Air pollution exposure and preeclampsia among US women with and without asthma

Maternal asthma and air pollutants have been independently associated with preeclampsia but rarely studied together. Our objective was to comprehensively evaluate preeclampsia risk based on the interaction of maternal asthma and air pollutants. Preeclampsia and asthma diagnoses, demographic and clinical data came from electronic medical records for 210,508 singleton deliveries. Modified Community Multiscale Air Quality models estimated preconception, first and second trimester and whole pregnancy exposure to: particulate matter (PM)\u3c2.5 and \u3c10µm, ozone, nitrogen oxides (NOx), sulfur dioxide (SO2) and carbon monoxide (CO); PM2.5 constituents; volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). Asthma-pollutant interaction adjusted relative risks (RR) and 95% confidence intervals (CI) for preeclampsia were calculated by interquartile range for criteria pollutants and high exposure (≥75th percentile) for PAHs and VOCs. Asthmatics had higher risk associated with first trimester NOx and SO2 and whole pregnancy elemental carbon (EC) exposure than non-asthmatics, but only EC significantly increased risk (RR=1.11, CI:1.03-1.21). Asthmatics also had a 10% increased risk associated with second trimester CO. Significant interactions were observed for nearly all VOCs and asthmatics had higher risk during all time windows for benzene, ethylbenzene, m-xylene, o-xylene, p-xylene and toluene while most PAHs did not increase risk

Maternal serum markers of lipid metabolism in relation to neonatal anthropometry

Objective: The objective of this study is to examine associations between lipids (high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides and lipoprotein (a)) measured on average three time points during pregnancy and neonatal anthropometrics. Study design: Stored samples from a preeclampsia trial measured as part of a case-control study from five US centers (1992 to 1995) were used. The sample included women without pregnancy complications (n=136) and cases of gestational diabetes (n=93), abnormal glucose tolerance (AGT; n=76), gestational hypertension (n=170) and preeclampsia (n=177). Linear regression and linear mixed-effects models estimated adjusted associations between lipids and birth weight z-score, ponderal index (PI), length and head circumference. Results: Among women without complications, cross-sectional associations between total cholesterol measured at different gestational ages increased PI 2.23 to 2.55 kg m-3 per-unit increase in cholesterol. HDL was inversely associated with birth length (β\u27s=-2.21 and -2.56 cm). For gestational hypertension, triglycerides were associated with birth weight z-score (β\u27s=0.24 to 0.31). For preeclampsia, HDL was associated with lower birth weight z-scores (β\u27s=-0.49 and -0.82). Women with gestational diabetes or AGT had inconsistent associations. Examining the level changes across pregnancy, each 0.0037 mmol l-1 increase in HDL was associated with decreased birth weight z-score (β=-0.22), length (β=-0.24 cm) and head circumference (β=-0.24 cm), whereas each 0.028 mmol l-1 increase in triglycerides was associated with increased birth weight z-score (β=0.13) and head circumference (β=0.19 cm). Conclusions: Although associations varied by complications, in general, growth-promoting fuels such as total cholesterol and triglycerides were associated with increased neonatal size, whereas high HDL was associated with smaller size. Maternal HDL that failed to decrease over pregnancy was associated with smaller neonate size

Preterm birth and air pollution: Critical windows of exposure for women with asthma

Background: Ambient air pollutants may increase preterm birth (PTB) risk, but critical exposure windows are uncertain. The interaction of asthma and pollutant exposure is rarely studied. Objective: We sought to assess the interaction of maternal asthma and air pollutant exposures in relation to PTB risk. Methods: Electronic medical records for 223,502 US deliveries were linked with modified Community Multiscale Air Quality model outputs. Logistic regression with generalized estimating equations estimated the odds ratio and 95% CIs for PTB on the basis of the interaction of maternal asthma and particulate matter with aerodynamic diameter of less than 2.5 microns and particulate matter with aerodynamic diameter of less than 10 microns, ozone (O3), nitrogen oxides (NOx), sulfur dioxide (SO2), and carbon monoxide (CO) per interquartile range. For each gestational week 23 to 36, exposures among women who delivered were compared with those remaining pregnant. Three-month preconception, whole pregnancy, weeks 1 to 28, and the last 6 weeks of gestation averages were also evaluated. Results: On assessing PTB by gestational week, we found that significant asthma interactions were sporadic before 30 weeks but more common during weeks 34 to 36, with higher risk among mothers with asthma for NOx, CO, and SO2 exposure and an inverse association with O3 in week 34. Odds of PTB were significantly higher among women with asthma for CO and NOx exposure preconception and early in pregnancy. In the last 6 weeks of pregnancy, PTB risk associated with particulate matter with aerodynamic diameter of less than 10 microns was higher among women with asthma. Conclusions: Mothers with asthma may experience a higher risk for PTB after exposure to traffic-related pollutants such as CO and NOx, particularly for exposures 3-months preconception and in the early weeks of pregnancy

