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  • 1
    Online Resource
    Online Resource
    Supporting Active Living Through Community Plans: The Association of Planning Documents With Design Standards and Features
    SAGE Publications ; 2019
    In:  American Journal of Health Promotion Vol. 33, No. 2 ( 2019-02), p. 191-198
    Details
    In: American Journal of Health Promotion, SAGE Publications, Vol. 33, No. 2 ( 2019-02), p. 191-198
    Abstract: The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living. Design: Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. Setting: Nationally representative sample of US municipalities. Participants: Respondents are 2005 local officials. Measures: Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development. Analysis: Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present. Results: Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P 〈 .05) in the prevalence of each design standard and requirement. Conclusions: Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities.
    Type of Medium: Online Resource
    ISSN: 0890-1171 , 2168-6602
    URL: Article
    DOI: 10.1177/0890117118779011
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2134271-4
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  • 2
    Online Resource
    Online Resource
    A Large Community Outbreak of Legionnaires’ Disease Associated With a Cooling Tower in New York City, 2015
    SAGE Publications ; 2017
    In:  Public Health Reports Vol. 132, No. 2 ( 2017-03), p. 241-250
    Details
    In: Public Health Reports, SAGE Publications, Vol. 132, No. 2 ( 2017-03), p. 241-250
    Abstract: Infections caused by Legionella are the leading cause of waterborne disease outbreaks in the United States. We investigated a large outbreak of Legionnaires’ disease in New York City in summer 2015 to characterize patients, risk factors for mortality, and environmental exposures. Methods: We defined cases as patients with pneumonia and laboratory evidence of Legionella infection from July 2 through August 3, 2015, and with a history of residing in or visiting 1 of several South Bronx neighborhoods of New York City. We describe the epidemiologic, environmental, and laboratory investigation that identified the source of the outbreak. Results: We identified 138 patients with outbreak-related Legionnaires’ disease, 16 of whom died. The median age of patients was 55. A total of 107 patients had a chronic health condition, including 43 with diabetes, 40 with alcoholism, and 24 with HIV infection. We tested 55 cooling towers for Legionella, and 2 had a strain indistinguishable by pulsed-field gel electrophoresis from 26 patient isolates. Whole-genome sequencing and epidemiologic evidence implicated 1 cooling tower as the source of the outbreak. Conclusions: A large outbreak of Legionnaires’ disease caused by a cooling tower occurred in a medically vulnerable community. The outbreak prompted enactment of a new city law on the operation and maintenance of cooling towers. Ongoing surveillance and evaluation of cooling tower process controls will determine if the new law reduces the incidence of Legionnaires’ disease in New York City.
    Type of Medium: Online Resource
    ISSN: 0033-3549 , 1468-2877
    URL: Article
    DOI: 10.1177/0033354916689620
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2017700-8
    SSG: 20,1
    SSG: 27
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  • 3
    Online Resource
    Online Resource
    Acute Alpha-Naphthylisothiocyanate-induced Liver Toxicity in Germfree and Conventional Male Rats
    SAGE Publications ; 2016
    In:  Toxicologic Pathology Vol. 44, No. 7 ( 2016-10), p. 987-997
    Details
    In: Toxicologic Pathology, SAGE Publications, Vol. 44, No. 7 ( 2016-10), p. 987-997
    Abstract: Differences in the responses of conventional and germfree male Sprague-Dawley rats to acute injury induced by alpha-naphthylisothiocyanate (ANIT), a well-characterized biliary epithelial toxicant, were evaluated. Conventional and germfree rats were dosed once orally with 50 mg/kg of ANIT or corn oil alone and serially sacrificed daily for the next 3 days. Germfree rats treated with ANIT tended to have greater increases in virtually all liver and biliary-related analytes compared with conventional rats treated with ANIT; however, significant differences were found only in a few of these analytes including increased bile acids on day 3, total bilirubin on day 4, glutamate dehydrogenase (GLDH) on day 3, and reduced paraoxonase 1 (PON1) on days 2 and 3. Histologic differences between the conventional and germfree rats were modest, but most pronounced on day 2 (24-hr post dosing). Based on subjective scoring, biliary necrosis, neutrophilic cholangitis, and portal tract edema were more severe in germfree rats at 24 hr post dosing compared with conventional rats. Biliary epithelial replication did not differ between treated groups, however. Overall, germfree rats had a modestly greater level of biliary tract injury based on subjective histologic scoring and clinical chemistry measurements following an acute exposure to the well-characterized biliary toxin, ANIT; however, the difference between the ANIT-treated germfree and conventional groups was modest and most evident only within the first day following exposure. These findings suggest that the microbiome did not significantly affect ANIT-induced acute biliary tract injury in the conditions of this study.
