bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconciling Paid Work and Informal Caregiving Among Older Adults: Implications for Work Interference With Family
Authors: Koreshi Shanika Yoshini , Alpass Fiona
Published: October 2023

Background and Objectives

Many older adults who combine paid work and informal caregiving responsibilities are often in work arrangements that differ from their preference. There is reason to believe that such work status incongruence may lead to work interference with family (WIF). In response, many governments have policies that support flexible work arrangements (FWA) to help individuals manage work and family commitments. This paper examines whether work status preferences contribute to WIF for older adults who combine work and care and whether the use of flexible work arrangements moderates this relationship.

Research Design and Methods

The study included 610 informal caregivers (aged 55–70 years) in paid employment who participated in either the 2018 or 2020 waves of the New Zealand Health, Work and Retirement study. Using a simple moderation analysis with demographic controls, the effects of work status preferences and FWAs on WIF were estimated.

Results

After controlling for confounds, significant main effects were found for both work status preferences and flexible work arrangements on WIF. The moderation analysis revealed that involuntary part-timers using flexible time-off arrangements reported lower levels of WIF. However, other types of flexible work arrangements did not moderate the relationship between work status preferences and WIF.

Discussion and Implications

These findings suggest that work status preferences can contribute to WIF, but not all types of flexible work arrangements alleviate it. Policy initiatives designed to reduce WIF for those combining work and care should consider accounting for differences in the work status preferences of older workers.
Characterization of recombinant photoconverting green fluorescent Akanes
Authors: Jimbo Mitsuru , Otake Mayumi , Amano Haruna , Yasumoto Ko , Watabe Shugo , Okada Daisuke , Kumagai Hiroshi
Published: October 2023

Akanes are fluorescent proteins that have several fluorescence maxima. In this report, Akane1 and Akane3 from Scleronephthya gracillima were selected, successfully overexpressed in Escherichia coli and purified by affinity chromatography. Fluorescence spectra of the recombinant Akanes matured in darkness, or ambient light were found to have several fluorescence peaks. SDS-PAGE analysis revealed that Akanes matured in ambient light have two fragments. MS/MS analysis of Akanes digested with trypsin showed that the cleavage site is the same as observed for the photoconvertible fluorescent protein Kaede. The differences between the calculated masses from the amino acid sequence of Akane1 and the measured masses of Akane1 fragments obtained under ambient light coincided with those of Kaede. In contrast, a mass difference between the measured N-terminal Akane3 fragment and the calculated mass indicated that Akane3 is modified in the N-terminal region. These results indicate that numerous peaks in the fluorescent spectra of Akanes partly arise from isoproteins of Akanes and photoconversion. Photoconversion of Akane1 caused a fluorescence change from green to red, which was also observed for Akane3; however, the fluorescent intensity decreased dramatically when compared with that of Akane3.
Intralesional Cryosurgery of a Bulky Postburned Auricular Keloid and EAR-Q Patient-reported Outcome Measure Assessment
Authors: Franco Eyal , Kreichman Rita , Metanes Issa , Segal Miriam , Nae Bluma , Bryzgalin Leonid , Zouboulis Christos , Har-Shai Yaron
Published: October 2023

Postburned auricular keloids are a challenging problem for the patient and physician. We describe a successful combined treatment of a bulky postburn auricular keloid employing intralesional cryosurgery followed by multiple W-plasty. An EAR-Q pre- and postoperative patient-reported outcome assessments have revealed a significant improvement in all ear parameters of appearance, adverse effects, and quality of life. This combined treatment might be added to the armamentarium of possible treatment modalities for this perplexing problem.
The Origins and Development of the National Transgender Rights Movement in the United States of America
Authors: Billard Thomas J
Published: October 2023

This article examines the emergence of a national transgender rights movement in the United States in the latter half of the twentieth and first decade of the twenty-first century. Drawing on newly available materials from the Trans Equality Archive at the National Center for Transgender Equality in Washington, DC, this study shows that the transgender movement has been neither wholly independent of the lesbian, gay, bisexual, and transgender (LGBT) movement, nor simply a subdivision of it. Through a process of hybridization, the transgender movement became simultaneously its own independent movement and a constituent of the LGBT movement. In building this argument, this article tells an untold story about the history of the movement. First, I narrate the emergence of a shared transgender collective identity separate from LGB identity. Second, I describe the burgeoning of a transgender movement and detail its continued distinction from the LGB movement. Third, I explain how the transgender movement pushed to turn the “LGB” movement into the “LGBT” movement, while still maintaining its independence. The article sheds light on the complex dynamics of contention among national advocacy organizations that gave shape to the contemporary transgender rights movement. It also contributes to the scholarship by tracing the distinctive evolution of the national transgender movement, which has operated alongside grassroots trans movements.
Telehealth group Cognitive–Behavioral Therapy for Insomnia (CBT-I) in primary brain tumor: Primary outcomes from a single-arm phase II feasibility and proof-of-concept trial
Authors: Loughan Ashlee R , Lanoye Autumn , Willis Kelcie D , Fox Amber , Ravyts Scott G , Zukas Alicia , Kim Youngdeok
Published: October 2023

Background

Cognitive–Behavioral Therapy for Insomnia (CBT-I), the frontline treatment for insomnia, has yet to be evaluated among patients with primary brain tumors (PwPBT) despite high prevalence of sleep disturbance in this population. This study aimed to be the first to evaluate the feasibility, safety, and acceptability of implementing telehealth group CBT-I as well as assessing preliminary changes in subjective sleep metrics in PwPBT from baseline to follow-up.

