Additional Unit Increase Research Articles

What is the optimal range of fasting stress hyperglycemia ratio for all-cause mortality in American adults: An observational study.

To date, no studies have been conducted to assess the impact of fasting stress hyperglycemia ratio (SHR) on all-cause mortality. Therefore, the objective of our study is to investigate the association between SHR and all-cause mortality in a population of American adults. The study population was derived from NHANES data spanning from 2005 to 2018. The exposure variable SHR was derived from fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c%), and the specific calculation formula was as follows: (FBG (mmol/L))/(1.59 × HbA1c (%) - 2.59). The outcome variable was all-cause mortality. A total of 18,457 participants were enrolled in this prospective cohort study. Following a median follow-up period of 90 months, all-cause mortality was observed in 10.32% of the subjects. Cox proportional hazards regression model indicates that there is no significant difference between SHR and all-cause mortality in the fully adjusted model, whether analyzed as a continuous or categorical variable (P for trend > 0.05). Through the 2-piecewise Cox proportional hazards regression model, we have determined that the inflection point of SHR in relation to all-cause mortality is 0.88. It has also been observed that when the value of SHR is on the left side of the inflection point (SHR ≤ 0.88), there is a significant 77% (HR: 0.23; 95% CI: 0.10-0.50) reduction in all-cause mortality for each additional unit increase in SHR. Conversely, when the value of SHR exceeds 0.88, there is a substantial 2.40-fold (HR: 2.40; 95% CI: 1.61-3.58) increase in the risk of all-cause mortality (P for log likelihood ratio test < .001). The subgroup analysis results demonstrate that sex has the potential to modify the association between SHR and all-cause mortality within the population exhibiting SHR ≤ 0.88. The relationship between SHR and all-cause mortality follows a U-shaped pattern, where in the lowest risk of death for the average American adult is observed at an SHR value of 0.88. Furthermore, in men with SHR ≤ 0.88, there is a significant inverse relationship between the increase in SHR and the risk of all-cause mortality.

Association of urinary and blood lead concentrations with all-cause mortality in US adults with chronic kidney disease: a prospective cohort study.

Epidemiological evidence on the relationship between lead exposure and mortality in specific chronic kidney disease (CKD) populations is limited. We aimed to examine the relationship between urinary lead and blood lead concentrations and all-cause mortality in US patients with CKD. This cohort study included 2320 participants with CKD from the National Health and Nutrition Examination Survey (2005-2018), with follow-up until December 31, 2019. All-cause mortality was ascertained by matching US National Death Index records. Hazard ratios (HRs) and 95% confidence intervals (CI) for urinary lead and blood lead concentrations in relation to all-cause mortality were estimated using a weighted Cox regression model. During a median follow-up period of 79months, a total of 625 participants with CKD succumbed to mortality. Compared to the lowest quartile, the highest quartile of urine and blood lead concentrations was associated with an increased risk of all-cause mortality, with HRs and corresponding 95% CIs of 1.77 (1.05-2.99) and 2.65 (1.38-5.10), respectively. Furthermore, each additional unit increase in urinary and blood lead concentrations was associated with HRs for all-cause mortality of 1.21 (95% CI 1.06-1.38) and 1.09 (95% CI 1.01-1.19), respectively. Kaplan-Meier survival curve analysis and restricted cubic regression spline curve analysis demonstrated significant positive associations between elevated blood lead levels, elevated urinary lead levels, and all-cause mortality risk (P < 0.05). A nonlinear concentration-response relationship was observed between blood lead level and all-cause mortality risk (PNonlinear < 0.05), with an inflection point at a concentration of 1.613µg/dL. Subgroup analysis as well as sensitivity analysis yielded consistent findings. Our findings demonstrate that elevated levels of lead in urine and blood are associated with a significantly increased mortality risk among patients with CKD, underscoring the importance of reducing lead exposure to mitigate mortality risk in individuals at high risk for CKD.

The impact of safety behavior, perceived risk, and workplace resources on COVID outcomes for U.S. Aircraft Rescue and Firefighting personnel.

