Maternal Mortality among African American Women in the State of Georgia, Causes, Policy, and Ethical Considerations

Background The U.S. is currently one of thirteen countries where maternal mortality rates (MMR) is worse now than it was fifteen years ago. Reducing maternal mortality is one of the significant challenges facing the health system in the United States, especially in the State of Georgia, which has one of the highest MMR in the nation. The purpose of this review is to explore the causes, policy, and ethical contextual factors contributing to increased maternal mortality rates among African American women in the State of Georgia. Also, identifying and addressing weaknesses and gaps that exist in the healthcare system and recommending policy implications to seek to reduce the MMR. Methods This study conducted a comprehensive literature review from the online database and also used data from CDC Wonder, OASIS Georgia, and Georgia Department of Public Health website to identify the primary antecedents of elevated MMR among African American women in the State of Georgia with specific attention to policy and ethical considerations. Results This review found factors that were related to causes of maternal death in the U.S. include socioeconomic status, communication between patient and healthcare provider, and maternal medical conditions and complications during pregnancy. In the State of Georgia, complications during pregnancy and cardiomyopathy were the leading cause of MMR, particularly among African American women in comparison with other races. However, inconsistency in reporting maternal death data was another issue that is discussed in this review. Conclusions Policies that incorporate ethical considerations need to be developed to benefit the family and society. Policymakers should seek to develop targeted policies in support of specific vulnerable populations through improving maternal screening, health promotion, behavior uptake, and effective case management

Hoxb2 and Hoxb4 Act Together to Specify Ventral Body Wall Formation

AbstractThree different alleles of the Hoxb4 locus were generated by gene targeting in mice. Two alleles contain insertions of a selectable marker in the first exon in either orientation, and, in the third, the selectable marker was removed, resulting in premature termination of the protein. Presence and orientation of the selectable marker correlated with the severity of the phenotype, indicating that the selectable marker induces cis effects on neighboring genes that influence the phenotype. Homozygous mutants of all alleles had cervical skeletal defects similar to those previously reported for Hoxb4 mutant mice. In the most severe allele, Hoxb4PolII, homozygous mutants died eitherin utero at approximately E15.5 or immediately after birth, with a severe defect in ventral body wall formation. Analysis of embryos showed thinning of the primary ventral body wall in mutants relative to control animals at E11.5, before secondary body wall formation. Prior to this defect, both Alx3 and Alx4 were specifically down regulated in the most ventral part of the primary body wall in Hoxb4PolII mutants. Hoxb4loxp mutants in which theneo gene has been removed did not have body wall or sternum defects. In contrast, both the Hoxb4PolII and the previously described Hoxb2PolII alleles that have body wall defects have been shown to disrupt the expression of bothHoxb2 and Hoxb4 in cell types that contribute to body wall formation. Our results are consistent with a model in which defects in ventral body wall formation require the simultaneous loss of at least Hoxb2 and Hoxb4, and may involve Alx3 and Alx4

White Paper: Certification, Credentials, and Credentialing in Pharmacy

The rapid evolution of the health care system has provided the pharmacy profession with opportunities to expand existing and develop new direct patient care roles. Two critical challenges that the pharmacy profession must contend with to ensure the continued expansion and acceptance of pharmacists in advanced practice roles (e.g. direct patient care roles) are: (1) To develop and implement a credible, systematic, standards-based, and profession-wide plan that includes a system for identifying the types of pharmacists\u27 practices requiring credentials, a validated certification process, and a computerized credentialing process that is current, comprehensive, and easily accessible; (2) To establish the credibility of these advanced practice credentials and the certification and credentialing processes with other health care providers, the public, employers and payers (government and commercial)

Impact of Sampling Frequency on Annual Load Estimation of Total Phosphorus and Total Suspended Solids

