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Topographic map evidence for previously unexplained Casselman River direction changes (including where it joins the Youghiogheny River) indicates prolonged and massive volumes of south-oriented water once flowed across the Conemaugh-Casselman River drainage divide and formed diverging southwest- and southeast-oriented channels with the southwest-oriented flow joining south-oriented flow on today’s north-oriented Youghiogheny River alignment. The southeast-oriented channel eroded a water gap across an emerging Negro Mountain and then a diverging southwest-oriented channel followed the northeast-oriented Casselman River alignment to reach south-oriented flow on the now north-oriented Youghiogheny River alignment while the southeast-oriented channel and a southeast-oriented channel which diverged from the southwest-oriented channel eroded the Flaughtery and Piney Creek water gaps into an emerging Meadow Mountain. Conemaugh River drainage system development ended south-oriented flow into the Casselman River drainage basin while regional uplift caused drainage reversals to create today’s northeast-, northwest-, and southwest-oriented Casselman River. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of literature that indicates positive outcomes of group treatment approaches to intervention for communication difficulties in chronic traumatic brain injury (TBI). The published research to date examines face‐to‐face group intervention. Aim: This study draws on one of these approaches, 'Improving Natural Social Interaction: Group reHabilitation after Traumatic brain injury' (INSIGHT), and examines the adaptation of this program to a virtual setting. The principles underlying the program, which involved providing an authentic contextualised and natural environment for group interactions and enhancing opportunities for identity expression, were maintained. Methods & Procedures: Six participants with mild to severe TBI and cognitive communication difficulties participated in an 8‐week pilot program of the virtual INSIGHT program. Goal Attainment Scaling (GAS) scores completed over the course of the intervention served as the primary outcome measure. Secondary outcomes measures included The Repeatable Battery for the Assessment of Neuropsychological Status Update, The Awareness of Social Inference Test‐Revised, the La Trobe Communication Questionnaire and the Satisfaction with Life Scale. Outcomes & Results: A mixed multilevel analysis revealed significant improvement in GAS scores. A Wilcoxon signed rank test revealed no significant changes in secondary measures. Conclusions & Implications: There is a growing potential for this group treatment approach, in an online medium, and progress towards individualised goals was clear. The data have implications for examining the assessment measures typically used to document functional outcomes in clinical intervention. Future directions indicate a need to pursue more ecologically valid assessment methods. What this paper adds: What is already known on the subject: Recent literature has focused on the benefits of group intervention for cognitive communication diffuclties after traumatic brain injury (TBI). However, research to date examines only face‐to‐face group rehabilitation. As there has been a demand for a shift in the way we communicate worldwide, we must make adaptations to current intervention procedures to continue to serve individuals with diverse communication needs. What this paper adds to existing knowledge: This study contributes new information about the feasibility of a virtual communication skills group for individuals with TBI. This virtual INSIGHT (Improving Natural Social Interaction: Group ehabilitation after Traumatic brain injury) group intervention facilitates progress towards collaboratively set communication goals and the online setting has the potential to increase the accessibility of these services. What are the potential or actual clinical implications of this work?: Progress towards cognitive and social communication goals can be facilitated by an online group intervention. However, this progress was not correlated with scores on standard assessments of cognitive communication, social communication and quality of life. This has implications for the evaluation of the assessments typically used and their ecological validity and applicability to the communication context. [ABSTRACT FROM AUTHOR]

Social workers have long been active in social and political organizing to ensure a living wage. Yet recent social work research largely neglects efforts to raise wages and effective means for organizing to do so. This paper draws on in-depth interviews from a longitudinal study of low-wage hospital workers who formed a union and negotiated annual, incremental wage increases to achieve a $15 minimum wage floor to understand their perceptions of the effects of the initial wage increase. Results show workers have a wide spectrum of perceptions, with many feeling no effect or even a negative effect due to losses in public benefits. A visualization used to aid interpretation of results identifies race and family structure as salient factors, pointing to the role of structural discrimination in experiences and perceptions of wage increases. Given that this workplace, like many other employers and localities, has implemented a $15 minimum wage through incremental raises across time, it is important that social workers be aware of the experiences of workers at each stage of this process. This study examines the impact of the first raise, establishing a framework from which future research can examine how individuals' perceptions and experiences develop over time. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper is to conduct a bibliometric analysis to examine the research status and development trend of anterior cruciate ligament injury and reconstruction in children and adolescents over the past 20 years. Design: Descriptive Research. Methods: This study obtained information regarding studies on Anterior Cruciate Ligament Reconstruction in Children and Adolescents from the Web of Science Core Collection database. Visual and bibliometric analysis were conducted using VOSviewer, Origin 2022, Pajek64 5.18and Excel 2019. These analytic tools facilitated the analysis of various aspects, including countries/regions, institutions, authors, journals and keywords related to the research. Results: From 2003 to 2023, a total of 1328 articles were retrieved in WOS, and 637 articles were selected by two authors. The most productive institutions are Childrens Hosp Philadelphia, Kocher, ms. Their articles have the highest number of publications and citations. The American journal of sports medicine is the most frequently cited journal for articles on anterior cruciate ligament reconstruction in children and adolescents. The most common keywords used in these articles were "anterior cruciate ligament reconstruction", "injury, children, adolescent", and "skeletally immature patients". Conclusions: This study provides valuable insights into the research focus of anterior cruciate ligament reconstruction in children and adolescents. In recent years, there has been significant attention paid to areas of "the return to sport, re-repture rate and functional recovery after anterior cruciate ligament reconstruction" in this specific population. These aspects have emerged as key directions for future research in this field. [ABSTRACT FROM AUTHOR]

The lives of caregivers can be deeply impacted by having a child with a developmental disability (DD). To offset those impacts, caregivers may engage in accommodations, or strategies to bolster everyday functioning. The nature and extent of these accommodations can provide insight into how the family is doing and what supports are needed from a family-centered perspective. This paper presents the development and preliminary validation of the Accommodations & Impact Scale for Developmental Disabilities (AISDD). The AISDD is a rating scale that measures day-to-day accommodations and impacts of raising a child with a DD. A sample of 407 caregivers of youth with DDs (Mage = 11.7 years; 63% males) completed the AISDD, along with measures of caregiver strain, daily challenges, child adaptive behavior, and behavior and emotional regulation. The AISDD is a unidimensional, 19-item scale with excellent internal consistency (ordinal alpha =.93) and test–retest (ICC =.95) reliability. Scores were normally distributed and sensitive to age (r = −.19), diagnosis (ASD + ID > ASD > ID), adaptive functioning (r = −.35), and challenging behaviors (r =.57). Finally, the AISDD showed excellent convergent validity with similar measures of accommodations and impacts. These findings support the use of the AISDD as a valid and reliable tool for measuring accommodations among caregivers of individuals with DDs. This measure shows promise in its ability to identify which families may need additional support for their children. [ABSTRACT FROM AUTHOR]

