The Impact of Altitude at Birth on Perinatal Respiratory Support for Neonates with Trisomy 21

2021 ◽  
Author(s):  
Jessica L. Bloom ◽  
Anna Furniss ◽  
Krithika Suresh ◽  
Robert C. Fuhlbrigge ◽  
Molly M. Lamb ◽  
...  
Keyword(s):  
Trisomy 21 ◽  
The United States ◽  
High Elevation ◽  
Assisted Ventilation ◽  
Respiratory Support ◽  
Chi Squared ◽  
Hospital Births ◽  
High Elevations ◽  
The Impact ◽  
Very High

Objective Both high altitude and trisomy 21 (T21) status can negatively impact respiratory outcomes. The objective of this study was to examine the association between altitude and perinatal respiratory support in neonates with T21 compared with those without T21. Study Design This retrospective cohort study used the United States all-county natality files that included live, singleton, in-hospital births from 2015 to 2019. Descriptive statistics for neonates with and without the primary outcome of sustained assisted ventilation (>6 hours) were compared using t-tests and Chi-squared analyses. Multivariable logistic regression was used to determine the association between respiratory support and the presence of T21, and included an interaction term to determine whether the association between respiratory support and the presence of T21 was modified by elevation at delivery. Results A total of 17,939,006 neonates, 4,059 (0.02%) with T21 and 17,934,947 (99.98%) without, were included in the study. The odds of requiring sustained respiratory support following delivery were 5.95 (95% confidence interval [CI]: 5.31, 6.66), 4.06 (95% CI: 2.39, 6.89), 2.36 (95% CI: 1.64, 3.40), and 5.04 (95% CI: 1.54, 16.54) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevations, respectively. The odds of requiring immediate ventilation support following delivery were 5.01 (95% CI: 4.59, 5.46), 5.90 (95% CI: 4.16, 8.36), 2.86 (95% CI: 2.15, 3.80), and 12.08 (95% CI: 6.78, 21.51) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevation, respectively. Conclusion Neonates with T21 have increased odds of requiring respiratory support following delivery when compared with neonates without T21 at all categories of altitude. However, the odds ratios did not increase monotonically with altitude which indicates additional research is critical in understanding the effects of altitude on neonates with T21. Key Points

scholarly journals Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States

2020 ◽  
Vol 37 (14) ◽  
pp. 1411-1416
Author(s):  
Michelle J. Wang ◽  
Melissa Schapero ◽  
Ronald Iverson ◽  
Christina D. Yarrington
Keyword(s):  
Pregnant Women ◽  
Maternal Morbidity ◽  
Medical Center ◽  
The United States ◽  
Composite Outcome ◽  
Obstetric Hemorrhage ◽  
Increased Risk ◽  
Chi Squared ◽  
Student’S T ◽  
The Impact

Objective The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis. Study Design This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables. Results Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17–1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50–1.93) when compared with those without a diagnosis of COVID-19. Conclusion Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes. Key Points

scholarly journals Strong changes in englacial temperatures despite insignificantchanges in ice thickness at Dôme du Goûter glacier (Mont-Blanc area)

2019 ◽  
Author(s):  
Christian Vincent ◽  
Adrien Gilbert ◽  
Bruno Jourdain ◽  
Luc Piard ◽  
Patrick Ginot ◽  
...  
Keyword(s):  
Numerical Modeling ◽  
Mass Balance ◽  
Snow Accumulation ◽  
Surface Mass Balance ◽  
Near Surface ◽  
Surface Mass ◽  
Precipitation Decrease ◽  
High Elevations ◽  
The Impact ◽  
Very High

Abstract. The response of very high elevation glaciated areas on Mont Blanc to climate change has been analyzed using observations and numerical modeling. Unlike the changes at low elevations, we observe very low glacier thickness changes, of about −2.6 m on the average since 1993. The slight changes in horizontal ice flow velocities and submergence velocities suggest a decrease of about 10 % in ice flux and surface mass balance. This is due to snow accumulation changes and is consistent with the precipitation decrease observed in meteorological data. Conversely, measurements performed in deep boreholes since 1994 reveal strong changes in englacial temperature reaching 1.5 °C at a depth of 50 m. We conclude that at such very high elevations, current changes in climate do not lead to visible changes in glacier thickness but cause invisible changes within the glacier in terms of englacial temperatures. Our analysis from numerical modeling shows that glacier near-surface temperature warming is enhanced by increasing melt-frequency at high elevations although the impact on surface mass balance is low. This results in a non-linear response of englacial temperature to currently rising air temperatures. In addition, borehole temperature inversion including a new dataset confirms previous findings of similar air temperature changes at high and low elevations in the Alps.

scholarly journals Telecommunications Mega-Mergers: Impact On Employee Morale And Turnover Intention

2011 ◽  
Vol 7 (2) ◽  
Author(s):  
Keisha Chambers ◽  
Andrew Honeycutt
Keyword(s):  
Mergers And Acquisitions ◽  
Turnover Intention ◽  
The United States ◽  
Employee Morale ◽  
Font Size ◽  
Know How ◽  
High Profile ◽  
Normal Text ◽  
The Impact ◽  
Very High

