mis...