Elucidating the Role of Neighborhood Deprivation in Hypertensive Disorders of Pregnancy

This dissertation examined risk factors for hypertensive disorders of pregnancy (HDP) — specifically whether neighborhood socioeconomic deprivation exacerbates individual socioeconomic disadvantage (deprivation amplification) to increase the likelihood of developing HDP. To select the optimal areal unit at which to investigate HDP, geographic proxies for neighborhoods were explored. A thematic review qualitatively examined nontraditional neighborhood boundaries identified through internet sources. Data from 2008–2012 Miami-Dade County, Florida birth records (n=121,421) and the U.S. Census Bureau were used for the remaining analyses. Ordinary least squares (OLS) and geographically weighted regression (GWR) analysis empirically compared the proportion of HDP prevalence explained by six areal units: census block groups, census tracts, ZIP code tabulation areas (ZCTAs), and three types of natural neighborhood — census units clustered based on an eight-item Neighborhood Deprivation Index. Multilevel logistic regression examined relationships between HDP, neighborhood deprivation, and individual-level factors. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated. The thematic review found 22 potential alternatives to census boundaries developed through techniques such as crowd-sourcing and qualitative research. In the sensitivity analysis, census tracts aggregated at the scale of ZCTAs performed twice as well as any other model (GWR2 = 0.27) and were used as the Aim 3 unit of analysis. In the multilevel logistic regression, HDP was associated with moderate (aOR=1.13; CI: 1.05, 1.21) and high neighborhood deprivation (aOR=1.16; CI: 1.07, 1.26). Compared with mothers with private insurance, uninsured women (aOR=1.69; CI: 1.56, 1.84) and Medicaid recipients (aOR=1.12; CI: 1.05, 1.18) had higher HDP odds. Non-Hispanic Black women’s HDP odds were 1.58 times those of non-Hispanic White women. Cross-level interactions — between neighborhood deprivation and educational attainment and neighborhood deprivation and insurance status — did not reach statistical significance. Private sector neighborhood boundaries hold promise for developing new public health tools. Because they are relatively easy to generate from census data, natural neighborhoods may balance tradition and innovation. While no evidence of deprivation amplification was found, results suggested that individual-level and neighborhood deprivation are HDP risk factors. Interventions that target expectant mothers in deprived neighborhoods — particularly non-Hispanic Black and Hispanic women who lack health insurance — may help reduce HDP prevalence and disparities

Cycles of construing in radicalization and deradicalization: a study of Salafist Muslims.

© Taylor & Francis Group, LLC.This article explores radicalization and deradicalization by considering the experiences of six young Tunisian people who had become Salafist Muslims. Their responses to narrative interviews and repertory grid technique are considered from a personal construct perspective, revealing processes of construing and reconstruing, as well as relevant aspects of the structure and content of their construct systems. In two cases, their journeys involved not only radicalization but self-deradicalization, and their experiences are drawn on to consider implications for deradicalization.Peer reviewedFinal Accepted Versio

Effect of emergency department fast track on emergency department length of stay : a case-control study

Objective: To examine the effect of fast track on emergency department (ED) length of stay (LOS).Design and setting: Pair-matched case&ndash;control design in a public teaching hospital in metropolitan Melbourne, Australia.Participants: Patients treated by the ED fast track (cases) between 1 January and 31 March 2007 were compared with patients treated by the usual ED processes (controls) from 1 July to 15 November 2006 (n = 822 matched pairs).Intervention: ED fast track was established in November 2006 and focused on the management of patients with non-urgent complaints.Main outcome measures: The primary outcome measure was ED LOS for fast-track patients. Secondary outcomes were waiting times and ED LOS for other ED patients.Results: Median ED LOS for non-admitted patients was 132 minutes (interquartile range (IQR) 83&ndash;205.25) for controls and 116 minutes (IQR 75.5&ndash;159.0) for cases (p&lt;0.01). Fast-track patients had a significantly higher incidence of discharge within 2 h (53% vs 44%, p&lt;0.01) and 4 h (92% vs 84%, p&lt;0.01).Conclusions: ED fast track decreased ED LOS for non-admitted patients without compromising waiting times and ED LOS for other ED patients<br /

Synchronous colorectal liver metastasis: A network meta-analysis review comparing classical, combined, and liver-first surgical strategies.

