The Implications of Socioeconomic Status by ZIP Code on Maternal-Fetal Morbidity and Mortality in San Antonio, Texas.

Introduction Over the past 20 years, the number of pregnancy-related fatalities in the United States has been on the rise. Increases in maternal and fetal mortality have been attributed to low socioeconomic status (SES). This raises the question of whether all geographical locations are proportionally affected by this upward trend in pregnancy-related fatalities. San Antonio is one of the largest cities in the United States and is known for its economic segregation. This study aims to compare the maternal and fetal health outcomes of mothers from diverse socioeconomic backgrounds in San Antonio, Texas. Methods To analyze the relationship between pregnancy-related mortality rates and SES in San Antonio, Texas, the International Classification of Diseases (ICD)-10 codes for maternal and fetal demise and their associated risk factors were identified. The ICD-10 codes were used to compare the health outcomes of pregnant women from the highest SES ZIP Code (78255, median income $124,397) to women from the lowest SES ZIP Code (78207, median income $25,415) using the Texas Inpatient Public Use Data File for 2016, which contains information on 93-97% of all hospital discharges in San Antonio, Texas. Results Notably, pregnant women from the high SES ZIP Code were admitted to the hospital from clinics or a physician's office (68.8%), while pregnant women from the low SES ZIP Code were admitted to the hospital from non-healthcare facilities like home or workplace (62.5%). In addition, a greater percentage of patients from the low SES ZIP Code were Black (4.3% vs 1.3%) or Hispanic (88.5% vs 35.1%). Compared to women from the high SES ZIP Code, women from the low SES ZIP Code experienced more fetal deaths and a higher prevalence of maternal and fetal risk factors such as obesity (47.6% vs 32.5%), asthma (1.7% vs 1.3%), hypertension (0.8% vs 0%), substance abuse (0.5% vs 0%), diabetes mellitus (9.8% vs 7.8%), preeclampsia (7.7% vs 2.6%), and multiple C-sections (35.5% vs 28.6%). Finally, fetal mortality rates were higher in the low SES ZIP Code (1.1% vs 0%). Although there were no statistically significant maternal or fetal mortality differences between the ZIP Codes, the trend suggests that women's health outcomes in San Antonio are not equitable. Discussion Analysis reveals disproportionate health outcomes for women in south San Antonio. Further investigation is warranted to better understand the role social and medical factors play in these results. Investigating the relationship between SES and pregnancy-related mortality can help to better inform healthcare providers and identify ways to improve women's health outcomes in San Antonio, Texas.

Suitability of containerized toxicant to control Solenopsis invicta (Hymenoptera: Formicidae) threatening cave species in Bexar County, Texas.

Several protected troglobitic invertebrate species are known to occur in caves on Joint Base San Antonio-Camp Bullis, Bexar County, Texas, United States. The United States Fish and Wildlife Service (USFWS) identified red-imported fire ant Solenopsis invicta (hereafter RIFA) (Buren 1972) as the primary threat to cave species' nutrient sources, cave crickets, Ceuthophilus secretus (Scudder 1894). Per the service's recommendations, Joint Base San Antonio-Camp Bullis currently implements boiling water mound injections with digging for RIFA control. However, treatment effectiveness is highly variable and largely dependent on the time of day, weather, and personnel diligence. Toxicants have been used for RIFA treatment throughout the world, but concerns exist that traditional applications of toxicant bait around caves might be accessible and inadvertently affect nontarget arthropods, including cricket populations. To mitigate this accessibility, physically limiting access to the toxicant from crickets may be an option. Our objectives were to (i) compare and evaluate the effectiveness of Amdro (Hydramethylnon) and Advion (Indoxacarb) granular baits housed in Ants-No-More Bait Stations (Kness MFG. Inc., Albia, IA) and (ii) evaluate the distance of effectiveness of each bait within a bait station. Ultimately, we observed a 98% reduction in RIFA mound abundance from both baits. Additionally, RIFA mounds within 10 m of the containerized toxicant were reduced by 70%. Our pilot study suggested that Ants-No-More Bait Stations are an effective way to reduce RIFA mounds by 70% if placed 10 m from each other. In practice, this could include bait stations completely covering a particular distance to a cave entrance or fewer bait stations in a ring barrier at a single radial distance to a cave entrance. Containerized toxicants may be a cost-effective and safe RIFA control option around protected cave environments, but further studies are needed to determine potential effects on nontarget arthropods, optimal bait station configuration, and potential effects of biomagnification.

