Digital Commons Network^™

Travel-Time Disparities In Access To Proton Beam Therapy For Cancer Treatment, Todd Burus, Alexander Vanhelene, Michael Rooney, Krystle Lang Kuhs, W. Jay Christian, Christopher Mcnair, Sanjay Mishra, Arnold Paulino, Grace Smith, Steven Frank, Jeremy Warner

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

IMPORTANCE: Proton beam therapy is an emerging radiotherapy treatment for patients with cancer that may produce similar outcomes as traditional photon-based therapy for many cancers while delivering lower amounts of toxic radiation to surrounding tissue. Geographic proximity to a proton facility is a critical component of ensuring equitable access both for indicated diagnoses and ongoing clinical trials.

OBJECTIVE: To characterize the distribution of proton facilities in the US, quantify drive-time access for the population, and investigate the likelihood of long commutes for certain population subgroups.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study analyzed travel times to proton facilities in …

The Associations Between Pornography Consumption And Domestic Violence Attitudes, Angela R. Nanayakkara, Jenna K. Rieder, Phd

Student Papers, Posters & Projects

Introduction

Pornography is a billion-dollar industry with harmful societal implications, such as human trafficking and exploitation of minors (Humphreys et al., 2019).

Research shows links between pornography usage and hostile and benevolent sexist attitudes toward women (Hald et al., 2013; Wright & Bae, 2015).

Pornography consumption also correlates with sexual objectification and pro-violence attitudes toward women (Wright & Tokunaga, 2016).

Studies show that the consumption of violent pornography is correlated with pro-rape and other sexually aggressive beliefs. (e.g., Demaré et al., 1993).

A meta-analysis shows that in nonexperimental studies, there is a significant relationship between exposure to pornography and beliefs …

Reaching The Unheard: Overcoming Challenges In Health Research With Hard-To-Reach Populations, Venera Bekteshi, Munjireen Sifat, Darla Kendzor

Kimmel Cancer Center Faculty Papers

PURPOSE: Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research.

METHODS: This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned.

RESULTS: Creative strategies to engage hard-to-reach populations in research included considering the participants' socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies …

Integrating Primary Care, Shared Decision Making, And Community Engagement To Facilitate Equitable Access To Multi-Cancer Early Detection Clinical Trials, Cheryl L. Thompson, Adam H. Buchanan, Ronald E. Myers, David S. Weinberg

Department of Medical Oncology Faculty Papers

Effective implementation of cancer screening programs can reduce disease-specific incidence and mortality. Screening is currently recommended for breast, cervical, colorectal and lung cancer. However, initial and repeat adherence to screening tests in accordance with current guidelines is sub-optimal, with the lowest rates observed in historically underserved groups. If used in concert with recommended cancer screening tests, new biospecimen-based multi-cancer early detection (MCED) tests could help to identify more cancers that may be amendable to effective treatment. Clinical trials designed to assess the safety and efficacy of MCED tests to assess their potential for reducing cancer mortality are needed and many …

Refugee Health In Philadelphia, Marc Altshuler, Md

Academic Commons Workshops and Presentations

No abstract provided.

Cancer Disparities In Southeast Asia: Intersectionality And A Call To Action, Erin Jay G. Feliciano, Frances Dominique V. Ho, Kaisin Yee, Joseph A. Paguio, Michelle Ann B. Eala, Janine Patricia G. Robredo, Kenrick Ng, Jasmine Lim, Khin Thuzar Pyone, Catherine A. Peralta, Jerickson Abbie Flores, J. Seth Yao, Patricia Mae G. Santos, Christian Daniel U. Ang, Gideon Lasco, Jeffrey Shi Kai Chan, Gary Tse, Enrico D. Tangco, T. Peter Kingham, Imjai Chitapanarux, Nirmala Bhoo-Pathy, Gerardo D. Legaspi, Edward Christopher Dee

Einstein Health Papers

No abstract provided.

