Transforming Social Determinants to Educational Outcomes: Geospatial Considerations

In recovering from one of the worst educational crises in recorded history due to the pandemic, in a mission to rebuild and become more resilient, there has been a heightened urgency to provide resources to communities most in need. However, precisely identifying those needs have become all the more important due to the increase in popularity of e-learning as a suitable option and the improvement of technologies. Most notably, socially disadvantaged and historically marginalized communities were disproportionately and severely impacted by several aspects of the pandemic, in terms of health, economics, access to education, and sustainable well-being. This differential effect was modeled spatially with the combination of aerial photogrammetry, traditional geospatial mapping, and other robust AI-driven techniques to synthesize and analyze the various types of data. In this original research study, we apply various spatial health variables, relate them to educational variables in an initial empirical process of understanding how to address equity-related considerations from the context of the learner’s experience, providing the empirical evidence for the development of locally tailored learner support and assistance, meeting students where they are by specifically identifying and targetting geographically underserved areas. We found that there were clear statistically significant relationships between educational attainment and several physical (p < 0.001), mental (p = 0.003), access to healthy food/food security (p < 0.001), and uptake of preventative health measures (p < 0.001), which also varied geographically. Geographic variations in learning experiences demonstrates the unquestionable need to understand a variety of physical, mental, and dietary factors surrounding the student’s success. Understanding a combination of these factors in a geospatial context will allow educational institutions to best serve the needs of learners.

Determination of Lead in Wine by Graphite Furnace Atomic Absorption Spectrophotometry: Interlaboratory Study

An interlaboratory study of a graphite furnace atomic absorption spectrophotometry (GFAAS) method for the determination of lead in wine was conducted. Seventeen laboratories from France, United States, and the United Kingdom, using a variety of GFAAS instruments, took part in the study. The method incorporated a novel matrix-matching procedure to minimize matrix effects between standards and samples. Six wine test materials were prepared and sent to participants as 12 blind duplicate or split level samples. There was good agreement between results obtained from participants and target values (24–279 μg/L) obtained with an inductively coupled plasma-mass spectrometry method. The precision of the GFAAS method was well within the range predicted by the Horwitz equation for the 6 test materials analyzed. Repeatability standard deviations ranged from 3 to 17%. Reproducibility standard deviations were in the range of 10 to 30%. The method is recommended for use for official purposes.

High-Mobility Multipurpose Wheeled Vehicle Rollover Accidents and Injuries to U.S. Army Soldiers by Reported Occupant Restraint Use, 1992-2013

OBJECTIVE

The high-mobility multipurpose wheeled vehicle (HMMWV) is a light military tactical vehicle. During Operation Iraqi Freedom and Operation Enduring Freedom, the U.S. Army modified the HMMWV into a combat vehicle by adding vehicle armor, which made the vehicle more difficult to control and more likely to roll over. Consequently, reports of fatal rollover accidents involving up-armored HMMWVs began to accumulate during the up-armoring period (August 2003 to April 2005). Furthermore, the lack of occupant restraint use prevalent in a predominantly young, male, and enlisted military population compounded the injuries resulting from these accidents. In this retrospective case series analysis, we describe the characteristics of U.S. Army HMMWV rollover accidents, occupants, and injuries reported worldwide from fiscal year 1992 to 2013 based on reported occupant restraint use.

METHODS

We conducted all analyses using Microsoft Excel 2010 and SAS version 9.1. Because this analysis does not constitute human subjects research, no institutional review board review was required. First, we obtained U.S. Army HMMWV accident records from the U.S. Army Combat Readiness Center, and selected those records indicating a HMMWV rollover had occurred. Next, we successively deduplicated the records at the accident, vehicle, occupant, and injury levels for descriptive analysis of characteristics at each level. For each occupant position, we calculated relative, attributable, and population attributable risks of nonfatal and fatal injury based on reported occupant restraint use. Finally, we analyzed body part injured and nature of injury to characterize the injury patterns that HMMWV occupants in each position sustained based on restraint use. We performed a χ² test of homogeneity to assess differences in injury patterns between restrained and unrestrained occupants.

