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Background: The new media provides a convenient platform to access, use and exchange health information. And as a special group of health care, maternal health care is still of international concern due to their high mortality rate. Scientific research is a good way to provide advice on how to improve maternal health through stringent reasoning and accurate data. However, the dramatic increase of publications, the diversity of themes, and the dispersion of researchers may reduce the quality of information and increase the difficulty of selection. Thus, this study aims to analyze the research progress on maternal health under the global new media environment, exploring the current research hotspots and frontiers. Methods: A scientometric analysis was carried out by CiteSpace5.7.R1. In total, 2270 articles have been further analyzed to explore top countries and institutions, potential articles, research frontiers, and hotspots. Results: The publications ascended markedly, from 29 in 2008 to 472 publications by 2020. But there is still a lot of room to grow, and the growth rate does not conform to the Price’s Law. Research centers concentrated in Latin America, such as the University of Toronto and the University of California. The work of Larsson M, Lagan BM and Tiedje L had high potential influence. Most of the research subjects were maternal and newborn babies, and the research frontiers were distributed in health education and psychological problems. Maternal mental health, nutrition, weight, production technology, and equipment were seemingly hotspots. Conclusion: The new media has almost brought a new era for maternal health, mainly characterized by psychological qualities, healthy and reasonable physical conditions and advanced technology.

To improve the visible-light photocatalytic activity and photo-carriers separation of BiVO4, highly efficient Z-scheme structured visible-light photocatalyst Ag@AgBr/BiVO4/Co3O4 was constructed by selective doping of Ag@AgBr and Co3O4 on {010} and {110} facets of BiVO4. Due to the different energy levels of conduction band (CB) and valence band (VB) between {010} facet and {110} facet, BiVO4 could act as the ‘pre-separation channel’ to achieve spatial charge separation. Such pre-separation channel effect improved photo-electrons transfer from BiVO4{010} facets to electron mediator (Ag°) for subsequent recombination with holes of AgBr. Thus, the photo-induced electrons of AgBr could be accumulated on CB for reduction of O2 to O2−. On the other hand, holes of BiVO4 accumulated on {110} facets were captured by deriving-hole-type co-catalysts Co3O4 for organics oxidation. In addition, Ag° not only served as the electron mediator of Z-scheme but also improve the visible-light utilization due to SPR-effect. Being attributed to the synergistic effect of pre-separation channel and deriving-hole-type co-catalysts, Z-scheme structured Ag@AgBr/BiVO4/Co3O4(0.15 wt%) achieved high photodegradation rate of organics. Even after 9th cycles, Ag@AgBr/BiVO4/Co3O4(0.15 wt%) could still photodegraded more than 90% of OTC within 24 min. DRS, PL and photoelectrochemical analyses also confirmed the improvement of visible-light utilization and charge separation of Ag@AgBr/BiVO4/Co3O4. The radical trapping experiments and EPR demonstrated that both superoxide radical ( O2−) and holes (h+) were main active species for organics photodegradation. In summary, this work not only constructed a highly efficient Z-scheme structured visible-light photocatalyst, but also provided a new method to diminish the photo-carriers recombination by pre-separation channel and hole-sink effects.

