bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002–2020
Authors: Castillo-Carniglia Alvaro , Rivera-Aguirre Ariadne , Santaella-Tenorio Julian , Fink David S. , Crystal Stephen , Ponicki William , Gruenewald Paul , Martins Silvia S. , Keyes Katherine M. , Cerdá Magdalena
Published: March 2023

Background:

Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020.

Methods:

Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin.

Results:

Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98).

Conclusions:

Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
Early Life Anti-Müllerian Hormone Trajectories in Infant Girls
Authors: Chin Helen B. , Krall Jenna R. , Goldberg Mandy , Stanczyk Frank Z. , Darge Kassa , Stallings Virginia A. , Rogan Walter J. , Umbach David M. , Baird Donna D.
Published: March 2023

Background:

Minipuberty is a period of increased reproductive axis activity in infancy, but the importance of this period is not well understood, especially in girls. Previous studies reported a peak in hormone concentrations at 3 to 4 months old. Our objective is to describe anti-Müllerian hormone (AMH) trajectories in the context of other minipuberty factors among healthy infant girls using longitudinal measures of AMH.

Methods:

The Infant Feeding and Early Development study is a longitudinal cohort study of healthy infants, recruited from hospitals in the Philadelphia area during 2010 to 2013. We measured AMH in 153 girls who contributed 1366 serum samples across 11 study visits over 36 weeks. We also measured follicle stimulating hormone (FSH), estradiol, and ovarian characteristics. We used latent class mixed effects models to cluster trajectories of AMH concentration with age. Using linear mixed models, we estimated FSH and ovarian characteristic trajectories separately by AMH cluster.

Results:

We classified infants into four clusters that represent patterns of AMH that were high and decreasing (decreasing), had a peak around 12 weeks or 20 weeks (early peak and middle peak), or were consistently low (low). Infants in these clusters differed in their FSH trajectories, timing of estradiol production, and ovarian characteristics.

Conclusions:

The AMH clusters identified suggest variation in the timing and the magnitude of the minipuberty response in infant girls. The decreasing and low clusters have not been described previously and should be further evaluated to determine whether they represent an opportunity for the early identification of later reproductive conditions.
Treatment options for molecular subtypes of endometrial cancer in 2023
Authors: Karpel Hannah C. , Slomovitz Brian , Coleman Robert L. , Pothuri Bhavana
Published: March 2023

Purpose of review

This article reviews treatment strategies in endometrial cancer by molecular subtype.

Recent findings

The Cancer Genome Atlas (TCGA) classifies four molecular subtypes of endometrial cancer – mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H), copy number high (CNH)/p53abn, copy number low (CNL)/no specific molecular profile (NSMP), and POLEmut – which are validated and highly prognostic. Treatment consideration by subtype is now recommended. FDA-approved immune checkpoint inhibitors (ICIs) include pembrolizumab and dostarlimab for previously treated dMMR/MSI-H EC, and pembrolizumab/lenvatinib for mismatch repair-proficient/microsatellite-stable endometrial cancer, including CNH/p53abn and CNL/NSMP. ICIs are being studied as first-line therapy in advanced/recurrent endometrial cancer by MMR status, as well as in combination with other targeted agents. Trastuzumab is NCCN compendium listed for HER2-positive serous endometrial cancer, which are primarily p53-abnormal. Antibody–drug conjugates targeting low and high HER2 levels show promise in breast cancer, and are beginning to be studied in endometrial cancer. In addition to hormonal therapy, maintenance therapy with selinexor (XPO1-inhibitor) showed potential benefit in p53-wildtype endometrial cancer and is being investigated prospectively. Multiple prospective trials are evaluating de-escalation of care for POLEmut endometrial cancer given favorable survival regardless of adjuvant therapy.

Molecular subtyping has important prognostic and therapeutic implications and should be guiding patient management and clinical trial design in endometrial cancer.
The importance of follicular flushing in optimizing oocyte retrieval
Authors: Lainas George , Lainas Tryfon , Kolibianakis Efstratios
Published: March 2023

Purpose of review

To critically evaluate the use of follicular flushing during oocyte retrieval.

