Browsing by Subject "New York"
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Item Open Access Analysis of Oyster Restoration Policy and Practitioner Feedback in the Hudson-Raritan Estuary(2023-04-28) Krupitsky, MarikaItem Open Access Association between stroke center hospitalization for acute ischemic stroke and mortality.(JAMA, 2011-01) Xian, Ying; Holloway, Robert G; Chan, Paul S; Noyes, Katia; Shah, Manish N; Ting, Henry H; Chappel, Andre R; Peterson, Eric D; Friedman, BruceAlthough stroke centers are widely accepted and supported, little is known about their effect on patient outcomes.To examine the association between admission to stroke centers for acute ischemic stroke and mortality.Observational study using data from the New York Statewide Planning and Research Cooperative System. We compared mortality for patients admitted with acute ischemic stroke (n = 30,947) between 2005 and 2006 at designated stroke centers and nondesignated hospitals using differential distance to hospitals as an instrumental variable to adjust for potential prehospital selection bias. Patients were followed up for mortality for 1 year after the index hospitalization through 2007. To assess whether our findings were specific to stroke, we also compared mortality for patients admitted with gastrointestinal hemorrhage (n = 39,409) or acute myocardial infarction (n = 40,024) at designated stroke centers and nondesignated hospitals.Thirty-day all-cause mortality.Among 30,947 patients with acute ischemic stroke, 15,297 (49.4%) were admitted to designated stroke centers. Using the instrumental variable analysis, admission to designated stroke centers was associated with lower 30-day all-cause mortality (10.1% vs 12.5%; adjusted mortality difference, -2.5%; 95% confidence interval [CI], -3.6% to -1.4%; P < .001) and greater use of thrombolytic therapy (4.8% vs 1.7%; adjusted difference, 2.2%; 95% CI, 1.6% to 2.8%; P < .001). Differences in mortality also were observed at 1-day, 7-day, and 1-year follow-up. The outcome differences were specific for stroke, as stroke centers and nondesignated hospitals had similar 30-day all-cause mortality rates among those with gastrointestinal hemorrhage (5.0% vs 5.8%; adjusted mortality difference, +0.3%; 95% CI, -0.5% to 1.0%; P = .50) or acute myocardial infarction (10.5% vs 12.7%; adjusted mortality difference, +0.1%; 95% CI, -0.9% to 1.1%; P = .83).Among patients with acute ischemic stroke, admission to a designated stroke center was associated with modestly lower mortality and more frequent use of thrombolytic therapy.Item Open Access Building a Better World: Youth, Radicalism, and the Politics of Space in New York City, 1945-1965(2012) Teal, OrionAccording to conventional wisdom, the period of intense antiradicalism that followed World War II effectively drove all radical activity underground by the early 1950s, severing the intergenerational connection between the "Old Left" of the Great Depression era and the "New Left" of the 1960s. Building a Better World revises this narrative by examining how radical activists in New York City carved out space for young people's participation in leftwing political culture between 1945 and 1965. Contrary to most studies of the postwar Red Scare that focus on the Left's decline, this study tells a story of survival. Despite concerted efforts by social critics and governmental officials to curtail radicals' political influence among the young, radicals maintained a surprisingly robust radical social world centered in summer camps, private schools, youth groups, cultural organizations, union halls, and homes throughout New York City and its environs. In these spaces, youth continued to absorb a radical worldview that celebrated the labor movement, decolonization struggles, and African Americans' quest for freedom, while forwarding a biting critique of American capitalism. This process of intergenerational transmission would not have been possible without access to social space and an ever-evolving interpretation of radical values responsive to changes in political culture and demographics. Building a Better World relies on extensive archival research, print material, visual sources, and original oral histories to document this hidden history. In so doing, the dissertation significantly revises our understanding of the American Left, the history of American childhood, spatial change in New York City, and the evolution of political, ethnic, and racial identities in modern American history.
Item Open Access Clinical outcomes of children with abnormal newborn screening results for Krabbe disease in New York State.(Genetics in medicine : official journal of the American College of Medical Genetics, 2016-12) Wasserstein, Melissa P; Andriola, Mary; Arnold, Georgianne; Aron, Alan; Duffner, Patricia; Erbe, Richard W; Escolar, Maria L; Estrella, Lissette; Galvin-Parton, Patricia; Iglesias, Alejandro; Kay, Denise M; Kronn, David F; Kurtzberg, Joanne; Kwon, Jennifer M; Langan, Thomas J; Levy, Paul A; Naidich, Thomas P; Orsini, Joseph J; Pellegrino, Joan E; Provenzale, James M; Wenger, David A; Caggana, MicheleBackground
Early infantile Krabbe disease is rapidly fatal, but hematopoietic stem cell transplantation (HSCT) may improve outcomes if performed soon after birth. New York State began screening all newborns for Krabbe disease in 2006.Methods
Infants with abnormal newborn screen results for Krabbe disease were referred to specialty-care centers. Newborns found to be at high risk for Krabbe disease underwent a neurodiagnostic battery to determine the need for emergent HSCT.Results
Almost 2 million infants were screened. Five infants were diagnosed with early infantile Krabbe disease. Three died, two from HSCT-related complications and one from untreated disease. Two children who received HSCT have moderate to severe developmental delays. Forty-six currently asymptomatic children are considered to be at moderate or high risk for development of later-onset Krabbe disease.Conclusions
