Legislation and Education as Strategies to Reduce Behavioral Health Risk Factors in the State of Nebraska

In the interest of improving health care planning and practice, this paper exami~es legislation and educational strategies designed to reduce behavioral health risk factors in the state of Nebraska and the United States. The growing problem of modifying health behavior in the nation and Nebraska is reviewed, including trends in seat belt use, drinking and driving, smoking, hypertension, obesity, and sedentary lifestyle. Nebraska\u27s rate of death associated with these risk factors is higher than the national average. Several of the strategies which Nebraska and the United States have implemented are reviewed. Legislation to reduce the prevalence of seat belt nonuse, drinking and driving, and smoking, is one prevention strategy which has been developed and implemented in both Nebraska and the United States, although levels of enforcement and type of penalties vary. Despite legislative action, many people still find ways to violate the laws without punishment; therefore, education plays a critical role in prevention. If programs are targeted to the right demographic groups with the right methodology, legislation may become less important in controlling or modifying human behavior. The most recent national goals and objectives (Healthy People, 1991) developed by the federal government indicated that, although the rate of increase in the number of deaths which can be attributed to poor health behavior is rising more slowly than in previous years, there is still an increase, which ideally should be reversed by the year 2000. Over the last few decades, both legislative and educational strategies have produced some moderate changes in the overall health of our nation, but with more resources devoted to planning and implementing legislative and educational strategies, Nebraska and the nation overall demonstrate potential for successfully addressing the problems and achieving the goal of preventing deaths due to poor health behavior. Since the financial impact on our health care system and the economy is a very critical issue at the present time, improvements in health care planning and practice, as well as further research and evaluation are warranted. Adviser: Professor Gordon Schol

The FLUXNET2015 dataset and the ONEFlux processing pipeline for eddy covariance data

The FLUXNET2015 dataset provides ecosystem-scale data on CO2, water, and energy exchange between the biosphere and the atmosphere, and other meteorological and biological measurements, from 212 sites around the globe (over 1500 site-years, up to and including year 2014). These sites, independently managed and operated, voluntarily contributed their data to create global datasets. Data were quality controlled and processed using uniform methods, to improve consistency and intercomparability across sites. The dataset is already being used in a number of applications, including ecophysiology studies, remote sensing studies, and development of ecosystem and Earth system models. FLUXNET2015 includes derived-data products, such as gap-filled time series, ecosystem respiration and photosynthetic uptake estimates, estimation of uncertainties, and metadata about the measurements, presented for the first time in this paper. In addition, 206 of these sites are for the first time distributed under a Creative Commons (CC-BY 4.0) license. This paper details this enhanced dataset and the processing methods, now made available as open-source codes, making the dataset more accessible, transparent, and reproducible.Peer reviewe

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs

Legislation and Education as Strategies to Reduce Behavioral Health Risk Factors in the State of Nebraska

In the interest of improving health care planning and practice, this paper exami~es legislation and educational strategies designed to reduce behavioral health risk factors in the state of Nebraska and the United States. The growing problem of modifying health behavior in the nation and Nebraska is reviewed, including trends in seat belt use, drinking and driving, smoking, hypertension, obesity, and sedentary lifestyle. Nebraska\u27s rate of death associated with these risk factors is higher than the national average. Several of the strategies which Nebraska and the United States have implemented are reviewed. Legislation to reduce the prevalence of seat belt nonuse, drinking and driving, and smoking, is one prevention strategy which has been developed and implemented in both Nebraska and the United States, although levels of enforcement and type of penalties vary. Despite legislative action, many people still find ways to violate the laws without punishment; therefore, education plays a critical role in prevention. If programs are targeted to the right demographic groups with the right methodology, legislation may become less important in controlling or modifying human behavior. The most recent national goals and objectives (Healthy People, 1991) developed by the federal government indicated that, although the rate of increase in the number of deaths which can be attributed to poor health behavior is rising more slowly than in previous years, there is still an increase, which ideally should be reversed by the year 2000. Over the last few decades, both legislative and educational strategies have produced some moderate changes in the overall health of our nation, but with more resources devoted to planning and implementing legislative and educational strategies, Nebraska and the nation overall demonstrate potential for successfully addressing the problems and achieving the goal of preventing deaths due to poor health behavior. Since the financial impact on our health care system and the economy is a very critical issue at the present time, improvements in health care planning and practice, as well as further research and evaluation are warranted. Adviser: Professor Gordon Schol

