Greater Atlanta Research Articles

Associations between neighbourhood-level median household income and outpatients' risk of antibiotic non-susceptible uropathogens in a major urban centre, USA.

Resistance to first-line antibiotics among urinary tract infections continues to rise, but how neighbourhood-level socioeconomic status impacts this risk remains unclear. We examined the effect of neighbourhood-level income on a patient's risk of having a uropathogen non-susceptible to trimethoprim/sulfamethoxazole (TMP/SMX) or nitrofurantoin. We used electronic health record data and antibiotic susceptibility test results for urinary Escherichia coli and Klebsiella pneumoniae collected at Emory Healthcare outpatient facilities in greater Atlanta between October 2022 and September 2023. We determined patients' block group median household income (MHI) using their residential addresses and 2017-21 US census data. We performed a logistic regression with a priori risk factors using a generalized estimating equation, with subgroup analysis by organism and for patients with diabetes mellitus. We included 9325 urine E. coli and K. pneumoniae isolates from 3867 outpatients. Compared to uropathogenic E. coli, K. pneumoniae were more likely to be non-susceptible to nitrofurantoin (P < 0.001) and less likely to be non-susceptible to TMP/SMX (P < 0.001). Compared to the lowest MHI quintile, patients in the highest MHI quintile neighbourhoods had 0.78 odds of harbouring a non-susceptible uropathogen (95% CI: 0.64, 0.95) after controlling for patient age, sex and race/ethnicity, along with neighbourhood-level characteristics. This association was stronger for K. pneumoniae infections and non-significant among people with diabetes. Higher neighbourhood-level MHI was associated with lower individual risk of harbouring a first-line antibiotic-non-susceptible uropathogen.

Who Takes the School Bus? The Roles of Location, Race, and Parents in Choosing Travel-to-School Mode in Georgia

In the United States, roughly one-third of students in public and private K-12 schools ride a school bus to school; in Georgia, that share is even higher (46%). But policy differences between and within states complicate explanations of school trip mode choice. To address this and create a consistent choice set, this article uses the 2017 National Household Travel Survey Georgia Add-On to construct a statewide analysis of school trip mode choice among school-bus-eligible students, as Georgia state law requires students receive a bus service if they live 1.5 mi or more from school, creating a consistent choice set. I use a binary logistic regression model and marginal effects to determine factors predicting school bus use on morning trips to school in Georgia among a suite of trip, individual, household, and environmental characteristics. I find that Black students, older students, and students in greater Atlanta are more likely to use a school bus, while students who live further from school, girls, students who have at least one parent with a college degree, and students who have at least one parent with a flexible work schedule are less likely to do so. Additionally, for those who are age-eligible, possessing a driver’s license strongly predicts not using a school bus. Notably, neither family income nor family structure are significant predictors of school bus use. Ultimately, these findings have implications for state school bus policy in Georgia and help elucidate who uses this important service so that resources can be directed appropriately.

Factors Associated with Disclosure of Sexual Orientation Among Black Sexual Minority Men.

Purpose: This study evaluated the characteristics associated with sexual orientation disclosure among HIV-negative Black sexual minority men (BSMM) in the greater Atlanta, Georgia area. Survey data were collected from 475 HIV-negative BSMM from 2017 to 2019 as part of a larger behavioral intervention study focused on stigma, prejudice, and HIV-testing uptake. Methods: Participants reported their levels of sexual orientation disclosure globally, to their community, and to their family. Data were analyzed using one-way analysis of variance and multinomial logistic regression to determine whether demographic, minority stress, substance use, and mental health were associated with sexual orientation disclosure globally, to community members, and to family members. Results: Findings revealed that participants with older age, bisexual identity, and higher levels of internalized homophobia had higher odds of global, community, and family sexual orientation nondisclosure. Furthermore, participants with higher levels of resilience had lower odds of partial sexual orientation disclosure compared with their fully disclosed counterparts. Conclusions: These findings reveal variations associated with sexual orientation disclosure across varying contexts among HIV-negative BSMM, particularly among family member disclosure.