Recent findings

The latest meta-analysis evaluating follicular flushing does not favour its use over single aspiration. The randomized controlled trials (RCTs) included, however, are characterized by significant heterogeneity regarding the population analysed, the needle type and lumen used, the aspiration pressure applied and the number of flushing attempts performed. More importantly, information regarding the flow rate used for aspiration is scarce. The only RCT employing a constant flow rate between single aspiration and follicular flushing in women with monofollicular development, suggests that a higher number of oocytes is retrieved after follicular flushing.

In order to eliminate clinical heterogeneity that might obscure the detection of the true effect of follicular flushing, randomization to single aspiration and follicular flushing should occur within the same patient. This can be achieved by randomly allocating each patient's ovary to either single aspiration or follicular flushing, maintaining similar flow rates between the groups compared.

Given the importance of maximizing the number of oocytes retrieved from a given number of follicles developed, the conduction of properly designed RCTs evaluating follicular flushing is certainly required.
Endophthalmitis following cataract surgery: visual outcomes, microbial spectrum and complications
Authors: Levin Hannah J. , Mehta Maitri S. , Storey Philip P. , Patel Samir N. , Kuley Brandon , Wibbelsman Turner D. , Obeid Anthony , Garg Sunir , Vander James , Dunn James P. , Ho Allen C.
Published: March 2023

Purpose of review

The aim of this study was to update visual outcomes, microbial spectrum and complications in eyes with endophthalmitis following cataract surgery.

Recent findings

A single-institution, retrospective review of eyes treated for endophthalmitis following cataract surgery between 2 January 2014 and 10 January 2017. This study included 112 cases of endophthalmitis following cataract surgery, 58 of which were culture-positive (51.8%). The most isolated organisms were coagulase-negative Staphylococci (56.9%). Oral flora were present in 17.2% of cases. At 6 months, 71.7% of patients achieved visual acuity of at least 20/200 and 51.7% achieved at least 20/40 or better. Visual acuity was better in culture-negative vs. culture-positive cases (∼20/290 vs. ∼20/80, P 
= 0.03), and in nonoral flora-associated vs. oral flora-associated culture-positive cases (∼CF vs. ∼20/150, P 
< 0.01).

Following postcataract surgery endophthalmitis, approximately 70% of eyes achieved vision of 20/200 or better and half achieved vision of 20/40 or better 6 months after treatment. Poor visual outcomes were seen in eyes with positive bacterial cultures and with oral flora.
Fibromyalgia patients with elevated levels of anti–satellite glia cell immunoglobulin G antibodies present with more severe symptoms
Authors: Krock Emerson , Morado-Urbina Carlos E. , Menezes Joana , Hunt Matthew A. , Sandström Angelica , Kadetoff Diana , Tour Jeanette , Verma Vivek , Kultima Kim , Haglund Lisbet , Meloto Carolina B. , Diatchenko Luda , Kosek Eva , Svensson Camilla I.
Published: March 2023

Transferring fibromyalgia patient immunoglobulin G (IgG) to mice induces pain-like behaviour, and fibromyalgia IgG binds mouse and human satellite glia cells (SGCs). These findings suggest that autoantibodies could be part of fibromyalgia pathology. However, it is unknown how frequently fibromyalgia patients have anti-SGC antibodies and how anti-SGC antibodies associate with disease severity. Here, we quantified serum or plasma anti-SGC IgG levels in 2 fibromyalgia cohorts from Sweden and Canada using an indirect immunofluorescence murine cell culture assay. Fibromyalgia serum IgG binding to human SGCs in human dorsal root ganglia tissue sections was also assessed by immunofluorescence. In the cell culture assay, anti-SGC IgG levels were increased in both fibromyalgia cohorts compared with control group. Elevated anti-SGC IgG was associated with higher levels of self-reported pain in both cohorts, and higher fibromyalgia impact questionnaire scores and increased pressure sensitivity in the Swedish cohort. Anti-SGC IgG levels were not associated with fibromyalgia duration. Swedish fibromyalgia (FM) patients were clustered into FM-severe and FM-mild groups, and the FM-severe group had elevated anti-SGC IgG compared with the FM-mild group and control group. Anti-SGC IgG levels detected in culture positively correlated with increased binding to human SGCs. Moreover, the FM-severe group had elevated IgG binding to human SGCs compared with the FM-mild and control groups. These results demonstrate that a subset of fibromyalgia patients have elevated levels of anti-SGC antibodies, and the antibodies are associated with more severe fibromyalgia symptoms. Screening fibromyalgia patients for anti-SGC antibodies could provide a path to personalized treatment options that target autoantibodies and autoantibody production.
The Effect of 2 Different Distraction Methods on Pain, Fear, and Anxiety Levels During Venous Blood Draw in Children in a Pediatric Emergency Unit
Authors: Akarsu Özlem , Semerci Remziye , Kılınç Derya
Published: March 2023