Yali Du,1 Yuzhou Huang,1 Wenzhe Zhou,1 Xinjian Liu,2 Fangfei Chen,1 Chen Yang,1 Miao Chen,1 Jing Ruan,1 Bing Han1 1Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People’s Republic of China; 2Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Institute of Hematology of Henan Province, Zhengzhou, People’s Republic of ChinaCorrespondence: Bing HanDepartment of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People’s Republic of ChinaEmail hanbing_li@sina.com.cnBackground: For symptomatic non-severe aplastic anemia (NSAA) patients who cannot afford anti-thymocyte globulin (ATG) or allogeneic hematopoietic stem cell transplantation (HSCT), tacrolimus (FK) may be an option if these patients do not respond or become tolerant to cyclosporine A (CsA).Methods: We enrolled 101 NSAA patients who were refractory or intolerant to CsA with no chance of HSCT or ATG treatment and treated these patients with tacrolimus for at least 6 months, with follow-up for at least one year.Results: The overall response rate (ORR) was 38.6% (complete response: 9.9%; partial response: 28.7%), and the median time to optimal response was 6 (3～10) months. Thirty-two (31.7%) cases had elevated creatinine levels. Eight (7.9%) cases had elevations in AST/ALT. A total of 25.6% (10/39) of patients relapsed at the end of follow-up. Age (P=0.0005), FK concentration (4.0∼ 12 ng/mL, P=0.0005) and intolerance to CsA (P=0.012) were the independent risk factors for ORR. Treg cell levels pre-FK treatment were much lower than those of healthy controls (3.7± 0.6% vs 6.8± 0.7%, P=0.0004) but increased significantly after FK treatment (3.7± 0.6% vs 7.1± 0.8%, P=0.0039).Conclusion: Our data suggest that tacrolimus is a salvage treatment for patients with NSAA that is refractory or intolerant to CsA.Keywords: non-severe aplastic anemia, tacrolimus, cyclosporine A

The standard therapies for autoimmune cytopenias, including idiopathic thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA) and Evans syndrome (ES), are corticosteroids and intravenous immunoglobulin G. However, the recurrence rate is high.Data from 80 patients with ITP, AIHA and ES who were refractory to corticosteroids/relapsed and were treated with tacrolimus from January 2018 to January 2019 in Peking Union Medical Colleague Hospital were reviewed retrospectively.There were 24 males and 56 females, with a median age of 43 (14-81) years, including 66 with ITP, 11 with AIHA and 3 with ES. The median disease duration before tacrolimus was 16 (2-432) months. The complete response (CR) rates were 30.3%, 63.6% and 0%; the overall response (OR) rates were 63.6%, 72.7% and 66.7% for ITP, AIHA and ES, respectively; and the median time to response was 3 (2-10) months. In a median of 18 (10-24) months of follow-up time, 21.4% of ITP patients relapsed at a median time of 7 months. No relapse was found for patients with AIHA and ES. Side effects occurred in 16.3% of patients, including elevated creatinine (Tacrolimus can achieve a durable response with mild side effects in patients with steroid-refractory/relapsed autoimmune cytopenias. Patients with younger age had a better response.

Background: For the symptomatic non-severe aplastic anemia (NSAA) patients who cannot afford anti-thymocyte globulin (ATG) or allogeneic hematopoietic stem cell transplantation (HSCT), tacrolimus (FK) was occasionally reported to be an option if they were not response or tolerant to the cyclosporine A (CsA). Method: We collected and analyzed respectively 101 NSAA patients refractory or intolerant to CsA with no chance of HSCT or ATG, and treated them with tacrolimus for at least 6 months and followed up for at least one year. Results: The overall response (ORR) was 38.6% (complete response: 9.9%; partial response: 28.7%) and the median time to optimal response was 6 (3～10) months. 32 (31.7%) cases had elevated creatinine level. 8 (7.9%) cases had elevation of AST/ALT. 25.6% (10/39) of patients relapsed at the end of follow-up. Age (P=0.0005), FK concentration (4.0~12ng/ml, P=0.0005) and intolerance to CsA (P=0.012) were the independent risk factors for ORR. Treg cells level pre-FK treatment was much lower than healthy controls (3.7±0.6% vs 6.8±0.7%, P=0.0004), but increased significantly after FK treatment (3.7±0.6% vs. 7.1±0.8%, P=0.0039). Conclusion: Our data provide a possibility of tacrolimus as a salvage treatment for patients with NSAA refractory or intolerant to CsA.