    Type of Medium: Online Resource
    ISSN: 0192-6233 , 1533-1601
    URL: Article
    DOI: 10.1177/0192623316662360
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2056753-4
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  • 4
    Online Resource
    Online Resource
    Analysis of an ordinal endpoint for use in evaluating treatments for severe influenza requiring hospitalization
    SAGE Publications ; 2017
    In:  Clinical Trials Vol. 14, No. 3 ( 2017-06), p. 264-276
    Details
    In: Clinical Trials, SAGE Publications, Vol. 14, No. 3 ( 2017-06), p. 264-276
    Abstract: A single best endpoint for evaluating treatments of severe influenza requiring hospitalization has not been identified. A novel six-category ordinal endpoint of patient status is being used in a randomized controlled trial (FLU-Intravenous Immunoglobulin - FLU-IVIG) of intravenous immunoglobulin. We systematically examine four factors regarding the use of this ordinal endpoint that may affect power from fitting a proportional odds model: (1) deviations from the proportional odds assumption which result in the same overall treatment effect as specified in the FLU-IVIG protocol and which result in a diminished overall treatment effect, (2) deviations from the distribution of the placebo group assumed in the FLU-IVIG design, (3) the effect of patient misclassification among the six categories, and (4) the number of categories of the ordinal endpoint. We also consider interactions between the treatment effect (i.e. factor 1) and each other factor. Methods We conducted a Monte Carlo simulation study to assess the effect of each factor. To study factor 1, we developed an algorithm for deriving distributions of the ordinal endpoint in the two treatment groups that deviated from proportional odds while maintaining the same overall treatment effect. For factor 2, we considered placebo group distributions which were more or less skewed than the one specified in the FLU-IVIG protocol by adding or subtracting a constant from the cumulative log odds. To assess factor 3, we added misclassification between adjacent pairs of categories that depend on subjective patient/clinician assessments. For factor 4, we collapsed some categories into single categories. Results Deviations from proportional odds reduced power at most from 80% to 77% given the same overall treatment effect as specified in the FLU-IVIG protocol. Misclassification and collapsing categories can reduce power by over 40 and 10 percentage points, respectively, when they affect categories with many patients and a discernible treatment effect. But collapsing categories that contain no treatment effect can raise power by over 20 percentage points. Differences in the distribution of the placebo group can raise power by over 20 percentage points or reduce power by over 40 percentage points depending on how patients are shifted to portions of the ordinal endpoint with a large treatment effect. Conclusion Provided that the overall treatment effect is maintained, deviations from proportional odds marginally reduce power. However, deviations from proportional odds can modify the effect of misclassification, the number of categories, and the distribution of the placebo group on power. In general, adjacent pairs of categories with many patients should be kept separate to help ensure that power is maintained at the pre-specified level.
    Type of Medium: Online Resource
    ISSN: 1740-7745 , 1740-7753
    URL: Article
    DOI: 10.1177/1740774517697919
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2159773-X
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  • 5
    Online Resource
    Online Resource
    Dermal Toxicity Studies : Factors Impacting Study Interpretation and Outcome
    SAGE Publications ; 2015
    In:  Toxicologic Pathology Vol. 43, No. 4 ( 2015-06), p. 474-481
    Details
    In: Toxicologic Pathology, SAGE Publications, Vol. 43, No. 4 ( 2015-06), p. 474-481
    Abstract: The field of dermal toxicity continues to evolve in order to accurately predict dermal (and systemic) responses in humans to topically applied chemicals. Although the testing methods have undergone extensive refinements, idiosyncrasies and unexpected issues during the conduct of these studies are not unusual due to the plethora of new vehicles available for formulating test substances, changing regulatory requirements, and introducting new strain and/or species of laboratory animals as no single species or method seems to suffice for evaluating skin toxicity. The objective of this article is to illustrate some pragmatic issues that should be considered during the conduct as well as interpretation of dermal toxicity studies. Routine procedure-related issues such as hair clipping, tape stripping, and wrapping the animal’s torso to prevent oral ingestion can influence the interpretation. Excipients used in dermal toxicity studies may be nontoxic when used alone but complex dermal formulations can result in unexpected irritation and toxicity. In conclusion, interpretation and risk assessment of dermal toxicity studies should be done in a comprehensive manner, taking into account procedure-related impact on study results, unique species susceptibility, limitation of gross visual (naked eye) observation for evidence of toxicity, and normal anatomical variation.
