Impact of race versus ethnicity on infertility diagnosis between Black American, Haitian, African, and White American women seeking infertility care: a retrospective review.

Objective: To determine whether infertility diagnoses differ between Black ethnic subgroups. Design: Retrospective review. Setting: an urban safety-net hospital. Patients: Women seeking infertility care between 2005 and 2015. Interventions: Charts of women with infertility and polycystic ovary syndrome (International Classification of Diseases, Ninth Revision diagnoses) were reviewed to confirm diagnoses. Data were stratified by race and subsequently by ethnicity to evaluate the differences in infertility diagnoses between Black American, Black Haitian, and Black African women. White American women were used as the comparison group. Main Outcome Measures: Infertility diagnoses between Black ethnic subgroups and White women. Results: A total of 358 women met the inclusion criteria, including 99 Black American, 110 Black Haitian, 61 Black African, and 88 White American women. Anovulation/polycystic ovary syndrome was the most common diagnosis in each ethnic group, accounting for 40% of infertility among White American, 57% among Black American, 25% among Black Haitian, and 21% among Black African women. There were no significant differences in the individual infertility diagnoses between Black and White women. Between ethnic subgroups, multivariate analysis showed significantly higher odds of infertility because of anovulation/polycystic ovary syndrome in Black American women compared with Black African women (odds ratio [OR], 4.9; 95% confidence interval [CI], 1.4-17.0). Compared with Black African women, higher odds of tubal factor infertility were observed in Black American (OR, 4.7; 95% CI, 1.16-18.7) and Black Haitian women (OR, 4.0; 95% CI, 1.1-14.0). Conclusions: Infertility diagnoses were not homogeneous across Black ethnic groups. Studies examining infertility should specify the ethnic subgroups within a race because this may affect results.

Outcomes of Women Undergoing Excision of the Retained Cervix After Supracervical Hysterectomy.

OBJECTIVE: To characterize the indications for and complication rates of excision of the retained cervix after supracervical hysterectomy. METHODS: We performed a retrospective cohort study of women undergoing excision of the retained cervix after supracervical hysterectomy in the 2010-2014 National Inpatient Sample. International Classification of Diseases, Ninth Revision codes were used to identify indication for the procedure and surgical complications. We weighted the hospital-level data to obtain nationwide estimates of patient characteristics, surgical complications, and length of stay. RESULTS: Nationwide, 1,140 women underwent excision of the retained cervix after hysterectomy. Their mean age was 49 years, and the majority were White and privately insured. Leiomyomas were the most commonly coded indication (35%, 95% CI 29-42), followed by prolapse (14%, 95% CI 9-18). Eighteen percent (95% CI 13.0-23.1) were performed for malignancy, including 5.3% (95% CI 2.3-8.2) for cervical cancer. Only 11.5% (95% CI 7.3-15.6) of cases were performed laparoscopically. The overall complication rate was high (38%, 95% CI 32-45), particularly for bleeding complications (26%, 95% CI 20-31) and transfusion (15%, 95% CI 11-20). Gastrointestinal complication rates were second highest (8%, 95% CI 5-12); ileus was the most common gastrointestinal complication (7.0%, 95% CI 3.7-10.4). The median length of stay was 2 days (range 0-34). CONCLUSION: Women who undergo excision of the retained cervix after supracervical hysterectomy experience high rates of complications, the most common of which was bleeding. Patient counseling regarding removal of the cervix at the time of hysterectomy should include this information.

Educational attainment predicts negative perceptions women have of their own climate change knowledge.

Education may encourage personal and collective responses to climate change, but climate education has proven surprisingly difficult and complex. Self-perception of knowledge and intelligence represent one factor that may impact willingness to learn about climate change. We explored this possibility with a case study in Raleigh, North Carolina in 2015 (n = 200). Our goal was to test how gender and ethnicity influenced perceptions people had of their own climate change knowledge. Survey respondents were asked how strongly they agreed with the statement "I feel knowledgeable about climate change" (1 = strongly disagree, and 5 = strongly agree). Our survey instrument also included demographic questions about race, age, income, gender, and education, as well as respondent's experience with natural disasters and drought. We observed an interaction between education and gender where women's self-perceived knowledge was higher than men among people with low levels of educational attainment, but was higher for men than women among people with high levels of educational attainment. In addition, minority respondents self-reported lower perceived climate change knowledge than white respondents, regardless of educational attainment. This study enhances our understanding of the gender gap in self-perceptions of climate knowledge by suggesting it is contingent on educational attainment. This could be the result of stereotype-threat experienced by women and minorities, and exacerbated by educational systems. Because people who question their knowledge are often more able to learn, particularly in ideologically charged contexts, highly educated women and minorities may be more successful learning about climate change than white men.