Institutional Experience With Venoarterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism: A Retrospective Case Series

Despite advances in treatment, massive pulmonary embolism (PE) remains associated with significant morbidity and mortality. The role of venoarterial extracorporeal membrane oxygenation (VA ECMO) in the setting of massive PE is evolving and includes potential roles both in initial management and as a rescue strategy. Single-center case series that reported demographics and outcomes for patients with massive PE who underwent VA ECMO. This investigation was performed at a quaternary referral center with several hospitals throughout the greater Atlanta, GA, area. The study comprised adult patients (age ≥18 y) admitted to the authors' hospital system. Patients were identified using an internal registry of ECMO patients that contains basic demographic information (age, weight, treatment dates and times, ECMO configuration) and primary diagnosis. No interventions were performed. Seventeen patients who met the inclusion criteria were identified, with 16 patients cannulated peripherally and one patient cannulated centrally for VA ECMO. Survival to hospital discharge was 80% for patients who underwent VA ECMO as an initial approach versus 42% for those in whom it was used as a rescue modality. The results suggested that patients placed on VA ECMO earlier during their course of massive PE may have improved mortality. Additional investigation is needed to clarify the optimal sequence and timing of therapies surrounding the initiation of VA ECMO in patients with massive PE.

Education for Sustainable Development

In 2003, in response to the United Nations (UN) Decade of Education for Sustainable Development, the United Nations University (UNU) Institute for the Advanced Study of Sustainability launched a global multi-stakeholder network of Regional Centers of Expertise (RCEs) on education for sustainable development (ESD). RCEs facilitate multi-sector collaboration and utilize formal, non-formal, and informal education to address sustainable development challenges in local and regional communities. In essence, RCEs are a tool for transformation to a more sustainable society, combining education and action for sustainable development. As we enter the new "ESD for 2030" decade, RCEs will continue to construct platforms for cross-sectoral dialogue between regional stakeholders and actors to promote and strengthen ESD at the local level. RCEs have committed to helping advance the five priority areas of action established in the Global Action Program on ESD and the new UN decade "ESD for 2030": advancing policy by mainstreaming ESD, transforming learning and training environments using whole-institution approaches, building capacities of educators and trainers, empowering and mobilizing youth, and accelerating sustainable solutions at the local level. RCEs are uniquely positioned to serve as shepherds in the realization of the new "ESD for 2030" decade. As of January 2019, 174 RCEs have officially been acknowledged by UNU worldwide, with eight RCEs in the United States: Georgetown, South Carolina; Grand Rapids, Michigan; Greater Atlanta, Georgia; Greater Burlington, Vermont; Greater Portland, Oregon; North Texas, Texas; Salisbury, Maryland; and Shenandoah Valley, Virginia. RCEs serve an essential role in the achievement of "ESD for 2030" goals by translating global objectives into the local contexts of our communities.

Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the MECA Study.

BackgroundCardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience.Methods and ResultsThe MECA (Morehouse‐Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to “resilience” in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine “at‐risk” and “resilient” neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and microRNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement.ConclusionsThe MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms.REGISTRATION URL: https://www.clini​caltr​ials.gov. Unique identifier: NCT03308812.

Creating Greater Atlanta: Tom Wolfe's A Man in Full, Twenty Years On

Creating Greater Atlanta: Tom Wolfe's A Man in Full, Twenty Years On

Estimating Household Travel Energy Consumption in Conjunction with a Travel Demand Forecasting Model

This paper presents a methodology for the calculation of the consumption of household travel energy at the level of the traffic analysis zone (TAZ) in conjunction with information that is readily available from a standard four-step travel demand model system. This methodology embeds two algorithms. The first provides a means of allocating non-home-based trips to residential zones that are the source of such trips, whereas the second provides a mechanism for incorporating the effects of household vehicle fleet composition on fuel consumption. The methodology is applied to the greater Atlanta, Georgia, metropolitan region in the United States and is found to offer a robust mechanism for calculating the footprint of household travel energy at the level of the individual TAZ; this mechanism makes possible the study of variations in the energy footprint across space. The travel energy footprint is strongly correlated with the density of the built environment, although socioeconomic differences across TAZs also likely contribute to differences in travel energy footprints. The TAZ-level calculator of the footprint of household travel energy can be used to analyze alternative futures and relate differences in the energy footprint to differences in a number of contributing factors and thus enables the design of urban form, formulation of policy interventions, and implementation of awareness campaigns that may produce more-sustainable patterns of energy consumption.

Do partial home smoking bans signal progress toward a smoke-free home?

Understanding who establishes partial home smoking bans, what these bans cover, and whether they are an intermediate step in going smoke-free would help to inform smoke-free home interventions. Participants were recruited from United Way of Greater Atlanta's 2-1-1 contact center. Data were collected at baseline, 3 and 6 months via telephone interview. Participants (n = 375) were mostly African American (84.2%) and female (84.3%). The majority (58.5%) had annual household incomes <$10,000. At baseline, 61.3% reported a partial smoking ban and 38.7% reported no ban. Existence of a partial ban as compared with no ban was associated with being female, having more than a high school education, being married and younger age. Partial bans most often meant smoking was allowed only in designated rooms (52.6%). Other common rules included: no smoking in the presence of children (18.4%) and smoking allowed only in combination with actions such as opening a window or running a fan (9.8%). A higher percentage of households with partial bans at baseline were smoke-free at 6 months (36.5%) compared with households with no bans at baseline (22.1%). Households with partial smoking bans may have a higher level of readiness to go smoke-free than households with no restrictions.