Aircraft rescue and firefighting (ARFF) personnel are first responders located at airports in the United States who provide emergency response, mitigation, evacuation, and rescue of passengers and crew of aircraft at airports. The nature of their work puts ARFF personnel in close contact with travelers on a regular basis and at elevated risk for COVID-19 exposure. In this study, we focused on safety behavior, perceived risk, and workplace resources to understand COVID-19 outcomes in the early pandemic among the overlooked worker population of ARFF personnel. The goal of this study was to examine how a self-reported positive COVID test were associated with safety behavior, perceived risk, and workplace resources. Cross-sectional survey data were collected among ARFF personnel a year into the COVID-19 pandemic. Regression results showed that each additional unit increase in perceived susceptibility to COVID-19 was associated with a 133% increase in the odds of testing positive for COVID-19 (OR = 2.33, p < 0.05), and with each additional unit increase in perceived severity level, the odds of getting COVID-19 decreased by 47% (OR = 0.53, p < 0.05). Infection control among first responders may be improved by providing relevant information physical and emotional resources, and support that help shape perceptions of risk and adoption of prevention behaviors.

Influence of Antibiotic Exposure Intensity on the Risk of Clostridioides difficile Infection.

Antibiotics are a strong risk factor for Clostridioides difficile infection (CDI), and CDI incidence is often measured as an important outcome metric for antimicrobial stewardship interventions aiming to reduce antibiotic use. However, risk of CDI from antibiotics varies by agent and dependent on the intensity (i.e., spectrum and duration) of antibiotic therapy. Thus, the impact of stewardship interventions on CDI incidence is variable, and understanding this risk requires a more granular measure of intensity of therapy than traditionally used measures like days of therapy (DOT). We performed a retrospective cohort study to measure the independent association between intensity of antibiotic therapy, as measured by the antibiotic spectrum index (ASI), and hospital-associated CDI (HA-CDI) at a large academic medical center between January 2018 and March 2020. We constructed a marginal Poisson regression model to generate adjusted relative risks for a unit increase in ASI per antibiotic day. We included 35,457 inpatient encounters in our cohort. Sixty-eight percent of patients received at least one antibiotic. We identified 128 HA-CDI cases, which corresponds to an incidence rate of 4.1 cases per 10,000 patient-days. After adjusting for known confounders, each additional unit increase in ASI per antibiotic day is associated with 1.09 times the risk of HA-CDI (Relative Risk = 1.09, 95% Confidence Interval: 1.06 to 1.13). ASI was strongly associated with HA-CDI and could be a useful tool in evaluating the impact of antibiotic stewardship on HA-CDI rates, providing more granular information than the more commonly used days of therapy.

Towards the global zero poverty agenda: examining the multidimensional poverty situation in South Africa

The vulnerability of smallholder farmers to multidimensional poverty in the Eastern Cape province of South Africa was assessed, using the Alkire Foster multidimensional poverty index developed by the Oxford Poverty and Human Development Initiative and aligned to the Sustainable Development Goals (SDGs). The findings show that the deprivation indicator ranges from 5 to 90%, revealing that access to a flush toilet facility is an imperative factor towards the households’ standard of living (SDG11). Also, 66% and 55% were deprived of food security (SDG2) and education (SDG4), respectively. The probit analysis result revealed that gender, remittances, crop diversification (CDV), education, seasonal farming and market outlets significantly influence the multidimensional poverty and vulnerability poverty of rural households in the Eastern Cape province of South Africa. For instance, factors such as household size showed that an additional unit increase in the size of a household would result in a 5% increase in the chances of the household’s vulnerability to multidimensional poverty. Likewise the extension contact, a unit increase resulted in 49% in the households’ vulnerability to multidimensional poverty. The study suggests that policies related to improving education, increasing CDV, promoting farmer groups and the effectiveness of extension contact, and increasing market stability for sales of farm products could contribute to reducing the multidimensional poverty level and the vulnerability of households.

