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PubMed1992

Condom use among male injecting-drug users--New York City, 1987-1990.

Heterosexual transmission of human immunodeficiency virus (HIV) continues to increase, especially among injecting-drug users (IDUs) and their sex partners. During 1991, 22% of women with acquired immunodeficiency syndrome (AIDS) in the United States reported having had sex with a male IDU; this risk behavior was second to injecting-drug use (48%) as a transmission category for women. To better understand how to reduce heterosexual transmission of HIV, a study on condom use among male IDUs on the Lower East Side of Manhattan, New York City, was conducted as part of CDC AIDS Community Demonstration Projects. This report summarizes the results of that study.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1985

The epidemiology of AIDS: current status and future prospects.

The reported incidence of acquired immune deficiency syndrome (AIDS) continues to increase in countries throughout the world. On the basis of a polynomial model for extrapolation, the cumulative number of cases diagnosed and reported since 1981 in the United States is expected to double during the next year with over 12,000 additional cases projected to be diagnosed by July 1986. The annual incidence rates for single (never-married) men in Manhattan and San Francisco, intravenous drug users in New York City and New Jersey, and persons with hemophilia A ranged from 261 to 350 per 100,000 population during 1984. For single men aged 25 to 44 years in Manhattan and San Francisco, AIDS was the leading cause of premature mortality in 1984 as measured by years of potential life lost. Infection with HTLV-III/LAV is considerably more common than reported AIDS in high-risk populations and can persist at least for several years, so the presence of specific antibody should be considered presumptive evidence of current infection. The screening of donated blood and plasma for antibody to HTLV-III/LAV and use of safer clotting factor concentrates should greatly reduce HTLV-III/LAV transmission through blood and blood products. Most HTLV-III/LAV infections occur through sexual transmission, use of contaminated needles, and as a result of infected mothers passing the virus to newborns. Continued research commitment is needed to develop an HTLV-III/LAV vaccine and therapy for this infection. In the interim, widespread community efforts are needed to minimize transmission.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Cancer education among primary care physicians in an underserved community.

INTRODUCTION: Urban minority groups, such as those living in north Manhattan, are generally underserved with regard to cancer prevention and screening practices. Primary care physicians are in a critical position to counsel their patients on these subjects and to order screening tests for their patients. METHODS: Eighty-four primary care physicians in two intervention communities who received educational visits about cancer screening and prevention were compared with 38 physicians in a nearby community who received no intervention. With pre- and post-test interviews over an 18-month period, the physicians were asked about their attitudes toward, knowledge of (relative to American Cancer Society guidelines), and likelihood of counseling and screening for breast, cervical, colorectal, and prostate cancers. RESULTS: Comparison of the two surveys of physicians indicated no statistically significant differences in knowledge of cancer prevention or screening. At post-test, however, intervention group physicians identified significantly fewer barriers to practice than control physicians (p<0.05). While overall, the educational visits to inner-city primary care physicians did not appear to significantly alter cancer prevention practices, there was a positive dose-response relationship among the subgroup of participants who received three or more project contacts. CONCLUSIONS: We uncovered significant changes in attitude due to academic detailing among urban primary care physicians practicing in north Manhattan. A significant pre-test sensitization effect and small numbers may have masked overall changes in cancer prevention and screening behaviors among physicians due to the intervention.

Adult↗
PubMedDate not supplied

The New York City neighborhood-based services strategy.

The New York City Administration for Children's Services (ACS) instituted a neighborhood-based services system through the realignment of all foster care, preventive, and protective services along community district lines. ACS, with its community partners, also formed neighborhood-based networks to improve service coordination and collaboration among key community stakeholders and to shape a multisystem strategy tailored to each district informed by child welfare data. Based on analysis of neighborhood-specific census tract child welfare data, ACS initiated the Community Partnership to Strengthen Families project to address the disproportionate number of foster care placements originating from a small group of high-need communities, including Manhattan's Central Harlem. This article describes examples of specific strategies based on the Central Harlem experience.