Relationship of Attention Deficit Hyperactivity Disorder and Postconcussion Recovery in Youth Athletes.

To investigate whether attention deficit hyperactivity disorder (ADHD) influences postconcussion recovery, as measured by computerized neurocognitive testing. This is a retrospective case control study. Computer laboratories across 10 high schools in the greater Atlanta, Georgia area. Immediate postconcussion assessment and cognitive testing (ImPACT) scores of 70 athletes with a self-reported diagnosis of ADHD and who sustained a sport-related concussion were compared with a randomly selected age-matched control group. Immediate postconcussion assessment and cognitive testing scores over a 5-year interval were reviewed for inclusion. Postconcussion recovery was defined as a return to equivalent baseline neurocognitive score on the ImPACT battery, and a concussion symptom score of ≤7. Athletes with ADHD had on average a longer time to recovery when compared with the control group (16.5 days compared with 13.5 days), although not statistically significant. The number of previous concussions did not have any effect on the rate of recovery in the ADHD or the control group. In addition, baseline neurocognitive testing did not statistically differ between the 2 groups, except in verbal memory. Although not statistically significant, youth athletes with ADHD took on average 3 days longer to return to baseline neurocognitive testing compared with a control group without ADHD. Youth athletes with ADHD may have a marginally prolonged recovery as indexed by neurocognitive testing and should be considered when prognosticating time to recovery in this subset of student athletes.

At the Heart of Integration: Aligning Physicians and Administrators to Create New Value

Because of its ability to create real incremental value for patients and providers, physician-hospital integration will continue to play a major role in transforming the way healthcare is delivered. Integration is more than a transaction, and without developing the right culture, new integrated organizations will struggle to transform their current model of care. Confronted with regulatory and specialty-specific environmental forces, cardiovascular physicians have integrated with health systems at a higher rate than other specialties have. In 2007, Piedmont Healthcare launched Piedmont Heart as the first integrated cardiovascular care delivery program affiliated with a community healthcare system in greater Atlanta. Piedmont Healthcare had successfully brought together hospitals and cardiovascular physicians in an organizational structure that allowed for the right culture, resulting in true integration and patient-centered care. Today, Piedmont Heart is one of the largest physician groups in the United States focused on delivering high-quality outcomes, aligning multidisciplinary cardiovascular initiatives, and allowing for smart, strategic growth. It has taken Piedmont Heart nearly five years to create new, incremental value from its center-of-excellence organizational structure, clinical pathways development, and Patient First program. Piedmont Heart had the advantage of starting earlier than many other physician-hospital integrated structures. As US healthcare moves from an industry driven by volume to one focused on value, it is organizations like Piedmont Heart that continue to drive smart integration forward and focus on innovation, despite potential disruption, that will be successful.

Relationship conflict in supervisor‐subordinate dyads:a subordinate perspective

PurposeThis paper aims to offer insights regarding antecedents and consequences of relationship conflict in supervisor‐subordinate dyads, regardless of the demographic characteristics of the dyads. The authors explain the causes and outcomes of relationship conflict utilizing an affective approach, and suggest that factors such as moods, values, and situational context play an important role in influencing relationship conflict and its outcomes – intention to quit and trust in supervisor.Design/methodology/approachThe authors surveyed 200 employees of multiple companies in the greater Atlanta, Georgia area. They utilized hierarchical regression, (with the inclusion of two‐ and three‐way interaction terms) to test their hypotheses and interaction effects.FindingsNegative mood and positive mood interacted to impact the level of relationship conflict experienced by subordinates. Subordinates' collectivism values strengthened the impact of the positive mood‐negative mood interaction on relationship conflict. Mentoring and supervisor‐subordinate dyad tenure moderated the relationship conflict to outcomes associations.Originality/valueThe study goes beyond traditional relational demography research in order to offer new insights and perspectives on the causes and outcomes of relationship conflict at different hierarchical levels from an affective approach, specifically, moods theory. Since relationship conflict is an inevitable process, an understanding of antecedents and consequences of the conflict can allow managers to be better equipped to create a healthy work environment.