These results show significant HSCT-associated morbidity and mortality in early infantile Krabbe disease and raise questions about its efficacy when performed in newborns diagnosed through newborn screening. The unanticipated identification of "at risk" children introduces unique ethical and medicolegal issues. New York's experience raises questions about the risks, benefits, and practicality of screening newborns for Krabbe disease. It is imperative that objective assessments be made on an ongoing basis as additional states begin screening for this disorder.Genet Med 18 12, 1235-1243.Item Open Access Comanagement of U.S. Marine Protected Areas: Current Efforts and their Potential Implications for Seagrass Management at Fishers Island, New York(2016-04-27) Collier, ChantalComanagement is practiced in many countries and recommended as an appropriate, equitable and effective approach to place-based, marine resource management. However, few examples of collaboratively managed marine protected areas (MPAs) involving government and community partners are found in the United States (U.S.). Efforts to share management of MPAs by the state and local communities have emerged in Florida, Hawai‘i, and California. These cooperative agreements demonstrate an alternative to the top-down, centralized government approach to natural resource management commonly practiced in the U.S. What conditions enabled or challenged the emergence of comanagement for these MPAs? How have local community norms, values and knowledge contributed to marine resource problem-solving in each case? Can experiences drawn from these cases inform or improve MPA management in other states? Recent legislation requiring the State of New York to designate Seagrass Management Areas and consult with local community members to effectively protect, manage and restore seagrass provides an opportunity to investigate these questions. This study reveals the conditions and strategies whereby solutions to MPA management problems emerged as a result of iterative, collaborative processes for Rookery Bay in Florida, Hā‘ena in Hawai‘i, and Catalina Island in California, where the state and local community share management responsibilities. For each case, I describe the development of MPAs and the collaborative agreement, identify the conditions that gave rise to comanagement, and map its problem-solving functions in the context of the social-ecological system. Drawing upon my analysis, I recommend strategies to enhance MPA comanagement and propose new conditions or drivers essential for comanagement of MPAs. Existing preconditions and the potential for a cooperative approach to seagrass management at Fishers Island, New York are derived from community members’ perceptions, values, hopes and concerns regarding local marine resources and the prospect of Seagrass Management Areas.Item Open Access EVALUATING THE SUCCESS OF STATE VOLUNTARY CLEANUP PROGRAMS: A PROGRAM ANALYSIS OF ILLINOIS, NEW YORK AND TENNESSEE(2007-05) Herrmann, Keith A.States developed Voluntary Cleanup Programs (VCPs) in the mid 1990s to promote the redevelopment of contaminated properties within state boundaries. Employing a variety of mechanisms and incentives to help overcome barriers to brownfield redevelopment, the primary responsibilities of VCPs involve providing legal liability, technical assistance and economic incentives. Despite diverse approaches and the successful cleanup of brownfields, few programs require routine or systematic methods to collect and record information to determine what aspects of state VCPs are successful (Wernstedt, 2004). This master’s project establishes a conceptual program analysis on the success of state VCPs and evaluates the programs in Illinois, New York, and Tennessee. States were selected based on maturity, size of program, and type of mandate. Evaluation criteria were established using a National Brownfield Association report that identified key elements to VCP success. Each VCP was examined in terms of environmental closure and liability clarity, use of agency resources, cleanup goals to protect human health and the environment, and the availability of financial incentives to meet brownfield needs. An overall score for each criterion was developed and determined by evaluating various sub-criteria. Results indicate that overall the three states incorporate diverse approaches while incorporating elements of success. While Illinois utilizes agency resources well, the financial incentives available in New York provide a creative means for voluntary parties to redevelop contaminated sites. Tennessee does well in providing several of the key elements, but minimal incentives are available for interested parties to overcome financial barriers of redevelopment.Item Open Access Newborn screening for Krabbe disease in New York State: the first eight years' experience.(Genetics in medicine : official journal of the American College of Medical Genetics, 2016-03) Orsini, Joseph J; Kay, Denise M; Saavedra-Matiz, Carlos A; Wenger, David A; Duffner, Patricia K; Erbe, Richard W; Biski, Chad; Martin, Monica; Krein, Lea M; Nichols, Matthew; Kurtzberg, Joanne; Escolar, Maria L; Adams, Darius J; Arnold, Georgianne L; Iglesias, Alejandro; Galvin-Parton, Patricia; Kronn, David F; Kwon, Jennifer M; Levy, Paul A; Pellegrino, Joan E; Shur, Natasha; Wasserstein, Melissa P; Caggana, Michele; New York State Krabbe Disease ConsortiumPurpose
Krabbe disease (KD) results from galactocerebrosidase (GALC) deficiency. Infantile KD symptoms include irritability, progressive stiffness, developmental delay, and death. The only potential treatment is hematopoietic stem cell transplantation. New York State (NYS) implemented newborn screening for KD in 2006.Methods
Dried blood spots from newborns were assayed for GALC enzyme activity using mass spectrometry, followed by molecular analysis for those with low activity (≤12% of the daily mean). Infants with low enzyme activity and one or more mutations were referred for follow-up diagnostic testing and neurological examination.Results
Of >1.9 million screened, 620 infants were subjected to molecular analysis and 348 were referred for diagnostic testing. Five had enzyme activities and mutations consistent with infantile KD and manifested clinical/neurodiagnostic abnormalities. Four underwent transplantation, two are surviving with moderate to severe handicaps, and two died from transplant-related complications. The significance of many sequence variants identified is unknown. Forty-six asymptomatic infants were found to be at moderate to high risk for disease.Conclusions
The positive predictive value of KD screening in NYS is 1.4% (5/346) considering confirmed infantile cases. The incidence of infantile KD in NYS is approximately 1 in 394,000, but it may be higher for later-onset forms.Item Open Access Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.(Medicine (Baltimore), 2016-04) Magdon-Ismail, Zainab; Sicklick, Alyse; Hedeman, Robin; Bettger, Janet Prvu; Stein, JoelThe process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.