Although photocatalytic reduction of nitrate attracted much attention recently, undesired intermediate products (nitrite and ammonium) limited its application in practice. In this study, novel Pd/GdCrO3 composite was successfully synthesized to photo-catalytically reduce nitrate to N2 with high selectivity. Compared with TiO2 (P25), GdCrO3, Ag/GdCrO3 and Cu/GdCrO3, 1 wt% Pd/GdCrO3 achieved higher removal rate of nitrate (98.7%) and selectivity to N2 (100%). The kinetics constant of 1 wt% Pd/GdCrO3 was two times higher than that of P25. Even after six cycling runs, 1 wt% Pd/GdCrO3 still remained high photocatalytic reduction rate of nitrate (95.5%) and selectivity to N2 (98.4%). Such advantages were not only attributed to the negative conduction band value of GdCrO3 but also attributed to the co-catalyst effect of Pd. On one hand, nano particles Pd improved the utilization of charge carriers of GdCrO3. On the other hand, nitrite was easily reduced to NO* on nano particles Pd surface, followed by decomposition step to N* and O*, and then the reduction of nitrite in the vicinity of the N* could yield N2O* which would be preferentially transformed into N2. Accordingly, high concentration of nitrite accumulated initially could enhance the likelihood of N* encountering nitrite so as to increasing the N2 selectivity. In addition, electron paramagnetic resonance and hole scavenger experiments demonstrated that both photo-generated electrons and CO2 − played important role in photocatalytic reduction process, suggesting a different mechanism from P25 where nitrate was mainly reduced by CO2 −. Thus, the present work not only prepared a promising photocatalyst for reduction of nitrate in water/wastewater treatment process, but also provided a simple and efficient way to improve the photocatalytic activity and selectivity to N2of photocatalysts.

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a disease presented with hemolysis, cytopenia and thrombosis. Apart from PIGA gene on hematopoietic stem cells which accounts for the glycosylphosphatidylinositol (GPI) anchor deficiency on the cell membrane, other mutations have also been detected in PNH through whole-exome sequencing (WES). However, the characteristics of mutations in patients with PNH and genes which may contribute to PNH clonal expansion have not been well defined. Methods: Peripheral blood samples were collected from 41 patients with PNH, among them samples from 6 patients were further separated into CD59- and CD59+ fractions by CD59 magnetic beads. Gene mutations were tested by whole-exome sequencing(WES). 178 genes commonly mutated in myeloid cancer were analyzed in the sequencing results, as well as their correlation with clinical indicators. Mutated genes correlated with cell proliferation were compared between sorted CD59+ and CD59- cells. Results: The most frequently mutated myeloid cancer-related genes were MAP3K4 and CSMD1 (12.2% respectively). Among them, RUNX1T1 mutation was found to be correlated with larger clone size, higher level of uncombined bilirubin, and lower level of hemoglobin (P Conclusions: Myeloid cancer-related mutations can be detected in patients with PNH with some correlation with clinical manifestations. Larger PNH clone may "save" patients from mutation indicating poor prognosis. CD59- fractions seemed to carry more proliferation related mutations, which may contribute to PNH clonal expansion. Disclosures No relevant conflicts of interest to declare.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemolytic disease with thrombosis as a major complication. The mechanism of thrombosis and related risk factors in PNH patients are still not well characterized. We retrospectively enrolled 99 patients with newly diagnosed PNH at our institute from 2011 to 2016. According to binary logistic regression model analysis, we first identified four baseline clinical risk factors which may be associated with incidence of thrombosis in the PNH cohort, including PNH clone sizes (fluorescent aerolysin of neutrophil) ≤ 80 (OR 1.056, 95%CI 1.016–1.097, P = 0.005), hemoglobin ≤ 75 g/L (OR 4.202, 95%CI 0.984–17.954, P = 0.053), platelet > 100 × 109/L (OR 6.547, 95%CI 1.490–28.767, P = 0.013) and rs495828 = G (OR 5.243, 95%CI 1.314–20.916, P = 0.019). These independent risk factors were combined together to develop a risk model to evaluate thrombosis risk (AUC = 0.756, 95%CI 0.607–0.905, P

The authors determined an error in the affiliation section; it was captured as Department of Hematology, Peking Union Hospital, CAMS & PUMC, Beijing 100,730, China. The correct affiliation should be Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.

