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Aim: The Pennsylvania first episode psychosis program evaluation (PA-FEP-PE) core assessment battery was developed as a standard and comprehensive clinical assessment and data collection tool in Pennsylvania coordinated specialty care programs (CSC). To reduce administrative time and maximize clinical utility by maintaining acceptable levels of precision, we aimed to generate a short form using item response theory (IRT)-based computer-adaptive test (CAT) simulation and analyse the implementation and acceptability of the short form among providers from PA-CSC., Methods: FEP participants (n = 759; age 14-36) from nine coordinated specialty care programs completed 156 items drawn from the PA-FEP-PE battery. Multidimensional IRT-based CAT simulations were used to select the best PA-FEP-PE items for abbreviated forms., Results: A 67-item PA-FEP-PE short form was developed to capture six factors: (1) positive affect and surgency (with negative loadings on Anxious-Misery items); (2) psychiatric services satisfaction; (3) antipsychotic side effect severity; (4) family turmoil and associated traumas; (5) trauma load; and (6) psychosis. The total number of items was reduced more than 50% in the PA-FEP-PE shortened forms. The short form demonstrated good psychometric properties, and it was well accepted by our providers in the implementation., Conclusions: The empirical derivation and implementation of abbreviated measures of key domains and constructs in FEP care have streamlined and facilitated PA-FEP program evaluation. Our work supports potential application of IRT based methods to empirically reduce core assessment battery measures in large-scale data collection efforts such as in the Early Psychosis Intervention Network., (© 2022 John Wiley & Sons Australia, Ltd.)

Founder populations have long contributed to our knowledge of rare disease genes and phenotypes. From the pioneering work of Dr. Victor McKusick to today, research in these groups has shed light on rare recessive phenotypes, expanded the clinical spectrum of disease, and facilitated disease gene identification. Current clinical and research studies in these special groups augment the wealth of knowledge already gained, provide new insights into emerging problems such as variant interpretation and reduced penetrance, and contribute to the development of novel therapies for rare genetic diseases. Clinical developments over the past 30 years have altered the fundamental relationship with the Lancaster Plain communities: research has become more collaborative, and the knowledge imparted by these studies is now being harnessed to provide cutting-edge translational medicine to the very community of vulnerable individuals who need it most., (© 2021 Wiley Periodicals LLC.)

Aim: Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes., Methods: Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization., Results: PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months., Conclusions: PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society., (© 2020 John Wiley & Sons Australia, Ltd.)

Background and Objectives: About 22% of adult smokers in the U.S. are intermittent cigarette smokers (ITS). ITS can be further classified as native ITS who never smoked daily and converted ITS who formerly smoked daily but reduced to intermittent smoking. Ecological momentary assessment (EMA) was conducted to determine the behaviors and experiences that are associated with the decision to smoke., Methods: The study included 24 native ITS and 36 converted ITS (N = 60) from the Pennsylvania Adult Smoking Study. A baseline questionnaire, daily log, and an EMA smoking log that assessed emotions, activities, and smoking urges was filled out with each cigarette for 1 week to capture 574 smoking sessions., Results: Both groups had very low levels of cigarette dependence. Both groups were more tempted to smoke in positive or negative situations than situations associated with habituation. EMA showed that the most common emotional state during smoking sessions was positive (47%), followed by negative (32%), neutral (16%), and mixed (5%) emotions. Smokers were more likely to smoke during activities of leisure (48%) than during performative duties (29%), social (16%) or interactive occasions (7%). Converted ITS were more likely to smoke alone compared to native ITS (p < .001)., Discussion and Conclusions: ITS report minimal levels of dependence when captured on traditional scales of nicotine dependence, yet experience loss of autonomy and difficulty quitting. The majority of the ITS reported positive emotions and leisure activities while smoking, and smoked during the evening., Scientific Significance: The current paper identifies environmental and behavioral factors that are associated with smoking among ITS in real time. (Am J Addict 2018;27:131-138)., (© 2018 American Academy of Addiction Psychiatry.)

This paper describes, for the first time, the utilization of nebulized morphine in the management of severe chest pain in two young adult African-American patients who suffered from generalized acute sickle cell painful episodes. While hospitalized, both patients developed new sharp chest wall pain, and were treated with nebulized morphine started at 20 mg MOSO4 in 3.0- to 5.0-mL physiologic buffered saline solution. Within minutes, both patients reported significant relief of chest wall pain. Patient 1 achieved 90% pain relief as well as a significant decrease in the pain intensity score. Patient 2 reported 40% pain relief, and the pain intensity score decreased to a mean of 5.6/10. Hence, treatment every 6 hr was continued for 10 days, after which the chest wall pain subsided. These findings indicate that nebulized morphine may prove effective in the management of acute chest pain in patients with sickle cell anemia. This is a desirable alternative in patients with difficult venous access and may more specifically target chest pain., (Copyright 2004 Wiley-Liss, Inc.)

