Migration Patterns of Young Adults Reared in Jackson County, Tennessee

Most Tennessee counties have experienced a net outmigration of persons in recent decades. For example, net outmigration for Tennessee was over one-fourth of a million persons from 1950 to 1960 or half of the level of natural population increase during this period. During the 1950-60 decade, 86 of the 95 counties had a net outmigration of persons. In 59 counties outmigration was sufficient to result in an aggregate population decline. Counties experiencing greatest population declines are largely rural containing few urban centers. The questions of who leaves and who stays in low income rural areas and the effects of leaving or staying have often been the subject of debate. Resolution of these questions is of great importance for those directing policy in various sectors of our society. Nevertheless, relevant data pertaining to such questions are few. While net migration figures can be estimated from the Census and Vital Statistics, these sources provide few precise data for estimating the parameters of the migrating and nonmigrating sectors. To provide more precise information on migration relationships, an exploratory study was conducted in Jackson County, Tennessee. Jackson County, located in the Cumberland Plateau Area, is a low-income rural county and has experienced high outmigration for the past several decades. In the 1950-60 decade, net outmigration was 35 percent of the 1950 population and the third highest of any Tennessee county. The population of Jackson County declined from 12,348 in 1950 to 9,233 in 1960, a 25 percent decrease and the highest rate of decline of any Tennessee county in the 1950-60 decade. In 1960, 63 percent of the population was classified as rural farm while 44 percent of the civilian labor force was employed in agriculture. Only 10 percent of the civilian labor force in Tennessee and 6 percent of the United States labor were employed in agriculture. Seventeen percent of the Jackson County labor force was employed in manufacturing compared to 26 percent for Tennessee and 27 percent for the United States. Median family income in 1960 was the third lowest of any Tennessee county, and only 30 percent of the United States and 43 percent of the Tennessee averages. Jackson County was selected for study because it represented a low-income and high-outmigration area with limited local employment opportunity. Much of the land in Jackson County is not adapted to mechanized farming, therefore, agriculture, the major employer of the labor force, has not been particularly profitable. The roughness of most of the uplands restricts their use for crop production. Overall, less than one-fourth of the agricultural area is suitable for regular cultivation. Burley tobacco represents the principal cash crop on many farms although agriculture is based more on livestock than on crop production. A basic problem in the Upper Cumberland Plateau Area of Tennessee is the overabundance of human resources relative to local employment opportunities. Low-production farming areas such as represented by Jackson County often lack the necessary natural resources and adequately trained manpower to compete successfully in attracting nonfarm employment opportunities. Thus, large numbers of people have left such areas to seek better opportunities elsewhere. Evidence also indicates that many low-income rural communities receive a low return on their investment in educating children due to high outmigration. Each migrant represents a large public expenditure of local funds. Where there is a sizeable net loss of young adults, resources devoted to education and training of the young people are in the immediate sense lost to the community. Urban areas receiving these young people, oh the other hand, benefit from this nonreciprocal migration of new members of the labor force. Heaviest migration occurs among individuals in the younger age groups. This selective migration changes the composition of the community from which they migrated. There is a depletion of productive manpower and an increasing proportion of people in the dependent age groups. Rural communities experiencing high outmigration are less able to support their businesses, schools, churches, and other social organizations. The consequences of a population decline on rural communities are both positive and negative. Population losses may reduce the pressure on the available resources. On the other hand, it may also weaken the business community. The phenomenon of migration has been variously regarded as a means for achieving a more productive and balanced national economy and as a way of raising the level of living. It also has been regarded as a drain on the talent and economic resources of agricultural areas, and as producing a weakened national character. With these problems in mind, the primary in mind, the primary objective of the present study are: (1) to determine the extent and pattern of migration of young adults reared in Jackson County, and (2) to relate these migration patterns to educate, occupation, residence, special job training, and level of living

The potential role of livestock in a nuclear-powered agro-industrial complex in the United Arab Republic