Association Between Lack Of Access To A Neighborhood Park And High Blood Pressure In The Philadelphia Metropolitan Area, Stephanie Kjelstrom, Richard W. Hass, Russell K. Mcintire

College of Population Health Faculty Papers

INTRODUCTION: Studies have shown a lower risk of high blood pressure (HBP) among people who live near parks; however, little information exists on how feeling safe and comfortable visiting the park affects blood pressure. We identified associations between neighborhood park access, comfort visiting a park, and HBP to understand how these factors may contribute to disparities in HBP prevalence.

METHODS: The 2018 Southeastern Pennsylvania Household Health Survey of 3,600 residents in the Philadelphia metropolitan area asked if respondents had ever been told they had HBP and whether they had a neighborhood park or outdoor space that they were comfortable visiting …

Multilevel Community Engagement To Inform A Randomized Clinical Trial, Kirby L. Wycoff, Jabina G. Coleman, Christine M. Santoro, Leah L. Zullig, Niesha Darden, Porsche M. Holland, Jane F. Cruice, Shukriyyah Mitchell, Michelle Smith, Saleemah J. Mcneil, Sharon J. Herring

Counseling and Behavioral Health Faculty Papers

OBJECTIVE: To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health.

METHODS: This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 …

Can The Date Of Last Menstrual Period Be Trusted In The First Trimester? Comparisons Of Gestational Age Measures From A Prospective Cohort Study In Six Low-Income To Middle-Income Countries, Archana Patel, Carla M. Bann, Vanessa R. Thorsten, Sowmya R. Rao, Adrien Lokangaka, Antoinette Tshefu Kitoto, Melissa Bauserman, Lester Figueroa, Nancy F. Krebs, Fabian Esamai, Sherri Bucher, Sarah Saleem, Robert L. Goldenberg, Elwyn Chomba, Waldemar A. Carlo, Shivaprasad Goudar, Richard Derman, Marion Koso-Thomas, Elizabeth Mcclure, Patricia L. Hibberd

Global Health Articles

OBJECTIVES: We examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites in six low-resource countries.

DESIGN: Prospective cohort study SETTING AND PARTICIPANTS: This study included data from the Global Network's population-based Maternal and Newborn Health Registry which follows pregnant women in six low-income and middle-income countries (Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan and Zambia). Participants in this analysis were 42 803 women, including their 43 230 babies, who registered for the study in their first trimester based …

Racial/Ethnic Disparities In Prostate Cancer 5-Year Survival: The Role Of Health-Care Access And Disease Severity, Christiane J. El Khoury, Sean A.P. Clouston

Department of Medical Oncology Faculty Papers

Introduction: Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. Methods: The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan–Meier method was performed for five racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the …

Racial Disparities In Access To Dbs: Results Of A Real-World U.S. Claims Data Analysis, Michael Frassica, Drew S Kern, Mitra Afshari, Allison T Connolly, Chengyuan Wu, Nathan Rowland, Juan Ramirez-Castaneda, Mwiza Ushe, Claudia Salazar, Xenos Mason

Farber Institute for Neuroscience Faculty Papers

INTRODUCTION: Deep brain stimulation (DBS) is an effective and standard-of-care therapy for Parkinson's Disease and other movement disorders when symptoms are inadequately controlled with conventional medications. It requires expert care for patient selection, surgical targeting, and therapy titration. Despite the known benefits, racial/ethnic disparities in access have been reported. Technological advancements with smartphone-enabled devices may influence racial disparities. Real-world evidence investigations can shed further light on barriers to access and demographic disparities for DBS patients.

METHODS: A retrospective cross-sectional study was performed using Medicare claims linked with manufacturer patient data tracking to analyze 3,869 patients who received DBS. Patients were …

Medical Student Sensitivity Training On The Differences In Sex Development, Paul Endres, Deborah Ziring, Dimitrios Papanagnou

Student Papers, Posters & Projects

No abstract provided.