The present study investigated the effect of the surface functional groups of nanosilica on the interfacial, crystallization, and thermal stability of polyamide 6/SiO2 (PA6/SiO2) nanocomposite, in which nanosilica was modified in situ with both 3-triethoxysilylpropylamine and 3-methacryloxypropyltrimethoxy silane¬ (KH-550 and KH-570). The FTIR analysis results showed the chemical bonding action between the reacting amino groups of nanosilica and end carboxyl groups of polyamide 6 enhanced with increasing the ratio of KH-550 and KH-570. The XRD spectrum indicated that the crystal structure of PA6/SiO2 nanocomposites tended to form α crystal type that was beneficial to an improvement of mechanical properties, and which was in agreement with the results of mechanical strength measurements. It was also found that crystallization temperature and crystallization rate of PA6/SiO2 nanocomposites were lower than that of neat polyamide 6.

Low nano-SiO2 loaded nylon 6 (PA6) nanocomposites were readily produced via in situ polymerization. The effect of surface-modified functional groups of nano-SiO2 on the interfacial structure and properties of nylon 6/SiO2 nanocomposites were studied, which indicated that the surfaces of the two kinds of nano-SiO2, namely RNS-A and DNS-3, contained amino groups and alkyl chains, respec‐ tively. Furthermore, as-prepared nanocomposites were characterized by means of transmission electron microsco‐ py (TEM), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). The results showed that the PA6 chains were attached to the surface of nano-SiO2 by the modes of physical adsorption and chemical bonding. Nano-SiO2 was found to uniformly disperse inside nanocomposites with RNS-A and DNS-3, thereby increasing the superior strength and toughness of nanocomposites in comparison to the pure PA6. Of particular interest was the enhancement of the thermal stability of nanocomposites by adding RNS- A; meanwhile, DNS-3 had little effect on thermal stability. This was the possibly explained by the enhancement of thermal stability owing to the cross-linked reaction. Moreover, the reaction system exhibited gelatine following the addition of RNS-A up to 1.5wt%.

The purpose of this study was to compare patient outcomes and quality of life for people with neurogenic bowel using either a standard bowel care program or colostomy.We analyzed survey data from a national sample, comparing outcomes between veterans with spinal cord injury (SCI) who perform bowel care programs vs individuals with colostomies. This study is part of a larger study to evaluate clinical practice guideline implementation in SCI. The sample included 1,503 veterans with SCI. The response rate was 58.4%. For comparison, we matched the respondents with colostomies to matched controls from the remainder of the survey cohort. A total of 74 veterans with SCI and colostomies were matched with 296 controls, using propensity scores. Seven items were designed to elicit information about the respondent's satisfaction with their bowel care program, whereas 7 other items were designed to measure bowel-related quality of life.No statistically significant differences in satisfaction or quality of life were found between the responses from veterans with colostomies and those with traditional bowel care programs. Both respondents with colostomies and those without colostomies indicated that they had received training for their bowel care program, that they experienced relatively few complications, such as falls as a result of their bowel care program, and that their quality of life related to bowel care was generally good. However, large numbers of respondents with colostomies (n = 39; 55.7%) and without colostomies (n = 113; 41.7%) reported that they were very unsatisfied with their bowel care program.Satisfaction with bowel care is a major problem for veterans with SCI.