The general objective of this study was to evaluate the potential role of livestock in an agricultural-industrial complex in the Middle East, and specifically for a potential site west of Alexandria in the United Arab Republic. Several analytical models were developed to determine the optimum organization of crop and livestock activities in terms of six alternative goals. These were: (1) maximizing financial returns, (2) maximizing the present value of foreign exchange net credit, (3) maximizing calorie production, (4) maximizing effective protein production, (5) maximizing domestic employment, and (6) minimizing investment capital required for the agricultural complex. Important sources of published data used in synthesizing live stock production coefficients were the various publications of the state agricultural experiment stations and extension services in the United States, publications of the United States Department of Agriculture and releases prepared by the Food and Agriculture Organization of the United Nations. Data relating to basic resources and investments in the agroindustrial complex were developed by other members of the Middle East Study Group. Data pertaining to crops were synthesized by members of the agricultural sector of the study team. The annual Income which was provided by various systems selected in each optimization model varied considerably. Relatively high levels of income were provided in the income, foreign exchange, and employment models, while income levels were much lower in the nutrition and investment models. The net return value, excluding water cost, in the income model was $27.8 million, as compared to only$5.6 million in the calorie model. Employment which would be provided was also considerably higher in the income, foreign exchange, and employment models than in the nutrition and investment models. The man-hours of employment to be provided totaled 11.4 million man-hours in the employment model but only 2.8 million man-hours in the calorie model. The quantity of calories and protein provided varied to a lesser extent among the models than did other alternative goal characteristics. The maximum quantity of calories, amounting to 1236 billion, was provided in the calorie model. The quantity of calories provided by the income model, on the other hand, was 556 billion. The maximum quantity of protein was provided by the protein model (50 million pounds). This compares with 34 million pounds of protein which were produced in the income model. Livestock production was included in four of the six optimum systems developed by the various models. Although the greatest contribution of livestock was in terms of income and foreign exchange, contributions to the nutrition and employment goals were quite significant in some models. In order to evaluate the sensitivity of net returns to the water desalination cost, the cost of water was deducted from the estimated income for each of the various optimization models at cost levels rang ing from $.10 to$.45 per thousand gallons. Break-even prices for water were also calculated. Of the 13 sale crops analyzed, only five could break even with water production cost at $.20 per thousand gallons. Only two crops showed a break-even water price of as much as$.35 per thousand gallons, which is considered to be the most likely for about 1980. The break-even water prices for the crop and livestock production systems selected in the six optimization models varied from $.09 per thousand gallons in the maximum calorie model to$.47 per thousand gallons in the maximum income model, The calorie model included no livestock in the production system, while the income model included livestock activities at the upper allowable levels

Caudate lobe resections: a single-center experience and evaluation of factors predictive of outcomes

BACKGROUND: Despite the increasing frequency of liver resection for multiple types of disease, caudate lobe resection remains a rare surgical event. The goal of this study is to review our experience and evaluate possible predictors of adverse outcomes in patients undergoing caudate lobectomy. METHODS: We reviewed a 1,900-patient prospective hepato-pancreatico-biliary database from January 2000 to December 2011, identifying 36 hepatectomy patients undergoing caudate lobe resection. Clinicopathologic characteristic and outcome data were compared using chi-square, T-test, ANOVA, Kaplan-Meier, and Cox regression analysis. Primary endpoints were the incidence and severity of complications, and secondary endpoints were blood loss, hospital stay, and transfusion requirements. Patients were also divided in two groups with group A being patients operated on before December 2007 and group B after 2007. We compared the demographics, risk factors, complication rates, and operative details between the two groups. RESULTS: Thirty-six patients underwent caudate lobe resection for cholangiocarcinoma (47.2%), metastatic colorectal cancer (36.1%), hepatocellular carcinoma (8.3%), or benign disease (8.3%). Nine patients (29%) had additional liver resection. Median overall survival (OS) was 21 months. Complications occurred in 52.7% (19/36) of patients with a median grade of 2. Tobacco abuse was associated with an increased risk of operative complications (73.3% vs. 38.9%, p = 0.03). Prior history of cardiac disease was associated with a higher complication rate (87% vs. 42%, p = 0.03). Neoadjuvant chemotherapy, biliary procedures, hepatitis, and prior major abdominal surgery were not predictive of complications. Major complication was also predicted by the volume of RBC transfusion (2.7 vs. 4.1 units, p = 0.003). In our subgroup analysis of the patients undergoing surgery before and after 2007, the two groups were well matched based on age, comorbidities, and risk factors. The complication rates and rates of high-grade complications were similar, but blood loss (600 ml vs. 400 ml, p = 0.03), inflow occlusion time (Pringle time 12.6 vs. 6, p = 0.00), and hospital stay (9.5 vs. 7 days, p = 0.01) were significantly lower in group B. CONCLUSIONS: With appropriate patient selection, caudate lobe resection is an effective component of surgery for hepatic disease. Tobacco use and prior cardiac history increase the risk of complications

Da aplicação à implicação na antropologia médica: leituras políticas, históricas e narrativas do mundo do adoecimento e da saúde

Revisa parte da literatura da antropologia médica contemporânea, guiando-se pela orientação/implicação política na escolha de seus objetos de estudo, na análise e na construção de soluções para os problemas investigados. A partir de narrativas de antropólogos, evidenciam-se as bases históricas e sociopolíticas que caracterizaram o campo em seus países de origem ou de migração. No panorama traçado das três principais vertentes contemporâneas – as antropologias médica crítica, do sofrimento e do biopoder –, são caracterizadas escolhas teóricas e temáticas para atender à demanda de “politização” do debate antropológico na saúde, defendendo-se uma antropologia médica “implicada”