Relationships between Characteristics of Urban Green Land Cover and Mental Health in U.S. Metropolitan Areas.

Urbanization increases risk for depression and other mental disorders. A growing body of research indicates the natural environment confers numerous psychological benefits including alleviation of mental distress. This study examined land cover types and landscape metrics in relation to mental health for 276 U.S. counties within metropolitan areas having a population of 1 million or more. County Health Rankings and Behavioral Risk and Factor Surveillance System (BRFSS) provided a measure of mental health. The 2011 National Land Cover Database (NLCD) provided data on green land cover types, from which seven landscape metrics were generated to characterize landscape patterns. Spearman's rho correlation and stepwise logistic regression models, respectively, were employed to examine bivariate and multivariate relationships. Models were adjusted for county population and housing density, region, race, and income to account for potential confounding. Overall, individual measures of landscape patterns showed stronger associations with mental health than percent total cover alone. Greater edge contrast was associated with 3.81% lower odds of Frequent Mental Distress (FMD) (Adjusted Odd's Ratio (AOR) = 0.9619, 95% CI = 0.9371, 0.9860). Shrubland cohesion was associated with greater odds of FMD (AOR = 1.0751, 95% CI = 1.0196, 1.1379). In addition, distance between shrubland cover was associated with greater odds of FMD (AOR = 1.0027, 95% CI = 1.0016, 1.0041). Although effect sizes were small, findings suggest different types of landscape characteristics may have different roles in improving mental health.

Carbon lost and carbon gained: a study of vegetation and carbon trade-offs among diverse land uses in Phoenix, Arizona.

Human modification and management of urban landscapes drastically alters vegetation and soils, thereby altering carbon (C) storage and rates of net primary productivity (NPP). Complex social and ecological processes drive vegetation cover in cities, leading to heterogeneity in C dynamics depending on regional climate, land use, and land cover. Recent work has demonstrated homogenization in ecological processes within human-dominated landscapes (the urban convergence hypothesis) in soils and biotic communities. However, a lack of information on vegetation in arid land cities has hindered an understanding of potential C storage and NPP convergence across a diversity of ecosystem types. We estimated C storage and NPP of trees and shrubs for six different land-use types in the arid metropolis of Phoenix, Arizona, USA, and compared those results to native desert ecosystems, as well as other urban and natural systems around the world. Results from Phoenix do not support the convergence hypothesis. In particular, C storage in urban trees and shrubs was 42% of that found in desert vegetation, while NPP was only 20% of the total NPP estimated for comparable natural ecosystems. Furthermore, the overall estimates of C storage and NPP associated with urban trees in the CAP ecosystem were much lower (8-63%) than the other cities included in this analysis. We also found that C storage (175.25-388.94 g/m2 ) and NPP (8.07-15.99 g·m-2 ·yr-1 ) were dominated by trees in the urban residential land uses, while in the desert, shrubs were the primary source for pools (183.65 g/m2 ) and fluxes (6.51 g·m-2 ·yr-1 ). These results indicate a trade-off between shrubs and trees in arid ecosystems, with shrubs playing a major role in overall C storage and NPP in deserts and trees serving as the dominant C pool in cities. Our research supports current literature that calls for the development of spatially explicit and standardized methods for analyzing C dynamics associated with vegetation in urbanizing areas.

Beyond Impervious: Urban Land-Cover Pattern Variation and Implications for Watershed Management.