The Clinic for Special Children in Lancaster County, Pennsylvania, is a community-supported, nonprofit pediatric medical practice for Amish and Mennonite children who have genetic disorders. Over a 14-year period, 1988-2002, we have encountered 39 heritable disorders among the Amish and 23 among the Mennonites. We emphasize early recognition and long-term medical care of children with genetic conditions. In the clinic laboratory we perform amino acid analyses by high-performance liquid chromatography (HPLC), organic acid analyses by gas chromatography/mass spectrometry (GC/MS), and molecular diagnoses and carrier tests by polymerase chain reaction (PCR) amplification and sequencing or restriction digestion. Regional hospitals and midwives routinely send whole-blood filter paper neonatal screens for tandem mass spectrometry and other modern analytical methods to detect 14 of the metabolic disorders found in these populations as part of the NeoGen Inc. Supplemental Newborn Screening Program (Pittsburgh, PA). Medical care based on disease pathophysiology reduces morbidity, mortality, and costs for the majority of disorders. Among our patients who are homozygous for the same mutation, differences in disease severity are not unusual. Clinical problems typically arise from the interaction of the underlying genetic disorder with common infections, malnutrition, injuries, and immune dysfunction that act through classical pathophysiological disease mechanisms to influence the natural history of disease., (Copyright 2003 Wiley-Liss, Inc.)

Due to the lack of a standardized methodology to identify agriculturally related fatalities and the inaccuracy of data from death certificates, NSC's and NIOSH's estimates of the level of agriculturally related fatalities conflict, and the validity of both is subject to criticism. A follow-up survey with the next of kin of 107 potential agricultural fatalities, from a pool of 150 Pennsylvania cases, has been conducted. This paper details the methods and success in gaining supplemental information. Next of kin were generally willing to provide the information (67%), with both telephone (66%) and mail (68%) methods generating comparable levels of cooperation. The optimal time frame for finding current addresses and telephone numbers as well as for gaining cooperation appeared to be about 1 year after the fatality. However, a retrospective investigation of up to 3 years past the anniversary of the fatality produced an acceptable rate of cooperation. How the collected data compares with fatality data for agriculture published by NSC and N1OSH has been addressed in another paper.

Polish Hill is an urban, ethnic enclave of approximately 3000 residents residing in a 25-block area of Pittsburgh. This paper documents changes in the fertility, morbidity, and mortality patterns in the community from the turn of the century to the present. The demographic reconstruction is based upon baptismal and marriage records, the administration of demographic proformae and population censuses. The high mortality, morbidity, and fertility variance suggest that the immigrant population has experienced a period of high opportunity for selection in the early 1900's and that Crow's index was gradually reduced to its present level.

The results of tympanoplastic surgery to repair a perforation of the tympanic membrane are less satisfactory in children than in adults. This paper reports the results of a propspective study of 45 children (51 ears) which was undertaken to determine which, if any, detectable and controllable pre or intraoperative parameters might predict the outcome of tympanoplasty surgery. A "successful" tympanoplasty was defined as that in which the initial graft took, in which the tympanic membrane remained intact, and which was not associated with high negative middle ear pressure, otitis media with effusion, or cholesteatoma during a follow-up period of one to two years. Assessment of hearing related to the tympanoplastic surgery was not included as an outcome measure. With this criteria, the overall success rate of tympanoplasty in children was 35%. The success of tympanoplasty was not related to graft placement, although the laterally placed grafts had a higher take rate (67%) than grafts placed medially (49%). Preoperative measures, such as the assessment of Eustachian tube function using the modified inflation-deflation test and tympanometric evaluation of the contralateral ear, failed to predict the success of tympanoplasty. Tympanoplasty universally failed in the ears in which an acquired cholesteatoma was present. Children remain uncertain candidates for tympanoplasty surgery since, as a group, their Eustachian tube function is not as good as that of adults.

This paper describes the extensive experience of the Department of Family Medicine at Jefferson Medical College in utilizing the modified essay question (MEQ) as a final examination for its required third-year clerkship in family medicine. The results of a preliminary study are presented, comparing the MEQ as a method of evaluation with the multiple choice question (MCQ) format on similar content material. MCQ performance was found to be a better predictor of National Board Part I and II scores, but neither format was found to be a good predictor of postgraduate performance. The data were statistically significant (P less than 0.05) that MEQ performance was related to postgraduate performance in the area of professional attitude while the MCQ was not; however, the number of students in the analysis was small. Additional studies are planned to test this hypothesis further.