Can birth weight predict offspring’s lung function in adult age? Evidence from two Swedish birth cohorts

BackgroundAssociations between birth weight (BW) and adult lung function have been inconsistent and limited to early adulthood. We aimed to study this association in two population-based cohorts and explore if BW, adjusted for gestational age, predicts adult lung function. We also tested adult lung function impairment according to the mis-match hypothesis—small babies growing big as adults.MethodsWe included 3495 individuals (aged 46.4 ± 5.4 years) from the Malmo Preventive Project (MPP), Sweden, born between 1921 and 1949, and 1401 young to middle-aged individuals (aged 28.6 ± 6.7 years) from the Malmo Offspring Study (MOS) with complete data on BW and gestational age. Adult lung function (forced vital capacity [FVC], forced expiratory volume in one second [FEV1] and the FEV1/FVC-ratio) were analysed as level of impairment (z-score), using multiple linear and logistic regressions.ResultsBW (z-score) did not predict adult lung function in MPP, whereas BW was a significant (p = 0.003) predictor of FEV1 following full adjustment in MOS. For every additional unit increase in BW, children were 0.77 (95% CI 0.65–0.92) times less likely to have impaired adult lung function (FEV1). Moreover, adults born with lower BW (< 3510 g) showed improved lung function (FEV1 and FEV1/FVC in MOS and MPP, respectively) if they achieved higher adult body weight.ConclusionsAdults born with lower birth weight, adjusted for gestational age, are more likely to have impaired lung function, seen in a younger birth cohort. Postnatal growth pattern may, however, compensate for low birth weight and contribute to better adult lung function.

Pediatric dentists' participation in advocacy and acceptance of new medicaid children in clinical practice.

IntroductionAdvocacy involves promoting a noble cause or voicing on behalf of a program, policy, or population group. Previous literature shows that dentists who provide services to Medicaid-enrolled, underserved, and vulnerable children are more compassionate than those who do not.AimTo explore the association between pediatric dentists' (PDs) participation in various advocacy-related activities (ARAs) and their monthly acceptance of new Medicaid-enrolled children in their clinical practice to provide dental care services.MethodsA 14-item pilot-tested survey was created on the SurveyMonkey® online platform and emailed to 5591 PDs, active American Academy of Pediatric Dentistry members. Data from 789 PD respondents were analyzed. Frequencies, percentages, means, and standard deviations were used to describe the sample. Independent t-tests and chi-square tests assessed the differences between PDs accepting new Medicaid-enrolled children in their clinical practice every month vs. PDs who did not. A multivariable adjusted logistic regression model determined if there was an association between PDs' participation in ARAs and their acceptance of new Medicaid-enrolled children in their clinical practice, controlling for other independent variables.ResultsThe mean number of different ARAs performed by PDs was 2.2 ± 1.8. Approximately 65% reported that they accepted new Medicaid-enrolled children every month in their dental clinic to provide dental care services. The multivariable logistic regression model showed that the odds of a PD accepting new Medicaid-enrolled children every month increased by 13% for each additional unit increase in ARA completed, with other variables being held constant (Odds ratio: 1.13, 95% CI: 1.03–1.25, p = 0.01).ConclusionPDs who performed more ARAs had greater odds of accepting new Medicaid-enrolled children into their dental practice every month. Education and training in oral health advocacy during dental education for dental students may promote performing ARAs and providing dental care services to Medicaid patients after graduation.

A-32 Association Between Adolescent Patient Emotional Factors and Adherence to a Sport-Related Concussion Treatment

Abstract Purpose: To determine the association between Anxiety Sensitivity Index (ASI) and Positive and Negative Affect Schedule (PANAS) and adherence to an exercise treatment for sport-related concussion (SRC). We hypothesized Positive Affect (PA) score would be positively associated, while ASI and Negative Affect (NA) score would be negatively associated with odds of treatment adherence. Methods: This was a prospective (2020–2021) analysis of adolescents (aged 14–17) diagnosed with SRC by a pediatric specialty concussion clinic and subsequently prescribed daily exercise. Adherence to the exercise protocol was defined as consistently increasing physical activity volume (measured by accelerometer) during recovery. Multivariable logistic regressions evaluated the independent associations between treatment adherence and ASI; PA score; NA score. Results: The mean (standard deviation [SD]) recovery time was 16.1 (9.0) days. Among the 32 (56.1%) adherent and 25 (43.9%) not adherent participants, the majority were aged 15 years (29.8%), male (50.9%), non-Hispanic White (70.2%), and had no concussion history (61.4%). After adjusting for age and sex, the odds of treatment adherence for each additional unit increase in ASI, PA score, and NA score was 1.03 (95% CI: 0.96–1.10), 1.14 (95% CI: 0.97–1.35), and 1.18 (95% CI: 0.95–1.47), respectively. Conclusions: Despite lack of statistical significance, it appears that PA score and NA score may contribute to exercise treatment adherence for SRC. As this study may be underpowered, future studies should aim to have a larger sample and investigate the discriminate utility of PANAS to identify those who may or may not adhere to SRC exercise treatments.