Child↗
PubMed2005

Risk assessment for asbestos-related cancer from the 9/11 attack on the World Trade Center.

OBJECTIVE: We sought to estimate the lifetime risk of asbestos-related cancer for residents of Lower Manhattan attributable to asbestos released into the air by the 9/11 attack on New York City's World Trade Center (WTC). METHODS: Exposure was estimated from available data and reasoned projections based on these data. Cancer risk was assessed using an asbestos risk model that differentiates asbestos fiber-types and the US Environmental Protection Agency's model that does not differentiate fiber-types and combines mesothelioma and lung cancer risks. RESULTS: The upper limit for the expected number of asbestos-related cancers is less than one case over the lifetime of the population for the risk model that is specific for fiber-types and 12 asbestos-related cancers with the US Environmental Protection Agency's model. CONCLUSIONS: The cancer risk associated with asbestos exposures for residents of Lower Manhattan resulting from the collapse of the WTC is negligible.

Adolescent↗
PubMed2002

Biotechnology's foreign policy.

From its inception, biotechnology has been a uniquely international enterprise. An American and an Englishman working together elucidated the structure of DNA almost 50 years ago; more recently, the Human Genome Project linked researchers around the world, from the Baylor College of Medicine in Houston to the Beijing Human Genome Center. Today our industry's researchers hail from African villages and Manhattan high rises; from Munich and Melbourne; from London, Ontario, and London, England; from Scotland and Nova Scotia--New Scotland; from Calcutta and Calgary. But in the beginning, the infrastructure that supported these efforts--intellectual property, venture capital, streamlined technology transfer--was less widely dispersed and the world's brightest biotech researchers clustered in only half a dozen scientific Meccas. Previous technological revolutions have spread around the world. Following in their footsteps, biotechnology's global diaspora seems inevitable, especially since governments are promoting it. But as our science and business emigrate from early strongholds in the United States, Canada and Europe across oceans and borders and into new cultures, international tensions over biotechnology continue to grow. In just the last few years, controversies have rolled over R&D spending priorities, genetic patents, bioprospecting, transgenic agriculture and drug pricing. My premise today is that our industry needs to formulate its first foreign policy, one which is cognizant of the miserable judgments and mistakes of other industries--and avoids them.

Biotechnology↗
PubMed2004

Elevated sex-hormone binding globulin in elderly women with Alzheimer's disease.

BACKGROUND: Hormone levels change significantly with increasing age. These changes may be related to, or be associated with, the emergence of age-related diseases, such as Alzheimer's disease (AD). METHODS: Five hundred and seventy-six women over the age of 65 were studied from the Washington Heights-Inwood Columbia Aging Project (WHICAP). These women were selected from a group of healthy Medicare beneficiaries that were aged 65 and older living in the geographically defined area of northern Manhattan in New York City. Serum levels of estrone (E1), estradiol (E2), total testosterone (TT), dehydroepiandosterone (DHEA), luteinizing hormone (LH), follicle stimulating hormone (FSH), and sex-hormone binding globulin (SHBG) were measured. RESULTS: Significant differences were found between patients with AD and controls only in the level of SHBG, which was 20% higher in patients compared to controls (68.5nmol/l versus 54.7nmol/l, P<0.001). We also estimated levels of total E2 because after menopause, E2 is largely derived from E1. AD patients had significantly lower levels of estimated E2 (AD 0.46 versus controls 0.49, P<0.01). Differences remained significant after adjusting for age, ethnic group, education, and body mass index (BMI). CONCLUSIONS: A marked increase in SHBG levels was found in AD patients. SHBG normally responds to circulating testosterone and estrogen, therefore, elevated SHBG suggests an abnormal increase in its production and regulation. Further work is needed to clarify the cause and consequences of this observation.

Aged↗
PubMed2005

Master of the house: Why a company should take control of its building projects.