Methods

Adult PwPBT were recruited to participate in six 90-min telehealth group CBT-I sessions. Feasibility was assessed by rates of screening, eligibility, enrollment, and data completion. Safety was measured by participant-reported adverse events. Acceptability was assessed by retention, session attendance, satisfaction, recommendation of program to others, and qualitative feedback. Participant subjective insomnia severity, sleep quality, and fatigue were assessed at baseline, post intervention, and 3-month follow-up.

Results

Telehealth group CBT-I was deemed safe. Following the 76% screening rate, 85% of interested individuals met study eligibility and 98% enrolled (N = 44). Ninety-one percent of enrolled participants completed measures at baseline, 79% at post intervention, and 73% at 3-month follow-up. Overall, there was an 80% retention rate for the 6-session telehealth group CBT-I intervention. All participants endorsed moderate-to-strong treatment adherence and 97% reported improved sleep. Preliminary pre–post intervention effects demonstrated improvements in subjective insomnia severity, sleep quality, and fatigue with large effect sizes. These effects were maintained at follow-up.

Conclusions

Results of this proof-of-concept trial indicate that telehealth group CBT-I is feasible, safe, and acceptable among PwPBT, providing support for future randomized controlled pilot trials.
Examining the Peer-Reviewed Literature on Tobacco-Related Social Media Data: Scoping Review
Authors: Donaldson Scott I , Dormanesh Allison , Majmundar Anuja , Pérez Cindy , Lopez Heather , Saghian Megan , Beard Trista A , Unger Jennifer B , Allem Jon-Patrick
Published: October 2023

Introduction

Tobacco researchers have used social media data to examine tobacco industry marketing practices (eg, influencers), and to document user experience with tobacco products. This study summarized the literature that analyzed tobacco-related social media data, including domain, social media platform, tobacco product type, and themes of findings, among other variables.

Aims and Methods

PubMed, PsycINFO, Web of Science, and Communication Source were searched between 2004 and 2022. Peer-reviewed articles were included if they were written in English, included at least one tobacco-related term, and one social media-related term, and analyzed a social media post. Two coders screened all-titles and abstracts. The final sample consisted of (n = 255) articles. Studies were coded for domain, social media platform, tobacco product type, data source, type of data, coding and analytic method, and presence of validation procedure, among other variables.

Results

A total of 10 504 820 581 tobacco-related social media posts were assessed across 255 studies. User experience (54.1%) and promotion (23.1%) were the most researched domains. Researchers used data from Twitter the most (42.7%). Text (43.1%) was the most common type of data analyzed. Thematic analysis (80.8%) was the most common analytic technique. Themes of findings from content analyses often pertained to the health effects of tobacco use (61.0%) and promotion (44.2%).

Conclusions

Researchers have analyzed billions of tobacco-related social media posts to describe user experience with, and promotions related to, tobacco products like e-cigarettes on platforms like Twitter. Future research may examine tobacco-related social media data from newer platforms like TikTok.

Implications

Real-time surveillance of tobacco-related content on social media can keep the tobacco control community abreast of tobacco industry promotional strategies, user experience with tobacco products, and perceived health effects of tobacco use. A framework may be developed to establish best-practices for social media data collection and analysis, including strategies to identify posts from bot accounts and validate methodological approaches used in thematic analysis.
Effectiveness of anthocyanin-rich foods on bone remodeling biomarkers of middle-aged and older adults at risk of osteoporosis: a systematic review, meta-analysis, and meta-regression
Authors: Quek Yu Yi , Cheng Ling Jie , Ng Yu Xuan , Hey Hwee Weng Dennis , Wu Xi Vivien
Published: October 2023

Context

Current osteoporosis pharmacological treatment has undesirable side effects. There is increasing focus on naturally derived food substances that contain phytonutrients with antioxidant effects in promoting health and regulating immune response.

Objective

This review aims to systematically evaluate the effectiveness of anthocyanin-rich foods on bone remodeling biomarkers in middle-aged and older adults (≥40 y old) at risk of osteoporosis.

Data Sources

Randomized controlled trials were searched on 8 bibliographic databases of PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Food Science and Technology Abstracts, Cochrane Library, and ProQuest.