RESULTS

A total of 819 U.S. Army HMMWV rollover accidents worldwide were reported from October 1991 through May 2013 involving 821 HMMWVs and 1,395 occupants (828 nonfatally injured, 151 fatally injured, and 416 noninjured). Thirty-five percent of more severe (class A and B) accidents involved the M1114 up-armored variant, whereas 32% of less severe (class C and D) accidents involved the M998 nonarmored variant. Unrestrained occupants were 20% more likely to be nonfatally injured and 5.6 times more likely to be fatally injured than were restrained occupants. Among unrestrained occupants, restraint use could have potentially saved 82% of lives lost. Among all occupants involved in a HMMWV rollover, an estimated 56% of fatalities could have been prevented by restraint use. Unrestrained drivers and vehicle commanders had greater than expected torso injuries, while restrained vehicle commanders and passengers had greater than expected upper extremity injuries. Unrestrained drivers had greater than expected fractures, whereas restrained drivers and vehicle commanders had greater than expected sprains/strains.

CONCLUSION

While reporting bias may exist, nevertheless these results show that occupant restraint use confers substantial life-saving protection to HMMWV occupants in rollover accidents. Therefore, commanders, safety officers, and peers should continue to promote and enforce restraint use consistently during all Army ground operations and training involving HMMWVs. Doing so will save Soldiers' lives in rollover accidents during the remaining years of the HMMWV program.

Proposing Using Waist-to-Height Ratio as the Initial Metric for Body Fat Assessment Standards in the U.S. Army

OBJECTIVES

Soldiers failing to meet Army Regulation 600-9 (AR 600-9) for weight-to-height standards are required to undergo body fat taping assessment. This article describes a clinical performance improvement project in which battalion medical staff identified a simpler way to improve on meeting AR 600-9 standards with proposing to use the waist-to-height ratio (WtHR) in place of the current methodology.

METHODS

During a yearlong combat deployment to Iraq from 2009 to 2010, 42 Soldiers (34 males, 8 females) were evaluated and monitored by battalion medical staff for weight and body fat loss. Mean body mass index and waist circumference were compared between baseline or initial assessment and final assessment. The percentage of Soldiers meeting body fat standards was compared among those who had attained a WtHR ≤ 55% versus those who had not.

RESULTS

By the final assessment, mean body mass index had decreased 2.21 kg/m² or 6.6% (p = 0.002) and mean waist circumference had decreased 6.0 cm or 5.8% (p = 0.008). All Soldiers who had attained a WtHR ≤ 55% met AR 600-9 body fat taping assessment standards and presented a professional military appearance.

CONCLUSION

Attaining a WtHR ≤ 55% is an effective measure of body composition that was able to predict a Soldiers' achievement of body fat standards metric for meeting AR 600-9 standards and achieving a professional military appearance.

ON THE PIGMENT OF THE NEGRO'S SKIN AND HAIR

The pigmentary granules of the negro's skin and hair can be freed in several ways from the cells in which they are lodged and collected in any desired amount. As thus obtained, these granules are found to be insoluble in dilute alkalies, dilute hydrochloric acid (hot or cold), alcohol, or other organic solvents when applied in the order named. If, after they have been subjected to the action of dilute hydrochloric acid, they are again treated with dilute alkalies, they are found to give up their pigment, and, on the continued application of heat, the granules dissolve entirely in the alkaline solution, leaving only an insignificant residue. The pigmentary granules are composed of a colourless ground substance or substratum, a pigment, and much inorganic matter. Their inorganic constituents, as thus far determined, are calcium, magnesium, iron, and silicic, phosphoric, and sulphuric acids; and these constituents possibly play an important part in the deposition and fixation of the colouring matter in the granules. The pigment isolated from the granules, and sufficiently freed from adherent inorganic matter, contains only the merest trace of iron-so little, in fact, that we must think of it when entirely pure as free of iron. Heating the isolated pigment with barium hydrate at a temperature of 260 degrees C. entirely frees it from the closely adherent ground substance, and it is then found that the vapours of pyrrol are no longer emitted when it is subjected to dry distillation, and the odour of burnt feathers is no longer discerned, although nitrogen is still present. We can not conclude as the result of our work that the pigment is a derivative of haemoglobin; it seems to us more probable that it is ultimately derived from the proteids of the parenchymatous juices. The total quantity of soluble pigment in the skin of a negro of average size is found to weigh about 1 gramme; the weight of the pigmentary granules is about 3.3 grammes, if we are right in our assumption that they contain sixty-five per cent of water and five per cent of mineral constituents in their natural state in the epidermis. The pigments of the epidermis and hair of the negro are very likely identical. In the present state of our knowledge we can only say that it seems highly probable that the pigment of the negro's hair is not different from the dark pigment found in the hair of the white races, and we may infer that the pigment of the black skin differs only in amount and not in kind from that deposited in the skin of the white man.

