Andrew Healy

Protected areas reduced poverty in Costa Rica and Thailand

As global efforts to protect ecosystems expand, the socioeconomic impact of protected areas on neighboring human communities continues to be a source of intense debate. The debate persists because previous studies do not directly measure socioeconomic outcomes and do not use appropriate comparison groups to account for potential confounders. We illustrate an approach using comprehensive national datasets and quasi-experimental matching methods. We estimate impacts of protected area systems on poverty in Costa Rica and Thailand and find that although communities near protected areas are indeed substantially poorer than national averages, an analysis based on comparison with appropriate controls does not support the hypothesis that these differences can be attributed to protected areas. In contrast, the results indicate that the net impact of ecosystem protection was to alleviate poverty.

Irrelevant events affect voters' evaluations of government performance

Does information irrelevant to government performance affect voting behavior? If so, how does this help us understand the mechanisms underlying voters’ retrospective assessments of candidates’ performance in office? To precisely test for the effects of irrelevant information, we explore the electoral impact of local college football games just before an election, irrelevant events that government has nothing to do with and for which no government response would be expected. We find that a win in the 10 d before Election Day causes the incumbent to receive an additional 1.61 percentage points of the vote in Senate, gubernatorial, and presidential elections, with the effect being larger for teams with stronger fan support. In addition to conducting placebo tests based on postelection games, we demonstrate these effects by using the betting markets estimate of a teams probability of winning the game before it occurs to isolate the surprise component of game outcomes. We corroborate these aggregate-level results with a survey that we conducted during the 2009 NCAA mens college basketball tournament, where we find that surprising wins and losses affect presidential approval. An experiment embedded within the survey also indicates that personal well-being may influence voting decisions on a subconscious level. We find that making people more aware of the reasons for their current state of mind reduces the effect that irrelevant events have on their opinions. These findings underscore the subtle power of irrelevant events in shaping important real-world decisions and suggest ways in which decision making can be improved.

Early access to prenatal care: implications for racial disparity in perinatal mortality.

OBJECTIVE: To investigate racial disparities in perinatal mortality in women with early access to prenatal care. METHODS: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals. RESULTS: The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5–4.9), Hispanic 1.5 (1.2–2.1), and other 1.9 (1.3–2.8). CONCLUSION: Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care. LEVEL OF EVIDENCE: II-2

Accuracy of fetal fibronectin to predict preterm birth in twin gestations with symptoms of labor.

OBJECTIVE: To investigate accuracy of fetal fibronectin testing to predict preterm birth in twin gestations with symptoms of preterm labor. METHODS: We reviewed charts of all patients with twin gestations who underwent fetal fibronectin testing and presented with complaints of preterm labor between January 1, 2000, and June 30, 2004. We also reviewed the charts of all singleton gestations with similar complaints that had fetal fibronectin testing between January 1, 2000, and December 31, 2001. All samples were processed using a rapid fetal fibronectin detection system. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of fetal fibronectin testing in singleton and twin gestations in predicting delivery within 14 days of testing. RESULTS: Four hundred twenty-nine singletons and 87 twins met the inclusion criteria. The birth rate before 34 weeks of gestation for singletons was 3.5% compared with the rate of twin pregnancies of 28.7%. Fetal fibronectin predicted delivery within 14 days of testing with a sensitivity, specificity, and positive and negative predictive values in singleton gestations of 82%, 90%, 17%, and 99%, respectively. In twin gestations, fetal fibronectin predicted delivery within 14 days of testing with a sensitivity, specificity, and positive and negative predictive values of 71%, 74%, 19%, and 97%, respectively. CONCLUSION: As noted in singleton pregnancies, fetal fibronectin testing in twins has a high negative predictive value. Fetal fibronectin evaluation may be a useful tool in screening twins with symptoms of preterm labor, because a negative result places these women at a low risk for delivering within 2 weeks of testing. LEVEL OF EVIDENCE: II

The use of high-frequency oscillatory ventilation in a patient with H1N1 pneumonia

A 32-year-old multigravida was admitted at 33.9 weeks with respiratory distress. Community-acquired pneumonia was suspected and antimicrobial treatment initiated with ceftriaxone sodium and azithromycin. However, despite these therapies her respiratory status deteriorated. She was subsequently diagnosed with Swine-origin Influenza A (H1N1) Virus pneumonia and treated with oseltamivir. After failing conventional ventilation, high-frequency oscillatory ventilation (HFOV) was utilized. In pregnant patients who fail to respond to conventional ventilation techniques, HFOV should be considered.

A pilot longitudinal study of anti‐Müllerian hormone levels throughout gestation in low risk pregnancy

Anti‐Mϋllerian hormone (AMH) plays an important role regulating ovarian sensitivity to follicle‐stimulating hormone and luteinizing hormone in folliculogenesis. Anti‐Mϋllerian hormone is well established as a biomarker of ovarian reserve but may also have utility in predicting pregnancy outcomes. Few studies have described AMH levels in pregnancy and, among those that have, most have used cross‐sectional study designs and are limited to participants seeking fertility treatment. Our aim was to analyze AMH longitudinally in low‐risk pregnancies.

Longitudinal Patterns of Inflammatory Cytokines Across Normal Gestation [24L]

INTRODUCTION: Dysregulation of inflammation is suspected as a cause of adverse pregnancy outcomes; however, limited data exists describing inflammatory cytokines during the course of uncomplicated pregnancies. Our objectives were to assess longitudinal patterns and associated variability of suspected inflammatory cytokines throughout a normal pregnancy. METHODS: We recruited 30 women with low risk pregnancies prior to 14 weeks gestational age at a large teaching hospital. Plasma levels of nine cytokines (GCSF, IFNg, TNFa, TGFb, IL1b, IL6, IL8, IL10, and IL23) were monitored in samples collected at five prenatal visits, at mean GAs of 11, 17, 25, 31, and 36 weeks. The longitudinal patterns of cytokines were analyzed using repeated measures ANOVA, and intraclass correlation coefficients were estimated using assessments of variation among women (between subject) and during pregnancy (within subject). RESULTS: Mean levels were significantly different between visits for IL6 (P<.01), IL8 (P=.04), GCSF (P<.01) and TGFb (P=.02) and displayed distinct patterns with levels increasing throughout pregnancy. ICC estimates ranged from 0.27 (for TGFb) to 0.74 (for IL23), indicating substantial and statistically significant intra-pregnancy variability when compared to the inter-pregnancy variability of cytokines Il1b, IL6, IL8, IL10, IFNg, and TGFb. CONCLUSION: Levels of specific inflammatory cytokines vary throughout the course of a normal pregnancy and have distinct patterns. Along with the significant within-person variability of cytokines in pregnancy, these findings suggest the importance of longitudinal risk assessment to reflect trajectories and address random variability. Further studies are needed to assess the significance of longitudinal cytokines in pregnancies complicated by preterm birth.