Purpose: Maternal substance use and deaths due to overdoses are increasing nationwide. Evidence suggests that the rate of resumed substance use, and fatal and non-fatal overdose is greatest in the first year after birth, particularly around six months postpartum, compared to other parts of the perinatal period. Doula care has been linked to improvements in perinatal health and outcomes. Description: In response to the opioid epidemic, the Philadelphia Department of Public Health developed and implemented the Doula Support Program (DSP), with a focus on one year of postpartum care for birthing people with a substance use disorder (SUD). In this paper, we describe the program and its formation and report on the early challenges and successes of the program implementation, based on information we received from program founders and managers in a group interview. Assessment: Early successes of the program include partnering with local community-based programs to recruit and retain doulas, supplementing traditional doula education with perinatal SUD-specific trainings, and maximizing client referrals by collaborating with local organizations and treatment centers that serve birthing people with SUD. Client retention, however, has proven to be challenging, especially during the COVID-19 pandemic. Conclusion: The DSP continues to grow, and lessons learned will facilitate program improvements. The goal of this paper is to outline the development and launch of the DSP and to act as a model for other state and local health departments interested in providing doula care for birthing people with SUD. Significance: Maternal substance use and fatal overdoses are increasing in Philadelphia, Pennsylvania. In response to this crisis, the Philadelphia Department of Public Health's Division of Maternal, Child and Family Health developed the Doula Support Program (DSP), offering doula care to pregnant people with a current or past SUD history up to one-year postpartum. To our knowledge, this is the only doula program in Pennsylvania offering one-year postpartum support to birthing people affected by SUD. [ABSTRACT FROM AUTHOR]

Rapid changes in technology make it increasingly important to understand the impact of modes of presentation and the use of computers to obtain data. In order to begin to explore the effects of new technologies in the domain of anti-drug public service announcements (PSAs), 154 adolescents from the Boys and Girls Clubs of Metropolitan Philadelphia were randomly assigned to one of three series of six anti-drug PSAs or a series of six political PSAs (control). Half the subjects viewed and evaluated the PSAs on a laptop computer, while the other half viewed the PSAs on a TV monitor and evaluated them using a paper and pencil self-completion questionnaire. As expected, sets of anti-drug PSAs were judged to be more effective in helping people avoid drugs than the set of political PSAs. There were, however, important differences in effectiveness as a function of gender and ethnicity. In addition, in contrast to previous research, there were only minimal differences between the use of computer methodology and the more traditional TV and paper and pencil methodology. [ABSTRACT FROM AUTHOR]

In light of numerous discussions about whether to follow Mark Greene and Dennis Meissner's suggestions to process lightly and broadly, valid reasons remain for continuing traditional practices for many literary correspondence collections. In this case study, the authors use the Kenneth Burke Papers in the Special Collections Library, Pennsylvania State University Libraries, as an example of when it is desirable to provide item level indexing. Recognizing that the majority of archival records may not require such detailed description, the authors discuss when it is appropriate to examine and index literary correspondents, a practice used with many other literary collections in which name access to literary correspondents is a legitimate, valued interest. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common cancer after non-melanoma skin cancer and the second leading cause of cancer deaths in US men. Its incidence and mortality rates vary substantially across geographical regions and over time, with large disparities by race, geographic regions (i.e., Appalachia), among others. The widely used Cox proportional hazards model is usually not applicable in such scenarios owing to the violation of the proportional hazards assumption. In this paper, we fit Bayesian accelerated failure time models for the analysis of prostate cancer survival and take dependent spatial structures and temporal information into account by incorporating random effects with multivariate conditional autoregressive priors. In particular, we relax the proportional hazards assumption, consider flexible frailty structures in space and time, and also explore strategies for handling the temporal variable. The parameter estimation and inference are based on a Monte Carlo Markov chain technique under a Bayesian framework. The deviance information criterion is used to check goodness of fit and to select the best candidate model. Extensive simulations are performed to examine and compare the performances of models in different contexts. Finally, we illustrate our approach by using the 2004-2014 Pennsylvania Prostate Cancer Registry data to explore spatial-temporal heterogeneity in overall survival and identify significant risk factors. [ABSTRACT FROM AUTHOR]

Background: Recruiting large cohorts efficiently can speed the translation of findings into care across a range of scientific disciplines and medical specialties. Recruitment can be hampered by factors such as financial barriers, logistical concerns, and lack of resources for patients and clinicians. These and other challenges can lead to underrepresentation in groups such as rural residents and racial and ethnic minorities. Here we discuss the implementation of various recruitment strategies for enrolling participants into a large, prospective cohort study, assessing the need for adaptations and making them in real-time, while maintaining high adherence to the protocol and high participant satisfaction. Methods: While conducting a large, prospective trial of a multi-cancer early detection blood test at Geisinger, an integrated health system in central Pennsylvania, we monitored recruitment progress, adherence to the protocol, and participants' satisfaction. Tracking mechanisms such as paper records, electronic health records, research databases, dashboards, and electronic files were utilized to measure each outcome. We then reviewed study procedures and timelines to list the implementation strategies that were used to address barriers to recruitment, protocol adherence and participant satisfaction. Results: Adaptations to methods that contributed to achieving the enrollment goal included offering multiple recruitment options, adopting group consenting, improving visit convenience, increasing the use of electronic capture and the tracking of data and source documents, staffing optimization via leveraging resources external to the study team when appropriate, and integrating the disclosure of study results into routine clinical care without adding unfunded work for clinicians. We maintained high protocol adherence and positive participant experience as exhibited by a very low rate of protocol deviations and participant complaints. Conclusion: Recruiting rapidly for large studies – and thereby facilitating clinical translation – requires a nimble, creative approach that marshals available resources and changes course according to data. Planning a rigorous assessment of a study's implementation outcomes prior to study recruitment can further ground study adaptations and facilitate translation into practice. This can be accomplished by proactively and continuously assessing and revising implementation strategies. [ABSTRACT FROM AUTHOR]