A reactive polyamide 6 (PA6)/SiO2 masterbatch (MA) containing 20% (mass fraction) of nano-SiO2 was prepared readily. Furthermore, the as-prepared reactive MA was used as a filler to prepare PA6/SiO2 nanocomposites (RA). The structure of RA was analyzed by means of Fourier transform infrared spectrophotometry (FTIR), transmission electron microscopy (TEM), powder X-ray diffractometry (XRD), scanning electronic microscopy (SEM) and polarizing microscopy (POM). Thermal stability and crystallization behaviors of RA were evaluated by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). Findings indicated that the PA6 molecular chains were anchored on the surface of nano-SiO2 through chemical bonding between the surface amino groups of nano-SiO2 and e-caprolactam monomer or prepolymer of PA6. As a result, a flexible interfacial layer was formed, thereby improving the compatibility of nano-SiO2 with PA6 matrix. Moreover, the enhancement effect of nano-SiO2 led to the improved mechanical properties of RA. Besides, due to the hindering effect of nano-SiO2 particles to the movement of PA6 molecular chains, the size of the PA6 spherocrystal was smaller, and its crystalline form was also affected. Furthermore, the molecular weight of the PA6 matrix tended to decrease gradually with increasing nano-SiO2 content.

In a military scenario, commanders need to determine what kinds of information will help them execute missions. The amount of information available to support each mission is constrained by the availability of information assets. For example, there may be limits on the numbers of sensors that can be deployed to cover a certain area, and limits on the bandwidth available to collect data from those sensors for processing. Therefore, options for satisfying information requirements should take into consideration constraints on the underlying information assets, which in certain cases could simultaneously support multiple missions. In this paper, we propose a system architecture for modeling missions and allocating information assets among them. We model a mission as a graph of tasks with temporal and probabilistic relations. Each task requires some information provided by the information assets. Our system suggests which information assets should be allocated among missions. Missions are compatible with each other if their needs do not exceed the limits of the information assets; otherwise, feedback is sent to the commander indicating information requirements need to be adjusted. The decision loop will eventually converge and the utilization of the resources is maximized.

Broadcast scheduling has been extensively studied in wireless environments, where a base station broadcasts data to multiple users. Due to the sole wireless channel's limited bandwidth, only a subset of the needs may be satisfiable, and so maximizing total (weighted) throughput is a popular objective. In many realistic applications, however, data are dependent or correlated in the sense that the joint utility of a set of items is not simply the sum of their individual utilities. On the one hand, substitute data may provide overlapping information, so one piece of data item may have lower value if a second data item has already been delivered; on the other hand, complementary data are more valuable than the sum of their parts, if, for example, one data item is only useful in the presence of a second data item. In this paper, we define a data bundle to be a set of data items with possibly nonadditive joint utility, and we study a resulting broadcast scheduling optimization problem whose objective is to maximize the utility provided by the data delivered.

Timely dissemination of information to mobile users is vital in many applications. In a critical situation, no network infrastructure may be available for use in dissemination, over and above the on-board storage capability of the mobile users themselves. We consider the following specialized content distribution application: a group of users equipped with wireless devices build an ad hoc network in order cooperatively to retrieve information from certain regions (the mission sites). Each user requires access to some set of information items originating from sources lying within a region. Each user desires low-latency access to its desired data items, upon request (i.e., when pulled). In order to minimize average response time, we allow users to pull data either directly from sources or, when possible, from other nearby users who have already pulled, and continue to carry, the desired data items. That is, we allow for data to be pushed to one user and then pulled by one or more additional users. The total latency experienced by a user vis-vis a certain data item is then in general a combination of the push delay and the pull delay. We assume each delay time is a function of the hop distance between the pair of points in question. Our goal in this paper is to assign data to mobile users, in order to minimize the total cost and the average latency experienced by all the users. In a static setting, we solve this problem in two different schemes, one of which is easy to solve but wasteful, one of which relates to NP-hard problems but is less so. Then in a dynamic setting, we adapt the algorithm for the static setting and develop a new algorithm with respect to users' gradual arrival. In the end we show a trade-off can be made between minimizing the cost and latency.