Social Determinants Of Health In Pulmonary Arterial Hypertension Patients In The United States: Clinician Perspective And Health Policy Implications, Vijay R. Nadipelli, Jean M. Elwing, Willie H. Oglesby, Karim El-Kersh

College of Population Health Faculty Papers

Social determinants of health (SDoH) can impact the vulnerable pulmonary arterial hypertension (PAH) population, especially during the COVID-19 pandemic. Providers' understanding of SDoH at the point of care and their impact is unknown. We conducted semi-structured virtual interviews with US clinicians at 17 pulmonary hypertension (PH) centers and one patient advocate from the Pulmonary Hypertension Association. We sought participants' perspective on SDoH in PAH and their impact. Transcripts were developed and analyzed for key themes to assess potential policy implications. Participants served a large PAH population and demonstrated high awareness of SDoH and its impact on treatment and outcomes. They …

Half The Picture: Word Frequencies Reveal Racial Differences In Clinical Documentation, But Not Their Causes, Jacqueline A Penn, Denis Newman-Griffis

Department of Medicine Faculty Papers

Clinical notes are the best record of a provider's perceptions of their patients, but their use in studying racial bias in clinical documentation has typically been limited to manual evaluation of small datasets. We investigated the use of computational methods to scale these insights to large, heterogeneous clinical text data. We found significant differences in negative emotional tone and language implying social dominance in clinical notes between Black and White patients, but identified multiple contributing factors in addition to potential provider bias, including mis-categorization of some healthcare vocabulary as emotion-related. We further found that notes for Black patients were significantly …

Specter Of Reform: Understanding The Violent Crime Control And Law Enforcement Act Of 1994 And Its Role In Expanding The Modern Prison Industrial Complex, Timothy Nii-Okai Welbeck

Arlen Specter Center Research Fellowship

The United States incarcerates more of its citizens than any other nation in recorded history, and currently houses roughly 25% of the world’s prison population. Though the US prison population dipped in 2016 to its lowest rate since 1993, the sheer number of people under the supervision of the criminal justice system within the country is staggering. As of 2012, one in one hundred adults in the US are in jail or prison, which makes the US the nation with the world’s largest prison population. The US also leads the world in rate of incarceration. Thus, the nation’s prisons teem …

Creation Of A Web-Based Tool To Facilitate Community Connectivity, Peter Zdunek, Sarah Reed, Saima Anis, J. Alex Wrem

Phase 1

Introduction: Artificial intelligence-based modelling has created an opportunity to improve upon existing hospital readmission risk score systems by redefining priority and uncovering new criteria, but inherent systematic errors known as algorithmic bias can impact applicability. This study evaluated whether there is racial bias for unplanned readmission risk scores in a novel model prepared for the CMS AI challenge.

Methods: The study population provided by the CMS challenge included Medicare recipients from 2012 (unique beneficiaries n=1,667,362, total claims n=34,233,260). Risk scores for unplanned hospital readmissions were projected on the basis of clinical and demographic criteria, including age, sex, comorbidities, and prior …

Safe Streets, Inc. : The 'Hustle' To End Black Gang Violence In Philadelphia, 1969-1976, Menika Dirkson

Arlen Specter Center Research Fellowship

From 1962 to 1968, gang stabbings and murders in Philadelphia drastically increased, inspiring Philadelphia District Attorney Arlen Specter (from 1965-1973) to establish Safe Streets, Inc. in August 1969 as a non-profit, anti-gang program designed to reduce gang violence, end turf wars between rival gangs, and provide social services like job training and academic tutoring to juveniles. Since the program came into existence amidst the Civil Rights Movement (1954-1968), numerous cases of police brutality, and over 200 race riots in post-industrial cities, the yearly Law Enforcement Assistance Administration (LEAA) grant from the federal government offered to cities under the Omnibus Crime …