Physical activity is known to contribute to good health, but most adults in the United States do not meet recommended physical activity guidelines. Social incentive interventions that leverage insights from behavioral economics have increased physical activity in short-term trials, but there is limited evidence of their effectiveness in community settings or their long-term effectiveness. The STEP Together study is a Hybrid Type 1 effectiveness-implementation study to address these evidence and implementation gaps. This paper describes the process of adapting study procedures prior to the effectiveness trial using Community Engagement (CE) Studios, facilitated meetings during which community members provide feedback on research projects. Six CE Studios were held with community members from the priority population. They were conducted remotely because of the COVID-19 pandemic. Fifteen liaisons representing 13 community organizations and 21 community members from different neighborhoods in Philadelphia participated. Three elements of the study design were modified based on feedback from the CE Studios: lowering the age requirement for an 'older adult', clarifying the definition of family members to include second-degree relatives, and adding a 6-month survey. These adaptations will improve the fit of the effectiveness trial to the local context and improve participant engagement and retention. CE Studios can be used to adapt intervention strategies and other aspects of study design during hybrid implementation-effectiveness trials. This approach was successfully used with remote online participation due to the COVID-19 pandemic and serves as a model for future community-engaged implementation research. [ABSTRACT FROM AUTHOR]

Focuses on the development of a local check-in system for serials management at the Nesbitt Library in Wilkes-Barre, Pennsylvania. Application of Microsoft Access and basic Kardex check-in principles; Common problems in automating check-in and claiming; Presentation of several possible check-in process based on predicted enumeration.

Scholars have spent decades arguing that policy entrepreneurs, change agents who work individually and in groups to influence the policy process, can be crucial in introducing policy innovation and spurring policy change. How to identify policy entrepreneurs empirically has received less attention. This oversight is consequential because scholars trying to understand when policy entrepreneurs emerge, and why, and what makes them more or less successful, need to be able to identify these change agents reliably and accurately. This paper explores the ways policy entrepreneurs are currently identified and highlights issues with current approaches. We introduce a new technique for eliciting and distinguishing policy entrepreneurs, coupling automated and manual analysis of local news media and a survey of policy entrepreneur candidates. We apply this technique to the empirical case of unconventional oil and gas drilling in Pennsylvania and derive some tentative results concerning factors which increase entrepreneurial efficacy. [ABSTRACT FROM AUTHOR]

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence. [ABSTRACT FROM AUTHOR]

Background and Objective: Hypothyroidism and autoimmune thyroiditis are more prevalent than previously considered in women during pregnancy and the postpartum, and are associated with adverse effects on the mother and her fetus. We determined the efficacy and accuracy of screening women for primary hypothyroidism and autoimmune thyroiditis by testing TSH and two thyroid antibodies (TAb): thyroperoxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), in eluates of filter paper specimens collected during early pregnancy and the postpartum. Methods: We enrolled 494 first-trimester pregnant women with no exclusion criteria into a prospective study to detect primary hypothyroidism and autoimmune thyroiditis. Finger stick blood was applied to filter paper, dried in room air, eluted, and promptly tested for TSH and TAb. A total of 178 of the pregnant women (36%) were tested in the early postpartum. Women with abnormal results had confirmatory serum tests. Results: It was found that 91 pregnant women (18.4%) and 43 postpartum women (24.2%) had abnormal TSH values (>4.0 mU/L) and/or positive TAb; 140 pregnant women (28.3%) had TSH values >2.5 mU/L. All subjects with TSH values >4.0 mU/L tested positive for TAb. Eighteen women (3.6%) who tested normal during pregnancy tested abnormal in the postpartum. Conclusions: This study confirms that TSH and TPOAb measured in eluates of blood-spotted filter paper specimens are excellent screening tests to detect primary hypothyroidism and autoimmune thyroiditis in pregnant and postpartum women. Results are very comparable to serum data in this population published in the literature. [ABSTRACT FROM AUTHOR]

Presents information on architectural and engineering education at Carnegie Mellon University in Pittsburgh, Pennsylvania. Educational programs in architecture; Information on graduate program in computational design; Educational programs in civil and environmental engineering.

Feasibility and suitability assessments have become increasingly important for trenchless projects, as some Federal and State permitting agencies have released guidance on the information required to complete their environmental review. The Federal Energy Regulatory Commission (FERC) released guidance in October 2019, and the Pennsylvania Department of Environmental Protection (PADEP) released a draft Trenchless Technology Technical Guidance Document for use by project applicants when considering trenchless crossing methods in the Commonwealth of Pennsylvania. For complex trenchless installations and those that involve multiple permitting agencies with different guidelines, adherence to these guidelines has become increasingly important in avoiding or minimizing potential permitting and project delays. This paper reviews the requirements established by FERC and PADEP as a case study that may be indicative of the regulatory trend emerging in various jurisdictions across the nation. Public data research, geohazards evaluation, geophysical evaluation, and geotechnical investigation are describe, while following both the FERC and PADEP trenchless technology guidelines. Finally, this paper demonstrates the consolidation of data gathering and engineering analysis to select the most practical and least impacting trenchless alternative. [ABSTRACT FROM AUTHOR]