Background:

Blood draw procedures can cause pain, fear, and anxiety in the pediatric population.

Purpose:

To compare the effects of watching cartoons either with virtual reality (VR) or via a tablet on pain, fear, and anxiety during venous blood draw procedures in children.

Methods:

A randomized controlled study was conducted with 159 children aged 5 to 12 years in the pediatric emergency unit. The 3 groups included cartoons with VR (n = 53) or a tablet (n = 53), and a control group (n = 53).

Results:

Children in the 2 intervention groups had lower perceptions of pain, fear, and anxiety, with those watching cartoons via VR having the lowest perceptions.

Conclusions:

Findings from this study showed a reduction in the perception of pain, fear, and anxiety in children who watched cartoons with VR or tablets during blood draw procedures. Nurses should consider using these nonpharmacological methods to reduce pain, fear, and anxiety, among pediatric patients.
Strategies to Address COVID-19 Vaccine and Pregnancy Myths
Authors: Berkowitz Heather E. , Vann Julie C. Jacobson
Published: March 2023

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses risks to pregnant women and their infants. The spread of misinformation about COVID-19 vaccination is a barrier to optimizing vaccination rates among women of childbearing age. We conducted an environmental scan to identify misinformation about COVID-19 vaccination, pregnancy, and fertility, and a review to identify evidence to refute misinformation and strategies to correct and prevent the spread of misinformation. Seven identified themes of misinformation are: the vaccine causes female infertility; can cause miscarriage; and can decrease male fertility; mRNA vaccines attack the placenta; pregnant and breastfeeding persons should not get the vaccine; the vaccine can change menstrual cycles; and vaccinated people can spread infertility symptoms to unvaccinated people. Strategies that can be implemented by social media platforms to help prevent misinformation spread and correct existing health misinformation include improving information regulation by modifying community standards, implementing surveillance algorithms, and applying warning labels to potentially misleading posts. Health services organizations and clinicians can implement health misinformation policies, directly recommend vaccinations, provide credible explanations and resources to debunk misinformation, educate patients and populations on spotting misinformation, and apply effective communication strategies. More research is needed to assess longer-term effects of vaccination among women of childbearing age to strengthen the defense against misinformation and to evaluate strategies that aim to prevent and correct misinformation spread about COVID-19 vaccinations.
Protecting Children's Health
Authors: McDermott-Levy Ruth , Pennea Emma , Moore Caroline
Published: March 2023

Children are particularly vulnerable to the impacts of climate change. Their lungs are developing, making children with asthma especially susceptible to temperature extremes, variations in precipitation, poor air quality, and changes in pollen and flora. Structural and social determinants of health, such as racism and poverty, that disproportionately affect children of color are linked to higher rates of asthma and negative effects of climate change. These factors lead to increased absences from school and social activities, loss of work for caregivers, and increased health care costs, thus negatively affecting children, their families, and the greater community. Nurses must support caregivers and children to link climate change to asthma care, be involved in health education; climate change mitigation and adaptation strategies and policies; and develop the evidence to address climate change and asthma strategies. We address the impacts of climate change on children with asthma and nursing adaptation responses.
Parental Caregiver Expectations and Satisfaction Following Hip Reconstruction and Spinal Fusion in Children With Cerebral Palsy
Authors: Geyer David , Vessey Judith A. , Chen Anna , DiFazio Rachel L.
Published: March 2023