Impervious surfaces degrade urban water quality, but their over-coverage has not explained the persistent water quality variation observed among catchments with similar rates of imperviousness. Land-cover patterns likely explain much of this variation, although little is known about how they vary among watersheds. Our goal was to analyze a series of urban catchments within a range of impervious cover to evaluate how land-cover varies among them. We then highlight examples from the literature to explore the potential effects of land-cover pattern variability for urban watershed management. High-resolution (1 m(2)) land-cover data were used to quantify 23 land-cover pattern and stormwater infrastructure metrics within 32 catchments across the Triangle Region of North Carolina. These metrics were used to analyze variability in land-cover patterns among the study catchments. We used hierarchical clustering to organize the catchments into four groups, each with a distinct landscape pattern. Among these groups, the connectivity of combined land-cover patches accounted for 40 %, and the size and shape of lawns and buildings accounted for 20 %, of the overall variation in land-cover patterns among catchments. Storm water infrastructure metrics accounted for 8 % of the remaining variation. Our analysis demonstrates that land-cover patterns do vary among urban catchments, and that trees and grass (lawns) are divergent cover types in urban systems. The complex interactions among land-covers have several direct implications for the ongoing management of urban watersheds.

Urban Vegetative Cover Fragmentation in the U.S.: Associations With Physical Activity and BMI.

INTRODUCTION: Urban vegetative cover provides a range of ecosystem services including contributions to human health and well-being. Urbanization exerts tremendous pressure on this natural resource, causing fragmentation and loss of urban greenspace. This study aimed to examine associations between vegetative cover fragmentation and physical activity and BMI at the county scale in the U.S. metropolitan statistical areas greater than 1 million in population. METHODS: National Land Cover Database 2006 and Behavioral Risk Factor Surveillance System 2008 provided land cover and human health data, respectively. Analyses were performed in 2013 at the county scale where the health data were reported. Spearman rank correlation and stepwise and hierarchical regression models were applied to estimate relationships between land cover and health variables. RESULTS: After controlling for median household income and race, greater forest edge density (ß=0.272, p<0.05) and larger size of herbaceous patches (ß=0.261, p<0.01) were associated with a higher percentage of participation in physical activity within counties. More connections between forest and developed area (ß=0.37, p<0.01) and greater edge density of shrubland (ß=0.646, p<0.001) were positively associated with a higher percentage of normal BMI (<25) within counties. CONCLUSIONS: Forest land cover and some degree of fragmentation are associated with population physical activity. Future studies should examine how built environments and varying land cover configurations influence physical activity and weight status.

Trees grow on money: urban tree canopy cover and environmental justice.

This study examines the distributional equity of urban tree canopy (UTC) cover for Baltimore, MD, Los Angeles, CA, New York, NY, Philadelphia, PA, Raleigh, NC, Sacramento, CA, and Washington, D.C. using high spatial resolution land cover data and census data. Data are analyzed at the Census Block Group levels using Spearman's correlation, ordinary least squares regression (OLS), and a spatial autoregressive model (SAR). Across all cities there is a strong positive correlation between UTC cover and median household income. Negative correlations between race and UTC cover exist in bivariate models for some cities, but they are generally not observed using multivariate regressions that include additional variables on income, education, and housing age. SAR models result in higher r-square values compared to the OLS models across all cities, suggesting that spatial autocorrelation is an important feature of our data. Similarities among cities can be found based on shared characteristics of climate, race/ethnicity, and size. Our findings suggest that a suite of variables, including income, contribute to the distribution of UTC cover. These findings can help target simultaneous strategies for UTC goals and environmental justice concerns.

Urban ecology in a developing world: why advanced socioecological theory needs Africa.

Socioecological theory, developed through the study of urban environments, has recently led to a proliferation of research focusing on comparative analyses of cities. This research emphasis has been concentrated in the more developed countries of the Northern Hemisphere (often referred to as the "Global North"), yet urbanization is now occurring mostly in the developing world, with the fastest rates of growth in sub-Saharan Africa. Countries like South Africa are experiencing a variety of land-cover changes that may challenge current assumptions about the differences between urban and rural environments and about the connectivity of these dynamic socioecological systems. Furthermore, questions concerning ecosystem services, landscape preferences, and conservation - when analyzed through rural livelihood frameworks - may provide insights into the social and ecological resilience of human settlements. Increasing research on urban development processes occurring in Africa, and on patterns of kinship and migration in the less developed countries of the "Global South", will advance a more comprehensive worldview of how future urbanization will influence the progress of sustainable societies.