Preconception and early pregnancy air pollution exposures and risk of gestational diabetes Mellitus

Background: Air pollution has been linked to gestational diabetes mellitus (GDM) but no studies have evaluated impact of preconception and early pregnancy air pollution exposures on GDM risk. Methods: Electronic medical records provided data on 219,952 singleton deliveries to mothers with (n=11,334) and without GDM (n=208,618). Average maternal exposures to particulate matter (PM) ≤ 2.5μm (PM2.5) and PM2.5 constituents, PM ≤ 10μm (PM10), nitrogen oxides (NOx), carbon monoxide, sulfur dioxide (SO2) and ozone (O3) were estimated for the 3-month preconception window, first trimester, and gestational weeks 1-24 based on modified Community Multiscale Air Quality models for delivery hospital referral regions. Binary regression models with robust standard errors estimated relative risks (RR) for GDM per interquartile range (IQR) increase in pollutant concentrations adjusted for study site, maternal age and race/ethnicity. Results: Preconception maternal exposure to NOX (RR=1.09, 95% CI: 1.04, 1.13) and SO2 (RR=1.05, 1.01, 1.09) were associated with increased risk of subsequent GDM and risk estimates remained elevated for first trimester exposure. Preconception O3 was associated with lower risk of subsequent GDM (RR=0.93, 0.90, 0.96) but risks increased later in pregnancy. Conclusion: Maternal exposures to NOx and SO2 preconception and during the first few weeks of pregnancy were associated with increased GDM risk. O3 appeared to increase GDM risk in association with mid-pregnancy exposure but not in earlier time windows. These common exposures merit further investigation

Towards Space-like Photometric Precision from the Ground with Beam-Shaping Diffusers

We demonstrate a path to hitherto unachievable differential photometric precisions from the ground, both in the optical and near-infrared (NIR), using custom-fabricated beam-shaping diffusers produced using specialized nanofabrication techniques. Such diffusers mold the focal plane image of a star into a broad and stable top-hat shape, minimizing photometric errors due to non-uniform pixel response, atmospheric seeing effects, imperfect guiding, and telescope-induced variable aberrations seen in defocusing. This PSF reshaping significantly increases the achievable dynamic range of our observations, increasing our observing efficiency and thus better averages over scintillation. Diffusers work in both collimated and converging beams. We present diffuser-assisted optical observations demonstrating $62^{+26}_{-16}$ppm precision in 30 minute bins on a nearby bright star 16-Cygni A (V=5.95) using the ARC 3.5m telescope---within a factor of $\sim$2 of Kepler's photometric precision on the same star. We also show a transit of WASP-85-Ab (V=11.2) and TRES-3b (V=12.4), where the residuals bin down to $180^{+66}_{-41}$ppm in 30 minute bins for WASP-85-Ab---a factor of $\sim$4 of the precision achieved by the K2 mission on this target---and to 101ppm for TRES-3b. In the NIR, where diffusers may provide even more significant improvements over the current state of the art, our preliminary tests have demonstrated $137^{+64}_{-36}$ppm precision for a $K_S =10.8$ star on the 200" Hale Telescope. These photometric precisions match or surpass the expected photometric precisions of TESS for the same magnitude range. This technology is inexpensive, scalable, easily adaptable, and can have an important and immediate impact on the observations of transits and secondary eclipses of exoplanets.Comment: Accepted for publication in ApJ. 30 pages, 20 figure