Children with severe (Gross Motor Function Classification System [GMFCS] IV–V) cerebral palsy (CP) exhibit profound physical and developmental impairments and require assistance for all activities of daily living. No curative treatments exist although surgical procedures to correct underlying hip and spine deformities can improve their quality of life. Despite the efficacy of these surgeries, little is known regarding parental caregivers' expectations specific to surgical outcomes and their satisfaction with surgical outcomes. The purpose was to explore parental caregiver expectations and satisfaction with hip and spine surgeries that their children with GMFCS IV–V CP underwent. Variations among preoperative expectations, changes in expectations over time, and the relationship of expectations on caregiver satisfaction were examined. A qualitative descriptive approach with conventional content analysis was utilized. Three preoperative caregiver expectation themes were identified: increasing functionality, increasing comfort, and maintaining health and averting crisis. These themes were still present at 5-year follow-up; however, more caregivers refocused their expectations from improving function to providing palliation. A clear relationship between expectations and caregiver satisfaction, however, was not identified. A deeper understanding surrounding caregiver expectation and satisfaction following surgical procedures is needed.
Discharge Planning and Challenges for Patients With Asian Lifestyles Following Total Hip Arthroplasty
Authors: Makabe Sachiko , Kume Yu , Akagawa Yuko , Wakasa Masahiko , Ito Kaina , Kijima Hiroaki
Published: March 2023

This study examined discharge planning and challenges for patients following total hip arthroplasty in Japan. A cross-sectional national survey of 500 hospitals was conducted in May 2019. Discharge planning education tended to include content on dislocation prevention, including prevention while using a squat toilet and crouching down to sit on the floor or sleep on a futon on the floor–activities common in many Asian communities that require a maximum flexion of the hip joint. The challenges of discharge planning included diverse lifestyles, aging issues, lack of assistance at home, lack of consensus on dislocation prevention intervention, limitation of standardized care, interprofessional collaboration, and lack of time to educate family. Tailored discharge planning can be challenging, particularly for aged patients who practice “floor culture”, i.e., sleeping, sitting and eating on the floor. Discharge planning needs to be task shifted from the surgeon to the nurse to enhance nurses' empowerment in Japan.
The Use of Risk Scores in Patient Preoperative Optimization for Total Joint Arthroplasty
Authors: Dlott Chloe C. , Wilkins Sarah G. , Miguez Sofia , Khunte Akshay , Johnson Charla B. , Kurek Donna , Wiznia Daniel H.
Published: March 2023

Preoperative optimization of patients seeking total joint arthroplasty is becoming more common, and risk scores, which provide an estimate for the risk of complications following procedures, are often used to assist with the preoperative decision-making process. The aim of this study was to characterize the use of risk scores at institutions that utilize nurse navigators in the preoperative optimization process. The survey included 207 nurse navigators identified via the National Association of Orthopaedic Nurses to better understand the use of risk scores in preoperative optimization and the different factors that are included in these risk scores. The study found that 48% of responding nurse navigators utilized risk scores in the preoperative optimization process. These risk scores often included patient comorbidities such as diabetes (85%) and body mass index (87%). Risk scores are commonly used by nurse navigators in preoperative optimization and involve a variety of comorbidities and patient-specific factors.
Sexual and Reproductive Health Care Visits as a Venue for Preexposure Prophylaxis Service Delivery Among Women in the United States: Results From a Nationally Representative Survey
Authors: Weigel Gabriela , Theva Meena , Hardy Erica , Wagner Stephen , Brown Benjamin
Published: March 2023

Background

Preexposure prophylaxis (PrEP) for HIV is disproportionately underprescribed to women. Centers for Disease Control and Prevention guidelines identify a group of women at risk of HIV acquisition who should be offered PrEP, but opportunities remain to improve patient awareness of and provider counseling about PrEP and to expand service delivery of PrEP.

Methods

Using nationally representative data from the 2017–2019 National Survey of Family Growth, we compared women with (n = 689) and without (n = 5,452) Centers for Disease Control and Prevention indications for PrEP on measures of PrEP awareness, counseling by a provider, and interaction with the health care system.