An Allelic Series of Mutations in the Kit ligand Gene of Mice. II. Effects of Ethylnitrosourea-Induced Kitl Point Mutations on Survival and Peripheral Blood Cells of KitlSteel Mice

The ligand for the Kit receptor tyrosine kinase is Kit ligand (Kitl; also known as mast cell growth factor, stem cell factor, and Steel factor), which is encoded at the Steel (Sl) locus of mice. Previous studies revealed that KitlSl mutations have semidominant effects; mild pigmentation defects and macrocytic, hypoplastic anemia occur in heterozygous mice, and more severe pigmentation defects and anemia occur in homozygotes. Lethality also occurs in mice homozygous for severe KitlSl mutations. We describe the effects of seven new N-ethyl-N-nitrosourea (ENU)-induced KitlSl mutations and two previously characterized severe KitlSl mutations on pigmentation, peripheral blood cells, and mouse survival. Mice heterozygous for each of the nine mutations had reduced coat pigmentation and macrocytosis of peripheral blood. In the case of some of these mutations, however, red blood cell (RBC) counts, hemoglobin concentrations, and hematocrits were normal in heterozygotes, even though homozygotes exhibited severely reduced RBC counts and lethality. In homozygous mice, the extent of anemia generally correlates with effects on viability for most KitlSl mutations; i.e., most mutations that cause lethality also cause a more severe anemia than that of mutations that allow viability. Interestingly, lethality and anemia were not directly correlated in the case of one KitlSl mutation.

An Allelic Series of Mutations in the Kit ligand Gene of Mice. I. Identification of Point Mutations in Seven Ethylnitrosourea-Induced KitlSteel Alleles

An allelic series of mutations is an extremely valuable genetic resource for understanding gene function. Here we describe eight mutant alleles at the Steel (Sl) locus of mice that were induced with N-ethyl-N-nitrosourea (ENU). The product of the Sl locus is Kit ligand (or Kitl; also known as mast cell growth factor, stem cell factor, and Steel factor), which is a member of the helical cytokine superfamily and is the ligand for the Kit receptor tyrosine kinase. Seven of the eight ENU-induced KitlSl alleles, of which five cause missense mutations, one causes a nonsense mutation and exon skipping, and one affects a splice site, were found to contain point mutations in Kitl. Interestingly, each of the five missense mutations affects residues that are within, or very near, conserved α-helical domains of Kitl. These ENU-induced mutants should provide important information on structural requirements for function of Kitl and other helical cytokines.

UNC-119 suppresses axon branching inC. elegans

The architecture of the differentiated nervous system is stable but the molecular mechanisms that are required for stabilization are unknown. We characterized the gene unc-119 in the nematode Caenorhabditis elegans and demonstrate that it is required to stabilize the differentiated structure of the nervous system. In unc-119 mutants, motor neuron commissures are excessively branched in adults. However, live imaging demonstrated that growth cone behavior during extension was fairly normal with the exception that the overall rate of migration was reduced. Later, after development was complete, secondary growth cones sprouted from existing motor neuron axons and cell bodies. These new growth cones extended supernumerary branches to the dorsal nerve cord at the same time the previously formed axons retracted. These defects could be suppressed by expressing the UNC-119 protein after embryonic development; thus demonstrating that UNC-119 is required for the maintenance of the nervous system architecture. Finally, UNC-119 is located in neuron cell bodies and axons and acts cell-autonomously to inhibit axon branching.

Drosophila alpha- and beta-spectrin mutations disrupt presynaptic neurotransmitter release

Spectrins are plasma membrane-associated cytoskeletal proteins implicated in several aspects of synaptic development and function, including presynaptic vesicle tethering and postsynaptic receptor aggregation. To test these hypotheses, we characterized Drosophila mutants lacking either alpha- or beta-spectrin. The Drosophila genome contains only one alpha-spectrin and one conventional beta-spectrin gene, making it an ideal system to genetically manipulate spectrin levels and examine the resulting synaptic alterations. Both spectrin proteins are strongly expressed in the Drosophila neuromusculature and highly enriched at the glutamatergic neuromuscular junction. Protein null alpha- and beta-spectrin mutants are embryonic lethal and display severely disrupted neurotransmission without altered morphological synaptogenesis. Contrary to current models, the absence of spectrins does not alter postsynaptic glutamate receptor field function or the ultrastructural localization of presynaptic vesicles. However, the subcellular localization of numerous synaptic proteins is disrupted, suggesting that the defects in presynaptic neurotransmitter release may be attributable to inappropriate assembly, transport, or localization of proteins required for synaptic function.

