Maternal Smoking During Pregnancy and Offspring Birth Weight: A Genetically-Informed Approach Comparing Multiple Raters

Maternal smoking during pregnancy (SDP) is a significant public health concern with adverse consequences to the health and well-being of the fetus. There is considerable debate about the best method of assessing SDP, including birth/medical records, timeline follow-back approaches, multiple reporters, and biological verification (e.g., cotinine). This is particularly salient for genetically-informed approaches where it is not always possible or practical to do a prospective study starting during the prenatal period when concurrent biological specimen samples can be collected with ease. In a sample of families (N = 173) specifically selected for sibling pairs discordant for prenatal smoking exposure, we: (1) compare rates of agreement across different types of report—maternal report of SDP, paternal report of maternal SDP, and SDP contained on birth records from the Department of Vital Statistics; (2) examine whether SDP is predictive of birth weight outcomes using our best SDP report as identified via step (1); and (3) use a sibling-comparison approach that controls for genetic and familial influences that siblings share in order to assess the effects of SDP on birth weight. Results show high agreement between reporters and support the utility of retrospective report of SDP. Further, we replicate a causal association between SDP and birth weight, wherein SDP results in reduced birth weight even when accounting for genetic and familial confounding factors via a sibling comparison approac

Missouri mothers and their children: A family study of the effects of genetics and the prenatal environment

The Missouri Mothers and Their Children Study was specifically designed to critically investigate prenatal environmental influences on child attention problems and associated learning and cognitive deficits. The project began as a pilot study in 2004 and was formally launched in 2008. Participants in the study were initially identified via the Department of Vital Statistics birth record database. Interview and lab-based data were obtained from (1) mothers of Missouri-born children (born 1998–2005), who smoked during one pregnancy but not during another pregnancy, (2) biological fathers when available, and (3) the children [i.e., full sibling pairs discordant for exposure to maternal smoking during pregnancy (SDP)]. This within-mother, between-pregnancy contrast provides the best possible methodological control for many stable maternal and familial confounding factors (e.g., heritable and socio-demographic characteristics of the mother that predict increased probability of SDP). It also controls for differences between mothers who do and do not smoke during pregnancy, and their partners, that might otherwise artifactually create, or alternatively mask, associations between SDP and child outcomes. Such a design will therefore provide opportunities to determine less biased effect sizes while also allowing us to investigate (on a preliminary basis) the possible contribution of paternal or other second-hand smoke exposure during the pre-, peri- and postnatal periods to offspring outcome. This protocol has developed a cohort that can be followed longitudinally through periods typically associated with increased externalizing symptoms and substance use initiation

Utah Adoption Services for Women, a Utah non-profit corporation v. Bradley Thomas Belanger : Brief of Appellant

AN APPEAL FROM THE DECISION OF THE THIRD JUDICIAL DISTRICT COURT OF SALT LAKE COUNTY, STATE OF UTAH, THE HONORABLE LEONARD H. RUSSON PRESIDING

Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism

Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.Conclusion: Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making

Gladys Fay Wells, Guardian Ad Litem For Dennis Edgar Wells, Jr., A Minor Over the Age of 14 Years, Plaintiffs and Respondents, v. Children\u27s Aid Society of Utah, Successor in Custody of Kimberly Bronson, Mother of Baby Boy Bronson and Kimberly Bronson, Defendants and Appellants, John Doe And Mary Doe, and Robert D. Maack, Esq/. Guardian Ad Litem For Baby Boy Bronson, Inventors And Appellants : Brief of Appellants Children\u27S Aid Society And Kimberly Bronson

Appeal from a final order of the Honorable Boyd Bunnell of the Second Judicial District Court of Grand County, Uta

De Jure School Segregation as the Result of Racist Housing Policies

It is no secret that African Americans have been and continue to be marginalized in American society. A revival of racial justice movements and protests have brought the issue back into the public eye across the country and even here at UVM. As this is being written, black lives matter flags fly high across campus and the Waterman building is serving as the epicenter of a demonstration motivated by the unfair treatment of minority students in a university setting. While black lives matter movements and others like it have been helpful in bringing to light the current position of minorities in America, understanding how it is that the state of affairs got to where they are is paramount. A commonly believed narrative is that the rising levels of segregation since the end of court ordered integration are the result of innocent private decisions, otherwise known as de facto or voluntary segregation. This paper will argue that modern segregation is in some significant parts the result of a combination of court decisions and discriminatory housing policies that have had long-term detrimental consequences for the education of African American Youth

Gladys Fay Wells, Guardian Ad Litem For Dennis Edgar Wells, Jr., A Minor Over the Age of 14 Years, Plaintiffs and Respondents, v. Children\u27s Aid Society of Utah, Successor in Custody of Kimberly Bronson, Mother of Baby Boy Bronson and Kimberly Bronson, Defendants and Appellants, John Doe And Mary Doe, and Robert D. Maack, Esq/. Guardian Ad Litem For Baby Boy Bronson, Inventors And Appellants : Respondent\u27s Brief on Appeal

Appeal from a Judgment of the District Court for Grand Count

Overall and abortion‐related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights

To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter‐Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five‐year period, the variation in the percentage of abortion‐related deaths, and the correlation with HDI indicators were evaluated. Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10 years also coincides with a reduction in poverty and an improvement in the HDI. A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.1341S20S2

Fractures in kidney transplant recipients : a comparative study between England and New York State

Objectives: Fractures are associated with high morbidity and are a major concern to kidney transplant recipients. There has not been any comparative analysis conducted between countries in the contemporary era to inform future international prevention trials. Materials and Methods: Data were obtained from the Hospital Episode Statistics and the Statewide Planning and Research Cooperative databases on all adult kidney transplants performed in England and New York State respectively (2003-2013) and on post-transplant fracture-related hospitalization (2003-2014). Results: In total, 18,493 English and 11,602 New York State kidney transplant recipients were included. Overall, 637 (3.4%) English and 398 (3.4%) New York State recipients sustained a fracture giving an unadjusted event rate of 7.0 and 5.9 per 1000 years respectively (P=0.948). A total of 147 (0.8%) English and 101 (0.9%) New York State recipients sustained a hip fracture, giving an unadjusted event rate of 1.6 and 1.5 per 1000 years respectively (P=0.480). There were no differences in the cumulative incidence of all fractures or hip fractures. One-year mortality after any fracture (9% and 11%) or after a hip fracture (15% and 17%) was not different between cohorts. Conclusions: Contemporaneous English and New York State kidney transplant recipients have very similar fracture rates and mortality post-fracture