Neurodevelopmental Outcomes in the Early CPAP and Pulse Oximetry Trial

BACKGROUND: Previous results from our trial of early treatment with continuous positive airway pressure (CPAP) versus early surfactant treatment in infants showed no significant difference in the outcome of death or bronchopulmonary dysplasia. A lower (vs. higher) target range of oxygen saturation was associated with a lower rate of severe retinopathy but higher mortality. We now report longer-term results from our prespecified hypotheses. METHODS: Using a 2-by-2 factorial design, we randomly assigned infants born between 24 weeks 0 days and 27 weeks 6 days of gestation to early CPAP with a limited ventilation strategy or early surfactant administration and to lower or higher target ranges of oxygen saturation (85 to 89% or 91 to 95%). The primary composite outcome for the longer-term analysis was death before assessment at 18 to 22 months or neurodevelopmental impairment at 18 to 22 months of corrected age. RESULTS: The primary outcome was determined for 1234 of 1316 enrolled infants (93.8%); 990 of the 1058 surviving infants (93.6%) were evaluated at 18 to 22 months of corrected age. Death or neurodevelopmental impairment occurred in 27.9% of the infants in the CPAP group (173 of 621 infants), versus 29.9% of those in the surfactant group (183 of 613) (relative risk, 0.93; 95% confidence interval [CI], 0.78 to 1.10; P = 0.38), and in 30.2% of the infants in the lower-oxygen-saturation group (185 of 612), versus 27.5% of those in the higher-oxygen-saturation group (171 of 622) (relative risk, 1.12; 95% CI, 0.94 to 1.32; P = 0.21). Mortality was increased with the lower-oxygen-saturation target (22.1%, vs. 18.2% with the higher-oxygen-saturation target; relative risk, 1.25; 95% CI, 1.00 to 1.55; P = 0.046). CONCLUSIONS: We found no significant differences in the composite outcome of death or neurodevelopmental impairment among extremely premature infants randomly assigned to early CPAP or early surfactant administration and to a lower or higher target range of oxygen saturation. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute; SUPPORT ClinicalTrials.gov number, NCT00233324.

Initial Laparotomy Versus Peritoneal Drainage in Extremely Low Birthweight Infants With Surgical Necrotizing Enterocolitis or Isolated Intestinal Perforation: A Multicenter Randomized Clinical Trial.

ObjectiveThe aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP).Summary background dataThe impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown.MethodsWe conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected age, analyzed using prespecified frequentist and Bayesian approaches.ResultsOf 992 eligible infants, 310 were randomized and 96% had primary outcome assessed. Death or NDI occurred in 69% of infants in the laparotomy group versus 70% with drainage [adjusted relative risk (aRR) 1.0; 95% confidence interval (CI): 0.87-1.14]. A preplanned analysis identified an interaction between preoperative diagnosis and treatment group (P = 0.03). With a preoperative diagnosis of NEC, death or NDI occurred in 69% after laparotomy versus 85% with drainage (aRR 0.81; 95% CI: 0.64-1.04). The Bayesian posterior probability that laparotomy was beneficial (risk difference <0) for a preoperative diagnosis of NEC was 97%. For preoperative diagnosis of IP, death or NDI occurred in 69% after laparotomy versus 63% with drainage (aRR, 1.11; 95% CI: 0.95-1.31); Bayesian probability of benefit with laparotomy = 18%.ConclusionsThere was no overall difference in death or NDI rates at 18 to 22 months corrected age between initial laparotomy versus drainage. However, the preoperative diagnosis of NEC or IP modified the impact of initial treatment