    Type of Medium: Online Resource
    ISSN: 0192-6233 , 1533-1601
    URL: Article
    DOI: 10.1177/0192623314548765
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2056753-4
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  • 6
    Online Resource
    Online Resource
    Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access
    SAGE Publications ; 2018
    In:  Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery Vol. 13, No. 1 ( 2018-01), p. 1-4
    Details
    In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, SAGE Publications, Vol. 13, No. 1 ( 2018-01), p. 1-4
    Abstract: Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access. We reviewed our multicenter experience with minimally invasive suprasternal transcatheter aortic valve replacement. Methods Consecutive patients with symptomatic severe aortic stenosis at high or intermediate risk for surgical aortic valve replacement underwent suprasternal transcatheter aortic valve replacement. A commercially available transcatheter heart valve was deployed under fluoroscopic guidance through the innominate artery or ascending aorta. Using a 3-cm skin incision just above the sternal notch, the Aegis Transit System (Aegis Surgical Ltd, Galway, Ireland) provided illuminated access to the mediastinum without bone disruption. Through a purse-string suture placed in the innominate artery or ascending aorta, transcatheter aortic valve replacement proceeded similarly to the direct aortic approach. Results Thirty patients at six medical centers successfully underwent suprasternal transcatheter aortic valve replacement. Implanted valves included 2 CoreValve and 12 Evolut-R (Medtronic, Inc, Minneapolis, MN USA), as well as 10 SAPIEN 3 and 6 SAPIEN XT (Edwards Lifesciences, Corp, Irvine, CA USA) with sizes ranging from 23 to 31 mm. Median procedure time was 90 minutes and median hospital stay was 4 days. Postoperatively, new permanent pacemaker (n = 3) was the most common Vascular Academic Research Consortium 2 complication. Conclusions These data demonstrate the early clinical feasibility of suprasternal transcatheter aortic valve replacement. Key advantages of this approach include direct access to the innominate artery and ascending aorta, precise sheath control, and confident arterial closure. Additional experience is warranted to confirm these favorable results.
    Type of Medium: Online Resource
    ISSN: 1556-9845 , 1559-0879
    URL: Article
    DOI: 10.1097/imi.0000000000000462
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2223439-1
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  • 7
    Online Resource
    Online Resource
    Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access
    SAGE Publications ; 2018
    In:  Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery Vol. 13, No. 1 ( 2018-01), p. 1-4
    Details
    In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, SAGE Publications, Vol. 13, No. 1 ( 2018-01), p. 1-4
    Type of Medium: Online Resource
    ISSN: 1556-9845 , 1559-0879
    URL: Article
    DOI: 10.1177/155698451801300101
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2223439-1
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  • 8
    Online Resource
    Online Resource
    Survival After Exercise-Related Sudden Cardiac Arrest in Young Athletes: Can We Do Better?
    SAGE Publications ; 2019
    In:  Sports Health: A Multidisciplinary Approach Vol. 11, No. 1 ( 2019-01), p. 91-98
    Details
    In: Sports Health: A Multidisciplinary Approach, SAGE Publications, Vol. 11, No. 1 ( 2019-01), p. 91-98
    Abstract: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes during sports. Hypothesis: Survival after SCA in young athletes is variable. Study Design: Prospective, active surveillance study. Level of Evidence: Level 3. Methods: From July 1, 2014, to June 30, 2016, exercise-related SCA in competitive young athletes was identified through a systematic search of traditional and social media sources, direct reporting to the National Center for Catastrophic Sports Injury Research, searching of the National Collegiate Athletic Association Resolutions List, regular communication with national and state high school athletic associations, and review of cases in the Parent Heart Watch database. Results: A total of 132 cases were identified during the 2-year study period (mean patient age, 16 years; age range, 11-27 years; 84% male; 51% white non-Hispanic/Latino, 30% black/African American, and 11% white Hispanic/Latino). High school athletes accounted for 78 (59%) cases, with 28 (21%) in middle school and 15 (11%) in college athletes. Overall survival was 48% (95% CI, 40%-57%; 64 survivors, 68 deaths). Survival was similar in male versus female athletes but higher in white non-Hispanic/Latino (40/67; 60%) versus black/African American (13/39; 33%) athletes (difference, 27%; 95% CI, 7%-45%; P = 0.008) and white non-Hispanic/Latino versus all minority (18/59; 31%) athletes (difference, 29%; 95% CI, 13%-46%; P = 0.001). Basketball accounted for 30% of cases, followed by football (25%), track/cross-country (12%), and soccer (11%). The majority (93%) of cases were witnessed. If a certified athletic trainer was on-site and involved in the resuscitation, 83% of athletes survived. If an on-site automated external defibrillator was used in the resuscitation, 89% of athletes survived. Conclusion: Exercise-related SCA in young, competitive athletes is typically witnessed, providing an opportunity for rapid resuscitation. Additional research is needed to identify factors that affect survival in different athlete populations. Clinical Relevance: Public access defibrillator programs should be universal in schools and youth sporting venues and have the potential to increase survival after SCA in young athletes.
    Type of Medium: Online Resource
    ISSN: 1941-7381 , 1941-0921
    URL: Article
    DOI: 10.1177/1941738118799084
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2474978-3
    SSG: 31
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