When you head up a big construction project for your organization, coming in on time and on budget isn't enough. If you want to avoid squandering what is probably your company's largest capital investment, it's important to create a building that reflects your company's mission and produces a truly energizing work environment, says David Thurm, CIO of the New York Times Company and head of the team responsible for designing and building the Times' new corporate headquarters in Manhattan. The only way to get this kind of package-great design and innovative features that together further your business goals- is to take an active role. Assemble the right team, and then stay involved, asking hard questions about things that are generally taken as givens. Articulate a vision of your future work space, and drive the search for ways to realize this vision. In short, be a builder, not merely an owner. It's easy to understand why this approach is the exception rather than the rule. To most companies, design and construction seem foreign and forbidding, rife with pitfalls. Because of the murkiness of the field and a lack of experience and confidence, most companies play a relatively minor role in their construction projects. But it's a giant mistake to be a passive consumer when it comes to one of your most important assets. At best, you'll get well-intentioned guesses by others as to what you want; at worst, you'll end up with a building that's at odds with your identity. The author shares a series of lessons learned. Implicit in all of them: You have to push yourself as hard as you push your contractors.

Commerce↗
PubMed1995

Injury prevention in an urban setting: challenges and successes.

The Harlem Hospital Injury Prevention Program (HHIPP) was established in 1988 with the goal of reducing injuries to children in central Harlem by providing safe play areas, supervised activities, and injury prevention education. To achieve this goal, a broad-based coalition was formed with state and local governmental agencies interested in injury prevention and with community groups, schools, parents, and hospital staff. An evaluation of the program in terms of both process and outcome formed a critical element of this effort. Since 1988 the HHIPP, as the lead agency for the Healthy Neighborhoods/Safe Kids Coalition, developed or participated in two types of programs: injury-prevention education programs and programs that provide safe activities and/or environments for children. The educational programs included Window Guards campaign; Safety City Program; Kids, Injuries and Street Smarts Program (KISS); Burn Prevention Curriculum and Smoke Detector Distribution; Harlem Alternative to Violence Program; Adolescent Outreach Program; and Critical Incident Stress Management Teams. The safe activities and environmental programs included the Bicycle Safety Program/Urban Youth Bike Corps; Playground Injury Prevention Program; the Greening of Harlem Program; the Harlem Horizon Art Studio; Harlem Hospital Dance Clinic; Unity through Murals project; baseball at the Harlem Little League; winter baseball clinic; and the soccer league. Each program was conceived using injury data, coupled with parental concern and activism, which acted as catalysts to create a community coalition to respond to a specific problem. Data systems developed over time, which monitored the prevalence and incidence of childhood injuries in northern Manhattan, including central Harlem, became essential not only to identify specific types of childhood injuries in this community but also to evaluate these programs for the prevention of injuries in children.

Accident Prevention↗
PubMed2003

Long-term mitochondrial toxicity in HIV-uninfected infants born to HIV-infected mothers.

Although children born to HIV-infected (HIV+) women receiving antiretroviral therapy during pregnancy show virtually no adverse clinical effects at birth, the antiretroviral nucleoside analog drugs are known to damage nuclear and mitochondrial DNA. In this study, biomarkers of mitochondrial toxicity and genotoxicity have been examined in a well-characterized sample set consisting of infants born to HIV-uninfected (HIV-) mothers (n = 30), and HIV- infants (n = 20) born to HIV-infected (HIV+) mothers who received either no antiretroviral therapy (n = 10) or zidovudine (3'-azido-3'-deoxythymidine [AZT]) during pregnancy (n = 10). DNA from cord blood leukocytes and peripheral blood leukocytes taken at 1 and 2 years of age was examined for loss of mitochondrial DNA (mtDNA) and telomere integrity. Telomere length, a measure of nuclear DNA damage, was the same in all infants at birth and at age 1 year. The quantity of mtDNA was assessed relative to nuclear DNA using a polymerase chain reaction-based chemiluminescence detection (PCR-CID) method that determined mitochondrial D Loop gene copies relative to nuclear 18S RNA gene copies by comparison with a standard curve. MtDNA quantity was expressed as a ratio of gene copy numbers. In infants of uninfected mothers (AZT-/HIV-) at the three time points, the ratios were 442 to 515, whereas in infants of untreated AZT-/HIV+ mothers the ratios were 261 to 297, and in infants of AZT-treated (AZT+/HIV+) mothers the ratios were 146 to 203. At all three time points, differences between the AZT-/HIV- group and the two HIV+ groups were statistically significant (p <.05), and differences between the AZT-/HIV+ and AZT+/HIV+ groups were also statistically significant (p <.05), demonstrating that AZT exposure causes a persistent depletion of mtDNA. The study shows that children of HIV+ mothers are at risk for mitochondrial damage that is further increased in infants of mothers receiving AZT during pregnancy.