Data Extraction and Analysis

Thirteen studies were included in the meta-analysis. Receptor activator of nuclear factor kappa-B ligand (RANKL) is exhibited from osteoblastic cells that gathered osteoclasts to bone sites for bone resorption, accelerating bone loss. Anthocyanin-rich food consumption showed statistically nonsignificant effects, with no substantial heterogeneity on bone remodeling biomarkers. However, there was a significant increase in lumbar spine L1–L4 bone mineral density. Mild-to-small effects were seen to largely favor the consumption of anthocyanin-rich foods. Berries (d = –0.44) have a larger effect size of RANKL than plums (d = 0.18), with statistically significant subgroup differences. Random-effects meta-regression found body mass index, total attrition rate, total energy, and dietary carbohydrate and fat intake were significant covariates for the effect size of RANKL. All outcomes had low certainty of evidence.

Conclusion

Anthocyanin-rich foods may improve bone health in middle-aged and older adults at risk of osteoporosis. This review contributes to the growing interest in nutrient-rich foods as a low-cost and modifiable alternative to promote human health and reduce disease burden. Future high-quality studies with larger sample sizes and longer treatment durations are required to fully understand the effect of anthocyanin-rich foods on bone health.

Systematic Review Registration

PROSPERO registration no. CRD42022367136.
COVID-19 associated with Raynaud’s phenomenon in a vibration-exposed worker
Authors: Cooke R
Published: October 2023

This is the first known case report of COVID-19-related Raynaud’s phenomenon (RP) identified at routine health surveillance of a male exposed to hand-transmitted vibration. The temporal relationship with COVID infection followed the course previously reported, being a late feature associated with mild COVID, and followed by gradual spontaneous recovery. It is not known whether the RP, in this case, is solely due to COVID or represents a summative effect of COVID and vibration exposure. A prudent approach is recommended in such circumstances with limitation of vibration exposure and continuing frequent surveillance pending improvement of the RP, with further prompt investigation if the expected recovery does not occur.
Risk of New-Onset Long COVID Following Reinfection With Severe Acute Respiratory Syndrome Coronavirus 2: A Community-Based Cohort Study
Authors: Bosworth Matthew L , Shenhuy Boran , Walker A Sarah , Nafilyan Vahé , Alwan Nisreen A , O’Hara Margaret E , Ayoubkhani Daniel
Published: October 2023

Background

Little is known about the risk of long COVID following reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We estimated the likelihood of new-onset, self-reported long COVID after a second SARS-CoV-2 infection, compared to a first infection.

Methods

We included UK COVID-19 Infection Survey participants who tested positive for SARS-CoV-2 between 1 November 2021 and 8 October 2022. The primary outcome was self-reported long COVID 12–20 weeks after each infection. Separate analyses were performed for those <16 years and ≥16 years. We estimated adjusted odds ratios (aORs) for new-onset long COVID using logistic regression, comparing second to first infections, controlling for sociodemographic characteristics and calendar date of infection, plus vaccination status in participants ≥16 years of age.

Results

Overall, long COVID was reported by those ≥16 years after 4.0% and 2.4% of first and second infections, respectively; the corresponding estimates among those aged <16 years were 1.0% and 0.6%. The aOR for long COVID after second compared to first infections was 0.72 (95% confidence interval [CI], .63–.81) for those ≥16 years and 0.93 (95% CI, .57–1.53) for those <16 years.

Conclusions

The risk of new-onset long COVID after a second SARS-CoV-2 infection is lower than that after a first infection for persons aged ≥16 years, though there is no evidence of a difference in risk for those <16 years. However, there remains some risk of new-onset long COVID after a second infection, with around 1 in 40 of those aged ≥16 years and 1 in 165 of those <16 years reporting long COVID after a second infection.
Comparative Law and Christianity—A Plank in the Eye?
Authors: Husa Jaakko
Published: October 2023

This article examines the epistemic bias of comparative law scholarship. Comparatists are unable or unwilling to recognise the religious dimensions in Western law as they see religion only in the context of non-Western law. This problem is typical of modern macro-comparative law, which fails to recount the influence of Christianity on Western law and legal culture. The article invites legal scholars to reach beyond the notions of ‘religious law’ and ‘secular law’ in terms of classifying the world’s legal systems. Firstly, the article explains how comparative law has a problematic relationship with religion; secondly, it shows that, despite Christianity having been deemed a thing of the past, its influence can and should also be charted in modern law. I argue for a need to rethink the manner in which Western law is depicted as a thoroughly secular law as opposed to the religious law of exoticised others.
NAKED ENDOSPERM1, NAKED ENDOSPERM2, and OPAQUE2 interact to regulate gene networks in maize endosperm development
Authors: Wu Hao , Galli Mary , Spears Carla J , Zhan Junpeng , Liu Peng , Yadegari Ramin , Dannenhoffer Joanne M , Gallavotti Andrea , Becraft Philip W
Published: October 2023