Simple Summary: Steel production emits manganese and other heavy metals into the environment, where these byproducts can lead to health problems in humans and other animals. Birds have historically been used to detect harmful chemicals in the air, and in this paper, we show that this role continues into the present day. Feathers of a small terrestrial songbird, the Tufted Titmouse, were collected from live birds captured both near (0.3 km) and far (4.0 km) from steel production facilities in western Pennsylvania, USA. Tail feathers from birds living near the facilities had significantly higher amounts of manganese embedded in their structure compared to the feathers of birds living farther away. This shows that manganese is present in the environment, is localized at industrial sites, is encountered by birds, and is sequestered in their tissues. Animals could suffer ill health if exposures are high enough. Feather data cannot be used to assess the magnitude of this health risk since metals laid down within feathers are no longer circulating in the birds' bodies. However, our data do suggest that the environmental monitoring of manganese should continue, as inadvertent exposure is still occurring. Human industry and land use has led to the anthropogenic release of manganese (Mn) into the air and soil near manufacturing centers. Overexposure to Mn can cause considerable health problems in birds. We studied whether the concentration of Mn in bird feathers correlates with the distance to point sources of Mn air emissions. Feathers were collected from Tufted Titmice (Baeolophus bicolor) at two sites in western Pennsylvania, USA. One site was in proximity (0.3 km) to a steel plant with documented Mn releases, and the other site was in a different town about 4.0 km away from other steel plants with documented Mn releases. Using the microwave plasma–atomic emission spectrometer (MP–AES), we found that tail feathers collected from nearest to a steel plant had a significantly higher concentration of Mn compared to the samples from the site further from the emission source. A body mass index was calculated for each set of birds; however, the indices did not vary significantly. This is the first published study of Mn sequestration in Tufted Titmouse feathers. This study develops our general understanding of the potential use of bird feathers as non-invasive bioindicators of environmental metal exposure. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and early parenthood can be challenging transitional times for many families, especially those struggling with opioid use disorder (OUD). Over 8 million children live with a parent with SUD and parental drug use has been attributed to rising rates of family instability and child welfare involvement (Lipari & Van Horn, 2017; AFCARS, 2020;). Community-based prevention programming for families with young children, such as evidence-based maternal and child home visiting (EBHV), may we well positioned to engage and support families impacted by the opioid epidemic through early childhood. This paper presents case studies to highlight promising practices for adapting EBHV models to families impacted by SUD from the perspectives of staff and administrators. Methods: Data from three pilot sites are presented as case studies. These sites were selected to represent the most innovative and developed adaptations to EBHV for families impacted by substance use from an implementation evaluation of state-funded pilot sites (N = 20) at existing home visiting agencies across Pennsylvania. Data reported here represent semi-structured interviews with 11 individuals. Data were coded to facilitators and barriers nodes to understand the process and impact of pilot implementation. Results: Systems-level collaboration and coordination were key to serving a population already engaged in multiple systems. Engagement of substance use experts allowed home visitors to focus on delivery of evidence-based curricula supporting family stability and child development. External partnerships reduced stigma among home visitors. Across sites, staff struggled with the increased acuity of social complexity of the OUD population. Conclusions for Practice: Pregnancy and early parenthood are challenging transitional times for many families, especially those with OUD. Evaluation results demonstrate the promise of systems-based adaptations to community-based prevention programming for families with young children, such as maternal and child home visiting, to better support families impacted by SUD. [ABSTRACT FROM AUTHOR]

Features abstracts of the research reports given at the Science Fairs, and the Display and Discussion poster session of the 17th Annual Meeting of The Society for Psychophysiological Research held in Philadelphia, Pennsylvania on October 19-22, 1977. Members of the Program Committee; Dual track workshops; Day-time program; Topics covered by the discussions and paper presentations.

In this paper, I reflect on my experiences conducting legal geographic research within a Central Pennsylvania courtroom. This research builds on my former professional experience as a legal advocate where I worked for five years providing advocacy services to over 800 survivors of domestic violence and sexual assault. I discuss how I incorporated two common advocacy practices – accompaniment and institutional advocacy – into my research praxis as a means to fulfil my commitment to conduct activist research as a feminist legal geographer. I argue that the advocacy skills I learned outside of academia helped me navigate the tensions of studying power with legal actors in the privileged space of the courtroom. This paper contributes to recent interest in the methodological practices that legal geographers utilise within courtroom spaces, while also encouraging legal geographers to consider what knowledge and skills – beyond academic methodologies and methods – might serve to support activist research within spaces of power. In this paper, I reflect on my experiences conducting legal geographic research within a Central Pennsylvania courtroom. I argue that the advocacy skills I learned outside of academia helped me navigate the tensions of studying power with legal actors in the privileged space of the courtroom. This paper contributes to recent interest in the methodological practices that legal geographers utilise within courtroom spaces, while also encouraging legal geographers to consider what knowledge and skills – beyond academic methodologies and methods – might serve to support activist research within spaces of power. [ABSTRACT FROM AUTHOR]

Batteries participating in frequency regulation (FR) markets earn revenue at the expense of longevity. The declining reward prices and highly stochastic automatic generation control (AGC) signals with short update intervals necessitate research into aging-aware real-time FR strategies for the battery. To address these challenges, this paper develops an online battery dispatch strategy based on Lyapunov optimization, accounting for Ah-throughput, C-rate, and temperature aging effects to enhance the service profitability of the battery. The strategy operates independently of probabilistic data from random processes, with its optimality gap inversely correlated with the control parameter. A systematic and intuitive approach is established for constructing virtual queues and determining the maximum feasible parameter. The proposed method is validated through extensive numerical simulations using actual lithium-ion battery aging data, along with year-long regulation signal and market price data from Pennsylvania-New Jersey-Maryland (PJM). Results show that the strategy can extend the battery lifespan by 83.41% and increase the net present value (NPV) by 172.67% compared to the conventional Ah-based strategy. • An aging-aware online frequency regulation strategy for profit-driven batteries. • Critical aging factors Ah-throughput, C-rate, and temperature are considered. • Lyapunov optimization enables the strategy not reliant on future forecasts. • A systematic method is designed to determine virtual queues and control parameter. [ABSTRACT FROM AUTHOR]

This paper features an oral history conversation and interview that the author had with Judah Samet who survived imprisonment in the Bergen-Belsen Concentration Camp during the Holocaust. Samet also survived a near brush with death as he was arriving to attend services at the Tree of Life Synagogue in Pittsburgh, Pennsylvania as the deadliest anti-Semitic attack in American history was underway. Samet would later be a featured guest during the 2019 State of the Union Address. This paper is predominantly focused on some select larger questions posed by the author to Samet that considered aspects of these facets of Samet's life history. Some larger reflections on the interview and The Tree of Life shooting, in particular, are also discussed. [ABSTRACT FROM AUTHOR]

Presents abstracts presented at the 1999 Pittsburgh Conference on automated methods and management in chemistry in Pennsylvania. 'Microfabrication as a Route to Nanovolume Separation Systems,' by Fred Regnier, Brian Burke and Bing He; 'Fast FTIR Imaging of Multicomponent Polymer Systems,' by J.L. Koenig and C.M. Snively; 'The Emergence of PC-based Measurement and Automation at Pittcon,' by Dudley Baker.