In this paper we propose system architecture for providing direction and dissemination in military environments. We start with a description of the problem of direction and dissemination. We then present our high level architecture and describe the functions of the main system components on which we focus. This includes the types of information and means by which they may be delivered, the filtering and fusion engines employed to focus and limit the information sent to each personnel, and the schedulers used to determine the order of delivery. We consider a structure that includes sending information directly to personnel, or depending on bandwidth and delay constraints, sending meta-information to personnel to assist in self-retrieval of information from a peer-to-peer network of sensors and other personnel. We illustrate the operation of the architecture using a specific military scenario.

Background Limited data exist describing vascular access conversions during the first year on dialysis therapy or the effect of converting to and from a catheter on subsequent mortality risk. Study Design Retrospective cohort study. Setting & Participants We studied a random sample of incident US hemodialysis patients (initiated long-term dialysis Predictors At dialysis therapy initiation, we assessed vascular access type in use (arteriovenous fistula [AVF], arteriovenous graft [AVG], or catheter) and other patient characteristics. We characterized changes in vascular access type (conversions) by using regularly collected functional status information. Outcome & Measurements We assessed time to all-cause mortality. We first described conversions, then used time-dependent Cox regression to estimate mortality hazard ratios (HRs) for conversions from a catheter to a permanent vascular access (versus no conversion) and conversions from a permanent vascular access to a catheter (versus no conversion). Results The study included 4,532 patients; 69.2% were dialyzing with a catheter; 17.6%, with an AVG; and 13.1%, with an AVF. In patients initiating therapy with an AVF or AVG, 22% experienced a conversion (failure), and median times to first failure were 62 and 84 days, respectively. In catheter patients, 59% converted to an AVF/AVG (predominantly AVG [57%]); median times to first conversion were 92 and 66 days, respectively. Conversion to a permanent access was associated with an adjusted mortality HR of 0.69 (95% confidence interval, 0.55 to 0.85). The effect was similar for conversion to an AVF or AVG, and these persisted across demographic groups and facilities with different conversion practices. Conversion from a permanent vascular access to a catheter was associated with an adjusted mortality HR of 1.81 (95% confidence interval, 1.22 to 2.68). Limitations Potential for residual confounding because of unmeasured factors influencing decision to convert. Conclusion Vascular access conversions are common in incident patients. Continued efforts to increase early nephrologist referral and permanent vascular access placement may help decrease mortality risk in incident dialysis patients.

Problem statement Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful. Specific aims The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment. Intervention The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy. Methods A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001–January 2002) and post-intervention (March 2002–November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs. Results The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of ‘unsafe' patient handling practices performed daily. Nurses ranked program elements they deemed to be "extremely effective": equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation. Conclusions This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

The purpose of the present study was to examine variation in heart disease death rates by the social class of decedents. The term, "social class" refers to a complex set of phenomena such as control over economic resources, social status, and power relative to others in society. The target population for this study was African-American adults aged 35-74 years old who resided in the United States during the years 1996-1997. As a proxy for social class, we examined 5 levels of educational attainment: 0-8 years of school completed (Social Class I), 9-11 years of school completed (Social Class II), high school graduate/12 years of school completed (Social Class III), some college completed (Social Class IV), and college degree completed (Social Class V). Older age, male gender, and lower social class were all independently associated with higher heart disease death rates. For all ages, more disadvantaged social classes had a higher risk of heart disease mortality. The highest relative risks were found for Social Classes I and II among the younger age groups. Many of the "prerequisites" for the "heart healthy lifestyle" are predicated on the benefits of a privileged social class position. For African Americans, there are the additional stressors of segregation, exclusion, and discrimination to overcome, as well as the cumulative physiological toll of lifetime resistance to various forms of racism. For many African Americans in disadvantaged social class positions, the obstacles to reducing the risk for heart disease are very difficult to overcome.