Associations between Dentition Status and Nutritional Status in Community-Dwelling Older Adults.

Older adults are at higher risk of malnutrition. The aim of this study was to explore associations between nutritional status and dentition status among older adults seeking care in a dental clinic. This was a cross-sectional study of data from older adults (65-89 y) who received care at a northeastern US urban dental school clinic between June 2015 and June 2020 (N = 305). Clinical and demographic data were obtained from the electronic health record; nutritional status was determined using the Self-Mini Nutritional Assessment (Self-MNA), and odontograms and digital radiography were used to determine dental data. Adjusted multivariable models were used to explore associations between variables. The sample was 53.8% female with a median age of 72.0 y. The median Self-MNA score was 13, reflective of normal nutritional status; 29.5% were at risk of or had malnutrition. Median numbers of teeth and posterior and anterior occluding pairs of teeth (POP, AOP) were 18.0, 2.0, and 5.0, respectively. Those with normal nutritional status had significantly more teeth, POPs, and AOPs than those at risk of or with malnutrition (P = 0.015, P = 0.015, and P = 0.039, respectively). Every additional unit increase in the number of natural or restored teeth or POP was associated with significantly lower odds of being at risk of or with malnutrition (3% and 13%, respectively). Having functional dentition was associated with 46% lower odds of being at risk of or with malnutrition. This study demonstrated that older adults who had more teeth, better occlusion, and functional dentition were more likely to be of normal nutritional status than those who had less teeth, had poorer occlusion, and lacked functional dentition. Further research with larger, more diverse samples and varied measures of dentition are needed to better understand the associations between nutritional status and dentition status. The findings from this study suggest that older adults with fewer teeth and therefore less efficient occlusion are at higher risk for malnutrition than those with more teeth and better occlusion. Health care professionals should include screening for dentition and malnutrition as part of their routine practice to identify patients who may have tooth loss and be at risk of malnutrition and refer them accordingly for interventions to optimize oral health and nutritional status.

Beyond the Blaze: The Impact of Forest Fires on Energy Poverty

There exists limited empirical evidence on the linkage between natural disasters and energy consumption in a developing country setting. This article exploits a plausibly exogenous distribution of fire radiative power over space and time to evaluate the impact of forest fires on energy poverty in Nepal. Results show that an additional unit increase in fire radiative power from last year’s forest fires is associated with a 0.43% decline in energy expenditure and a 0.36% decrease in energy poverty among Nepalese households. Energy poverty induced by forest fires is pronounced among individuals from rural areas and villages with smaller degrees of ethnic fractionalization. Findings indicate that forest fire incidents may differentially alter energy-related responses among individuals belonging to different caste groups. Estimates suggest that individuals likely shifted to alternative energy sources for adequate food consumption in response to forest fire events. These results support the hypothesis that natural disasters may exceed a country’s capacity to recover from economic damages and cause a significant overall decrease in energy consumption.