Crohnʼs disease is 3 fold higher compared with ulcerative colitis among African-Americans; combined pediatric and adult data from the greater Atlanta area

Crohnʼs disease is 3 fold higher compared with ulcerative colitis among African-Americans; combined pediatric and adult data from the greater Atlanta area

The Atlanta Riot: Race, Class, and Violence in a New South City

Gregory Mixon traces the roots of the Atlanta Riot of 1906, exploring the intricate political, social, and urban conditions that led to one of the defining events of race relations in southern and African-American history. On September 22, 1906, several thousand white Atlantans rioted, ostensibly because they believed that black men had committed repeated assaults on the white women of Fulton County, according to newspapers at the time. Four days after the massacre began, 32 people had died and 70 were wounded. Mixon acknowledges the traditional interpretation of factors that precipitated the riot - postbellum race relations and the codification of Jim Crow, an inflammatory press, and the race-baiting tactics of the gubernatorial candidates Hoke Smith and Clark Howell. But he argues that a complex coalition of Atlanta's white commercial and civic leaders also contributed to political divisions within Georgia's Democratic Party and to the riot as well. As Atlanta's elite crafted new forms of segregation and modes of disempowering blacks (and also working-class whites), Mixon says, their machinations led directly to the tragedy. At the turn of the 20th century, urbanization and industrialization were changing Atlanta's racial boundaries, and black Atlantans aspired to be city builders both in their neighborhoods and in greater Atlanta. They competed with whites for jobs and public space. The growing autonomy and political influence of blacks threatened white supremacy, Mixon says, and the violence of 1906 was an attempt by Atlanta's elites to reaffirm their dominance. Mixon also documents the activism of the city's black elite, especially professors and administrators at Atlanta University, including W.E.B. Du Bois, and ministers. While they defended all blacks against notions of racial inferiority and worked to improve the lives of the poor and uneducated of both races, they nonetheless criticized members of the black working class for irregular work habits and destructive use of their leisure hours. Looking at both white and black issues in the growth of Atlanta, this book establishes a context for racial violence in the city, the state, and the region. It also raises broader questions of conflicting agendas among whites and blacks that defined labor, politics, and urban space in the New South.

Comparison of Two Bioassessment Protocols in Five Georgia Streams

ABSTRACT We compared two stream water quality biomonitoring methods used by the environmental agencies of the state of Georgia. One uses fish communities; the other uses benthic macroinvertebrate populations. Five wadeable streams of varying water quality, size, and impacts in the greater Atlanta area were selected as study sites at which both bioassessment protocols were carried out, along with a physical habitat assessment. To compare the protocols, we examined correlations between specified indices of stream health based on each protocol as well as correlations among their individual components. Although general classification of the five streams by the indices from the protocols was consistent, the indices for stream assessment themselves were not correlated. Furthermore, many component metrics were not correlated with their index, especially for the fish indices. As a result, these indices may need to be considered and modified to reflect properly stream impact and degradation.

A Letter from Quesnel: The Teacher in History, and Other Fables

LATE in May, 1808, a quarter century before Hardy Ivy built his settler's cabin hereabouts, Simon Fraser and his North West Company voyageurs discovered River, a Fraser River tributary of central B.C., named after explorer-clerk Jules Maurice Quesnel. But unlike Atlanta whose founding dates (Terminus, 1837, Marthasville, 1843, Atlanta, 1845) roughly parallel Quesnel's discovery, gold strike, and early settlement phases, latter town is taking its time to grow-population, say, 6,000 as compared with Greater Atlanta's one and one half-million. Just same, it enjoys a good school system, administered at time of writing by an aggressive board and a persuasive superintendent. Now, same day that Vincent Lannie pressed me for title of my talk, I had perused for first time School Board's Open Letter to All Faculties of Education in of British Columbia. This is mysterious from Quesnel which doubtless has been puzzling you. So permit me to cite a passage or two in order to venture a reasonably legitimate transition to my subtitle-the teacher in history, and other fables. The letter starts by recognizing faculties' sincere intentions to produce good but alleging their annual failure to do so. It goes on to distinguish between today's university-trained novice and yesterday's normal school product. The former, it concedes, appears academically more alert. The latter, though, proved more competent in management skills, exercising discipline, classroom housekeeping, the orderly use of supplies, and settling down of classes to quiet learning. There followed proposition that faculty indifference to producing teachers who can control classrooms of this Province might well result in removal of teacher education from their authority. (1) Of course, teacher as control agent is scarcely a novel concept. Seeing

THE MATRIFOCAL FAMILY AND ITS RELATIONSHIP TO MENTAL RETARDATION

(1968). THE MATRIFOCAL FAMILY AND ITS RELATIONSHIP TO MENTAL RETARDATION. The Journal of Mental Subnormality: Vol. 14, No. 27, pp. 80-83.