A new version of the HBSC Family Affluence Scale - FAS III: Scottish qualitative findings from the International FAS Development Study

A critical review of the Family Affluence Scale (FAS) concluded that FAS II was no longer discriminatory within very rich or very poor countries, where a very high or a very low proportion of children were categorised as high FAS or low FAS respectively (Currie et al. 2008). The review concluded that a new version of FAS - FAS III - should be developed to take into account current trends in family consumption patterns across the European region, the US and Canada. In 2012, the FAS Development and Validation Study was conducted in eight countries - Denmark, Greenland, Italy, Norway, Poland, Romania, Slovakia and Scotland. This paper describes the Scottish qualitative findings from this study. The Scottish qualitative fieldwork comprising cognitive interviews and focus groups sampled from 11, 13 and 15 year-old participants from 18 of the most- and least- economically deprived schools. These qualitative results were used to inform the final FAS III recommendations.Publisher PDFPeer reviewe

Setting a common standard in clinical skills assessment: The experience of the California Consortium for the Assessment of Clinical Competence

Objective or purpose of innovation: To identify common clinical skills competency thresholds across schools by centralizing standard setting for a multi-institutional assessment. Background and/or theoretical framework and importance to the field: The California Consortium for the Assessment of Clinical Competence (CCACC) comprises 10 medical schools that administer a common multi-station clinical skills assessment (CPX). Previously, each institution determined their own, largely norm-referenced passing thresholds for the examination. With the elimination of USMLE Step 2 CS, there is a recognized need for robust clinical skills assessment beyond the individual institutional level. A collaboratively developed, multi-institutional examination with passing thresholds established via a rigorous process offers greater validity evidence for summative decisions made based on its results. Accordingly, the CCACC undertook centralized, criterion-based standard setting for the CPX. Design: Passing thresholds for the six core CPX cases were determined via two methods: modified Angoff, using expert raters from multiple institutions, and borderline regression, using global encounter ratings assigned by standardized patients. Results from the two methods were compared to each other and to institutions’ prior thresholds. Outcomes: Both methods yielded the same cumulative cut score based on averages across all cases (70%), but exhibited variation between individual cases, suggesting case-specificity. Compared with prior thresholds, some institutions’ pass rates would have been higher using the common criterion-referenced cut score, while others would have been lower. Innovation’s strengths and limitations: This study demonstrates the feasibility of centralizing standard setting across multiple institutions using two criterion-based methods. Standardized patient ratings may generate similar passing thresholds to those determined by clinicians. Further studies are necessary to determine whether these findings generalize to other case types and how best to apply centralized standards within each institution’s context. Feasibility and generalizability: The CCACC’s standard setting approaches may be applied across other institutions sharing an assessment, allowing for comparison of learner performance to a common standard. Given the similar results, the choice of method may be determined by resource availability

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home� program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake

Postsecondary Completion in Rural Texas: A Statewide Overview

Educate Texas, our client, is a partner and key player in postsecondary education in Texas. The nonprofit seeks to improve postsecondary completion statewide. Under their mission, our capstone was charged with assessing the state of postsecondary completion in Rural Texas. Using a mixed methods approach, the capstone studied institutional, attitudinal, and academic barriers that impede rural students from pursuing and obtaining a postsecondary credential. Why should policymakers and stakeholders focus specifically on the rural student population in Texas for postsecondary enrollment and completion? Texas ranks below the national average in postsecondary educational enrollment and completion. Texas needs to “enroll immediately 200,000 more students” to reach the national average, according to Closing the Gaps, the Texas Higher Education Coordinator Board strategic plan. Within the state, the issue also applies to rural students. Only 26% of the most recent Texas high school graduating class tracked as a cohort ended up earning a postsecondary credential. There are 834,000 rural K-12 students in Texas, which is 18% of the total K-12 enrollment. Approximately 43% of the rural K-12 student population is considered low income. With the largest population of rural students in the country, Texas has a unique opportunity to capitalize on the success of these youth completing a postsecondary credential.Educate Texa