Measuring Reticulocyte Hemoglobin Content As a Marker for Iron Deficiency and Response to Therapy Represents a Paradigm Shift in Care

It is estimated anemia affects over 30% of the world's population, with iron deficiency (ID) the overwhelmingly most common cause. Whether absolute due to blood loss and/or iron sequestration to underlying morbidity, the need for repletion especially in females, is a formidable medical issue. The diagnosis of iron deficient erythropoiesis has been traditionally based on the biochemical parameters ferritin and percent transferrin saturation (TSAT), mean cell volume and hemoglobin (Hb) concentration. In recent years, reticulocyte Hb content has emerged as a parameter helpful in identifying iron deficient erythropoiesis and informing a need, or lack thereof, for replacement. 556 consecutive, non-selected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. CBC, serum ferritin, iron and TSAT were performed as clinically indicated. RET-He was measured with a Sysmex XN-450 analyzer on the residual CBC sample. 556 patients were studied at baseline and 150 were subsequently treated with intravenous (IV) iron. 240/556 were seen at follow-up, with 57 treated and 183 not treated with IV iron. At baseline, ret-He, positively correlated with Hb (Spearman correlation (rho)=0.365, P &amp;lt; 0.001), MCV (rho=0.576, P &amp;lt; 0.001), MCH (rho=0.777, P &amp;lt; 0.001), serum iron (rho=0.526, P &amp;lt; 0.001) and TSAT (rho=0.492, P &amp;lt; 0.001). Serum iron, and TSAT (but not serum ferritin or MCV, or absolute reticulocyte count) positively correlated with Hb concentrations. Based on either a serum ferritin &amp;lt;30 ng/ml and/or a TSAT&amp;lt; 20%, 241/556 (43.4%) patients were diagnosed as iron deficient. Anemia was present in 64/241 of the iron deficient patients (26.6%). Despite the limitations of the biochemical markers outlined above, we performed ROC analysis assessing the value of RET-He in identifying iron deficiency as defined by serum ferritin &amp;lt;30 ng/mL or transferrin saturation &amp;lt;20%. ROC analysis demonstrates a reasonable performance for RET-He (AUC= 0.733, 95% CI: 0.692, 0.775), with a cut-off value of &amp;lt;30.7 pg yielding 68.2% sensitivity and 69.7% specificity. Using both Hb and RET-He in a multivariable ROC analysis does not provide an improved AUC, as compared to just using RET-He (AUC=0.605 vs.0.733). IV iron administration was associated with significant increases in Hb, MCV, MCH, RET-He, serum ferritin, iron and TSAT, whereas in the no-IV iron cohort, there was a small reduction in RET-He and small increases in MCV and MCH, with no significant variations in Hb and in the other parameters. Serum ferritin was below 30 ng/mL in 18/57 (32%) of the patients requiring IV iron and in 19/183 (10.4%) of those not requiring iron at visit 1. These values changed to 4/57 (7%) (P=0.002) and 23/183 (13%) (P=0.623) at visit 2, respectively. Regression analysis for Hb response following IV iron showed that baseline RET-He values are predictive of Hb response, with every unitary increase in RET-He corresponding to a blunting of the Hb change by -0.19 g/dl (95% CI: -0.27, -0.11; P &amp;lt; 0.001). Changes in RE-He associated with IV iron administration are also predictive of the Hb response, with every additional unit increase in RET-He corresponding to a 0.21 g/dL increase in Hb (95% CI: 0.13, 0.28; P &amp;lt; 0.009). ROC analysis for the capability to predict Hb response among the 57 patients receiving IV iron shows that a value of baseline RET-He &amp;lt; 28.5 pg together with a baseline Hb value &amp;lt; 10.3 g/dL provide the highest Youden's index for predicting Hb response &amp;gt; 1.0 g/dl, with sensitivity of 84% and specificity of 78%. The Figure presents data for the 21/57 patients who had RET-He &amp;lt; 28.5 pg and Hb &amp;lt; 10.3 g/dL vs the 36/57 who did not. The present data show that an abnormally low ret-He value (&amp;lt; 28.5 pg) identifies patients who will respond to iron replacement, obviating delays to obtain standard iron parameters. Baseline and changes in ret-He also associate with Hb response. Given the enormous prevalence of ID in the general population the use of the ret-He, which is available with the CBC on the autoanalyzer, informs need for iron replacement, or lack thereof, represents an increase in convenience for patient and physician, decreases costs, streamlines care and represents an improvement in the treatment paradigm of one of the commonest maladies on the planet. Figure 1 Disclosures Auerbach: AMAG: Research Funding; Sysmex: Research Funding. Brugnara:American Journal of Hematology: Other; Sysmex America Inc.: Consultancy.