Impacts of anthropogenic emissions and meteorology on spring ozone differences in San Antonio, Texas between 2017 and 2021.

San Antonio has been designated as ozone nonattainment under the current National Ambient Air Quality Standards (NAAQS). Ozone events in the city typically occur in two peaks, characterized by a pronounced spring peak followed by a late summer peak. Despite higher ozone levels, the spring peak has received less attention than the summer peak. To address this research gap, we used the Weather Research and Forecasting (WRF)-driven GEOS-Chem (WRF-GC) model to simulate San Antonio's ozone changes in the spring month of May from 2017 to 2021 and quantified the respective contributions from changes in anthropogenic emissions and meteorology. In addition to modeling, observations from the San Antonio Field Studies (SAFS), the Texas Commission on Environmental Quality (TCEQ) Continuous Ambient Monitoring Stations (CAMS), and the spaceborne TROPOspheric Monitoring Instrument (TROPOMI) are used to examine and validate changes in ozone and precursors. Results show that the simulated daytime mean surface ozone in May 2021 is 3.8 ± 0.6 ppbv lower than in May 2017, which is slightly less than the observed average differences of -5.3 ppbv at CAMS sites. The model predicted that the anthropogenic emission-induced changes contribute to a 1.4 ± 0.5 ppbv reduction in daytime ozone levels, while the meteorology-induced changes account for a 2.4 ± 0.6 ppbv reduction over 2017-2021. This suggests that meteorology plays a relatively more important role than anthropogenic emissions in explaining the spring ozone differences between the two years. We additionally identified (1) reduced NO2 and HCHO concentrations as chemical reasons, and (2) lower temperature, higher humidity, increased wind speed, and a stronger Bermuda High as meteorological reasons for lower ozone levels in 2021 compared to 2017. The quantification of the different roles of meteorology and ozone precursor concentrations helps understand the cause and variation of ozone changes in San Antonio over recent years.

Lipidomic profiling in the Strong Heart Study identified American Indians at risk of chronic kidney disease.

Dyslipidemia associates with and usually precedes the onset of chronic kidney disease (CKD), but a comprehensive assessment of molecular lipid species associated with risk of CKD is lacking. Here, we sought to identify fasting plasma lipids associated with risk of CKD among American Indians in the Strong Heart Family Study, a large-scale community-dwelling of individuals, followed by replication in Mexican Americans from the San Antonio Family Heart Study and Caucasians from the Australian Diabetes, Obesity and Lifestyle Study. We also performed repeated measurement analysis to examine the temporal relationship between the change in the lipidome and change in kidney function between baseline and follow-up of about five years apart. Network analysis was conducted to identify differential lipid classes associated with risk of CKD. In the discovery cohort, we found that higher baseline level of multiple lipid species, including glycerophospholipids, glycerolipids and sphingolipids, was significantly associated with increased risk of CKD, independent of age, sex, body mass index, diabetes and hypertension. Many lipid species were replicated in at least one external cohort at the individual lipid species and/or the class level. Longitudinal change in the plasma lipidome was significantly associated with change in the estimated glomerular filtration rate after adjusting for covariates, baseline lipids and the baseline rate. Network analysis identified distinct lipidomic signatures differentiating high from low-risk groups. Thus, our results demonstrated that disturbed lipid metabolism precedes the onset of CKD. These findings shed light on the mechanisms linking dyslipidemia to CKD and provide potential novel biomarkers for identifying individuals with early impaired kidney function at preclinical stages.

Traffic, transport, and vegetation drive VOC concentrations in a major urban area in Texas.