NAKED ENDOSPERM1 (NKD1), NKD2, and OPAQUE2 (O2) are transcription factors important for cell patterning and nutrient storage in maize (Zea mays) endosperm. To study the complex regulatory interrelationships among these 3 factors in coregulating gene networks, we developed a set of nkd1, nkd2, and o2 homozygous lines, including all combinations of mutant and wild-type genes. Among the 8 genotypes tested, we observed diverse phenotypes and gene interactions affecting cell patterning, starch content, and storage proteins. From ∼8 to ∼16 d after pollination, maize endosperm undergoes a transition from cellular development to nutrient accumulation for grain filling. Gene network analysis showed that NKD1, NKD2, and O2 dynamically regulate a hierarchical gene network during this period, directing cellular development early and then transitioning to constrain cellular development while promoting the biosynthesis and storage of starch, proteins, and lipids. Genetic interactions regulating this network are also dynamic. The assay for transposase-accessible chromatin using sequencing (ATAC-seq) showed that O2 influences the global regulatory landscape, decreasing NKD1 and NKD2 target site accessibility, while NKD1 and NKD2 increase O2 target site accessibility. In summary, interactions of NKD1, NKD2, and O2 dynamically affect the hierarchical gene network and regulatory landscape during the transition from cellular development to grain filling in maize endosperm.
Risk factors of major bleeding detected by machine learning method in patients undergoing liver resection with controlled low central venous pressure technique
Authors: Liu Jing , Cao Bingbing , Luo Yuelian , Chen Xianqing , Han Hong , Li Li , Zeng Jianfeng
Published: October 2023

Background

Controlled low central venous pressure (CLCVP) technique has been extensively validated in clinical practices to decrease intraoperative bleeding during liver resection process; however, no studies to date have attempted to propose a scoring method to better understand what risk factors might still be responsible for bleeding when CLCVP technique was implemented.

Methods

We aimed to use machine learning to develop a model for detecting the risk factors of major bleeding in patients who underwent liver resection using CLCVP technique. We reviewed the medical records of 1077 patients who underwent liver surgery between January 2017 and June 2020. We evaluated the XGBoost model and logistic regression model using stratified K-fold cross-validation (K = 5), and the area under the receiver operating characteristic curve, the recall rate, precision rate, and accuracy score were calculated and compared. The SHapley Additive exPlanations was employed to identify the most influencing factors and their contribution to the prediction.

Results

The XGBoost classifier with an accuracy of 0.80 and precision of 0.89 outperformed the logistic regression model with an accuracy of 0.76 and precision of 0.79. According to the SHapley Additive exPlanations summary plot, the top six variables ranked from most to least important included intraoperative hematocrit, surgery duration, intraoperative lactate, preoperative hemoglobin, preoperative aspartate transaminase, and Pringle maneuver duration.

Conclusions

Anesthesiologists should be aware of the potential impact of increased Pringle maneuver duration and lactate levels on intraoperative major bleeding in patients undergoing liver resection with CLCVP technique.

  What is already known on this topic—Low central venous pressure technique has already been extensively validated in clinical practices, with no prediction model for major bleeding. What this study adds—The XGBoost classifier outperformed logistic regression model for the prediction of major bleeding during liver resection with low central venous pressure technique. How this study might affect research, practice, or policy—anesthesiologists should be aware of the potential impact of increased PM duration and lactate levels on intraoperative major bleeding in patients undergoing liver resection with CLCVP technique.
A Critical Legal Analysis of the Effect of the Proposed ‘Two-Pot System’ on Spouses in Unregistered Customary Marriages in South Africa
Authors: Rikhotso Teron
Published: October 2023

For the first time in the history of South African pension laws, a system is proposed that will enable pension fund members to access a portion of their pension benefits while still actively employed. The proposed system seeks to provide pension fund members with financial relief without requiring them to quit their jobs due to financial strain. This paper commends the government’s initiative in response, among others, to the financial problems caused by the coronavirus disease (COVID-19) pandemic. This paper argues, however, that despite the potential beneficial effects the system may have on pension fund members, it may introduce new challenges that pension fund stakeholders have never faced before. This paper aims to highlight a potential defect in the proposed system, particularly in cases where pension benefits are included in the joint estate of a pension fund member. South African customary marriages, whether or not they are registered, are by default in community of property. The pension benefits of a member who is a spouse in these marriages form a part of the joint estate. This paper examines and proposes solutions to the challenges that the proposed system may present to spouses in unrecorded customary marriages.
Attending to Our Own Trauma: Promoting Vicarious Resilience and Preventing Vicarious Traumatization among Researchers
Authors: AbiNader Millan A , Messing Jill Theresa , Pizarro Jesenia , Kappas Mazzio Andrea , Turner B Grace , Tomlinson Laurel
Published: October 2023

Vicarious trauma refers to the cognitive and affective impacts of trauma exposure through one’s work, with traumatization indicating negative effects and resilience, positive. While vicarious trauma has been studied among practitioners, little is known about trauma exposure’s effects on researchers. This exploratory study addresses this gap through an examination of vicarious trauma policies and procedures used by a homicide research team, and aims to understand if and how research assistants (RAs) were affected by reading homicide case files, how they took care of themselves while working, and how the policies supported their well-being. Eleven RAs participated in focus groups and interviews and responded to a quantitative survey about their experiences. Data were analyzed using thematic analysis and descriptive statistics. All RAs mentioned traumatic impact, noting that certain factors increased or buffeted against traumatization. RAs described several means of supporting their own well-being, such as cooking or talking with friends. Findings indicated the trauma-informed policies, and the related informal team dynamics, were core to promoting RAs’ well-being. It is imperative that future studies proactively promote vicarious resilience among team members to ensure sustainable and accurate data collection, prevent RA burnout, and effectively train future researchers to sustain their work throughout their careers.
Government Support, Professional Support, and Vicarious Trauma in Social Workers during the COVID-19 Pandemic: The Mediating Roles of Compassion Fatigue and Professional Identity
Authors: Yu Zhan , Shen Li , Huang Chenxi , Shields John , Zhao Jia-Lin
Published: October 2023