<p class="APAparagraph" style="text-align: justify; line-height: normal; text-indent: 0in; margin: 0in 0.5in 0pt;"><span style="font-family: Times New Roman;"><span style="color: black; font-size: 10pt;">The number of mergers and acquisitions grew at record rates in the United States over the past 10 years, and mega telecommunications mergers have been no exception. Three very high-profile telecommunications mergers included MCI and Verizon, Sprint and Nextel, and BellSouth and AT&amp;T. These megamergers have changed the competitive landscape dramatically in the telecom arena. Despite the popularity of mergers and acquisitions (M&amp;As), evidence has shown that the majority have failed to improve performance and failed to achieve anticipated strategic and financial objectives set forth in the premerger planning phase, according to J. Krug and R. Aguilera&rsquo;s 2004 article &ldquo;Top Management Team Turnover in Mergers and Acquisitions&rdquo; in Advances in Mergers and Acquisitions. The primary reason behind such common performance failures according to S. Cartwright and C. L. Cooper&rsquo;s 2000 </span><span style="color: black; font-size: 10pt; mso-ansi-language: EN-GB;" lang="EN-GB">HR Know-How in Mergers and Acquisitions</span><span style="color: black; font-size: 10pt;" lang="EN-GB"> </span><span style="color: black; font-size: 10pt;">was based on various human resources factors such as culture, management, poor motivation, and loss of talent. Based on the aforementioned post corporate merger performance failure considerations, this research study examined the impact on employee morale and turnover intention related to a recent megamerger between two telecommunications conglomerates. </span></span></p>

scholarly journals Severity of the COVID-19 pandemic assessed with all-cause mortality in the United States during 2020.

2021 ◽  
Author(s):  
Fredrick Dahlgren ◽  
Lauren Rossen ◽  
Alicia Fry ◽  
Carrie Reed
Keyword(s):  
United States ◽  
New York ◽  
Age Groups ◽  
The United States ◽  
Mortality Data ◽  
Demographic Groups ◽  
High Severity ◽  
All Cause Mortality ◽  
The Impact ◽  
Very High

Background. In the United States, infection with SARS-CoV-2 caused 380,000 reported deaths from March to December 2020. Methods. We adapted the Moving Epidemic Method to all-cause mortality data from the United States to assess the severity of the COVID-19 pandemic across age groups and all 50 states. By comparing all-cause mortality during the pandemic with intensity thresholds derived from recent, historical all-cause mortality, we categorized each week from March to December 2020 as either low severity, moderate severity, high severity, or very high severity. Results. Nationally for all ages combined, all-cause mortality was in the very high severity category for 9 weeks. Among people 18 to 49 years of age, there were 29 weeks of consecutive very high severity mortality. Forty-seven states, the District of Columbia, and New York City each experienced at least one week of very high severity mortality for all ages combined. Conclusions. These periods of very high severity of mortality during March through December 2020 are likely directly or indirectly attributable to the COVID-19 pandemic. This method for standardized comparison of severity over time across different geographies and demographic groups provides valuable information to understand the impact of the COVID-19 pandemic and to identify specific locations or subgroups for deeper investigations into differences in severity.

scholarly journals Strong changes in englacial temperatures despite insignificant changes in ice thickness at Dôme du Goûter glacier (Mont Blanc area)

2020 ◽  
Vol 14 (3) ◽  
pp. 925-934 ◽  
Author(s):  
Christian Vincent ◽  
Adrien Gilbert ◽  
Bruno Jourdain ◽  
Luc Piard ◽  
Patrick Ginot ◽  
...  
Keyword(s):  
Numerical Modelling ◽  
Mass Balance ◽  
Snow Accumulation ◽  
Surface Mass Balance ◽  
Near Surface ◽  
Surface Mass ◽  
Precipitation Decrease ◽  
High Elevations ◽  
The Impact ◽  
Very High

Abstract. The response of very-high-elevation glaciated areas on Mont Blanc to climate change has been analysed using observations and numerical modelling over the last 2 decades. Unlike the changes at low elevations, we observe very low glacier thickness changes, of about −2.6 m on average since 1993. The slight changes in horizontal ice flow velocities and submergence velocities suggest a decrease of about 10 % in ice flux and surface mass balance. This is due to less snow accumulation and is consistent with the precipitation decrease observed in meteorological data. Conversely, measurements performed in deep boreholes since 1994 reveal strong changes in englacial temperature reaching a 1.5 ∘C increase at a depth of 50 m. We conclude that at such very high elevations, current changes in climate do not lead to visible changes in glacier thickness but cause invisible changes within the glacier in terms of englacial temperatures. Our analysis from numerical modelling shows that glacier near-surface temperature warming is enhanced by increasing melt frequency at high elevations although the impact on surface mass balance is low. This results in a non-linear response of englacial temperature to currently rising air temperatures. In addition, borehole temperature inversion including a new dataset confirms previous findings of similar air temperature changes at high and low elevations in the Alps.

Kinship as a Factor Affecting Cantonese Economic Adaptation in the United States

1960 ◽  
Vol 19 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Milton Barnett
Keyword(s):  
United States ◽  
Family System ◽  
The United States ◽  
Chinese Society ◽  
Joint Family ◽  
City Life ◽  
Money Economy ◽  
And Performance ◽  
The Impact ◽  
Very High

The joint family system in Chinese society has shown remarkable survival strength among the Chinese immigrants to the United States, contrary to what might have been expected from previous studies of the impact of migration and city life upon family organization. It is generally assumed that economic change is necessarily destructive to the joint family system and that the corporate nature of the latter is antithetical to the stress given individual initiative and performance in Western commercial enterprises. Schapera has described the disruptive influence of a money economy among the Kgatla of Bechuanaland, and similar instances can be readily drawn from other parts of the world. These have been sufficient in number to warrant Linton's stating: ... as a theorem, valid in a very high percentage of cases, that the greater the opportunities for individual economic profit provided by any socio-cultural situation, the weaker the ties of extended kinship will become.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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