New York City, NY, United States
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Migliori G.B.,World Health Organization | Sotgiu G.,University of Sassari | Gandhi N.R.,Yeshiva University | Falzon D.,World Health Organization | And 69 more authors.
European Respiratory Journal | Year: 2013

The broadest pattern of tuberculosis (TB) drug resistance for which a consensus definition exists is extensively drug-resistant (XDR)-TB. It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance in order to explore the need for a new definition. Individual patient data on XDR-TB outcomes were included in a meta-analysis comparing outcomes between XDR alone and three nonmutually exclusive XDR-TB patient groups: XDR plus resistance to all the second-line injectables (sli) and capreomycin and kanamycin/amikacin (XDR+2sli) XDR plus resistance to second-line injectables and to more than one group 4 drug, i.e. ethionamide/protionamide, cycloserine/ terizidone or para-aminosalicylic acid (XDR+sliG4) and XDR+sliG4 plus resistance to ethambutol and/or pyrazinamide (XDR+sliG4EZ). Of 405 XDR-TB cases, 301 were XDR alone, 68 XDR+2sli, 48 XDR+sliG4 and 42 XDR+sliG4EZ. In multivariate analysis, the odds of cure were significantly lower in XDR+2sli (adjusted OR 0.4, 95%CI 0.2- 0.8) compared to XDR alone, while odds of failure and death were higher in all XDR patients with additional resistance (adjusted OR 2.6-2.8). Patients with additional resistance beyond XDR-TB showed poorer outcomes. Limitations in availability, accuracy and reproducibility of current drug susceptibility testing methods preclude the adoption of a useful definition beyond the one currently used for XDR-TB. Copyright © ERS 2013.

Falzon D.,World Health Organization | Gandhi N.,Yeshiva University | Migliori G.B.,Harvard University | Sotgiu G.,University of California at Davis | And 86 more authors.
European Respiratory Journal | Year: 2013

A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95%CI 57-72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95%CI 45-66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95%CI 36-60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95%CI 27-53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95%CI 1.4-16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95%CI 1.4-26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6-9.0 months duration and the total duration of treatment 20.1-25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens. Copyright © ERS 2013.

Appell K.A.,AECOM Technology Corporation | Syrett C.,AECOM Technology Corporation | Wynne T.,Long Island City | Zuberbuhler-Yafar S.,Long Island City
Journal of New England Water Environment Association | Year: 2014

Through its green Infrastructure plan, New York City is proposing to spend more than $1 billion over the next 20 years to reduce stormwater runoff and Improve water quality. A major plan component Includes Installation of curbside bioswales throughout the city. Starting in 2011,22 Initial bioswales were Installed in the boroughs of Brooklyn and Queens by the New York City Department of Design and Construction (DDC), in conjunction with the New York City Department of Environmental Protection (DEP). to Inform and Improve future bioswale construction, the construction process and system components were evaluated. The results Included process enhancement recommendations and suggested design alternatives to Improve construction, maintenance, and performance. A graphic construction guide and checklist were developed as aids for future projects. The results provide the opportunity to understand in detail how these streetscape structures have been Installed and to Identify the need for any Improvements.

Xin W.,KLD Engineering | Chang J.,KLD Engineering | Muthuswamy S.,KLD Engineering | Talas M.,Long Island City | Prassas E.,New York University
Transportation Research Record | Year: 2013

A hierarchical adaptive signal control was developed and implemented in New York City to manage congestion in a complex urban roadway environment. Control strategies, including strategically regulating traffic demand and balancing the queue-storage ratio at critical intersections, work in concert to systematically alleviate congestion and improve mobility. The high usage of electronic toll collection tags in this area allows large amounts of per trip travel time data to be collected (nearly 1 million per trip travel time records daily) and used in real time for effective control. Congestion levels are mapped to different control regimes. Various demand-regulating strategies are applied at the peripheral roadways of the target control zone. These strategies proactively employ signal offsets and splits to exert a tapering and rebalancing effect on the traffic. Demand regulation results in a better use of available network storage spaces while preserving the capacity of the target control zone. Inside the target control area, a dynamic queue-balancing strategy is implemented at selected critical intersections to prevent propagation of spillovers with stabilized or diminished queues. The initial implementation covered 110 intersections in the highly congested central business district of midtown Manhattan New York City. Results to date are summarized.

PubMed | Mount Sinai Beth Israel, NYU Langone Medical Center, Weill Cornell Medicine NYP Lower Manhattan Hospital and Long Island City
Type: | Journal: BMJ case reports | Year: 2016

Mixed corticomedullary adrenal tumours (MCMT) are rare. We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT. A man aged 48years presented with hypertension and signs of Cushing syndrome. 24-hour urine cortisol was elevated, with detectable adrenocorticotropic hormone (ACTH). A high-dose dexamethasone suppression test indicated an adrenal or ectopic Cushing syndrome. Plasma metanephrines were normal. A 3cm left adrenal mass was identified without potential ectopic sources of ACTH on imaging. After induction of anaesthesia for laparoscopic adrenalectomy, the patient developed resistant hypertension with stress-dose hydrocortisone administration. Surgery was cancelled and repeat testing revealed elevated plasma metanephrines. -Blockade was administered for a presumed coexisting pheochromocytoma, and the patient underwent adrenalectomy. Pathology revealed an MCMT. This case highlights the importance of a thorough biochemical evaluation in patients with adrenal masses to rule out multiple hormone producing tumours.

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