COVID-19 has had a profound effect on frontline social workers as well as their clients, and mitigating the risk of recurrence warrants an investigation of the individual and contextual factors associated with social workers’ experience of helper-related trauma. In this study authors explore the effects of government support and professional support on social workers’ vicarious trauma and the mediating roles of compassion fatigue and professional identity during the COVID-19 pandemic. Surveying 388 social workers from Wuhan, Hubei Province, China, during the pandemic, indicated that professional support was indirectly related to vicarious trauma while compassion fatigue played a fully mediating role. Government support had a negative direct effect on vicarious trauma, and professional identity played a partially mediating role. However, contrary to authors’ expectations, professional identity was positively rather than negatively related to vicarious trauma. These findings suggest, first, that coping strategies for compassion fatigue should be included in professional supervision and, second, that government should provide more substantive support to effectively reduce vicarious trauma among social workers during the pandemic.
Not all lasers are the same: a scoping review evaluating laser therapy for vulvodynia
Authors: Starzec-Proserpio Małgorzata , Bardin Marcela Grigol , Morin Melanie
Published: October 2023

Introduction

Lasers are commonly used for treating various vaginal/vulvar conditions. To date, there is to our knowledge no available literature review on the effects of different types of lasers for the treatment of women with vulvodynia, a condition that causes chronic pain in the vulvar area.

Objectives

We sought to review the literature and summarize the existing published evidence regarding the effects of lasers for the treatment of women with vulvodynia.

Methods

A scoping review with a systematic search was conducted that included studies investigating the use of laser treatment in women with vulvodynia. The National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for the quality assessment. The type of laser, effects on pain and function, and participants’ perceived improvement as well as adverse events were analyzed.

Results

Eight studies investigating laser therapy were included in the analysis: 1 randomized controlled trial, 5 before-after studies, 1 nonrandomized intervention study, and 1 case report. Several types of laser therapies were identified, ranging from mild noninvasive photobiomodulation to more invasive ablative procedures. Of the 6 studies that included pain outcomes, 3 studies showed statistically significant improvements from baseline to follow-up, and 3 demonstrated a reduction in pain from subjectively interpreted data. Similarly, each of the 2 studies investigating sexual function also reported an improvement (based only on subjective interpretation). Of the 2 studies with a comparison group, neither study was adequately powered to detect between-group differences. Furthermore, 57%-78% of participants reported improvement, with 1 study showing a greater statistically significant improvement in the low-level laser therapy patient group compared to the sham laser group. Outcomes and adverse events varied depending on the type of laser used.

Conclusions

Although these studies demonstrated some benefits of laser therapy for the treatment of vulvodynia, these findings should be interpreted with caution given the scarcity of the included studies that were robust and sufficiently powered. Future research should focus on conducting well-designed randomized controlled trials to evaluate the efficacy of different types of lasers in the treatment of vulvodynia.
An emerging spectrum of therapeutic targets for Alzheimer's disease
Authors: Goetzl Edward J.
Published: October 2023

Development of effective preventative and therapeutic measures for Alzheimer's disease has been unsuccessful because of the long and subtly symptomatic preclinical period, difficulties obtaining tissue and biochemical data from living patients, and the many complex underlying pathogenic processes. Recent applications of sensitive specific bioimaging techniques, analyses of RNAs and proteins of neural cell‐derived extracellular vesicles in blood, and sophisticated genetic procedures in cellular and rodent models have yielded hopeful new therapeutic targets. These newer targets are described here in relation to their neural cellular location, potential genetic modifications and possible pharmacological approaches.
Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment
Authors: Arnautovic Tamara , Sinha Sanghamitra , Laptook Abbot R.
Published: October 2023