Aim: This study aims to present a general bibliometric overview of the development status of global nursing research from 2000 to 2019. Design: A longitudinal bibliometric analysis of nursing research was conducted. Methods: Nursing research publications (N = 88,665) were obtained from Web of Science. Bibliometric method was used to map the output and citation impact trends of countries/regions, institutions, disciplines, and journals and analyse the research collaboration among countries/regions and institutions. Results: The global paper output in nursing research increased steadily over the past two decades and it varied in different countries/regions with the USA being far ahead of the others. The paper output and cross‐border collaboration are mainly distributed in several developed countries like the USA, the UK, Australia, and Canada. The University of Pennsylvania, Harvard University, University of Toronto, and University of North Carolina at Chapel Hill have high academic influence in the field of nursing. Increasing attention from academic fields has been paid to research on nursing. Journal of Advanced Nursing is the most prolific and most cited journal in nursing field. Conclusion: Nursing research has developed steadily over the last two decades. Both the scientific output and research collaboration are disproportionally distributed between high‐income countries/regions and low‐ and middle‐income countries/regions. Most research and collaboration have taken place in a few developed countries across North America, Europe, and Oceania. Impact: The study highlighted the need for policy makers and funding agencies, especially those from low‐ and middle‐income countries/regions, to allocate research funding that supports the nursing higher education and international cooperation so as to promote the development of high‐quality nursing research in those countries/regions. At the same time, researchers from non‐English‐speaking countries/regions should attach more importance to publishing papers in English, strengthening the academic exchanges with international nursing colleagues and better integrating into the international academic community. [ABSTRACT FROM AUTHOR]

The Advocacy Coalition Framework (ACF), a well‐known framework used to understand policy changes at the subsystem level, is predicated on the idea that coalitions with distinct beliefs compete to influence policy subsystem decisions. The ACF is noted as being most appropriate for, and is typically applied to, high salience policy areas. However, scholars have noted the need to also apply the ACF to less typical application settings in the interest of theoretical refinement. This paper thus explores the applicability of the ACF to Day Habilitation and Employment services systems for working‐age adults with intellectual and developmental disabilities in two U.S. states, Washington and Pennsylvania, both of which have experienced distinct state‐level policy changes during the last two decades despite low levels of public attention and conflict. Using a mixed‐methods approach, the paper identifies the presence of two advocacy coalitions (Employment First and Choice) in both states. The study concludes that there is sufficient evidence to apply the ACF to these low salience subsystems, noting theoretical and practical implications for scholars and policymakers interested in applying the ACF to similar settings. [ABSTRACT FROM AUTHOR]

Authors share an initial exploration of the pedagogy practiced at The Camphill School, specifically in relation to the integration of technology into its program. An approved private school situated in rural Pennsylvania, which caters to students on the autism spectrum, and others with different or additional physical and developmental disabilities, Camphill School works out of an adapted Waldorf curriculum, and integrates Waldorf Education, traditional special education strategies, and strategies informed by the curative educational approach to working with children and adolescents with intellectual disabilities and developmental delays. As a "tech-light" school, for pedagogical and therapeutic reasons, Camphill School has a pressing need to examine the current numbers of screen-based devices in the residential houses, classrooms, and therapy sessions, and the sharp increase in their presence in the last decade. This paper highlights several areas of concern related to the children's physical, and emotional wellbeing, and the wellbeing of the community in which the school is located. While research indicates a benefit to speech development for children using these devices, there are several gaps, which need to be examined, particularly for the population of children that is served. The necessity to preserve the organization's pedagogical integrity and identity as a school that provides a nurturing, natural environment for the children, while keeping abreast of trends in their professional field, leads to a series of recommendations in orienting toward the future. [ABSTRACT FROM AUTHOR]

Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directive or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty or agency of one's future incompetent self by issuing an advance directive? In this paper, I use a virtue‐ethical approach to explore this question, focusing on the case of an advance directive for the future self with moderate dementia. First, I examine virtuous attitudes with regard to autonomy and argue that one can manifest vices or ethically undesirable character traits in trying to intervene in the future self's life. In particular, I argue that this case can manifest vices such as disdainfulness, intellectual arrogance, and self‐dictatorship, which is the vice of trying to control one's life to an excessive degree, and that a self‐dictator fails to give due moral consideration to the future self's liberty or agency. I then introduce the Daoist idea of wu‐wei, which recommends embracement of what happens in one's life, as one of the possible remedies for the overemphasis on the value of autonomy and control. [ABSTRACT FROM AUTHOR]

Political redistricting is the redrawing of electoral district boundaries. It is normally undertaken to reflect population changes. The process can be abused, in what is called gerrymandering, to favor one party or interest group over another, resulting thereby in broadly undemocratic outcomes that misrepresent the views of the voters. Gerrymandering is especially vexing in the United States. This paper introduces an algorithm, with an implementation, for creating districting plans (whether for political redistricting or for other districting applications). The algorithm, Seed-Fill-Shift-Repair (SFSR), is demonstrated for Congressional redistricting in American states. SFSR is able to create thousands of valid redistricting plans, which may then be used as points of departure for public deliberation regarding how best to redistrict a given polity. The main objectives of this paper are: (i) to present SFSR in a broadly accessible form, including code that implements it and test data, so that it may be used for both civic deliberations by the public and for research purposes. (ii) to make the case for what SFSR essays to do, which is to approach redistricting, and districting generally, from a constraint satisfaction perspective and from the perspective of producing a plurality of feasible solutions that may then serve in subsequent deliberations. To further these goals, we make the code publicly available. The paper presents, for illustration purposes, a corpus of 11,206 valid redistricting plans for the Commonwealth of Pennsylvania (produced by SFSR), using the 2017 American Community Survey, along with descriptive statistics. Also, the paper presents 1,000 plans for each of the states of Arizona, Michigan, North Carolina, Pennsylvania, and Wisconsin, using the 2018 American Community Survey, along with descriptive statistics on these plans and the computations involved in their creation. [ABSTRACT FROM AUTHOR]

Farmland preservation has been an important issue in the United States for over 40 years. Since 1977, 28 states and over 95 local governments have formed farmland preservation programs to acquire development rights from willing farm owners. These programs have preserved over three and a half million acres. Private nonprofit land trusts have preserved nearly three million acres. Maryland and Pennsylvania have preserved nearly one million acres, accounting for almost one-sixth of the nation's preserved agricultural land. Ten adjoining counties in Pennsylvania and Maryland have preserved 660,000 acres, or one-tenth of the nation's preserved agricultural land. This paper defines "large scale preservation" and analyzes the funding mechanisms and land use policies that have enabled these ten counties to achieve it. The paper also identifies additional indicators of preservation success that give a more complete picture of the long-term viability of agriculture as an industry. [ABSTRACT FROM AUTHOR]