Improving Function In Age-Related Macular Degeneration: Design And Methods Of A Randomized Clinical Trial., Barry W Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in older adults and impairs the ability to read, drive, and live independently and increases the risk for depression, falls, and earlier mortality. Although new medical treatments have improved AMD's prognosis, vision-related disability remains a major public health problem. Improving Function in AMD (IF-AMD) is a two-group randomized, parallel design, controlled clinical trial that compares the efficacy of Problem-Solving Therapy (PST) with Supportive Therapy (ST) (an attention control treatment) to improve vision function in 240 patients with AMD. PST and ST therapists deliver 6 one-hour respective treatment sessions …

Universal Or Indicated Screening In Primary Care?, Matthew Wintersteen, Md

Department of Psychiatry and Human Behavior Faculty Papers

To the Editor: In the November 2010 issue, Schmitt and colleagues (1) reported that the duration of visits increased when depression screening was conducted in primary care. This report is timely given recent recommendations for both adult and pediatric screening for depression in primary care. Schmitt and colleagues examined data representative of more than 641 million primary care visits in2005–2007 and found that when depression screening was documented in patients’ records, physicians’ time with patients increased significantly.

Attachment-Based Family Therapy For Adolescents With Suicidal Ideation: A Randomized Controlled Trial., Guy S. Diamond, Matthew B. Wintersteen, Gregory K. Brown, Gary M. Diamond, Robert Gallop, Karni Shelef, Suzanne Levy

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. METHOD: This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access …

Activity Loss Is Associated With Cognitive Decline In Age-Related Macular Degeneration., Barry W. Rovner, Robin J. Casten, Benjamin E. Leiby, William S. Tasman

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND/METHODS: The objective of this study was to determine whether relinquishing cognitive, physical, and social activities is associated with an increased risk of cognitive decline in patients with age-related macular degeneration (AMD). We conducted a 3-year longitudinal study of 206 nondemented patients with AMD.

RESULTS: Twenty-three subjects (14.4%) declined cognitively. Age, sex, education, decline in visual acuity, and number of dropped activities were associated with cognitive decline; each additional dropped activity increased the risk by 58%. Subjects who relinquished three activities were 3.87 times (95% confidence interval, 1.95-7.76) more likely to become demented than subjects who relinquished no activities; those …

Women's History Month 2008

Diversity Programs

Lectures and Events during Women's History Month, March 2008.

Black History Month 2008 Supplement

Diversity Programs

Lectures, Cultural Events and Cuisine during Black Heritage Month, February 2008.

Black Heritage Month 2008

Diversity Programs

Lectures, Cultural Events and Cuisine during Black Heritage Month, February 2008.

Mlk Day 2008

Diversity Programs

Calendar of event in Honor of Dr. Martin Luther King, Jr. Day, January 2008.

Off-Label Psychopharmacologic Prescribing For Children: History Supports Close Clinical Monitoring., Julie M Zito, Albert T Derivan, Christopher J Kratochvil, Daniel J Safer, Joerg M Fegert, Laurence L Greenhill

Department of Psychiatry and Human Behavior Faculty Papers

The review presents pediatric adverse drug events from a historical perspective and focuses on selected safety issues associated with off-label use of medications for the psychiatric treatment of youth. Clinical monitoring procedures for major psychotropic drug classes are reviewed. Prior studies suggest that systematic treatment monitoring is warranted so as to both minimize risk of unexpected adverse events and exposures to ineffective treatments. Clinical trials to establish the efficacy and safety of drugs currently being used off-label in the pediatric population are needed. In the meantime, clinicians should consider the existing evidence-base for these drugs and institute close clinical monitoring.

Expressions Of Asia 2008

Diversity Programs

Lectures, cultural events, and Asian cuisine during Expressions of Asia, January 2008.

International Education Week 2007

Diversity Programs

Lectures during International Education Week, November 2007.

Native American Heritage Month 2007

Diversity Programs

Lecture during Native American Heritage Month, November 2007.

Lgbt History Month 2007

Diversity Programs

Lectures and Activities during LGBT History Month, October 2007.