The determination of sediment and nutrient loads is typically based on the collection and analysis of grab samples. The frequency and regularity of traditional sampling may not provide representation of constituent loading, particularly in systems with flashy hydrology. At two sites in the Little Bear River, Utah, continuous, high-frequency turbidity was used with surrogate relationships to generate estimates of total phosphorus and total suspended solids concentrations, which were paired with discharge to estimate annual loads. The high frequency records were randomly subsampled to represent hourly, daily, weekly, and monthly sampling frequencies and to examine the effects of timing, and resulting annual load estimates were compared to the reference loads. Higher frequency sampling resulted in load estimates that better approximated the reference loads. The degree of bias was greater at the more hydrologically responsive site in the upper watershed, which required a higher sampling frequency than the lower watershed site to achieve the same level of accuracy in estimating the reference load. The hour of day and day of week of sampling impacted load estimation, depending on site and hydrologic conditions. The effects of sampling frequency on the determination of compliance with a water quality criterion were also examined. These techniques can be helpful in determining necessary sampling frequency to meet the objectives of a water quality monitoring program

Specific food intake, fat and fiber intake, and behavioral correlates of BMI among overweight and obese members of a managed care organization

BACKGROUND: The study examined correlates of body mass index (BMI) in overweight and obese members of a managed care organization seeking treatment for obesity. It assessed intake of specific foods, dietary fat or fiber, and behaviors attempted to control weight. METHODS: Participants were 508 men and 1293 women who were > 18 years and had a self-reported BMI > 27.0. This paper reports analyses of baseline and 24-month follow-up data from a randomized weight-loss trial. Cross-sectional and prospective relationships between BMI and behaviors were examined with regression analyses controlling for age and education. RESULTS: At baseline, hamburger and beef consumption were associated with higher BMI for men; for women, hamburger, fried chicken, hot dog, bacon or sausage, egg, French fry, and overall fat consumption were associated with higher BMI, while eating high fiber cereal, fruit, and overall fiber intake were associated with lower BMI. Virtually all forms of weight control behavior were reported more often in heavier people. Subscribing to exercise magazines, however, was associated with lower BMI. Decreased fat intake and increased fruit/vegetable/fiber intake over the course of the study were associated with reductions in BMI at 24 months. CONCLUSION: The same behaviors that differentiate individuals with different body weight in the general population also differentiate between individuals of different body weights at the high end of the weight distribution. Educational efforts aimed at preventing weight gain and reducing obesity might benefit from focusing on specific foods known to be associated empirically with body weight and weight change over time

Developing a Comprehensive Pesticide Health Effects Tracking System for an Urban Setting: New York City’s Approach

In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors

Experimental Investigation of Flow Condensation in Microgravity

Future manned missions to Mars are expected to greatly increase the space vehicle's size, weight, and heat dissipation requirements. An effective means to reducing both size and weight is to replace single-phase thermal management systems with two-phase counterparts that capitalize upon both latent and sensible heat of the coolant rather than sensible heat alone. This shift is expected to yield orders of magnitude enhancements in flow boiling and condensation heat transfer coefficients. A major challenge to this shift is a lack of reliable tools for accurate prediction of two-phase pressure drop and heat transfer coefficient in reduced gravity. Developing such tools will require a sophisticated experimental facility to enable investigators to perform both flow boiling and condensation experiments in microgravity in pursuit of reliable databases. This study will discuss the development of the Flow Boiling and Condensation Experiment (FBCE) for the International Space Station (ISS), which was initiated in 2012 in collaboration between Purdue University and NASA Glenn Research Center. This facility was recently tested in parabolic flight to acquire condensation data for FC-72 in microgravity, aided by high-speed video analysis of interfacial structure of the condensation film. The condensation is achieved by rejecting heat to a counter flow of water, and experiments were performed at different mass velocities of FC-72 and water and different FC-72 inlet qualities. It is shown that the film flow varies from smooth-laminar to wavy-laminar and ultimately turbulent with increasing FC-72 mass velocity. The heat transfer coefficient is highest near the inlet of the condensation tube, where the film is thinnest, and decreases monotonically along the tube, except for high FC-72 mass velocities, where the heat transfer coefficient is enhanced downstream. This enhancement is attributed to both turbulence and increased interfacial waviness. One-ge correlations are shown to predict the average condensation heat transfer coefficient with varying degrees of success, and a recent correlation is identified for its superior predictive capability, evidenced by a mean absolute error of 21.7%

Performance of Landscape Plants from Northern Japan in the North Central United States