The paper analyzes the act of forgiveness and reconciliation illustrated by events and examples from the film Amish Grace (2010). The film is based on a true story regarding Amish school shooting that took place in October 2006, when five girls had been killed and five other girls had been injured in Nickel Mines, Pennsylvania. The Amish community then made an incredible gesture to the family of Charlie Roberts, the perpetrator. Journalists, the entire society, and above all the Roberts family, were overwhelmed by the love, condolences and forgiveness of the Amish community. The film has received numerous awards. It is an inspiring, powerful and enlightening drama that shows the power and importance of true, human forgiveness, as well as the difficulties and complexity of giving and/or receiving forgiveness. In the paper author described family relationships, journalistic scepticism regarding Amish forgiveness, discussions with a grief counsellor, difficulty accepting tragedies, and being asked how to forgive things that are unforgivable are described. This is followed by a section on the concept of Amish forgiveness, with numerous quotations from the Bible. The final part of the paper deals with the possibilities of applying restorative justice, with focus on restorative dialogue and restorative cirlce. [ABSTRACT FROM AUTHOR]

• Paper estimates a CMF for high friction surface treatment (HFST) applied to horizontal curves on undivided two-lane roads. • Propensity score matching is incorporated into EB before-after methodology to select more appropriate reference group. • Results indicate significant reductions in crash frequency (of all types considered) when applying HFST. Horizontal curves are locations that, as a result of the changing alignment, may be a contributing factor in roadway departure crashes. One low-cost countermeasure to mitigate crashes at these locations is the installation of the high friction surface treatment (HFST), which increases roadway friction and is intended to help keep drivers on the roadway when traversing a horizontal curve. This treatment has been implemented at numerous curves in Pennsylvania, but the overall safety effectiveness is not known. The purpose of this study is to estimate a suite of Crash Modification Factors (CMFs) for HFST applied to curve sections of undivided two-lane roadways. A novel combination of the empirical Bayes observational before-after study design and propensity score matching was used to estimate CMFs for multiple crash types, crash severities, and roadway settings (urban and rural). Propensity score matching was implemented to identify the most appropriate reference group to use within the empirical Bayes methodology. The results indicate that the installation of HFST is associated with a statistically significant decrease in all crash types and severities considered. [ABSTRACT FROM AUTHOR]

Work zone safety is a high priority for transportation agencies across the United States. Enforcing speed compliance in work zones is an important factor for reducing the frequency and severity of crashes. This paper uses connected vehicle trajectory data to evaluate the impact of automated work zone speed enforcement on three work zones in Pennsylvania and two work zones in Indiana. Analysis was conducted on more than 300 million datapoints from over 71 billion records between April and August 2021. Speed distribution and speed compliance studies with and without automated enforcement were conducted along every tenth of a mile, and the results found that overall speed compliance inside the work zones increased with the presence of enforcement. In the three Pennsylvania work zones analyzed, the proportions of vehicles travelling within the allowable 11 mph tolerance were 63%, 75% and 84%. In contrast, in Indiana, a state with no automated enforcement, the proportions of vehicles travelling within the same 11 mph tolerance were found to be 25% and 50%. Shorter work zones (less than 3 miles) were associated with better compliance than longer work zones. Spatial analysis also found that speeds rebounded within 1–2 miles after leaving the enforcement location. [ABSTRACT FROM AUTHOR]

In this paper, we examine whether women candidates are more likely to spur turnout in election years when gender-related issues are central to the national debate. We argue that having women on the ballot in a gendered electoral environment mobilizes specific groups of voters. Utilizing voter files in Pennsylvania and Washington for 2014 and the more gender focused 2018 election, we evaluate this potential mobilizing effect in both primary and general midterm elections. Our results show that both female and male voters were more likely to turn out in the 2018 midterm elections when a woman was on the ballot for the U.S. House of Representatives. In Pennsylvania, which tracks registrants' party affiliation, Democrats, members of third parties, and independents were particularly impacted by the presence of a female candidate. Moreover, in both states, a woman on the ballot was especially important for young people, a group that is traditionally less engaged. Utilizing a difference-in-difference approach, we confirm these results are not due to the endogenous selection of where women choose to run. These findings demonstrate that the mobilizing effect of women candidates is dependent on political context. [ABSTRACT FROM AUTHOR]

The profile of households receiving rental assistance has changed over time, yet much of the policy and political dialogue surrounding rental assistance has not. Understanding the changing profile of subsidized households is important to evaluating the role of rental subsidies, particularly in the context of neighborhood access. This paper analyzes how the composition of subsidized households has changed over time, and how this relates to existing measures of neighborhood opportunity. We find that since 2000, the share of subsidized households headed by seniors grew, while the share with children dropped. In particular, households using vouchers used to be young relative to the general population and to households in other housing subsidy programs but have aged rapidly. We also find that current neighborhood amenity measures do not reflect these changes, and we use a national analysis and a case study of southeastern Pennsylvania to test alternative metrics. [ABSTRACT FROM AUTHOR]

Comprehensive sexual health education is critical for the prevention of STIs and unintended pregnancy among young people. Yet, increasing barriers to comprehensive sexual health education in classroom settings underscore the importance of youth-friendly technologies to address sexual health among young people. It's OK to Ask Someone (IOTAS) uses a customised technology to expand Planned Parenthood of Western Pennsylvania's sexual health programming with a confidential sexual health textline designed to answer sexual health questions in a timely, user-friendly manner. This paper describes results from a process evaluation focused on assessing who uses IOTAS, how they use IOTAS and in what ways IOTAS is perceived to be helpful to texters. Results illustrate that a textline-approach is an acceptable and appropriate way to engage with young people. Findings demonstrate that young people are using the confidential textline to seek information about sexual health and report it as a helpful resource. Findings are relevant for sexual health educators and practitioners working with young people, including those interested in using a technology approach to expand health education opportunities. Additional research should continue to explore the potential of youth-friendly, technology-based approaches to support sexual health information seeking. [ABSTRACT FROM AUTHOR]