Bus ridership and service reliability: The case of public transportation in Western Massachusetts

The linkage between crowding and service quality in transit systems is an issue of major concern among city planners, transportation managers and passengers. This article analyzes over 1.3 million readings on daily bus service running every 15 minutes across eleven routes in Western Massachusetts to investigate the relationship between ridership and the reliability of a bus service. Results indicate that an additional unit increase in the number of passengers results in a 0.9% reduction in the reliability of bus services. Estimates suggest that high volumes of bus ridership cause a significant increase in the variance of bus service reliability. Results also show that the bus service is more reliable during the weekends and in the summer session when relatively fewer students need public transportation. These findings have policy implications for quantifying the economic cost of unreliable bus services associated with large volumes of passengers.

Healthcare Capacity, Health Expenditure, and Civil Society as Predictors of COVID-19 Case Fatalities: A Global Analysis.

Background: The rapid growth in cases of COVID-19 has challenged national healthcare capacity, testing systems at an advanced ICU, and public health infrastructure level. This global study evaluates the association between multi-factorial healthcare capacity and case fatality of COVID-19 patients by adjusting for demographic, health expenditure, population density, and prior burden of non-communicable disease. It also explores the impact of government relationships with civil society as a predictor of infection and mortality rates.Methods: Data were extracted from the Johns Hopkins University database, World Bank records and the National Civic Space Ratings 2020 database. This study used data from 86 countries which had at least 1,000 confirmed cases on 30th April 2020. Negative binomial regression model was used to assess the association between case fatality (a ratio of total number of confirmed deaths to total number of confirmed cases) and healthcare capacity index adjusting for other covariates.Findings: Regression analysis shows that greater healthcare capacity was related to lesser case-fatality [incidence rate ratio (IRR) 0.5811; 95% confidence interval (CI) 0.4727–0.7184; p < 0.001] with every additional unit increase in the healthcare capacity index associated with a 42% decrease in the case fatality. Health expenditure and civil society variables did not reach statistical significance but were positively associated with case fatalities.Interpretation: Based on preliminary data, this research suggests that building effective multidimensional healthcare capacity is the most promising means to mitigate future case fatalities. The data also suggests that government's ability to implement public health measures to a degree determines mortality outcomes.

Relationship Between Plasma Copper Concentration and Body Fat Distribution in Children in China: a Cross-Sectional Study.

This study aimed to explore the association of the plasma copper concentration with body fat distribution and the potential mediating effect of inflammation status in children. A total of 454 children were recruited in this study. Dual-energy X-ray absorptiometry was applied to measure the fat mass (FM) and fat mass percentages (FM%) at whole body, trunk, appendicular, android, and gynoid regions. Android to gynoid fat mass ratio and fat mass to lean mass (FM/LM) ratio at whole body, trunk, and appendicular sites were calculated. Plasma copper concentration was measured via inductively coupled plasma mass spectrometry. C-reactive protein (CRP) was determined by ELISA. After adjusting for covariates, multiple linear regression analyses showed that, for every additional unit increase in the plasma copper concentration, the FM, FM%, and FM/LM at whole body and subregions increased by 0.030-0.472kg (P < 0.001-0.019), 0.013-1.04% (P = 0.007-0.042), and 0.021-0.030 (P < 0.001), respectively. Mediating analysis suggested that CRP significantly mediated 22.0-30.6% (P < 0.001) of the estimated association of copper with FM% and FM/LM at whole body and limbs. Thus, children with higher plasma levels of copper tended to have a higher regional and overall body fat deposition, and this relationship was partly mediated by inflammatory status.

