Screening Mammography Compliance in Rural and Urban Women in Tennessee

Between 1990 and 2002, breast cancer mortality rates decreased by over 2% each year. Regular screening mammography is largely credited with the decline as it permits detection of breast cancer at its most treatable stage. In the United States approximately 75% of women over forty years of age report mammography screening within the past two years. However, rates vary by age, income, education, and residence. The purpose of this study was to determine the prevalence of screening mammography compliance in women living in rural and urban areas of Tennessee; as well as the associated risk factors with special emphasis on risk associated with rural residence. Using combined data from the Tennessee Behavioral Risk Factor Surveillance System (2001 and 2003), compliance with having accessed a screening mammogram within a two-year period was examined for a sample of 1922 women 40 years and older. Demographic, behavioral, and health-related variables were used to explore associations with compliance. Multivariate logistic regression was performed to identify the association between residence and compliance. The prevalence of screening mammography compliance (71.3% 95% CI 67.4-75.2) in women living in rural areas of Tennessee was significantly different from the prevalence of compliance in women living in urban areas (78.3% 95% CI 75.9-80.7). Significantly higher rates of compliance were associated with income ≥ $50,000, having at least a high school education, having health insurance, having a personal healthcare giver, non-smoking, recent use of alcohol, recent clinical breast exam or Pap test, and meeting the Healthy People 2010 (HP2010) recommendation for physical activity. After controlling for all other factors, residence was not significantly associated with likelihood of compliance. Specific to rural women, identifying a personal healthcare giver and smoking status were significantly associated with increased likelihood of compliance. These associations can be used by health educators and service providers for identifying at-risk population and making programmatic decisions

Forgiveness and interpersonal skills in same-sexed friendships

Although forgiveness is a largely interpersonal process, little research has examined the relationship between forgiveness and the interpersonal skills that may be important in forgiving another for an offence. The current study addressed this issue by investigating the relationship between forgiveness and interpersonal skills in same-sexed friendships among a community sample of 210 people (mean age 38.32 years). Each participant completed the Heartland Forgiveness Scale (Thompson et al., 2005), which assesses forgiveness of self, others, and situations; and the same-sex friend version of the Interpersonal Competence Questionnaire (Buhrmester, Furman, Wittenberg, & Reis, 1988) which assesses skills in initiation, negative assertion, self-disclosure, emotional support, and conflict management. Positive correlations were found between all five interpersonal skills and the three types of forgiveness, with only the relationship between forgiveness of others and negative assertion failing to reach significance. Separate hierarchical regressions were conducted to predict each type of forgiveness, with age and gender entered at Step 1 and the interpersonal skills variables entered at Step 2. Age, initiation skills, and conflict management skills each contributed uniquely to the prediction of all three types of forgiveness. Discussion centres around the relationship between forgiveness and interpersonal skills

Validation of two multiplex platforms to quantify circulating markers of inflammation and endothelial injury in severe infection

Biomarkers can prognosticate outcome and enable risk-stratification. In severe infection, focusing on multiple markers reflecting pathophysiological mechanisms of organ injury could enhance management and pathway-directed therapeutics. Limited data exist on the performance of multiplex biomarker platforms. Our goal was to compare endothelial and immune activation biomarkers in severe pediatric infections using two multiplex platforms. Frozen plasma from 410 children presenting to the Jinja Regional Hospital in Uganda with suspected infection was used to measure biomarkers of endothelial (Angiopoietin-2, sFlt-1, sVCAM-1, sICAM-1) and immune (IL-6, IP-10, sTNFR-1, CHI3L1) activation. Two multiplex platforms (Luminex®, EllaTM) based on monoclonal antibody sandwich immunoassays using biotin-streptavidin conjugate chemistry were selected with reagents from R&D Systems. The two platforms differed in ease and time of completion, number of samples per assay, and dynamic concentration range. Intra-assay variability assessed using a coefficient of variation (CV%) was 2.2-3.4 for Luminex® and 1.2-2.9 for EllaTM. Correlations for biomarker concentrations within dynamic range of both platforms were best for IL-6 (ρ = 0.96, p<0.0001), IP-10 (ρ = 0.94, p<0.0001) and sFlt-1 (ρ = 0.94, p<0.0001). Agreement between concentrations obtained by both methods assessed by the Bland-Altman test varied, with best agreement for CHI3L1. Our data suggest that biomarkers of endothelial and immune activation can be readily measured with multiplex platforms. Luminex® and EllaTM produced reliable results with excellent CV% values. The EllaTM platform was more automated and completed in 75 minutes, potentially compatible with near-patient use. Trends in concentrations obtained by these methods were highly correlated, although absolute values varied, suggesting caution is required when comparing data from different multiplex platforms