In 2010, twenty-eight bovines on a Pennsylvania beef farm were exposed to a hydraulic fracturing wastewater leak on their grazing pasture. Over the following year, eleven out of seventeen calves born to the exposed animals died. The farmers framed the deaths as outside normal deathly production on the farm, while state institutions claimed the deaths resulted from the farmers' negligence, framing them as ordinary. I draw on necropolitics to examine how death becomes a normalized mode of capital production in agri-food systems, investigating how the wastewater spill and calves' deaths ruptured the everyday production of bovine death. The paper argues that death must occur in prescribed sites and at approved times to function as a site of value accumulation in capitalist agriculture. I examine how the spill and calf death events emerged through promiscuous entanglements between overlapping modes of capital extraction across and through the site of the farm. Using assemblages, I trace unruly, promiscuous encounters at this food-energy contact zone to consider how the calves' deaths render visible the space-time boundaries used to manage more-than-human mortality as a metabolic process in livestock production, and highlight disparate power relations between diverse necropolitical actors and modes of governance. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to highlight a less illustrated topic in Romanian bibliographic resources. According to the World Health Organization reports, breast cancer is one of the most common types of cancer worldwide. The sequelae of mastectomy are systematised as follows: conditions secondary to the application of local radiotherapy, systemic conditions after oncological treatment and psychosocial conditions. The most common side effect of the treatment applied for breast cancer is lymphoedema and, according to a study carried out in Pennsylvania, 42% of patients develop lymphoedema. Some authors classify it into mild, moderate and severe, but others highlight four stages of lymphoedema development. Physiotherapy has a major role in post-mastectomy recovery and requires various kinetic means, which can be both specific (physical exercise, hydrokinetic therapy, massage, posture) and non-specific (multilayer compression bandage and wearing a compression sleeve). Over time, a lot of clinical studies have been conducted on the implications of physical therapy for post-mastectomy functional recovery. Thus, physical exercise performed during the kinetic programme improves muscle strength, the activity of the cardiorespiratory system and self-esteem. Several authors recommend the practice of aerobic exercise and moderate-intensity exercise twice a week during chemotherapy treatment to prevent the development of lymphoedema. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is to describe the utility of various recruitment modalities utilized in the Working to Increase Stability through Exercise (WISE) study. WISE is a pragmatic randomized trial that is testing the impact of a 3-year, multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers or delivered via DVD on the rate of serious fall-related injuries among adults 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The modified goal was to recruit 1130 participants over 2 years in three regions of Pennsylvania.Methods: The at-risk population was identified primarily using letters mailed to patients of three health systems and those over 65 in each region, as well as using provider alerts in the health record, proactive recruitment phone calls, radio advertisements, and presentations at community meetings.Results: Over 24 months of recruitment, 209,301 recruitment letters were mailed, resulting in 6818 telephone interviews. The two most productive recruitment methods were letters (72% of randomized participants) and the research registries at the University of Pittsburgh (11%). An average of 211 letters were required to be mailed for each participant enrolled. Of those interviewed, 2854 were ineligible, 2,825 declined to enroll and 1139 were enrolled and randomized. Most participants were female (84.4%), under age 75 (64.2%), and 50% took an osteoporosis medication. Not having a prior fragility fracture was the most common reason for not being eligible (87.5%). The most common reason provided for declining enrollment was not feeling healthy enough to participate (12.6%).Conclusions: The WISE study achieved its overall recruitment goal. Bulk mailing was the most productive method for recruiting community-dwelling older adults at risk of serious fall-related injury into this long-term physical activity intervention trial, and electronic registries are important sources and should be considered. [ABSTRACT FROM AUTHOR]

This paper investigates economic and psychological hardship during the COVID‐19 pandemic among a diverse sample (61% Latinx; 16% White; 9% Black; 14% mixed/other race) of socioeconomically disadvantaged parents (90% mothers; mean age = 35 years) and their elementary school‐aged children (ages 4–11; 49% female) in rural Pennsylvania (N = 272). Families participating in a local food assistance program reported on food insecurity (FI) and parent and child mood and behavior daily from January to May 2020. Longitudinal models revealed that FI, negative parent and child mood, and child misbehavior significantly increased when schools closed; only FI and parent depression later decreased. FI decreased most among those who received the local food assistance program; Supplemental Nutrition Assistance Program receipt uniquely predicted decreases in child FI. [ABSTRACT FROM AUTHOR]

Highlights • The flux of multivalent cations across non-selective CMX membranes was 1.4 times > sodium. • A CMX-S membrane at the cathode boundary reduced the flux of Ca, Mg, and Ba into the electrode rinse. • Ca, Mg and Ba interfered by blocking transfer sites on the CMX-S membrane at the cathode barrier. • Overall flux was improved by unblocking the CMX-S membrane with periodic polarity reversal. • Soluble Fe precipitated throughout the stack and within the diluate and concentrate tanks. Abstract Electrodialysis is an electrochemically driven membrane technology usually used for treating feed water containing several thousand mg/l total dissolved solids (TDS). This research investigated the use of conventional ED for the treatment of flowback water from shale gas hydraulic fracturing that contains up to tens of thousands of mg/l TDS and contain a mixture of multivalent cations. This paper discusses efforts to treat concentrated brines with electrodialysis and focuses on the mitigation of the detrimental effects of multivalent cations such as calcium, magnesium, barium, iron, and in the feedstock. A previous paper detailed the effects of calcium under defined lab conditions. The apparent calcium fouling (in and around) the electrode cells was mitigated by changing the single cathode chamber boundary membrane to a (CMX-S) that was more selective for monovalent cations. This paper covers efforts undertaken to mitigate problems associated with high concentrations of calcium, barium, iron, and magnesium. Four field samples of produced water from oil and gas operations in from the Marcellus shale formation (generally Pennsylvania, USA) and the Barnett shale formation (generally north central Texas, USA) were also tested. These results from field samples were similar to the results from lab defined tests. Mechanisms of process interference by the different multivalent cations appear different for each species. Calcium, magnesium, barium, and iron were preferentially transported from the diluate to the concentrate compared to sodium by a factor of about 1.4:1 on a charge basis resulting in a suppression of the flux of sodium to the concentrate. A single CMX-S membrane selective for monovalent cations was placed at the cathode barrier resulting in a reduced flux of calcium, magnesium and barium into the electrode rinse. However total ion flux was inhibited caused by apparent blockage of the cation transfer sites on the CMX-S membrane by the stagnant multivalent cations. A series of tests with periodic pulse polarity-reversal (anode and cathode reversed for a brief time) indicted the blockage by calcium and barium was immediately reversable, however, iron was more problematic and may have precipitated on membrane surfaces other than the cathode barrier. [ABSTRACT FROM AUTHOR]

