Dune Evolution Westmoreland County, Virginia Potomac River Shoreline

Shoreline evolution is the change in shore position through time. In fact, it is the material resistance of the coastal geologic underpinnings against the impinging hydrodynamic (and aerodynamic) forces. Along the shores of Chesapeake Bay, it is a process-response system. The processes at work include winds, waves, tides and currents, which shape and modify coastlines by eroding, transporting and depositing sediments. The shore line is commonly plotted and measured to provide a rate of change but it is as important to understand the geomorphic patterns of change. Shore analysis provides the basis to know how a particular coast has changed through time and how it might proceed in the future. The purpose of this report is to document how the dunes on Potomac River shores of Westmoreland (Figure 1) have evolved since 1937. Aerial imagery was taken for most of the Bay region beginning that year, and it is this imagery that allows one to assess the geomorphic nature of shore change. Aerial imagery shows how the coast has changed, how beaches, dunes, bars, and spits have grown or decayed, how barriers have breached, how inlets have changed course, and how one shore type has displaced another or has not changed at all. Shore change is a natural process but, quite often, the impacts of man through shore hardening or inlet stabilization come to dominate a given shore reach. Most of the change in shore positions where dunes occur will be quantified in this report. Others, particularly very irregular coasts, around inlets, and other complicated areas will be subject to interpretation

Development and evaluation of a wearable peripheral vascular compensation sensor in a swine model of hemorrhage

Postpartum hemorrhage (PPH) is the leading and most preventable cause of maternal mortality, particularly in low-resource settings. PPH is currently diagnosed through visual estimation of blood loss or monitoring of vital signs. Visual assessment routinely underestimates blood loss beyond the point of pharmaceutical intervention. Quantitative monitoring of hemorrhage-induced compensatory processes, such as the constriction of peripheral vessels, may provide an early alert for PPH. To this end, we developed a low-cost, wearable optical device that continuously monitors peripheral perfusion via laser speckle flow index (LSFI) to detect hemorrhage-induced peripheral vasoconstriction. The measured LSFI signal produced a linear response in phantom models and a strong correlation coefficient with blood loss averaged across subjects (\u3e0.9) in a large animal model, with superior performance to vital sign metrics

Shoreline Evolution Lancaster County, Virginia Chesapeake Bay and Rappahannock River Shorelines 2006

Shoreline evolution is the change in shore position through time. In fact, it is the material resistance of the coastal geologic underpinnings against the impinging hydrodynamic (and aerodynamic) forces. Along the shores of Chesapeake Bay and Rappahannock River, it is a process-response system. The processes at work include winds, waves, tides and currents, which shape and modify coastlines by eroding, transporting and depositing sediments. The shore line is commonly plotted and measured to provide a rate of change but it is as important to understand the geomorphic patterns of change. Shore analysis provides the basis to know how a particular coast has changed through time and how it might proceed in the future. The purpose of this report is to document how the dunes along the Bay and river shores of Lancaster (Figure 1) have evolved since 1937. Aerial imagery was taken for most of the Bay region beginning that year, and it is this imagery that allows one to assess the geomorphic nature of shore change. Aerial imagery shows how the coast has changed, how beaches, dunes, bars, and spits have grown or decayed, how barriers have breached, how inlets have changed course, and how one shore type has displaced another or has not changed at all. Shore change is a natural process but, quite often, the impacts of man through shore hardening or inlet stabilization come to dominate a given shore reach. Most of the change in shore positions will be quantified in this report. Others, particularly very irregular coasts, around inlets, and other complicated areas will be subject to interpretation

Dune Evolution Middlesex County, Virginia Rappahannock River and Piankatank River Shorelines

Shoreline evolution is the change in shore position through time. In fact, it is the material resistance of the coastal geologic underpinnings against the impinging hydrodynamic (and aerodynamic) forces. Along the shores of Chesapeake Bay, it is a process-response system. The processes at work include winds, waves, tides and currents, which shape and modify coastlines by eroding, transporting and depositing sediments. The shore line is commonly plotted and measured to provide a rate of change but it is as important to understand the geomorphic patterns of change. Shore analysis provides the basis to know how a particular coast has changed through time and how it might proceed in the future. The purpose of this report is to document how the dunes on Piankatank River and Rappahannock River shores of Middlesex (Figure 1) have evolved since 1937. Aerial imagery was taken for most of the Bay region beginning that year, and it is this imagery that allows one to assess the geomorphic nature of shore change. Aerial imagery shows how the coast has changed, how beaches, dunes, bars, and spits have grown or decayed, how barriers have breached, how inlets have changed course, and how one shore type has displaced another or has not changed at all. Shore change is a natural process but, quite often, the impacts of man through shore hardening or inlet stabilization come to dominate a given shore reach. Most of the change in shore positions where dunes occur will be quantified in this report. Others, particularly very irregular coasts, around inlets, and other complicated areas will be subject to interpretation

Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus-Associated Pneumonia Among Children Aged \u3c5 Years in the PERCH Study.

Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization–defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for “confirmed” bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to “RSV pneumonia” (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)–negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial

Importance: Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV. Objective: To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone. Design, Setting, and Participants: Cluster-based, single-blind, randomized clinical trial at 15 sites in 8 US states (May 2011-May 2015) enrolling 492 socially disadvantaged pregnant women (≥16 years) participating in a 2.5-year nurse home visitation program. Interventions: In augmented program sites (n = 229 participants across 7 sites), nurses received intensive IPV education and delivered an IPV intervention that included a clinical pathway to guide assessment and tailor care focused on safety planning, violence awareness, self-efficacy, and referral to social supports. The standard program (n = 263 participants across 8 sites) included limited questions about violence exposure and information for abused women but no standardized IPV training for nurses. Main Outcomes and Measures: The primary outcome was quality of life (WHOQOL-BREF; range, 0-400; higher score indicates better quality of life) obtained through interviews at baseline and every 6 months until 24 months after delivery. From 17 prespecified secondary outcomes, 7 secondary end points are reported, including scores on the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2. Results: Among 492 participants enrolled (mean age, 20.4 years), 421 (86%) completed the trial. Quality of life improved from baseline to 24 months in both groups (change in WHOQOL-BREF scores from 299.5 [SD, 54.4] to 308.2 [SD, 52.6] in the augmented program group vs from 293.6 [SD, 56.4] to 316.4 [SD, 57.5] in the standard program group). Based on multilevel growth curve analysis, there was no statistically significant difference between groups (modeled score difference, -4.9 [95% CI, -16.5 to 6.7]). There were no statistically significant differences between study groups in any of the secondary participant end points. There were no adverse events recorded in either group. Conclusions and Relevance: Among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention. Trial Registration: ClinicalTrials.gov Identifier: NCT01372098

In Vivo Raman Spectroscopy for Biochemical Monitoring of the Human Cervix Throughout Pregnancy

Background The cervix must undergo significant biochemical remodeling to allow for successful parturition. This process is not fully understood, especially in instances of spontaneous preterm birth. In vivo Raman spectroscopy is an optical technique that can be used to investigate the biochemical composition of tissue longitudinally and noninvasively in human beings, and has been utilized to measure physiology and disease states in a variety of medical applications. Objective The purpose of this study is to measure in vivo Raman spectra of the cervix throughout pregnancy in women, and to identify biochemical markers that change with the preparation for delivery and postpartum repair. Study Design In all, 68 healthy pregnant women were recruited. Raman spectra were measured from the cervix of each patient monthly in the first and second trimesters, weekly in the third trimester, and at the 6-week postpartum visit. Raman spectra were measured using an in vivo Raman system with an optical fiber probe to excite the tissue with 785 nm light. A spectral model was developed to highlight spectral regions that undergo the most changes throughout pregnancy, which were subsequently used for identifying Raman peaks for further analysis. These peaks were analyzed longitudinally to determine if they underwent significant changes over the course of pregnancy (P \u3c .05). Finally, 6 individual components that comprise key biochemical constituents of the human cervix were measured to extract their contributions in spectral changes throughout pregnancy using a linear combination method. Patient factors including body mass index and parity were included as variables in these analyses. Results Raman peaks indicative of extracellular matrix proteins (1248 and 1254 cm−1) significantly decreased (P \u3c .05), while peaks corresponding to blood (1233 and 1563 cm–1) significantly increased (P \u3c .0005) in a linear manner throughout pregnancy. In the postpartum cervix, significant increases in peaks corresponding to actin (1003, 1339, and 1657 cm–1) and cholesterol (1447 cm–1) were observed when compared to late gestation, while signatures from blood significantly decreased. Postpartum actin signals were significantly higher than early pregnancy, whereas extracellular matrix proteins and water signals were significantly lower than early weeks of gestation. Parity had a significant effect on blood and extracellular matrix protein signals, with nulliparous patients having significant increases in blood signals throughout pregnancy, and higher extracellular matrix protein signals in early pregnancy compared to patients with prior pregnancies. Body mass index significantly affected actin signal contribution, with low body mass index patients showing decreasing actin contribution throughout pregnancy and high body mass index patients demonstrating increasing actin signals. Conclusion Raman spectroscopy was successfully used to biochemically monitor cervical remodeling in pregnant women during prenatal visits. This foundational study has demonstrated sensitivity to known biochemical dynamics that occur during cervical remodeling, and identified patient variables that have significant effects on Raman spectra throughout pregnancy. Raman spectroscopy has the potential to improve our understanding of cervical maturation, and be used as a noninvasive preterm birth risk assessment tool to reduce the incidence, morbidity, and mortality caused by preterm birth

Using Genome and Transcriptome Data From African-Ancestry Female Participants To Identify Putative Breast Cancer Susceptibility Genes

African-ancestry (AA) participants are underrepresented in genetics research. Here, we conducted a transcriptome-wide association study (TWAS) in AA female participants to identify putative breast cancer susceptibility genes. We built genetic models to predict levels of gene expression, exon junction, and 3\u27 UTR alternative polyadenylation using genomic and transcriptomic data generated in normal breast tissues from 150 AA participants and then used these models to perform association analyses using genomic data from 18,034 cases and 22,104 controls. At Bonferroni-corrected P \u3c 0.05, we identified six genes associated with breast cancer risk, including four genes not previously reported (CTD-3080P12.3, EN1, LINC01956 and NUP210L). Most of these genes showed a stronger association with risk of estrogen-receptor (ER) negative or triple-negative than ER-positive breast cancer. We also replicated the associations with 29 genes reported in previous TWAS at P \u3c 0.05 (one-sided), providing further support for an association of these genes with breast cancer risk. Our study sheds new light on the genetic basis of breast cancer and highlights the value of conducting research in AA populations