Gestational diabetes: is a higher cesarean section rate inevitable?

OBJECTIVE

To determine the rate of and indication for cesarean section for women with gestational diabetes mellitus (GDM) compared with glucose-tolerant women.

RESEARCH DESIGN AND METHODS

From a consecutive series of women with GDM seen over a 9-year period for medical management, women who had had a cesarean section were identified and the reason for the section determined from a review of the medical record. A control group of women who had had a section were obtained from an existing database of glucose-tolerant women.

RESULTS

The section rate for women with GDM was higher at 19.8% than the 15.6% for glucose-tolerant women. However, after adjustment for age and parity, no significant differences were found. There were also no differences found for the primary indication for section.

CONCLUSIONS

In our health area of New South Wales, Australia, women with GDM do not have a higher section rate compared with glucose-tolerant women. Concerns about the diagnosis of GDM leading to an increased rate of obstetric intervention should not be generalized.

UNC-13 is required for synaptic vesicle fusion in C. elegans

We analyzed the synaptic physiology of unc-13 mutants in the nematode C. elegans. Mutants of unc-13 had normal nervous system architecture, and the densities of synapses and postsynaptic receptors were normal at the neuromuscular junction. However, the number of synaptic vesicles at neuromuscular junctions was two- to threefold greater in unc-13 mutants than in wild-type animals. Most importantly, evoked release at both GABAergic and cholinergic synapses was almost absent in unc-13 null alleles, as determined by whole-cell, voltage-clamp techniques. Although mutant synapses had morphologically docked vesicles, these vesicles were not competent for release as assayed by spontaneous release in calcium-free solution or by the application of hyperosmotic saline. These experiments support models in which UNC-13 mediates either fusion of vesicles during exocytosis or priming of vesicles for fusion.

Drosophila UNC-13 is essential for synaptic transmission

The UNC-13 protein family has been suggested to be critical for synaptic vesicle dynamics based on its interactions with Syntaxin, Munc-18 and Doc 2alpha. We cloned the Drosophila homolog (Dunc-13) and characterized its function using a combination of electrophysiology and ultrastructural analyses. Dunc-13 contained a C1 lipid-binding motif and two C2 calcium-binding domains, and its expression was restricted to neurons. Elimination of dunc-13 expression abolished synaptic transmission, an effect comparable only to removal of the core complex proteins Syntaxin and Synaptobrevin. Transmitter release remained impaired under elevated calcium influx or application of hyperosmotic saline. Ultrastructurally, mutant terminals accumulated docked vesicles at presynaptic release sites. We conclude that Dunc-13 is essential for a stage of neurotransmission following vesicle docking and before fusion.

The stoned proteins regulate synaptic vesicle recycling in the presynaptic terminal

The Drosophila stoned locus was identified 25 years ago on the basis of stress-sensitive behavioral mutants (Grigliatti et al., 1973). The locus is dicistronic and encodes two distinct proteins, stoned A and stoned B, which are expressed specifically in presynaptic terminals at central and peripheral synapses. Several stoned mutant alleles cause embryonic lethality, suggesting that these proteins are essential for synaptic function. Physiological analyses at the stoned synapse reveal severe neurotransmission defects, including reduced and asynchronous neurotransmitter release and rapid fatigue after repetitive stimulation. At the EM level, stoned synapses show a depletion of synaptic vesicles and a concomitant increase in membrane-recycling intermediates. Mutant terminals also display a specific mislocalization of the synaptic vesicle protein synaptotagmin. These results suggest that the stoned proteins are essential for the recycling of synaptic vesicle membrane and are required for the proper sorting of synaptotagmin during endocytosis.

Gestational diabetes: do lean young caucasian women need to be tested?

OBJECTIVE

The American Diabetes Association has recommended that pregnant women with low-risk factors need not be tested for gestational diabetes mellitus (GDM). The aim of this study was to determine the prevalence of GDM in women with low-risk factors and to see if the pregnancy outcomes of women with GDM from a low-risk group were different from the outcomes of other women with GDM. RESEARCH DESION AND METHODS: Over an 18-month period, all pregnant women were offered a test for GDM using a 75-g glucose tolerance test at the beginning of the 3rd trimester. GDM was diagnosed if the 2-h glucose level was > or =8.0 mmol/l. The prevalence of GDM was determined in women with defined low-risk factors (Caucasian ethnic origin, age <25 years, and BMI <25 kg/m2). The pregnancy outcomes of women with GDM from a low-risk group were compared with those of other women with GDM.