BACKGROUND: In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal-first approach have been proposed. These include the liver-first and combined resections approaches. The objectives of this review were to compare the short- and long-term outcomes for all three approaches. METHODS: A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5-year overall survival, 30-day mortality, and post-operative complications). Pair-wise and network meta-analysis (NMA) were performed to compare survival outcomes. RESULTS: Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal-first, mean odds ratio (OR) 1.02 (95% CI 0.8-1.28, P = 0.93); liver-first versus colorectal-first, mean OR 0.81 (95% CI 0.53-1.26, P = 0.37); liver-first versus combined, mean OR 0.80 (95% CI 0.52-1.24, P = 0.41). In addition NMA of the 30-day mortality among the three approaches also did not observe statistical difference. Analysis of variance showed that mean post-operative complications of all approaches were comparable (P = 0.51). CONCLUSION: There are considerable differences in the peri-operative management of synchronous CLM patients. This meta-analysis demonstrated no clear statistical surgical outcome or survival advantage towards any of the three approaches. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc

Novel urinary biomarkers for the detection of bladder cancer: A systematic review

BACKGROUND: Urinary biomarkers for the diagnosis of bladder cancer represents an area of considerable research which has been tested in both patients presenting with haematuria and non-muscle invasive bladder cancer patients requiring surveillance cystoscopy. In this systematic review, we identify and appraise the diagnostic sensitive and specificity of reported novel biomarkers of different 'omic' class and highlight promising biomarkers investigated to date. METHODS: A MEDLINE/Pubmed systematic search was performed between January 2013 and July 2017 using the following keywords: (bladder cancer OR transitional cell carcinoma OR urothelial cell carcinoma) AND (detection OR diagnosis) AND urine AND (biomarker OR assay). All studies had a minimum of 20 patients in both bladder cancer and control arms and reported sensitivity and/or specificity and/or receiver operating characteristics (ROC) curve. QUADAS-2 tool was used to assess risk of bias and applicability of studies. The search protocol was registered in the PROSPERO database (CRD42016049918). RESULTS: Systematic search yielded 115 reports were included for analysis. In single target biomarkers had a sensitivity of 2-94%, specificity of 46-100%, positive predictive value (PPV) of 47-100% and negative predictive value (NPV) of 21-94%. Multi-target biomarkers achieved a sensitivity of 24-100%, specificity of 48-100%, PPV of 42-95% and NPV of 32-100%. 50 studies achieved a sensitivity and specificity of ≥80%. Protein (n = 59) and transcriptomic (n = 21) biomarkers represents the most studied biomarkers. Multi-target biomarker panels had a better diagnostic accuracy compared to single biomarker targets. Urinary cytology with urinary biomarkers improved the diagnostic ability of the biomarker. The sensitivity and specificity of biomarkers were higher for primary diagnosis compared to patients in the surveillance setting. Most studies were case control studies and did not have a predefined threshold to determine a positive test result indicating a possible risk of bias. CONCLUSION: This comprehensive systematic review provides an update on urinary biomarkers of different 'omic' class and highlights promising biomarkers. Few biomarkers achieve a high sensitivity and negative predictive value. Such biomarkers will require external validation in a prospective observational setting before adoption in clinical practice

Concepts and characteristics of the 'COST Reference Microplasma Jet'