Blackwater fever and acute kidney injury in children hospitalized with an acute febrile illness: pathophysiology and prognostic significance

Background: Acute kidney injury (AKI) and blackwater fever (BWF) are related but distinct renal complications of acute febrile illness in East Africa. The pathogenesis and prognostic signifcance of BWF and AKI are not well understood. Methods: A prospective observational cohort study was conducted to evaluate the association between BWF and AKI in children hospitalized with an acute febrile illness. Secondary objectives were to examine the association of AKI and BWF with (i) host response biomarkers and (ii) mortality. AKI was defned using the Kidney Disease: Improving Global Outcomes criteria and BWF was based on parental report of tea-colored urine. Host markers of immune and endothelial activation were quantifed on admission plasma samples. The relationships between BWF and AKI and clinical and biologic factors were evaluated using multivariable regression. Results: We evaluated BWF and AKI in 999 children with acute febrile illness (mean age 1.7 years (standard deviation 1.06), 55.7% male). At enrollment, 8.2% of children had a history of BWF, 49.5% had AKI, and 11.1% had severe AKI. A history of BWF was independently associated with 2.18-fold increased odds of AKI (95% CI 1.15 to 4.16). When examining host response, severe AKI was associated with increased immune and endothelial activation (increased CHI3L1, sTNFR1, sTREM-1, IL-8, Angpt-2, sFlt-1) while BWF was predominantly associated with endothelial activation (increased Angpt-2 and sFlt-1, decreased Angpt-1). The presence of severe AKI, not BWF, was associated with increased risk of in-hospital death (RR, 2.17 95% CI 1.01 to 4.64) adjusting for age, sex, and disease severity. Conclusions: BWF is associated with severe AKI in children hospitalized with a severe febrile illness. Increased awareness of AKI in the setting of BWF, and improved access to AKI diagnostics, is needed to reduce disease progression and in-hospital mortality in this high-risk group of children through early implementation of kidney-protective measures

The variance shared across forms of childhood trauma is strongly associated with liability for psychiatric and substance use disorders

Introduction: Forms of childhood trauma tend to co-occur and are associated with increased risk for psychiatric and substance use disorders. Commonly used binary measures of trauma exposure have substantial limitations. Methods: We performed multigroup confirmatory factor analysis (CFA), separately by sex, using data from the Childhood Trauma (CT) Study's sample of twins and siblings (N = 2594) to derive three first-order factors (childhood physical abuse, childhood sexual abuse, and parental partner abuse) and, as hypothesized, one higher order, childhood trauma factor (CTF) representing a measure of their common variance. Results: CFA produced a good-fitting model in the CT Study; we replicated the model in the Comorbidity and Trauma (CAT) Study's sample (N = 1981) of opioid-dependent cases and controls. In both samples, first-order factors are moderately correlated (indicating they measure largely unique, but related constructs) and their loadings on the CTF suggest it provides a reasonable measure of their common variance. We examined the association of CTF score with risk for psychiatric and substance use disorders in these samples and the OZ-ALC GWAS sample (N = 1538) in which CT Study factor loadings were applied. We found that CTF scores are strongly associated with liability for psychiatric and substance use disorders in all three samples; estimates of risk are extremely consistent across samples. Conclusions: The CTF is a continuous, robust measure that captures the common variance across forms of childhood trauma and provides a means to estimate shared liability while avoiding multicollinearity. Confirmatory factor analysis was used to derive a higher order, childhood trauma factor representing a measure of the common variance across three forms of trauma: childhood physical abuse, childhood sexual abuse, and parental partner abuse. We replicated the model in a second sample. We then examined the association of childhood trauma score with risk for psychiatric and substance use disorders in these samples and a third sample in which the primary sample's factor loadings were applied finding factor scores to be strongly and consistently associated with liability for psychiatric and substance use disorders in all three samples

Low metallicities and old ages for three ultra-diffuse galaxies in the Coma cluster