RESULTS

From a tested population of 2,907 women, 573 were identified as coming from a low-risk group. The prevalence of GDM in this low-risk group was 2.8%. The pregnancy outcomes of women with GDM from a low-risk group were no different from the pregnancy outcomes of other women with GDM, with respect to frequency of insulin use, units of insulin per day, morbidity, emergency caesarian section, and the percentage of both large- and small-for-gestational-age babies. In our population, if low-risk women were excluded, 80% of women would still require testing and nearly 10% of all cases of GDM would be missed.

CONCLUSIONS

Women from a low-risk group have a 2.8% prevalence rate of GDM. The pregnancy outcomes of women with GDM from a low-risk group are similar to the outcomes of other women with GDM. Concerning the use of the 75-g glucose tolerance test in pregnancy, the recommendation not to test women from a low-risk group requires further evaluation in different populations before it can be endorsed.

Responsiveness of vein bypass grafts to stimulation with norepinephrine and 5-hydroxytryptamine

The in vitro reactivity of vein bypass grafts to norepinephrine (NE) and 5-hydroxytryptamine (5-HT) was studied in 20 rabbits undergoing bypass grafting. In these animals the right external jugular vein was grafted into the right carotid artery. The cumulative dose-response to NE and 5-HT of rings of vein grafts 2, 4, and 6 weeks after insertion was compared with that of rings from the normal contralateral jugular vein by means of an organ bath to measure changes in isometric tension. With NE there was no significant difference in the response of vein grafts harvested at 2 weeks and control veins. However, at 4 and 6 weeks there was a progressive decrease in the sensitivity of the grafts to NE. The difference in ED50 values (ED50 defined as concentration of agonist required to elicit 50% of the maximal response) between control veins and vein grafts at 4 weeks was twofold and at 6 weeks it was fivefold. None of the control veins responded to 5-HT stimulation. However, the vein grafts contracted with 5-HT, exhibiting sigmoid dose-response curves. The vein grafts showed intimal hyperplasia, which was maximal after 4 weeks. These results show that vein grafts undergo a progressive decrease in their sensitivity to norepinephrine and develop a marked, sustained increase in sensitivity to 5-HT. This finding is in contrast to previous observations in intimal hyperplastic rabbit aorta, suggesting a fundamental difference in the functional expression of arterial and venous intimal hyperplasia.

Bone mineralization in the distal forearm of hemiplegic patients

Bone mineral content was measured by single photon absorptiometry using a modified bone densitometer (Packard) with 125I as the source. In 42 hemiplegic subjects, matched for sex and age, the bone density was compared bilaterally on the radius and ulna 2 cm and 4 cm above the wrist. The nonparalyzed side served as a control for the paralyzed side. The results indicate a consistent, general loss of bone mineral on the paralyzed side compared with the nonparalyzed side. The extent of demineralization in females was greater than in male subjects. Right-dominant left-paralyzed patients showed a greater loss of bone density than right-dominant right-paralyzed subjects. The absorption ratio of the paralyzed vs the nonparalyzed sides revealed that there was a 5.3% and 7.4% decrease in the average bone density at 4 and 2 cm above the wrist, respectively. There was a progressive loss of bone mineral content relative to time after the onset of paralysis, amounting to an average of 6.4% approximately three months after the onset of injury. It was estimated that before the onset of paralysis there was an excess of bone mineral on the dominant vs the nondominant side of +5.4% and +3.2% for males and females, respectively.

Neonatal small left colon syndrome. Occurrence in asymptomatic infants of diabetic mothers

An unusually high incidence (40%) of maternal diabetes was observed in a series of 20 newborn infants who had low colonic obstruction and barium enema findings of a uniformly narrowed colon from the splenic flexure to the anus. This has been termed the "neonatal small left colon syndrome." We investigated the incidence of this colon configuration in gastrointestinally asymptomatic infants of diabetic mothers. Of 12 such infants examined by barium enema, six have shown this same narrowing of the left colon. The relationship of maternal diabetes to the small left colon is not yet clearly understood.