Neonatal hypoxic-ischemic encephalopathy (HIE) is an important clinical entity because it is associated with death and long-term disability, including cognitive impairment, cerebral palsy, seizures, and neurosensory deficits. Over the past 40 years, there has been an intensive search to identify therapies to improve the prognosis of neonates with HIE. Hypothermia treatment represents the culmination of laboratory investigations including small and large animal studies, followed by pilot human studies, and, finally, randomized controlled trials to establish efficacy and safety. Clinical trials have demonstrated that hypothermia treatment reduces mortality and improves early childhood outcome among survivors. Hypoxic-ischemic encephalopathy is a multi-system disease process that requires intensive medical support for brain monitoring and monitoring of non–central nervous system organ dysfunction. Treatment must be conducted in a level III or IV neonatal intensive care unit with infrastructure for an integrated approach to care for critically ill neonates. Hypothermia treatment is the first and currently the only therapy to improve outcomes for neonates with HIE and indicates that HIE is modifiable. However, outcomes likely can be improved further. Hypothermia treatment has accelerated investigation of other therapies to combine with hypothermia. It has also stimulated a more intensive approach to brain monitoring, which allows earlier intervention for complications. Finally, HIE and hypothermia treatment negatively influences the psychological state of affected families, and there is growing recognition of the importance of trauma-informed principles to guide medical professionals.
Prior Hospitalization, Severe Maternal Morbidity, and Pregnancy-Associated Deaths in Massachusetts From 2002 to 2019
Authors: Declercq Eugene R. , Cabral Howard J. , Liu Chia-Ling , Amutah-Onukagha Ndidiamaka , Meadows Audra , Cui Xiaohui , Diop Hafsatou
Published: October 2023

OBJECTIVE:

To examine demographic and clinical precursors to pregnancy-associated deaths overall and when pregnancy-related deaths are excluded.

METHODS:

We conducted a retrospective cohort study based on a Massachusetts population–based data system linking data from live birth and fetal death certificates to corresponding delivery hospital discharge records and a birthing individual's nonbirth hospital contacts and associated death records. Exposures included maternal demographics, severe maternal morbidity (without transfusion), hospitalizations in the 3 years before pregnancy, comorbidities during pregnancy, and opioid use. In cases of postpartum deaths, hospitalization between delivery and death was examined. The primary outcome measure was pregnancy-associated death, defined as death during pregnancy or up to 1 year postpartum.

RESULTS:

There were 1,291,626 deliveries between 2002 and 2019, of which 384 were linked to pregnancy-associated deaths. Pregnancy-associated but not pregnancy-related deaths (per 100,000 deliveries) were highest for birthing people with opioid use before pregnancy (498.3), severe maternal morbidity (387.3), a comorbidity (106.3), or a prior hospitalization (88.9). In multivariable analysis, the adjusted risk ratios associated with severe maternal morbidity (9.37, 95% CI, 6.14–14.31) and opioid use (6.49, 95%, CI, 3.71–11.35) were highest. Individuals with pregnancy-associated deaths were also more likely to have been hospitalized before or during pregnancy (2.30, 95% CI, 1.62–3.26). Among postpartum deaths, more than two-thirds (69.9%) of birthing people had a hospital contact after delivery and before their death.

CONCLUSION:

Severe maternal morbidity and opioid use disorder were precursors to pregnancy-associated deaths. Individuals with pregnancy-associated but not pregnancy-related deaths experienced a history of hospital contacts during and after pregnancy before death.
Intrauterine Postpartum Hemorrhage-Control Devices
Authors: Jackson Tracy L. , Tuuli Methodius G.
Published: October 2023

Postpartum hemorrhage, defined as a cumulative blood loss of 1,000 mL or more or blood loss associated with signs or symptoms of hypovolemia regardless of the route of delivery, is the leading cause of preventable maternal death worldwide. The United States has one of the highest maternal mortality rates among developed countries, with about 14% of all maternal deaths associated with postpartum hemorrhage. Although postpartum hemorrhage has multiple causes, the most common is uterine atony—when the uterus fails to adequately contract after childbirth—accounting for 80% of all postpartum hemorrhages. When postpartum hemorrhage occurs despite preventive measures, therapeutic measures are used. Intrauterine hemorrhage-control devices are often the second-line therapy when medical management is unsuccessful. Despite its widespread use in current obstetric practice, the mechanism of intrauterine balloon tamponade, such as the Bakri balloon, is counterintuitive to the physiologic uterine contraction that occurs after delivery to control bleeding, and data on its effectiveness are mixed. Vacuum-induced hemorrhage control, such as with the Jada System, cleared by the U.S. Food and Drug Administration in 2020, is a novel modality for control of postpartum bleeding. It mimics postpartum physiology by applying low-level intrauterine negative pressure to facilitate uterine compressive forces, thereby constricting blood vessels to achieve hemostasis. Preliminary data from four studies are promising but are limited by a lack of control groups, selection bias, or modest sample sizes. The results of ongoing and planned randomized controlled trials will clarify the role of the Jada System for reducing morbidity from postpartum hemorrhage.
Characteristics of Scoliosis in Mice Induced by Chondrocyte-specific Inactivation of L-type Amino Acid Transporter 1
Authors: Handa Makoto , Demura Satoru , Yokogawa Noriaki , Hinoi Eiichi , Hiraiwa Manami , Kato Satoshi , Shinmura Kazuya , Annen Ryohei , Kobayashi Motoya , Yamada Yohei , Nagatani Satoshi , Kurokawa Yuki , Tsuchiya Hiroyuki
Published: October 2023

Study Design.

A mouse study of the Slc7a5 gene using conditional knockout to assess the effects of its inactivation on spinal deformity.

Objectives.