A.W. acknowledges support of a Leverhulme Trust Early Career Fellowship.A large population of ultra-diffuse galaxies (UDGs) was recently discovered in the Coma cluster. Here we present optical spectra of three such UDGs, DF 7, DF 44, and DF 17, which have central surface brightnesses of μ g ≈ 24.4–25.1 mag arcsec−2. The spectra were acquired as part of an ancillary program within the SDSS-IV MaNGA Survey. We stacked 19 fibers in the central regions from larger integral field units (IFUs) per source. With over 13.5 hr of on-source integration, we achieved a mean signal-to-noise ratio in the optical of 9.5 Å−1, 7.9 Å−1, and 5.0 Å−1, respectively, for DF 7, DF 44, and DF 17. Stellar population models applied to these spectra enable measurements of recession velocities, ages, and metallicities. The recession velocities of DF 7, DF 44, and DF 17 are ${6599}_{-25}^{+40}$ km s−1, ${6402}_{-39}^{+41}$ km s−1, and ${8315}_{-43}^{+43}$ km s−1, spectroscopically confirming that all of them reside in the Coma cluster. The stellar populations of these three galaxies are old and metal-poor, with ages of ${7.9}_{-2.5}^{+3.6}$ Gyr, ${8.9}_{-3.3}^{+4.3}$ Gyr, and ${9.1}_{-5.5}^{+3.9}$ Gyr, and iron abundances of [Fe/H] $-{1.0}_{-0.4}^{+0.3}$, $-{1.3}_{-0.4}^{+0.4}$, and $-{0.8}_{-0.5}^{+0.5}$, respectively. Their stellar masses are (3–6) × 108M⊙. The UDGs in our sample are as old or older than galaxies at similar stellar mass or velocity dispersion (only DF 44 has an independently measured dispersion). They all follow the well-established stellar mass–stellar metallicity relation, while DF 44 lies below the velocity dispersion-metallicity relation. These results, combined with the fact that UDGs are unusually large for their stellar masses, suggest that stellar mass plays a more important role in setting stellar population properties for these galaxies than either size or surface brightness.Publisher PDFPeer reviewe

Planning for Sustainability in Small Municipalities: The Influence of Interest Groups, Growth Patterns, and Institutional Characteristics

How and why small municipalities promote sustainability through planning efforts is poorly understood. We analyzed ordinances in 451 Maine municipalities and tested theories of policy adoption using regression analysis.We found that smaller communities do adopt programs that contribute to sustainability relevant to their scale and context. In line with the political market theory, we found that municipalities with strong environmental interests, higher growth, and more formal governments were more likely to adopt these policies. Consideration of context and capacity in planning for sustainability will help planners better identify and benefit from collaboration, training, and outreach opportunities

Sequential disruptions to inflammatory and angiogenic pathways and risk of spontaneous preterm birth in Malawian women

Preterm birth is a leading cause of death in children under five years of age. We hypothesized that sequential disruptions to inflammatory and angiogenic pathways during pregnancy increase the risk of placental insufficiency and spontaneous preterm labour and delivery. We conducted a secondary analysis of inflammatory and angiogenic analytes measured in plasma samples collected across pregnancy from 1462 Malawian women. Women with concentrations of the inflammatory markers sTNFR2, CHI3L1, and IL18BP in the highest quartile before 24 weeks gestation and women with anti-angiogenic factors sEndoglin and sFlt-1/PlGF ratio in the highest quartile at 28-33 weeks gestation, had an increased relative risk of preterm birth. Mediation analysis further supported a potential causal link between early inflammation, subsequent angiogenic dysregulation detrimnental to placental vascular development, and earlier gestational age at delivery. Interventions designed to reduce the burden of preterm birth may need to be implemented before 24 weeks of gestation

Count every newborn; a measurement improvement roadmap for coverage data.

BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks

Intestinal barrier disruption with Plasmodium falciparum infection in pregnancy and risk of preterm birth: a cohort study

Malaria in early pregnancy is a risk factor for preterm birth and is associated with sustained inflammation and dysregulated angiogenesis across gestation. This study investigated whether malaria is associated with increased gut leak and whether this contributes to systemic inflammation, altered angiogenesis, and preterm birth. We quantified plasma concentrations of gut leak markers, soluble CD14 (sCD14) and lipopolysaccharide binding protein (LBP) from 1339 HIV-negative pregnant Malawians at <24 weeks gestational age. We assessed the relationship of sCD14 and LBP concentrations with markers of inflammation, angiogenesis, and L-arginine bioavailability and compared them between participants with and without malaria, and with and without preterm birth. Plasma concentrations of sCD14 and LBP were significantly higher in participants with malaria and were associated with parasite burden (p <0.0001, both analyses and analytes). The odds ratio for preterm birth associated with one log sCD14 was 2.67 (1.33 to 5.35, p = 0.006) and 1.63 (1.07-2.47, p = 0.023) for LBP. Both gut leak analytes were positively associated with increases in proinflammatory cytokines CRP, sTNFR2, IL18-BP, CHI3L1 and Angptl3 (p <0.05, all analytes) and sCD14 was significantly associated with angiogenic proteins Angpt-2, sENG and the sFLT:PlGF ratio (p <0.05, all analytes). sCD14 was negatively associated with L-arginine bioavailability (p <0.001). Malaria in early pregnancy is associated with intestinal barrier dysfunction, which is linked to an increased risk of preterm birth. Open Philanthropy, Canadian Institutes of Health Research, Canada Research Chair program, European and Developing Countries Clinical Trials Partnership, Bill & Melinda Gates Foundation