Biomedical applications of non-equilibrium atmospheric pressure plasmas have attracted intense interest in the past few years. Many plasma sources of diverse design have been proposed for these applications, but the relationship between source characteristics and application performance is not well-understood, and indeed many sources are poorly characterized. This circumstance is an impediment to progress in application development. A reference source with well-understood and highly reproducible characteristics may be an important tool in this context. Researchers around the world should be able to compare the characteristics of their own sources and also their results with this device. In this paper, we describe such a reference source, developed from the simple and robust micro-scaled atmospheric pressure plasma jet (μ-APPJ) concept. This development occurred under the auspices of COST Action MP1101 'Biomedical Applications of Atmospheric Pressure Plasmas'. Gas contamination and power measurement are shown to be major causes of irreproducible results in earlier source designs. These problems are resolved in the reference source by refinement of the mechanical and electrical design and by specifying an operating protocol. These measures are shown to be absolutely necessary for reproducible operation. They include the integration of current and voltage probes into the jet. The usual combination of matching unit and power supply is replaced by an integrated LC power coupling circuit and a 5 W single frequency generator. The design specification and operating protocol for the reference source are being made freely available

Risk of Cerebrovascular Events in 178 962 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The TYACSS (Teenage and Young Adult Cancer Survivor Study)

Background: Survivors of teenage and young adult (TYA) cancer are at risk of cerebrovascular events, but the magnitude of and extent to which this risk varies by cancer type, decade of diagnosis, age at diagnosis and attained age remains uncertain. This is the largest ever cohort study to evaluate the risks of hospitalisation for a cerebrovascular event among long-term survivors of TYA cancer. Methods:The population-based Teenage and Young Adult Cancer Survivor Study (N=178,962) was linked to Hospital Episode Statistics data for England to investigate the risks of hospitalisation for a cerebrovascular event among 5-year survivors of cancer diagnosed when aged 15-39 years. Observed numbers of first hospitalisations for cerebrovascular events were compared to that expected from the general population using standardised hospitalisation ratios (SHR) and absolute excess risks (AER) per 10,000 person-years. Cumulative incidence was calculated with death considered a competing risk. Results: Overall, 2,782 cancer survivors were hospitalised for a cerebrovascular event—40% higher than expected (SHR=1.4, 95% confidence interval [CI]=1.3-1.4). Survivors of central nervous system (CNS) tumours (SHR=4.6, CI=4.3-5.0), head & neck tumours (SHR=2.6, CI=2.2-3.1) and leukaemia (SHR=2.5, CI=1.9-3.1) were at greatest risk. Males had a significantly higher AER than females (AER=7 versus 3), especially among head & neck tumour survivors (AER=30 versus 11). By age 60, 9%, 6% and 5% of CNS tumour, head & neck tumour, and leukaemia survivors, respectively, had been hospitalised for a cerebrovascular event. Beyond age 60, every year 0.4% of CNS tumour survivors were hospitalised for a cerebral infarction (versus 0.1% expected. Whereas at any age, every year 0.2% of head & neck tumour survivors were hospitalised for a cerebral infarction 7 (versus 0.06% expected). Conclusions: Survivors of a CNS tumour, head & neck tumour, and leukaemia are particularly at risk of hospitalisation for a cerebrovascular event. The excess risk of cerebral infarction among CNS tumour survivors increases with attained age. For head & neck tumour survivors this excess risk remains high across all ages. These groups of survivors, and in particular males, should be considered for surveillance of cerebrovascular risk factors and potential pharmacological interventions for cerebral infarction prevention

Optical--to--X-ray emission in low-absorption AGN: Results from the Swift-BAT 9 month catalogue