The population of Texas has increased rapidly in the past decade. The San Antonio Field Study (SAFS) was designed to investigate ozone (O3) production and precursors in this rapidly changing, sprawling metropolitan area. There are still many questions regarding the sources and chemistry of volatile organic compounds (VOCs) in urban areas like San Antonio which are affected by a complex mixture of industry, traffic, biogenic sources and transported pollutants. The goal of the SAFS campaign in May 2017 was to measure inorganic trace gases, VOCs, methane (CH4), and ethane (C2H6). The SAFS field design included two sites to better assess air quality across the metro area: an urban site (Traveler's World; TW) and a downwind/suburban site (University of Texas at San Antonio; UTSA). The results indicated that acetone (2.52 ± 1.17 and 2.39 ± 1.27 ppbv), acetaldehyde (1.45 ± 1.02 and 0.93 ± 0.45 ppbv) and isoprene (0.64 ± 0.49 and 1.21 ± 0.85 ppbv; TW and UTSA, respectively) were the VOCs with the highest concentrations. Additionally, positive matrix factorization showed three dominant factors of VOC emissions: biogenic, aged urban mixed source, and acetone. Methyl vinyl ketone and methacrolein (MVK + MACR) exhibited contributions from both secondary photooxidation of isoprene and direct emissions from traffic. The C2H6:CH4 demonstrated potential influence of oil and gas activities in San Antonio. Moreover, the high O3 days during the campaign were in the NOx-limited O3 formation regime and were preceded by evening peaks in select VOCs, NOx and CO. Overall, quantification of the concentration and trends of VOCs and trace gases in a major city in Texas offers vital information for general air quality management and supports strategies for reducing O3 pollution. The SAFS campaign VOC results will also add to the growing body of literature on urban sources and concentrations of VOCs in major urban areas.

Growth estimates of young-of-the-year broadnose sevengill shark, Notorynchus cepedianus, a top predator with poorly calcified vertebrae.

The broadnose sevengill shark, Notorynchus cepedianus (Péron, 1807), is a large marine top predator in temperate coastal ecosystems. Some aspects of its life history have been determined, but its growth pattern is yet to be fully understood. The authors used a multi-modelling approach and a sensitivity test to estimate growth parameters from young-of-year (YOY) length data collected off San Antonio Cape (SAC), Argentina, a critical habitat in the Southwest Atlantic Coastal Zone (SACZ). The best selected model, a sex-combined logistic growth model, estimated an asymptotic length (L∞ ) of 92.58 cm TL (95% C.I.: 86.48-105.89 cm), a growth coefficient (K) of 0.006818 days -1 (95% C.I.: 0.004948-0.008777) and a size at birth (L0 ) of 40.73 cm. The predicted annual growth (i.e., L1 - L0 ) was 43.2 cm TL. Males had smaller L0 , higher K and achieved larger sizes after 1 year. The YOY in SAC attained a larger L1 and grew faster than their Australian and South African wild counterparts. The consistent year-round presence of YOY in the SAC highlights the importance of this area as a pupping ground and potential nursery for N. cepedianus; this has direct implications for the allocation of research and management effort for the conservation of this species in the Southwest Atlantic.

SABCS 2020: update on triple-negative and metastatic HER2-positive breast cancer.

One year into the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, the 2020 San Antonio Breast Cancer Symposium (SABCS) was another large congress held in a virtual format. Despite these circumstances, clinically relevant data were presented, and this short review focuses on developments in the fields of triple-negative breast cancer (TNBC) and metastatic HER2-positive breast cancer. A quality-of-life (QoL) analysis from IMPassion031 showed that adding atezolizumab to neoadjuvant chemotherapy was not associated with a detrimental effect on QoL, while the burden of treatment-induced side effects increased with each cycle of neoadjuvant therapy in both treatment arms. KEYNOTE-355 evaluated the addition of pembrolizumab to chemotherapy as first-line treatment in metastatic TNBC (mTNBC); a significant improvement of progression-free survival (PFS) was reported in the pembrolizumab arm. At the 2020 SABCS, results with respect to different chemotherapy backbones were reported and the benefit of pembrolizumab was maintained irrespective of the type of taxane. Disappointingly, the phase III IPATunity130 study could not confirm a PFS improvement with the AKT inhibitor ipatasertib when added to paclitaxel as first-line treatment in mTNBC. A biomarker analysis from the phase III ASCENT study showed that the antibody-drug conjugate sacituzumab govitecan was superior to chemotherapy by investigator's choice independent of Trop­2 expression and BRCA mutation status. In HER2-positive breast cancer, the PRECIOUS trial suggested a small albeit significant benefit with reinduction of pertuzumab in later treatment lines in patients progressing on prior dual HER2-blockade in the first- or second-line setting. The HER2-specific tyrosine kinase inhibitor tucatinib when added to trastuzumab and capecitabine was shown to improve PFS and overall survival (OS) over trastuzumab and capecitabine alone in pretreated patients in the randomized HER2CLIMB trial; this benefit was apparently independent of hormone-receptor expression. An update from the DESTINY-Breast01 trial reported a median PFS of 19.4 months with trastuzumab deruxtecan in heavily pretreated patients. Finally, an analysis from the PERTAIN trial with > 6 years median follow-up showed excellent OS in patients with luminal B/HER2-positive receiving first-line trastuzumab/pertuzumab in combination with endocrine therapy suggesting that chemotherapy-free treatment is an option in highly selected patients.

Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has had profound and differential impacts on metropolitan areas across the United States and around the world. Within the United States, metropolitan areas that were hit earliest with the pandemic and reacted with scientifically based health policy were able to contain the virus by late spring. For other areas that kept businesses open, the first wave in the United States hit in mid-summer. As the weather turns colder, universities resume classes, and people tire of lockdowns, a second wave is ascending in both metropolitan and rural areas. It becomes more obvious that additional SARS-CoV-2 surveillance is needed at the local level to track recent shifts in the pandemic, rates of increase, and persistence. OBJECTIVE: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk and persistence, and weekly shifts, to better understand and manage risk in metropolitan areas. Existing surveillance measures coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until, and after, an effective vaccine is developed. Here, we provide values for novel indicators to measure COVID-19 transmission at the metropolitan area level. METHODS: Using a longitudinal trend analysis study design, we extracted 260 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in the 25 largest US metropolitan areas as a function of the prior number of cases and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Minneapolis and Chicago have the greatest average number of daily new positive results per standardized 100,000 population (which we refer to as speed). Extreme behavior in Minneapolis showed an increase in speed from 17 to 30 (67%) in 1 week. The jerk and acceleration calculated for these areas also showed extreme behavior. The dynamic panel data model shows that Minneapolis, Chicago, and Detroit have the largest persistence effects, meaning that new cases pertaining to a specific week are statistically attributable to new cases from the prior week. CONCLUSIONS: Three of the metropolitan areas with historically early and harsh winters have the highest persistence effects out of the top 25 most populous metropolitan areas in the United States at the beginning of their cold weather season. With these persistence effects, and with indoor activities becoming more popular as the weather gets colder, stringent COVID-19 regulations will be more important than ever to flatten the second wave of the pandemic. As colder weather grips more of the nation, southern metropolitan areas may also see large spikes in the number of cases.

A comparison of digital subtraction angiography and computed tomography angiography for the diagnosis of penetrating cerebrovascular injury.

OBJECTIVE: Penetrating cerebrovascular injury (PCVI) is a subset of traumatic brain injury (TBI) comprising a broad spectrum of cerebrovascular pathology, including traumatic pseudoaneurysms, direct arterial injury, venous sinus stenosis or occlusion, and traumatic dural arteriovenous fistulas. These can result in immediate or delayed vascular injury and consequent neurological morbidity. Current TBI guidelines recommend cerebrovascular imaging for detection, but there is no consensus on the optimum modality. The aim of this retrospective cohort study was to compare CT angiography (CTA) and digital subtraction angiography (DSA) for the diagnosis of PCVI. METHODS: The records of all patients presenting to two level I trauma centers in the United States between January 2010 and July 2016 with penetrating head or neck trauma were reviewed. Only those who had undergone both CTA and DSA were included. Clinical and neuroimaging data were collected, and PCVIs were stratified using a modified Biffl grading scheme. DSA and CTA results were then compared. RESULTS: Of 312 patients with penetrating trauma over the study period, 56 patients (91% male, mean age 32 years) with PCVI met inclusion criteria and constituted the study cohort. The mechanism of injury was a gunshot wound in 86% (48/56) of patients. Twenty-four (43%) patients had sustained an angiographically confirmed arterial or venous injury. Compared with DSA as the gold standard, CTA had a sensitivity and specificity of 72% and 63%, respectively, for identifying PCVI. CTA had a positive predictive value of 61% and negative predictive value of 70%. Seven patients (13%) required immediate endovascular treatment of PCVI; in 3 (43%) of these patients, the injury was not identified on CTA. Twenty-two patients (39%) underwent delayed DSA an average of 25 days after injury; 2 (9%) of these patients were found to harbor new pathological conditions requiring treatment. CONCLUSIONS: In this retrospective analysis of PCVI at two large trauma centers, CTA demonstrated low sensitivity, specificity, and positive and negative predictive values for the diagnosis of PCVI. These findings suggest that DSA provides better accuracy than CTA in the diagnosis of both immediate and delayed PCVI and should be considered for patients experiencing penetrating head or neck trauma.

Leptonotus vincentae, a new pipefish species (Syngnathidae: Syngnathinae) from the south-west Atlantic Ocean near northern Patagonia.

