Persistent left superior vena cava with partial anomalous venous return in a liver transplant patient.

Insertion of central venous catheters is commonly performed on critically ill patients. Successful placement requires knowledge of vascular anatomy, but vascular anomalies may pose difficulties during insertion and confirmation of catheter position. This report describes the incidental discovery of a persistent left superior vena cava emptying into a pulmonary vein with partial anomalous pulmonary venous return to the left innominate vein and ultimately into the right superior vena cava, after placement of a left internal jugular central line in a patient presenting for liver transplant. We discuss the clinical implications of persistent left superior vena cava and the steps we took to evaluate catheter position.

The inequitable distribution of tobacco outlet density: the role of income in two Black Mid-Atlantic geopolitical areas.

OBJECTIVES: Studies have shown that communities with higher concentrations of low-income racial and ethnic minorities correlate with a greater presence of tobacco outlets. Community-level income has consistently been among the strongest predictors of tobacco outlet density. This study analyzes two Maryland geopolitical areas with similar racial concentrations yet differing income levels in an attempt to disentangle the race-income relationship with tobacco outlet density. STUDY DESIGN: In this cross-sectional examination of tobacco outlet and census tract-level sociodemographic data, Baltimore City, Maryland, and Prince George's County, Maryland, were geocoded to determine tobacco outlet density. METHODS: Tobacco outlet density was defined as the mean number of tobacco outlets per 1000 persons per census tract. Comparisons of tobacco outlet density and sociodemographic variables were analysed via two-sample t-tests, and the direct effect of sociodemographic variables on tobacco outlet density for each area was analysed via spatial lag regressions. RESULTS: Prince George's County, the area with the higher income level ($77,190 vs $43,571), has a significantly lower tobacco outlet density than Baltimore City (P < 0.001). Prince George's County has a 67.5% Black population and an average of 3.94 tobacco outlets per 1000 persons per tract. By contrast, Baltimore City has a 65.3% Black population and an average of 7.95 tobacco outlets per 1000 persons per tract. Spatial lag regression model results indicate an inverse relationship between income and tobacco outlet density in Baltimore City and Prince George's County (ß = -0.03, P < 0.01 &ß = -0.01, P = 0.02, respectively), and a significant interaction term indicating a greater magnitude in the relationship between income and tobacco outlet density in Baltimore City (ß = -0.05, P < 0.01). CONCLUSION: Results suggest that higher socio-economic status, even in primarily underrepresented racial and ethnic geopolitical areas, is linked to lower tobacco outlet density.

Risk for exposure to alcohol, tobacco, and other drugs on the route to and from school: the role of alcohol outlets.

Despite the national push encouraging children to walk to school, little work has been done to examine what hazards children encounter on the route to school. This study examined the association between the presence of alcohol outlets on children's route to school and perceived safety on the route to school as well as exposure to alcohol, tobacco, and other drugs (ATOD). Data come from a community-based epidemiological study of 394 urban elementary school students. Participants' residential address, school location, and alcohol outlet data were geocoded and the route to school was mapped. The route to school layer and the geocoded alcohol outlet data were joined to determine the number of alcohol outlets children pass on the route to school. Logistic regression models estimated the association between the presence of alcohol outlets on the route to school, alcohol and drug exposure, and self-reported safety. Children with an alcohol outlet on the route to school were more likely to be offered ATOD (OR = 2.20, p = 0.02) as well as be exposed to drug selling (OR = 1.72, p = 0.02) and seeing people using drugs (OR = 1.93, p = 0.02). After adjusting for individual-level variables, the relationship between presence of alcohol outlets and being offered ATOD and seeing people using drugs remained significant. However, after adjusting for individual-level control variables and a proxy for the larger neighborhood context, the association between the presence of alcohol outlets and exposure to ATOD was no longer significant. As national campaigns are encouraging children to walk to school, it is essential to consider what children are exposed to on the route to school.

Metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy): an environmental assessment tool for measuring indicators of violence, alcohol, tobacco, and other drug exposures.

OBJECTIVES: Establish metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy). METHOD: A total of 919 residential block faces were assessed by paired raters using the NIfETy. Reliability was evaluated via interrater and internal consistency reliability; validity by comparing NIfETy data with youth self-reported violence, alcohol, and other drug exposure and crime statistics. RESULTS: Validity and reliability metrics were moderate to exemplary for the total scale and subscales. NIfETy data correlated strongly with crime data and youth self-reported exposure. CONCLUSIONS: The NIfETy is valid and reliable. Future investigations will explore its use in other urban centers and association to other health outcomes.