Writing in Britain and Ireland, c. 400 to c. 800

No abstract available

The value of episodic, intensive blood glucose monitoring in non-insulin treated persons with type 2 diabetes: Design of the Structured Testing Program (STeP) Study, a cluster-randomised, clinical trial [NCT00674986]

<p>Abstract</p> <p>Background</p> <p>The value and utility of self-monitoring of blood glucose (SMBG) in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues.</p> <p>Methods/design</p> <p>The Structured Testing Program (STeP) study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c ≥ 7.5%), non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG) that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG). A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL) over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010.</p> <p>Discussion</p> <p>The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of SMBG by both patients and physicians. Utilization of per protocol and intent-to-treat analyses facilitates a comprehensive assessment of the intervention. Use of practice site cluster-randomisation reduces the potential for intervention contamination, and inclusion criteria (HbA1c ≥ 7.5%) reduces the possibility of floor effects. Inclusion of multiple dependent variables allows us to assess the broader impact of the intervention, including changes in patient and physician attitudes and behaviours.</p> <p>Trial Registration</p> <p>Current Controlled Trials NCT00674986.</p

Competitive Interactions between Invasive Nile Tilapia and Native Fish: The Potential for Altered Trophic Exchange and Modification of Food Webs

Recent studies have highlighted both the positive and negative impacts of species invasions. Most of these studies have been conducted on either immobile invasive plants or sessile fauna found at the base of food webs. Fewer studies have examined the impacts of vagile invasive consumers on native competitors. This is an issue of some importance given the controlling influence that consumers have on lower order plants and animals. Here, we present results of laboratory experiments designed to assess the impacts of unintended aquaculture releases of the Nile tilapia (Oreochromis niloticus), in estuaries of the Gulf of Mexico, on the functionally similar redspotted sunfish (Lepomis miniatus). Laboratory choice tests showed that tilapia prefer the same structured habitat that native sunfish prefer. In subsequent interspecific competition experiments, agonistic tilapia displaced sunfish from their preferred structured habitats. When a piscivore (largemouth bass) was present in the tank with both species, the survival of sunfish decreased. Based on these findings, if left unchecked, we predict that the proliferation of tilapia (and perhaps other aggressive aquaculture fishes) will have important detrimental effects on the structure of native food webs in shallow, structured coastal habitats. While it is likely that the impacts of higher trophic level invasive competitors will vary among species, these results show that consequences of unintended releases of invasive higher order consumers can be important

A Regulatory Network for Coordinated Flower Maturation

For self-pollinating plants to reproduce, male and female organ development must be coordinated as flowers mature. The Arabidopsis transcription factors AUXIN RESPONSE FACTOR 6 (ARF6) and ARF8 regulate this complex process by promoting petal expansion, stamen filament elongation, anther dehiscence, and gynoecium maturation, thereby ensuring that pollen released from the anthers is deposited on the stigma of a receptive gynoecium. ARF6 and ARF8 induce jasmonate production, which in turn triggers expression of MYB21 and MYB24, encoding R2R3 MYB transcription factors that promote petal and stamen growth. To understand the dynamics of this flower maturation regulatory network, we have characterized morphological, chemical, and global gene expression phenotypes of arf, myb, and jasmonate pathway mutant flowers. We found that MYB21 and MYB24 promoted not only petal and stamen development but also gynoecium growth. As well as regulating reproductive competence, both the ARF and MYB factors promoted nectary development or function and volatile sesquiterpene production, which may attract insect pollinators and/or repel pathogens. Mutants lacking jasmonate synthesis or response had decreased MYB21 expression and stamen and petal growth at the stage when flowers normally open, but had increased MYB21 expression in petals of older flowers, resulting in renewed and persistent petal expansion at later stages. Both auxin response and jasmonate synthesis promoted positive feedbacks that may ensure rapid petal and stamen growth as flowers open. MYB21 also fed back negatively on expression of jasmonate biosynthesis pathway genes to decrease flower jasmonate level, which correlated with termination of growth after flowers have opened. These dynamic feedbacks may promote timely, coordinated, and transient growth of flower organs

Localization of type 1 diabetes susceptibility to the MHC class I genes HLA-B and HLA-A

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1-3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region. Owing to the region's extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods - recursive partitioning and regression - to pinpoint disease susceptibility to the MHC class I genes HLA-B and HLA-A (risk ratios >1.5; Pcombined = 2.01 × 10-19 and 2.35 × 10-13, respectively) in addition to the established associations of the MHC class II genes. Other loci with smaller and/or rarer effects might also be involved, but to find these, future searches must take into account both the HLA class II and class I genes and use even larger samples. Taken together with previous studies, we conclude that MHC-class-I-mediated events, principally involving HLA-B*39, contribute to the aetiology of type 1 diabetes. ©2007 Nature Publishing Group