A new species of pipefish Leptonotus vincentae sp. nov. (Syngnathidae) is described on the basis of 12 specimens found in shallow waters (<2 m depth) of San Antonio Bay, Patagonia, Argentina, in the south-west Atlantic Ocean. The species is distinguished from congeners by the combination of: dorsal-fin rays 30-33, pectoral-fin rays 12-13, trunk rings 18-19, tail rings 43-46, subdorsal rings (2-4) + (5.5-8) = (8.5-10), head length 13-14% standard length, snout length 35-55% head length and snout depth 21-30% in snout length. Although this species has often been mistaken for Leptonotus blainvilleanus, most diagnostic characters of the two species differ. Both species are clearly distinguished by their snout length. L. blainvilleanus has a relatively longer snout than L. vincentae sp. nov. The new species is similar to a south-west Pacific species, Leptonotus elevatus. However, L. vincentae sp. nov. differs from this species in that it exhibits a lower number of dorsal-fin rays and a relatively longer head.

Geospatial Analysis of Refugee Access to Primary Care Physicians in San Antonio, Texas.

This study investigated refugee access to primary care physicians (PCP) in San Antonio, Texas. Catholic Charities of San Antonio (CCSA) is the primary agency responsible for connecting refugees to a PCP. Data on refugees were collected from CCSA between May to September 2013 (N = 547). PCPs information was accessed at the Texas Medicaid and Healthcare Partnership (TMHP) website. The 2SFCA method was used in geographic information systems (GIS) to analyze the ratio of healthcare providers relative to refugees within varying walking distances. The highest concentration of accessibility was at 20 min distance in the Medical Center area. The highest concentration of accessibility at all walking distances were also in the Medical Center area. The univariate and multivariate analyses did not result in significant findings for the association between demographic variables and the accessibility scores. These findings recommend building new and more relationships with healthcare providers where PCPs access is low.

Metal biomonitoring in a Patagonian salt marsh.

Patagonian salt marshes are not affected by pollution, but historical mining wastes are a continuous source of metals to salt marsh in San Antonio Bay. The present study evaluated the concentration of metals in sediments and used the halophyte Spartina spp. and the crab N. granulata as biomonitors. The levels of metals in sediment and organisms in SAB remained at levels corresponding to a slight enrichment or contamination. The highest levels corresponded to innermost sites of the Encerrado channel and close to the mining wastes. Spartina is a phytostabilizer so its aboveground tissues do not reflect the concentrations in the sediment; although, it retains the metals in its belowground tissues and in the rhizosediment. N. granulata showed to be a useful biomonitor for Pb, but not for the other metals.

SABCS 2017: update on chemotherapy, targeted therapy, and immunotherapy.

In the areas of chemotherapy, targeted therapy and immunotherapy, several interesting and clinically relevant data were presented at the 2017 San Antonio Breast Cancer Symposium (SABCS). This short review focuses on dose-dense and/or sequential administration of adjuvant chemotherapy, provides an update on targeted therapies for HER2-positive and triple-negative breast cancer and summarizes new results in the field of immunotherapy.

SABCS 2017: lifestyle factors, hormone receptor-positive advanced disease, liquid biopsies, and prognosis.

This article reviews the clinically most relevant presentations at the San Antonio Breast Cancer Symposium (SABCS) 2017 on the topics lifestyle factors, hormone receptor-positive advanced disease, liquid biopsies, and prognosis. In a retrospective analysis of the Women's Health Initiative Observational Study, a reduction in the body mass index (BMI) of at least 5% within 3 years significantly reduced the risk of breast cancer compared to women with a stable weight (HR 0.77; 95% CI 0.78-0.98). In the MONALEESA-7 trial investigating ribociclib or placebo in combination with endocrine therapy as first-line treatment in pre- and perimenopausal women with hormone receptor-positive, human epidermal growth factor 2 (HER2)-negative metastatic breast cancer, a significantly longer progression-free survival was shown for patients treated with ribociclib compared to the placebo group (23.8 vs. 13.0 months; HR 0.55; 95% CI 0.43-0.72; P < 0.001). In a pooled toxicity and efficacy analysis of elderly women treated with a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor in combination with an aromatase inhibitor in first-line, toxicities of higher grade were more common in elderly compared to younger patients, despite comparable efficacy. And the Clinical Treatment Score post-5 years (CTS5), accurately estimated the risk of late recurrence after 5 years of adjuvant endocrine treatment using routinely available clinical parameters.