Results

Women with PrEP indications were no more likely to report awareness of PrEP (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.82–1.29) or PrEP counseling by a provider (OR, 1.32; 95% CI, 0.77–2.27), compared with those without PrEP indications. However, women with PrEP indications were more likely than those without to report a birth control visit (OR, 1.82; 95% CI, 1.39–2.38) or an abortion within the last 12 months (OR, 5.93; 95% CI, 1.48–23.73), and to currently use prescription contraception (OR, 1.45; 95% CI, 1.19–1.78). A majority of both groups reported accessing prenatal care within the last 12 months.

Conclusions

There remains a gap in PrEP awareness and counseling among women at highest risk for HIV acquisition. Sexual and reproductive health visits represent a logical and feasible venue for PrEP provision. Obstetrician-gynecologists and other family planning providers may be able to aid in service delivery innovations by providing PrEP alongside other sexual and reproductive health care.
Prevalence of and Factors Associated With Intimate Partner Violence Victimhood Among Men Who Have Sex With Men in Guangzhou, China
Authors: Lin Kaihao , Tan Zhimin , Li Jing , Cheng Weibin , Yang Yi , Jiang Hongbo
Published: March 2023

Background

Intimate partner violence (IPV) has been a concern among men who have sex with men (MSM), but less attention has been paid to the factors associated with this population in China.

Aims

We investigated the prevalence of and factors associated with IPV victimhood among MSM in Guangzhou, China.

Methods

Men who have sex with men were recruited from May to November 2017, and data were collected using an anonymous electronic questionnaire. χ
2 Tests and nonconditional logistic regressions were used to explore the factors associated with IPV victimhood.

Results

A total of 129 in 976 MSM (13.22%) reported experiencing IPV victimhood. Multivariable logistic regression analysis showed that individuals who had condomless anal intercourse (CAI; adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.00–2.17) or had sex with a female partner (aOR, 1.81; 95% CI, 1.15–2.83) in the past 6 months were at a higher risk of IPV victimhood. Participants who had ever experienced child sexual abuse (CSA) were more likely to experience IPV (aOR, 1.97; 95% CI, 1.32–2.94). Individuals who used rush poppers before sex had a higher risk of IPV (aOR, 1.79; 95% CI, 1.21–2.63). In addition, ever having sex with a female sex partner (aOR, 1.65; 95% CI, 1.04–2.60), ever having used rush poppers before sex (aOR, 1.79; 95% CI, 1.22–2.64) in the past 6 months, and ever having experienced CSA (aOR, 2.01; 95% CI, 1.35–3.01) were associated with experiencing more types of IPV.

Conclusions

Intimate partner violence victimhood was relatively common among MSM in Guangzhou, particularly among those who had CAI, experienced CSA, had sex with a female partner, used rush poppers before sex, and with less education.
Postintubation Sedation Practices Within Multiple Emergency Departments Across a Large Pediatric Health Care Organization
Authors: Reiter Pamela D. , Bianchini Monica L. , Dietrich Scott , Soles Stephanie A. , Bacher Rachel S. , Finical Kristen L. , Peterson Eric , Neubrand Tara
Published: March 2023

Objective

Children requiring rapid or standard sequence intubation are at risk of experiencing paralysis without adequate sedation when the duration of neuromuscular blockade exceeds the duration of sedation provided by the induction agent. The objective of this study was to evaluate the rate of appropriately timed postintubation sedation (PIS; defined as the administration of PIS before the clinical effects of the induction agent have dissipated) in patients requiring intubation across multiple emergency department/urgent care sites within a large pediatric health care organization.

Methods

This retrospective cohort study included patients admitted to 1 of 6 affiliated pediatric emergency department or urgent care sites who were intubated with an induction agent and neuromuscular blocker between January 2016 and December 2021. Patients were excluded if they were intubated in the setting of status epilepticus or cardiac arrest. Stepwise logistic regression identified factors associated with appropriately timed PIS.

Results

A total of 283 patients met the inclusion criteria (mean age, 8 ± 7.6 years; 56% male). Two hundred thirty-eight patients (83%) received some form of PIS (105 [37%] received appropriately timed PIS and 133 [47%] received delayed PIS), and 45 patients (16%) received no PIS. The median time to receive PIS following administration of the induction agent was 21 minutes (interquartile range, 11–40 minutes). Patients induced with fentanyl were the least likely to receive PIS, whereas patients induced with etomidate were the most likely. However, because of the short duration of etomidate, most patients induced with etomidate failed to receive PIS in a timely manner.