This study aimed to investigate whether the mice with scoliosis (induced by chondrocyte-specific inactivation of L-type amino acid transporter 1 [LAT1]) show a developmental process similar to that of pediatric scoliosis and to examine the relationship between reduced bone mineral density (BMD) and scoliosis. Furthermore, we aimed to obtain insights into elucidating the etiology and pathophysiology of scoliosis.

Summary of Background Data.

The etiology and pathogenesis of scoliosis are not fully understood despite substantial investigative efforts. LAT1 is an amino acid transporter that mediates the cellular uptake of large neutral amino acids. A recent study revealed that chondrocyte-specific inactivation of LAT1 in mice results in scoliosis (Col2a1-Cre;Slc7a5fl/fl mice: “Sko mice”).

Methods.

Body length, body weight, Cobb angle, vertebral body rotation angle, and BMD at 1, 2, 4, 6, and 8 weeks of age were examined and statistically compared with those of normal control mice. Pathological and morphological evaluation was performed on specimens from 10-week-old euthanized mice.

Results.

The Sko mice developed thoracic scoliosis in infancy without congenital malformations. This spinal deformity progressed rapidly during growth, with diverse curve patterns and hypoplastic vertebral bodies.　Pathological examination revealed thickening of the growth plates and decreased osteoblasts, suggesting that impaired endochondral ossification was the cause of the scoliosis.　Sko mice were also observed to have decreased BMD and degraded bone microstructure. Reduced BMD and bone quality may not be the causes of the onset and progression of scoliosis in the Sko mice.

Conclusions.

In Sko mice, the characteristics of scoliosis and vertebral pathology showed many similarities with syndromic scoliosis in humans. Endochondral ossification defects may impair growth, leading to scoliosis and decreased BMD.
Annexin A5 in Patients With Severe COVID-19 Disease: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Feasibility Trial
Authors: Martin Claudio M. , Slessarev Marat , Campbell Eileen , Basmaji John , Ball Ian , Fraser Douglas D. , Leligdowicz Aleksandra , Mele Tina , Priestap Fran , Tschirhart Brent J. , Bentall Tracey , Lu Xiangru , Feng Qingping
Published: October 2023

OBJECTIVES:

To evaluate the study design and feasibility of drug administration and safety in a randomized clinical trial of recombinant human annexin A5 (SY-005), a constitutively expressed protein with anti-inflammatory, antiapoptotic, and anticoagulant properties, in patients with severe coronavirus disease 2019 (COVID-19).

DESIGN:

Double-blind, randomized clinical trial.

SETTING:

Two ICUs at an academic medical center.

PATIENTS/SUBJECTS:

Adults admitted to the ICU with a confirmed diagnosis of COVID-19 and requiring ventilatory or vasopressor support.

INTERVENTIONS:

SY-005, a recombinant human annexin A5, at 50 or 100 µg/kg IV every 12 hours for 7 days.

MEASUREMENTS AND MAIN RESULTS:

We enrolled 18 of the 55 eligible patients (33%) between April 21, 2021, and February 3, 2022. We administered 82% (196/238) of the anticipated doses of study medication and 86% (169/196) were given within 1 hour of the scheduled time. There were no drug-related serious adverse events. We captured 100% of the data that would be required for measuring clinical outcomes in a phase 2 or 3 trial.

LIMITATIONS:

The small sample size was a result of decreasing admissions of patients with COVID-19, which triggered a stopping rule for the trial.

CONCLUSIONS:

Although enrollment was low, administration of SY-005 to critically ill patients with COVID-19 every 12 hours for up to 7 days was feasible and safe. Further clinical trials of annexin A5 for the treatment of COVID-19 are warranted. Given reduction of severe COVID-19 disease, future studies should explore the safety and effectiveness of SY-005 use in non-COVID-related sepsis.
Successful YAG Laser Treatment for Epithelial Ingrowth in Descemet Stripping Endothelial Keratoplasty Interface
Authors: Commaroto Sarah A. , Hu Jimmy Y.
Published: October 2023

Purpose:

To present a case of epithelial ingrowth in the graft–host interface after Descemet stripping endothelial keratoplasty (DSEK) surgery that was successfully treated with an Nd:YAG Laser.

Methods:

A 79-year-old Caucasian female underwent a repeat DSEK 9 months after a prior DSEK graft rejection and subsequent failure. At her regularly scheduled 1-month follow-up visit, an asymptomatic dense white interface opacity was observed within the stromal interface, with an appearance consistent with epithelial ingrowth. The depth and location was confirmed by anterior segment optical coherence tomography. After initial observation, the opacity was noted to be growing over 2 months. The epithelial ingrowth cells were then treated with an Nd:YAG Laser.

Results:

The patient remained stable 12 months post laser treatment with no recurrence of epithelial ingrowth. Focal stromal pits were noted at the site of Nd:YAG Laser treatment within the DSEK graft stromal interface, but were not visually significant.

