Geographic Health Disparities in Kentucky: Starting a Conversation About Local Solutions

A recently released map of Kentucky demonstrates how life expectancy varies across the state’s 120 counties. The map vividly shows a decline in life expectancy as one travels east from the “Golden Triangle” in central urban Kentucky to the mountains of Appalachia. The lowest life expectancies are largely in the far southeastern portion of the state, where residents of the Central Highlands have confronted adverse social determinants of health for generations. Indeed, companion maps released by the Center on Society and Health, which plot median household income, poverty, and educational attainment at the census tract level, show the stark socioeconomic disadvantage in this distressed Appalachian region. The maps are intended as “conversation starters” to stimulate public discourse about the factors that shape health outcomes and to mobilize community concern and policy action to address health disparities in Appalachia. Meaningful change at the local level will be essential to transform the social and economic factors responsible for the region’s health

Advanced characterization and simulation of SONNE: a fast neutron spectrometer for Solar Probe Plus

SONNE, the SOlar NeutroN Experiment proposed for Solar Probe Plus, is designed to measure solar neutrons from 1-20 MeV and solar gammas from 0.5-10 MeV. SONNE is a double scatter instrument that employs imaging to maximize its signal-to-noise ratio by rejecting neutral particles from non-solar directions. Under the assumption of quiescent or episodic small-flare activity, one can constrain the energy content and power dissipation by fast ions in the low corona. Although the spectrum of protons and ions produced by nanoflaring activity is unknown, we estimate the signal in neutrons and γ−rays that would be present within thirty solar radii, constrained by earlier measurements at 1 AU. Laboratory results and simulations will be presented illustrating the instrument sensitivity and resolving power

Theory of Systematic Computational Error in Free Energy Differences

Systematic inaccuracy is inherent in any computational estimate of a non-linear average, due to the availability of only a finite number of data values, N. Free energy differences (DF) between two states or systems are critically important examples of such averages in physical, chemical and biological settings. Previous work has demonstrated, empirically, that the ``finite-sampling error'' can be very large -- many times kT -- in DF estimates for simple molecular systems. Here, we present a theoretical description of the inaccuracy, including the exact solution of a sample problem, the precise asymptotic behavior in terms of 1/N for large N, the identification of universal law, and numerical illustrations. The theory relies on corrections to the central and other limit theorems, and thus a role is played by stable (Levy) probability distributions.Comment: 5 pages, 4 figure

Hip fracture, mortality risk, and cause of death over two decades

Summary: Men and women with hip fracture have higher short-term mortality. This study investigated mortality risk over two decades post-fracture; excess mortality remained high in women up to 10 years and in men up to 20 years. Cardiovascular disease (CVD) and pneumonia were leading causes of death with a long-term doubling of risk. Introduction: Hip fractures are associated with increased mortality, particularly short term. In this study with a two-decade follow-up, we examined mortality and cause of death compared to the background population. Methods: We followed 1013 hip fracture patients and 2026 matched community controls for 22 years. Mortality, excess mortality, and cause of death were analyzed and stratified for age and sex. Hazard ratio (HR) was estimated by Cox regression. A competing risk model was fitted to estimate HR for common causes of death (CVD, cancer, pneumonia) in the short and long term (>1 year). Results: For both sexes and at all ages, mortality was higher in hip fracture patients across the observation period with men losing most life years (p <0.001). Mortality risk was higher for up to 15 years (women (risk ratio (RR) 1.9 [95 % confidence interval (CI) 1.7–2.1]); men (RR 2.8 [2.2–3.5])) and until end of follow-up ((RR 1.8 [1.6–2.0]); (RR 2.7 [2.1–3.3])). Excess mortality by time intervals, censored for the first year, was evident in women (80 years, for 5 years) and in me

Hormonal replacement therapy, prothrombotic mutations and the risk of venous thrombosis

Hormone replacement therapy (HRT) increases the risk of venous thrombosis. We investigated whether this risk is affected by carriership of hereditary prothrombotic abnormalities. Therefore, we determined the two most common prothrombotic mutations, factor V Leiden and prothrombin 20210A in women who participated in a case-control study on venous thrombosis. Relative risks were expressed as odds ratios (OR) with 95% confidence intervals (CI95). Among 7 7 women aged 45-64 years with a first venous thrombosis, 51% were receiving HRT at the time of thrombosis, compared with 24% of control women (OR = 3.3, CI95 1.8-5.8). Among the patients, 23% had a prothrombotic defect, versus 7% among the control women (OR = 3.8, CI95 1.7- 8.5). Women who had factor V Leiden and used HRT had a 15-fold increased risk (OR = 15.5, CI95 3.1-77), which exceeded the expected joint odds ratio of 6.1 (under an additive model). We conclude that the thrombotic risk of HRT may particularly affect women with prothrombotic mutations. Efforts to avoid HRT in women with increased risk of thrombosis are advisable