Biofunctional materials for directing vascular development.

Engineered tissue constructs are inherently limited by their lack of microvascularization. Evidence suggests that combining a scaffold material with cells and their cell-secreted signals instigates tubule formation, and various strategies can be employed to tailor the vascular response. This review focuses on rationally designed materials capable of supporting functional neovessel formation and stabilization. Biomaterial scaffolds and their use as growth factor delivery systems are discussed, as well as other functional enhancement strategies to direct cellular responses for effective formation of a mature vascular network.

Integration of Self-Assembled Microvascular Networks with Microfabricated PEG-Based Hydrogels.

Despite tremendous efforts, tissue engineered constructs are restricted to thin, simple tissues sustained only by diffusion. The most significant barrier in tissue engineering is insufficient vascularization to deliver nutrients and metabolites during development in vitro and to facilitate rapid vascular integration in vivo. Tissue engineered constructs can be greatly improved by developing perfusable microvascular networks in vitro in order to provide transport that mimics native vascular organization and function. Here a microfluidic hydrogel is integrated with a self-assembling pro-vasculogenic co-culture in a strategy to perfuse microvascular networks in vitro. This approach allows for control over microvascular network self-assembly and employs an anastomotic interface for integration of self-assembled micro-vascular networks with fabricated microchannels. As a result, transport within the system shifts from simple diffusion to vessel supported convective transport and extra-vessel diffusion, thus improving overall mass transport properties. This work impacts the development of perfusable prevascularized tissues in vitro and ultimately tissue engineering applications in vivo.

Physiologic pulsatile flow bioreactor conditioning of poly(ethylene glycol)-based tissue engineered vascular grafts.

Mechanical conditioning represents a potential means to enhance the biochemical and biomechanical properties of tissue engineered vascular grafts (TEVGs). A pulsatile flow bioreactor was developed to allow shear and pulsatile stimulation of TEVGs. Physiological 120 mmHg/80 mmHg peak-to-trough pressure waveforms can be produced at both fetal and adult heart rates. Flow rates of 2 mL/sec, representative of flow through small diameter blood vessels, can be generated, resulting in a mean wall shear stress of approximately 6 dynes/cm(2) within the 3 mm ID constructs. When combined with non-thrombogenic poly(ethylene glycol) (PEG)-based hydrogels, which have tunable mechanical properties and tailorable biofunctionality, the bioreactor represents a flexible platform for exploring the impact of controlled biochemical and biomechanical stimuli on vascular graft cells. In the present study, the utility of this combined approach for improving TEVG outcome was investigated by encapsulating 10T-1/2 mouse smooth muscle progenitor cells within PEG-based hydrogels containing an adhesive ligand (RGDS) and a collagenase degradable sequence (LGPA). Constructs subjected to 7 weeks of biomechanical conditioning had significantly higher collagen levels and improved moduli relative to those grown under static conditions.

Synthesis and in vitro evaluation of enzymatically cross-linked elastin-like polypeptide gels for cartilaginous tissue repair.

Genetically engineered elastin-like polypeptide (ELP) hydrogels offer unique promise as scaffolds for cartilage tissue engineering because of the potential to promote chondrogenesis and to control mechanical properties. In this study, we designed and synthesized ELPs capable of undergoing enzyme-initiated gelation via tissue transglutaminase, with the ultimate goal of creating an injectable, in situ cross-linking scaffold to promote functional cartilage repair. Addition of the enzyme promoted ELP gel formation and chondrocyte encapsulation in a biocompatible process, which resulted in cartilage matrix synthesis in vitro and the potential to contribute to cartilage mechanical function in vivo. A significant increase in the accumulation of sulfated glycosaminoglycans was observed, and histological sections revealed the accumulation of a cartilaginous matrix rich in type II collagen and lacking in type I collagen, indicative of hyaline cartilage formation. These results provide evidence of chondrocytic phenotype maintenance for cells in the ELP hydrogels in vitro. In addition, the dynamic shear moduli of ELP hydrogels seeded with chondrocytes increased from 0.28 to 1.7 kPa during a 4-week culture period. This increase in the mechanical integrity of cross-linked ELP hydrogels suggests restructuring of the ELP matrix by deposition of functional cartilage extracellular matrix components.