Effects of Suicidal Ideation on Unmet Mental Health Needs Among Young Adults in Canada

Although there has been an increase in public health campaigns and initiatives aimed at preventing suicidal behaviors, suicide rates in Canada appear to be increasing particularly among young adults. Yet, few studies in Canada have examined the effect of suicidal ideation on unmet mental health needs among young adults. The objective of this study is to examine the association between suicidal ideation and unmet mental health needs, over and above predisposing, enabling, and need factors. This study uses data on 3393 young adults aged 20–29 years from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Binary logistic regression analysis was conducted with unmet mental health needs as the outcome variable and suicidal ideation as the main explanatory variable. Of the 3393 respondents, 8.8% had unmet mental health needs and 16.5% had suicidal ideation. In the multivariate logistic regression model, respondents who experienced suicidal ideation had 2.55 times higher odds of having unmet mental health needs. Respondents were also more likely to have unmet mental health needs if they are female, experienced childhood adversity, or were diagnosed with mental health disorders or cannabis abuse or dependence. Each additional unit increase in social support decreased the odds of unmet mental health needs by 11%. Community peer support programs for young adults may be beneficial in enhancing access to mental health particularly for at-risk individuals.

Shear Wave Elastography to Assess Perineal Body Stiffness During Labor.

The objective of this study was to evaluate perineal body stiffness intrapartum using shear wave elastography ultrasound and to study its association with maternal and labor characteristics. This was a prospective observational study. Pregnant women with term pregnancy who had been admitted for labor management were recruited into the study. Transperineal shear wave elastography of perineal body was performed. Maternal and labor data were retrieved from electronic medical charts. Thirty-two patients' data were available for analysis. Mean (SD) melastography modulus was 15.33 (5.49). While comparing the mean elastography modulus across maternal and labor characteristics, the difference was statistically different between parity, cervical dilation, and perineal laceration presence groups (P < 0.05). The mean of elastography modulus of primiparous women with cervical dilation less than 3 cm was 21.47 kPa, whereas that of multiparous women was 13.17 kPa (P = 0.0511). Perineal laceration was more prevalent in women with stiffer perineal body. The risk of having perineal laceration compared with no perineal laceration was 29.1% higher for each additional unit increase in perineal body elastography modulus (odds ratio, 0.709; 95% confidence interval, 0.507-0.992). Shear wave elastography can be used to quantify perineal body stiffness. Primiparous women in early stages of labor have stiffer perineal body than multiparous women in any stage of labor and primiparous women in late stage of labor.

Effect of Social Support and Disclosure of Child Abuse on Adult Suicidal Ideation: Findings From a Population-Based Study.

To examine the proportion of Canadian adults with a history of child abuse who disclosed the abuse to child protection services before age 16 years and identify the effect of social support and disclosure of child abuse on lifetime suicidal ideation. Data for this study came from the Statistics Canada 2012 Canadian Community Health Survey-Mental Health (N = 9,076). Binary logistic regression was conducted to identify the effect of social support and disclosure of child abuse on suicidal ideation while simultaneously adjusting for the effect of type of child abuse and demographic, socioeconomic, health, and mental health factors. Of the 9,076 respondents who experienced at least one child abuse event, 21.5% reported ever experiencing suicidal ideation. Fewer than 6% of the respondents disclosed the abuse to someone from a child protection service before age 16 years. In the multivariate logistic regression model, respondents who disclosed the abuse to someone from child protection services were 1.37 times more likely to report lifetime suicidal ideation (95% CI, 1.10-1.71) than those who did not. Each additional unit increase in social support decreased the odds of lifetime suicidal ideation by a factor of 3% (95% CI, 0.95-0.98). Social support interventions that are effective in improving individuals' perception that support is available to them may help reduce suicidal ideation among those with a history of child abuse.

Cross-Sectional and Longitudinal Associations Between Parental Support and Children's Physical Activity in the Early Years.

The purpose of this study was to examine cross-sectional and longitudinal associations between parental support and children's physical activity outside of child care, and whether children's age or sex moderated the associations. Results are based on 93 children aged 19 to 60 months at baseline from 8 child care centers across Alberta, Canada. Parental support (ie, transportation, coactivity, watching, encouragement, and informing) and children's physical activity outside of child care were measured with a parental questionnaire at baseline (October/November 2013) and follow-up (May/June 2014). Every additional unit increase in parental support was significantly associated with 48.5 minutes/week [95% Confidence Interval (CI): 29.3-67.6] and 52.2 (95% CI: 32.0-72.3) minutes/week higher parental reported children's physical activity outside of child care at baseline and follow-up, respectively. A 1-unit increase in parental support from baseline to follow-up was significantly associated with a 24.8 (95% CI: 2.8-46.8) minutes/week increase in parental reported children's physical activity outside of child care. Children's age was a moderator at baseline only. Parental support was positively associated with children's physical activity across all analyses. Parental support may be an important correlate to target in future interventions aiming to promote physical activity in the early years.