In 1984 and 1985, 21 landscape plant introductions from northern Japan were distributed for testing in the NC-7 Regional Ornamental Plant Trials. Seventeen of these introductions were evaluated for 10 years at six to ten sites representing a cross-section of growing conditions in the north central United States. For these 17 introductions, first-year survival averaged 60%; however, by year 10, fewer than 20% of the original 425 plants were alive. Based on these evaluations, the populations could be divided into four groups. One population of Rosa rugosa was adapted to most trial sites; two populations (Alnus hirsuta and Lonicera chrysantha) were adapted to some sites; three populations were of poorly adapted dieback shrubs, and the remaining II populations included a diverse set of trees and shrubs unadapted to any, or nearly any, trial site. Temperature and moisture data from Japan and from trial sites were used to examine relationships between plant adaptation and climate. Statistically significant, multiple-regression models were calculated to describe the functional relationships between temperature and moisture conditions and plant adaptation at the various trial sites. Our models predict that plants from northern Japan are best adapted to sites in the northeastern United States where moisture surpluses exceed those typically found in the north central United States. These models also suggest criteria to evaluate sites throughout northeastern Asia for future exploration

Bradykinin B 2 Receptor Does Not Contribute to Blood Pressure Lowering during AT 1 Receptor Blockade

ABSTRACT This study tested the hypothesis that endogenous bradykinin contributes to the effects of angiotensin AT 1 receptor blockade in humans. The effect of the bradykinin B 2 receptor antagonist D-Arg-Arg-Pro-Hyp-Gly-Thi-Ser-D-Tic-Oic-Arg (HOE-140) (18 g/kg/h i.v. for 6 h) on hemodynamic and endocrine responses to acute and chronic (1-month) treatment with valsartan (160 mg/day) was determined in 13 normotensive and 12 hypertensive salt-deplete subjects. Acute valsartan increased plasma renin activity (PRA) from 5.3 Ϯ 9.9 to 15.6 Ϯ 19.8 ng of angiotensin (Ang) I/ml/h (P Ͻ 0.001) and decreased aldosterone from 18.3 Ϯ 10.5 to 12.0 Ϯ 9.6 ng/dl (P Ͻ 0.001). Chronic valsartan significantly increased baseline PRA (10.5 Ϯ 15.5 ng of Ang I/ml/h; P ϭ 0.004) but did not affect baseline angiotensinconverting enzyme activity or aldosterone. HOE-140 tended to increase the PRA response to valsartan, and it attenuated the decrease in aldosterone following chronic valsartan (P ϭ 0.03). Acute valsartan decreased mean arterial pressure 12.7 Ϯ 6.9% (from 100.2 Ϯ 8.4 to 87.5 Ϯ 9.8 mm Hg in hypertensives and from 82.4 Ϯ 8.6 to 70.3 Ϯ 8.4 mm Hg in normotensives). HOE-140 did not affect the blood pressure response to either acute (effect of valsartan, P Ͻ 0.001; effect of HOE-140, P ϭ 0.98) or chronic (valsartan, P ϭ 0.01; HOE-140, P ϭ 0.84) valsartan. Plasma cGMP was increased significantly during chronic valsartan (P ϭ 0.048) through a bradykinin receptorindependent mechanism (effect of HOE-140, P ϭ 0.13). Both acute (P Ͻ 0.001) and chronic (P Ͻ 0.001) valsartan increased heart rate. HOE-140 augmented the heart rate response to chronic valsartan (P ϭ 0.04). These data suggest that endogenous bradykinin does not contribute significantly to the blood pressure-lowering effect of valsartan through its B 2 receptor. The availability of the specific bradykinin B 2 receptor antagonist D-Arg-Arg-Pro-Hyp-Gly-Thi-Ser-D-Tic-Oic-Arg (HOE-140) as well as the combined B 1 and B 2 antagonist D-Arg-Arg-ProHyp-Gly-Thi-Ser-D-Igl-Oic-Arg (B9340) has allowed investigators to determine the contribution of endogenous bradykinin to the effects of angiotensin-converting enzyme (ACE) inhibitors in animals and humans. For example, In congestive heart failure patients treated chronically with ACE inhibitor, combined B 1 and B 2 inhibition, but not B 2 inhibition alone, caused vasoconstriction Whether bradykinin contributes to the blood pressure-lowering effect of AT 1 receptor blockade remains to be determined. Unlike ACE inhibition, acute AT 1 receptor blockade does not potentiate the vasodilator effects of exogenous bradykinin in the human forearm vasculatur