Adult↗
PubMed2006

Chemical contamination of the Hudson-Raritan Estuary as a result of the attack on the World Trade Center: analysis of polycyclic aromatic hydrocarbons and polychlorinated biphenyls in mussels and sediment.

The September 11, 2001 attack on the World Trade Center (WTC) resulted in a massive plume of dust and smoke that blanketed lower Manhattan and part of the Hudson-Raritan Estuary (HRE). The NOAA National Status and Trends Mussel Watch Program has long-term monitoring sites in the area and thus had an opportunity to assess the effect of the WTC attack on PAH and PCB contamination of the surrounding estuary. Seven additional sites were added in the Upper HRE to attain higher sampling resolution for comparison with regularly sampled Mussel Watch Project HRE sites. Elevated background levels of PCBs and PAHs in mussel tissue and sediments were high enough before the WTC attack that concentrations were not measurably changed by WTC derived contaminant input.

Animals↗
PubMed1989

Developing wellness programs: a nurse-managed Stay Well Center for senior citizens.

This article describes the process from conception to implementation of developing a nurse-managed wellness center for senior citizens. The center was established in a federally subsidized high rise residential complex in midtown Manhattan. The unique senior population living in this New York City community includes a large proportion of performing artists. These individuals are struggling to maintain ties to their community at a time when their most productive performing years have passed. A health needs assessment was designed to evaluate whether or not these seniors were interested and would participate in a nurse-managed wellness center. The strategies needed to propose and move the project forward through all systems are explored. Two clinical nurse specialists assessed the need, proposed the center, and guided it through several political systems while maintaining leadership to establish a viable and innovative hospital-based health center based on prevention.

Aged↗
PubMed2003

Fine urban and precursor emissions control for diesel urban transit buses.

Particulate emission from diesel engines is one of the most important pollutants in urban areas. As a result, particulate emission control from urban bus diesel engines using particle filter technology is being evaluated at several locations in the US. A project entitled "Clean Diesel Air Quality Demonstration Program" has been initiated by the New York City Metropolitan Transit Authority (MTA) under the supervision of New York State Department of Environmental Conservation and with active participation from Johnson Matthey, Corning, Equilon, Environment Canada and RAD Energy. Under this program, several MTA transit buses with DDC Series 50 engines were equipped with Continuously Regenerating Technology (CRTTM) particulate filter systems and have been operated with ultra low sulfur diesel (<30 ppm S) in transit service in Manhattan since February 2000. These buses were evaluated over a 9-month period for durability and maintainability of the particulate filter. In addition, an extensive emissions testing program was carried out using transient cycles on a chassis dynamometer to evaluate the emissions reductions obtained with the particle filter. In this paper, the emissions testing data from the Clean Diesel Air Quality Demonstration Program are discussed in detail.

Filtration↗
PubMed1991

The development of a Children's Implant Profile.

