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Background Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an “Other” race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.Nongenetic, environmental factors contribute to maternal morbidity and mortality through chemical exposures via air, water, soil, food, and consumer products. Pregnancy represents a particularly sensitive window of susceptibility during which physiological changes to every major organ system increase sensitivity to chemicals that can impact a woman’s long-term health. Nonchemical stressors, such as low socioeconomic status, may exacerbate the effects of chemical exposures on maternal health. Racial/ethnic minorities are exposed disproportionately to both chemicals and nonchemical stressors, which likely contribute to the observed health disparities for maternal morbidities and mortality. Epidemiological studies linking exposures to adverse maternal health outcomes underscore the importance of environmental health impacts, and mechanistic studies in model systems reveal how chemicals perturb biological pathways and processes. Environmental stressors are associated with a variety of immediate maternal health impacts, including hypertensive disorders of pregnancy, fibroids, and infertility, as well as long-term maternal health impacts, such as higher risk of breast cancer and metabolic disorders. Identifying and reducing a pregnant woman’s environmental exposures is not only beneficial to her offspring but also important to preserve her short- and long-term health.Background Women Veterans using Veterans Affairs (VA) maternity care represent a high-risk population owing to the high prevalence of psychiatric disorders, such as depression, anxiety, and posttraumatic stress disorder (PTSD). Given the increased risk of symptom recurrence and/or medication discontinuation during pregnancy, the aim of this study was to understand the relationship between mental health and health care utilization in pregnant Veterans within the Veterans Health Administration (VHA). Materials and Methods Women with a confirmed pregnancy were recruited from 15 VA sites across the United States. Data sources included diagnosis codes, clinic stop codes for outpatient visits, and 30-day antidepressant prescriptions in the electronic health record. Results Overall, mental health visits increased slightly from prepregnancy to pregnancy before decreasing in the postpartum period. For women with a prepregnancy diagnosis of depression, anxiety, and/or PTSD, there was an increase in psychotherapy utilization during the pregnancy and postpartum periods, whereas the percentage of women utilizing antidepressants only or antidepressants plus therapy decreased during these same time periods. A small proportion of women with histories of mental health conditions did not utilize mental health care within the VA during pregnancy and postpartum. Conclusions These results inform our understanding of VA health care utilization patterns in pregnant Veterans, particularly those with a history of depression, PTSD, and/or anxiety. The strong utilization of VA mental health services during this time emphasizes the importance of optimizing the coordination of care between VA mental health providers and community-provided obstetric care to enhance outcomes for both mother and child.Background With the emergence of the 2019 novel coronavirus disease (COVID-19), appropriate training for emergency medical services (EMS) personnel on personal protective equipment (PPE) is essential. We aimed 1) to examine the change in proportions of EMS personnel reporting awareness of and training in PPE during the COVID-19 pandemic; and 2) to determine factors associated with reporting these outcomes. We conducted a cross-sectional analysis of data collected from October 1, 2019 to June 30, 2020 from currently working, nationally certified EMS personnel (n = 15,339), assessing N95 respirator fit testing; training in air purified respirators (APR) or powered APR (PAPR) use; and training on PPE use for chemical, biological, and nuclear (CBN) threats. WAY-309236-A We used an interrupted time series analysis to determine changes in proportions of EMS personnel reporting training per week, using the date of Centers for Disease Control and Prevention’s (CDC) initial EMS guidance (February 6, 2020) as the interruption. We fported in efforts to adequately prepare their staff.

The purpose of this study was to evaluate the tumor control probability (TCP), normal tissue complication probability (NTCP) and adaptive time management (ATM) in patients who had non-small cell lung cancer (NSCLC) and underwent radiotherapy with same gap length at different treatment weeks.

Twenty patients’ definitive radiotherapy treatments, completed in 6.5 weeks, were evaluated retrospectively. Three different scenarios with gaps in 5 fractions at different weeks of treatment (2nd, 4th, and 6th week) were planned. Three ATM models (biologically effective dose (C

), time-dose-fractionation (C

) and in-house developed (C

)) were calculated for each scenario. TCP and NTCP were calculated and compared with the dose-volume histogram (DVH) of each model.

TCP was accepted as 100% in uninterrupted treatments. When treatment was interrupted and not compensated with ATM, the highest TCP difference was determined as 23.46% in the 4th week (

<.001). Based on comparisons of ATM models, the lowest TCP decrease was found in C

.