Coal mine methane (CMM) and abandoned mine methane (AMM) are by-products of underground mining of gassy coal beds. The quantity and the emission rate of CMM and AMM may vary depending on the type of mine, gas content of the mined coal bed, and gas sourced from strata and coal beds in overlying and underlying formations affected by mining. Therefore, if a mine has the potential of accumulating gas after being abandoned and sealed properly, that methane may be produced and used as an energy source to serve local communities in the area. Producing AMM also prevents methane, which is a potent greenhouse gas, from leaking to the atmosphere through seals, shaft plugs or surface cracks. A technical barrier to economical utilization of CMM and AMM is the uncertainty about how much methane may be available in the gas emission zone (GEZ) as a resource during mining, as well as after the panels are sealed and the mine is abandoned. Another difficulty is estimating how much of the potential methane resource can be produced from gob gas ventholes (GGV) converted to capture AMM. In this study, a comparative assessment is presented to address the issues stated above. The assessment was conducted on two adjacent panels of a longwall mine that operated in Pennsylvania until 2016 in the Northern Appalachian Basin. The study is based on two approaches that might be used depending on the availability of data. The first approach uses an extensive geological data set, geostatistics, and measured shaft gas emission and GGV production values that were collected while the panel (s) were active to assess the AMM resource. The second approach uses a minimal amount of geologic data, uncertainty of the data as probabilistic distributions, and the use of publicly available software to predict during-mining emissions. Results showed that both approaches provide relatively comparable estimates of AMM resources and AMM recovery potential using wellbores. The differences in assessed quantities are mostly due to the characteristics of the two methods. In that regard, this paper can be considered as guidance to choose the assessment approach based on data availability. • A comparative assessment procedure for CMM and AMM resource potential is presented. • The assessment was conducted on two adjacent panels of a longwall mine that operated in in the Northern Appalachian basin. • Results showed that both approaches provide relatively comparable estimates. • The differences in assessed quantities are mostly due to the characteristics of the two methods. • This paper can be considered as guidance in the choice of assessment approaches based on data availability. [ABSTRACT FROM AUTHOR]

Objective: To document the terminology patients hear during the treatment course for a nonviable pregnancy and to ask patients their perceived clarity and preference of terminology to identify a patient-centered lexicon.Methods: We performed a preplanned substudy survey of English-speaking participants in New York, Pennsylvania, and California at the time of enrollment in a randomized multisite trial of medical management of first-trimester early pregnancy loss. The six-item survey, administered on paper or an electronic tablet, was developed and piloted for internal and external validity. We used a visual analog scale and quantified tests of associations between participant characteristics and survey responses using risk ratios.Results: We approached 155 English-speaking participants in the parent study, of whom 145 (93.5%) participated. In the process of receiving their diagnosis from a clinician, participants reported hearing the terms "miscarriage" (n=109 [75.2%]) and "early pregnancy loss" (n=73 [50.3%]) more than "early pregnancy failure" (n=31 [21.3%]) and "spontaneous abortion" (n=21 [14.4%]). The majority selected "miscarriage" (n=79 [54.5%]) followed by "early pregnancy loss" (n=49 [33.8%]) as their preferred term. In multivariable models controlling for study site, ethnicity, race, history of induced abortion, and whether the current pregnancy was planned, women indicated that "spontaneous abortion" and "early pregnancy failure" were significantly less clear than "early pregnancy loss" (53/145, adjusted risk ratio 0.12, 95% CI 0.07-0.19 and 92/145, adjusted risk ratio 0.38, 95% CI 0.24-0.61, respectively, as compared with 118/145 for "early pregnancy loss"). "Miscarriage" scored similarly to "early pregnancy loss" in clarity (119/145, adjusted risk ratio 1.05, 95% CI 0.62-1.77).Conclusion: The terminology used to communicate "nonviable pregnancy in the first trimester" is highly variable. In this cohort of women, most preferred the term "miscarriage" and classified both "miscarriage" and "early pregnancy loss" as clear labels for a nonviable pregnancy. Health care providers can use these terms to enhance patient-clinician communication.Clinical Trial Registration: ClinicalTrials.gov, NCT02012491. [ABSTRACT FROM AUTHOR]

The article reports on the resignation of Bambang Parmanto, the editor-in-chief of "The Open Information Science Journal" in Pittsburgh, Pennsylvania. It notes that the Parmanto claimed the its publisher Bentham Science Publishing received a fake article without his knowledge. Mahmood Alam, director of publications at Bentham Science Publishing emphasizes the conviction of submitting fake manuscripts because of its being unethical.

Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD – is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care. This paper employs a qualitative approach to the analysis of provider-based stigma among professionals involved in the treatment or supervision of individuals with OUD. We conducted and analyzed interviews with 19 professionals as part of a larger mixed methods study on stigma among substance use treatment providers and court personnel in Pennsylvania. Beyond capturing providers' perceptions of PWUO and MOUD, the authors asked participants to describe barriers to recovery, and the effective delivery of care within this population. Interviewees enumerated multiple entrenched barriers that sometimes operated at different levels, such as criminal-legal involvement, which weakened PWUO's social networks and employment prospects, while undermining providers' attempts at continuity of care; moreover, participants cited the "War on Drugs" as an overarching impediment to effective substance use treatment, not least for its role in perpetuating stigma against PWUO. Interestingly, while an overwhelming majority of participants named stigma as a barrier to treatment at every level, most also articulated stigmatizing beliefs around PWUO. Namely, providers evoked one element of stigma – blameworthiness – in their contention that many PWUO are inadequately motivated to recover. In addition to adding further complexity to MOUD barriers research, this study troubles the notion that professional training and education on the disease model of addiction serve to eradicate stigma. • Uptake of medications for opioid use disorder remains low despite efforts to expand access. • Individual, institutional, and systemic barriers to MOUD interact to reduce usage. • Treatment providers identify stigma as a primary barrier to MOUD effectiveness at all levels. • Many treatment providers also express conceptions of people who use opioids as "blameworthy." [ABSTRACT FROM AUTHOR]