The decision to provide a child with a cochlear implant is quite complex, as it must include consideration not only of the implant itself but also of the habilitative services necessary following the surgical procedure. To provide a systematic means of selecting hearing-impaired children for cochlear implants, a team at Children's Hearing Institute, Manhattan Eye, Ear and Throat Hospital, developed the Children's Implant Profile (ChIP). There is no one profile of a successful implant user--at least 11 factors appear to contribute to successful implantation. In the ChIP, each factor is evaluated on a three-point scale: (1) no concern, (2) mild-to-moderate concern, and (3) great concern. A profile showing "no concern" on all 11 factors denotes clear acceptability of the child as an implant candidate. A profile including several ratings in the "mild-to-moderate concern" category suggests a need for further study to determine if improvements could be made in projected outcomes before initiating surgical procedures. Finally, ratings of "great concern," especially on more than one factor, indicate a very limited probability of successful implant outcomes, at least at the time of evaluation. A case study is presented to demonstrate the relationship between the evaluated factors and to show how the profile is used to address and remedy areas of concern.

Child↗
PubMed2006

Mapping your innovation strategy.

In the complex sport of American football, teams rely on playbooks as thick as the Manhattan phone directory. But when it comes to creating innovative growth businesses-which is at least as complicated as professional football--most companies have not developed detailed game plans. Indeed, many managers have concluded that a fog enshrouds the world of innovation, obscuring high-potential opportunities. The authors believe that companies can penetrate that fog by developing growth strategies based on disruptive innovations, as defined by Clayton Christensen. Such innovations conform to a pattern: They offer an entirely new solution; they perform adequately along traditional dimensions and much better along other dimensions that matter more to target customers; and they are not initially appealing to powerful incumbents. Companies can develop customized checklists, or playbooks, by combining this basic pattern with analysis of major innovations in their markets. The key early on is to focus not on detailed financial estimates--which will always guide companies toward the markets most hostile to disruptive innovations--but on how well the innovation fits the pattern of success. It's also crucial to encourage flexibility: Companies must be willing to kill projects that are going nowhere, exempt innovations from standard development processes, and avoid burdening project teams with extra financing, which can keep them heading in the wrong direction. Companies can create competitive advantage by becoming champions at defining the pattern of successful innovations and executing against it. But as that pattern becomes obvious--and others emerge-building a sustainable advantage on innovation competencies will again prove elusive.

Commerce↗
PubMed2001

Veterans aging cohort three-site study (VACS 3): overview and description.

Outcomes for middle-aged and older individuals with HIV infection are poor, and are likely to be mediated by age-related differences in risks and resources (access to care, relationship with the provider, comorbid conditions, health habits, and changes brought about by aging). The goal of the Veterans Aging Cohort Three-Site Study (VACS 3) is to study the influence of age and mediating factors on outcomes with HIV in order to identify mutable mediators of poorer outcomes. VACS 3 is an observational, longitudinal study. Data sources include patient and provider surveys and electronic medical data collected at baseline and 12-month follow-up from the Infections Disease Clinics at three Veterans Affairs Medical Centers (Cleveland, OH, Houston, TX, and Manhattan, NY). Trained Survey Coordinators at each site determined which patients are HIV infected, obtained consent, and asked the patient to complete a questionnaire. The primary provider also completed a questionnaire. Twelve-month follow-up will be completed July 2001. Of all veterans with HIV seen in these clinics 85% (881) have consented and enrolled. Of the 881 corresponding provider surveys, 92% were completed. Mean age is 49; 55% are African-American; 38% of the sample were men who have sex with men; and less than 2% are women. Almost a third (32%) have been without a permanent address. Complimentary or alternative therapies are common as are the use of cigarettes, alcohol, and illicit drugs. The majority (87%) of the patients are taking multiple antiretroviral medications. The median CD4 count is 331 mm(3), and the median viral load was 714 copies/ml. There is substantial variation by site. Veterans with HIV infection have characteristics that will likely become more prevalent among HIV-infected persons in the United States: they are older, commonly suffer comorbid disease, and are members of minority populations. VACS 3 may help inform the design of future clinical interventions to improve outcomes for people aging with HIV.

Aged↗