(Abridged) We present simultaneous optical--to--X-ray spectral energy distributions (SEDs) from Swift's X-ray and UV--optical telescopes (XRT and UVOT) for a well-selected sample of 26 low-redshift (z<0.1) AGN from the Swift/BAT 9-month catalogue, the largest well-studied, hard X-ray selected survey of local AGN to date. Our subsample consists of AGN with low intrinsic X-ray absorption (N_H<10^22 cm^-2) and minimal spectral complexity, to more accurately recover the intrinsic accretion luminosity in these sources. We perform a correction for host galaxy contamination in all available UVOT filter images to recover the intrinsic AGN emission, and estimate intrinsic dust extinction from the resultant nuclear SEDs. Black hole mass estimates are determined from the host-galaxy 2MASS K-band bulge luminosity. Accretion rates determined from our SEDs are on average low (Eddington ratios <~ 0.1) and hard X-ray bolometric corrections cluster at ~10-20, in contrast with the higher values seen for quasars. An average SED for the 22 low accretion rate (Eddington ratio < 0.1) objects is presented, with and without correction for intrinsic extinction. We do not find a correlation of optical--to--X-ray spectral index with Eddington ratio, regardless of the optical reference wavelength chosen for defining the spectral index. The low accretion rates and bolometric corrections found for this representative low-redshift sample are of particular importance for studies of AGN accretion history.Comment: 25 pages, 22 figures, 4 tables, accepted for publication in MNRA

CAIXA: a Catalogue of AGN In the XMM-Newton Archive II. Multiwavelength correlations

We presented CAIXA, a Catalogue of AGN in the XMM-Newton Archive, in a companion paper. Here, a systematic search for correlations between the X-ray spectral properties and the multiwavelength data was performed for the sources in CAIXA. All the significant (>99.9% confidence level) correlations are discussed along with their physical implications on current models of AGN. Two main correlations are discussed in this paper: a) a very strong anti-correlation between the FWHM of the H$\beta$ optical line and the ratio between the soft and the hard X-ray luminosity. Although similar anti-correlations between optical line width and X-ray spectral steepness have already been discussed in the literature (see e.g., Laor et al. 1994, Boller et al. 1996, Brandt et al. 1997), we consider the formulation we present in this paper is more fundamental, as it links model-independent quantities. Coupled with a strong anti-correlation between the V to hard X-ray flux ratio and the H$\beta$ FHWM, it supports scenarios for the origin of the soft excess in AGN, which require strong suppression of the hard X-ray emission; b) a strong (and expected) correlation between the X-ray luminosity and the black hole mass. Its slope, flatter than 1, is consistent with Eddington ratio-dependent bolometric corrections, such as that recently proposed by Vasudevan & Fabian (2009). Moreover, we critically review through various statistical tests the role that distance biases play in the strong radio to X-ray luminosity correlation found in CAIXA and elsewhere; we conclude that only complete, unbiased samples (such as that recently published by Behar & Laor, 2008) should be used to draw observational constraints on the origin of radio emission in radio-quiet AGN.Comment: 12 pages, 11 figures, accepted for publication in Astronomy and Astrophysics; two figures erroneously attached by astroph to the paper were remove

Controlled dehydration of a ruthenium complex-DNA crystal induces reversible DNA kinking

Hydration-dependent DNA deformation has been known since Rosalind Franklin recognised that the relative humidity of the sample had to be maintained to observe a single conformation in DNA fibre diffraction. We now report for the first time the crystal structure, at the atomic level, of a dehydrated form of a DNA duplex and demonstrate the reversible interconversion to the hydrated form at room temperature. This system, containing d(TCGGCGCCGA) in the presence of Λ-[Ru(TAP)2(dppz)]2+ (TAP = 1,4,5,8-tetraazaphenanthrene, dppz = dipyridophenazine), undergoes a partial transition from an A/B hybrid to the A-DNA conformation, at 84-79% relative humidity. This is accompanied by an increase in kink at the central step from 22° to 51°, with a large movement of the terminal bases forming the intercalation site. This transition is reversible on rehydration. Seven datasets, collected from one crystal at room temperature, show the consequences of dehydration at near-atomic resolution. This result highlights that crystals, traditionally thought of as static systems, are still dynamic and therefore can be the subject of further experimentation