Conclusions:

Nd:YAG laser treatment is a safe and effective way to treat early-stage epithelial ingrowth in the interface after DSEK surgery.
Variation in Caregiver-Reported Child Sleep Patterns and Problems by Family Socioeconomic Indicators
Authors: Lupini Francesca , Daniel Lauren C. , Mindell Jodi A. , Williamson Ariel A.
Published: October 2023

Objective:

Previous studies of sleep patterns, as well as rates and correlates of perceived problems in early childhood, indicate variation by neighborhood-level socioeconomic indicators. The purpose of this study was to examine variation in (1) sleep patterns, behaviors, and problems by family-based socioeconomic indicators (income-to-needs ratio and caregiver education level) and (2) sociodemographic and sleep correlates of a caregiver-endorsed child sleep problem across and within socioeconomic indicator groups in a diverse sample.

Methods:

Two hundred eighty-three caregiver-child dyads (ages 1‐5 years) completed the Brief Child Sleep Questionnaire. Family-level socioeconomic indicators included income-to-needs ratio and caregiver educational level.

Results:

Sleep patterns varied based on income-to-needs ratio, with children living in poverty experiencing the longest sleep onset latencies and night awakening durations and shortest nighttime sleep durations. Rates of an endorsed child sleep problem were similar across income-to-needs groups. Although sleep patterns did not vary by caregiver education level, caregivers with an education beyond high school were more likely to endorse a child sleep problem; later bedtimes, more frequent night awakenings, and greater bedtime difficulties were the strongest correlates of a perceived sleep problem in this subgroup. No specific correlates of a child sleep problem emerged for those with a high school education or less.

Conclusion:

Sleep patterns may be more robustly linked to family income-to-needs ratio, whereas perceptions of a child sleep problem may be more linked to caregiver education level. Clinicians should consider expanding sleep screening questions to include specific sleep outcomes to effectively assess child sleep and guide intervention.
Association of Food Insecurity Status with Resolution of Mental Health Conditions in Children and Adolescents
Authors: Sanjeevi Namrata , Monsivais Pablo
Published: October 2023

Objective:

Adverse consequences related to unresolved mental health issues underscore the importance of identifying factors that impede resolution of mental health conditions. Although studies have identified food insecurity as a risk factor for the diagnosis of mental health conditions, its impact on unresolved mental health issues is not understood. The objective of this study is to investigate the association of food insecurity status with resolution of depression, anxiety, and behavioral/conduct problems in children and adolescents.

Methods:

Using National Survey of Children's Health 2016 to 2019, logistic regression analyses examined the relationship of food insecurity status with the diagnosis and resolution of depression, anxiety, and behavioral/conduct problems in children (aged 5–11 years) and adolescents (aged 12–17 years).

Results:

Mild, moderate, and severe food insecurity were significantly associated with higher odds of being diagnosed with depression, anxiety, and behavioral/conduct problems. Severe food insecurity was significantly associated with higher odds of unresolved behavioral/conduct problems in children (adjusted odds ratio [aOR], 10.09; 95% confidence interval [CI], 2.99–34.04), after adjustment for demographic covariates. In adolescents, severe food insecurity was significantly related to greater odds of unresolved depression (aOR, 6.64; 95% CI, 2.13–20.70), anxiety (aOR, 3.27; 95% CI, 1.31–8.14), and behavioral/conduct problems (aOR, 5.57; 95% CI, 2.09–14.85). These associations of severe food insecurity with unresolved mental health conditions were significant even after adjustment for the receipt of mental health care. Mild and moderate food insecurity were not significantly associated with unresolved mental health conditions.

Conclusion:

The findings suggest that severe food insecurity is associated with increased odds of unresolved mental health conditions in children and adolescents. This study highlights the importance of tailoring interventions to provide appropriate mental health services for children and adolescents from severely food insecure households.
Addressing Adolescent Suicidality in Pediatric Primary Care
Authors: Kenny Jessica , Kelsay Kimberly , Bunik Maya , Xiong Shengh , Millar Amanda , Talmi Ayelet
Published: October 2023

Objective:

This study examines prevalence rates of reported suicidal ideation (SI) in 2107 adolescents, characterizes recommendations and interventions given by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to SI on the Patient Health Questionnaire 9-Item Modified for Adolescents (PHQ-9A) for 140 adolescents, and identifies factors associated with a decrease in the frequency of SI at follow-up visits for 85 adolescents.

Methods:

A retrospective mixed-method approach was taken. Clinical informatics was used to extract visit data, demographics, and PHQ-9A scores for all visits between January 3, 2017, and August 31, 2018. Conventional content analysis of electronic medical records was used to examine qualitative results, and qualitative codes were then analyzed using point-biserial correlations. The setting includes a fully integrated behavioral health team within the primary care clinic.

Results:

Of the 2107 adolescents, 140 (7%) endorsed SI within the past 2 weeks. Content analysis yielded 40 actions (17 PCP codes and 23 BHC codes) used in response to SI. Significant correlations were found between decreased SI frequency and the PCP referring to integrated behavioral health (r = 0.24) and family navigators (r = 0.26) and BHCs conducting a risk assessment (r = 0.24), completing a safety plan (r = 0.21), involving caregivers (r = 0.29), sending the adolescent to the emergency department (r = 0.28), and referring to family navigators (r = 0.21; all p values < 0.05).

Conclusion:

The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.