Surrogate safety measure for evaluating rear-end collision risk related to kinematic waves near freeway recurrent bottlenecks

This study presents a surrogate safety measure for evaluating the rear-end collision risk related to kinematic waves near freeway recurrent bottlenecks using aggregated traffic data from ordinary loop detectors. The attributes of kinematic waves that accompany rear-end collisions and the traffic conditions at detector stations spanning the collision locations were examined to develop the rear-end collision risk index (RCRI). Together with RCRI, standard deviations in occupancy were used to develop a logistic regression model for estimating rear-end collision likelihood near freeway recurrent bottlenecks in real-time. The parameters in the logistic regression models were calibrated using collision data gathered from the 6-mile study site between 2006 and 2007. Findings indicated that an additional unit increase in RCRI results in increasing the odds of rear-end collision by 21.1%, a unit increase in standard deviation of upstream occupancy increases the odds by 19.5%, and a unit increase in standard deviation of downstream occupancy increases the odds by 18.7%. The likelihood of rear-end collisions is highest when the traffic approaching from upstream is near capacity state while downstream traffic is highly congested. The paper also reports on the findings from comparing the predicted number of rear-end collisions at the study site using the proposed model with the observed traffic collision data from 2008. The proposed model's true positive rates were higher than those of existing real-time crash prediction models.

GROWTH, YIELD, AND ION RELATIONS OF STRAWBERRY IN RESPONSE TO IRRIGATION WITH CHLORIDE-DOMINATED WATERS

Strawberry is listed as the most salt sensitive fruit crop in comprehensive salt tolerance data bases. Recently, concerns have arisen regarding declining quality of irrigation waters available to coastal strawberry growers in southern and central California. Over time, the waters have become more saline, with increasing sodium (Na+) and chloride (Cl−). Due to the apparent extreme Cl− sensitivity of strawberry, the rising Cl− levels in the irrigation waters are of particular importance. In order to establish the specific ion causing yield reduction in strawberry, cultivars ‘Ventana’ and ‘Camarosa’ were grown in twenty-four outdoor sand tanks at the ARS-USDA U. S. Salinity Laboratory in Riverside, CA and irrigated with waters containing a complete nutrient solution plus Cl− salts of calcium (Ca2+), magnesium (Mg2+), Na+, and potassium (K+). Six salinity treatments were imposed with electric conductivities (EC) = 0.835, 1.05, 1.28, 1.48, 1.71, and 2.24 dS m−1, and were replicated four times. Fresh and dry weights of ‘Camarosa’ shoots and roots were significantly higher than those of ‘Ventana’ at all salinity levels. Marketable yield of ‘Camarosa’ fruit decreased from 770 to 360 g/plant as salinity increased and was lower at all salinity levels than the yield from the less vigorous ‘Ventana’ plants. ‘Ventana’ berry yield decreased from 925 to 705 g/plant as salinity increased from 0.835 to 2.24 dS m−1. Relative yield of ‘Camarosa’ decreased 43% for each unit increase in salinity once irrigation water salinity exceeded 0.80 dS m−1. Relative ‘Ventana’ yield was unaffected by irrigation water salinity up to 1.71 dS m−1, and thereafter, for each additional unit increase in salinity, yield was reduced 61%. Both cultivars appeared to possess an exclusion mechanism whereby Na+ was sequestered in the roots, and Na+ transport to blade, petiole and fruit tissues was limited. Chloride content of the plant organs increased as salinity increased to 2.24 dS m−1 and substrate Cl increased from 0.1 to13 mmolcL−1. Chloride was highest in the roots, followed by the leaves, petioles and fruit. Based on plant ion relations and relative fruit yield, we determined that, over the range of salinity levels studied, specific ion toxicity exists with respect to Cl−, rather than to Na+ ions, and, further, that the salt tolerance threshold is lower for ‘Camarosa’ than for ‘Ventana’.