Conclusions

Delayed PIS is common and may result in periods of ongoing paralysis without adequate sedation. Emergency department providers and pharmacists must recognize the brevity of some induction agents and provide more timely PIS.
Recent Trend of Using Computed Tomography to Diagnose Pediatric Appendicitis at the First Hospital Visit
Authors: Yoneyama Tetsuji , Sato Izumi , Nakashima Masayuki , Takeuchi Masato , Kawakami Koji
Published: March 2023

Objective

We recognize that computed tomography (CT) should not be used to diagnosis pediatric appendicitis due to radiation exposure. However, few studies have recently shown a trend in its use. This study aimed to investigate the annual use of CT for the diagnosis of pediatric appendicitis at the first hospital visit.

Methods

This was a descriptive study using nationwide claims data. We extracted the data of children younger than 15 years who underwent imaging tests to diagnose acute and suspected appendicitis at the first visit between January 2008 and September 2018. We summarized the patient characteristics and the percentage of CT, ultrasonography (US), or CT/US utilization by year, age, and department.

Results

We identified 6658 children who underwent CT (2349 [35.8%]), US (53,57 [54.5%]), and CT/US (634 [9.7%]). The annual CT use dropped from 43.1% in 2012 to 29.4% in 2018. According to age group, the highest percentage of CT use in 2018 was 84.6% in preschool children, followed by adolescents (40.3%), upper-grade (26.0%), and lower-grade (15.0%) children. Data of annual CT use by department revealed that CT usage was much higher in internal and emergency medicine than in pediatrics. Furthermore, adolescents accounted for approximately 50% of CT use in internal medicine.

Conclusions

The percentage of CT use for pediatric appendicitis at the first visit declined annually. However, CT use still tended to be higher in preschool- and adolescent-aged children, or in departments other than pediatrics. Further studies are required to clarify the clinical benefits of CT use to diagnose pediatric appendicitis.
Association Between Racial Segregation and COVID-19 Vaccination Rates
Authors: Swietek Karen , Gianattasio Kan Z. , Henderson Shalanda , Khanna Saumya , Ubri Petry , Douglas Megan , Baltrus Peter , Freij Maysoun , Mack Dominic H. , Gaglioti Anne
Published: March 2023

Objective:

To examine the association between county-level Black-White residential segregation and COVID-19 vaccination rates.

Design:

Observational cross-sectional study using multivariable generalized linear models with state fixed effects to estimate the average marginal effects of segregation on vaccination rates.

Setting:

National analysis of county-level vaccination rates.

Main Outcome Measure:

County-level vaccination rates across the United States.

Results:

We found an overall positive association between county-level segregation and the proportion population fully vaccinated, with a 6.8, 11.3, and 12.8 percentage point increase in the proportion fully vaccinated by May 3, September 27, and December 6, 2021, respectively. Effects were muted after adjustment for sociodemographic variables. Furthermore, in analyses including an interaction term between the county proportion of Black residents and the county dissimilarity index, the association between segregation and vaccination is positive in counties with a lower proportion of Black residents (ie, 5%) but negative in counties with the highest proportions of Black residents (ie, 70%).

Conclusions:

Findings highlight the importance of methodological decisions when modeling disparities in COVID-19 vaccinations. Researchers should consider mediating and moderating factors and examine interaction effects and stratified analyses taking racial group distributions into account. Results can inform policies around the prioritization of vaccine distribution and outreach.
A Novel Risk Model for Predicting Dysphagia after Tongue Reconstruction: A Retrospective Multicenter Study in Japan
Authors: Araki Jun , Mori Keita , Yasunaga Yoshichika , Onitsuka Tetsuro , Yurikusa Takashi , Sakuraba Minoru , Higashino Takuya , Hashikawa Kazunobu , Ishida Katsuhiro , Sarukawa Shunji , Hamahata Atsumori , Kimata Yoshihiro , Matsumoto Hiroshi , Terao Yasunobu , Yokogawa Hideki , Sekido Mitsuru , Asato Hirotaka , Miyamoto Shimpei , Hyodo Ikuo , Nakagawa Masahiro ,   on behalf of the OPERA study group
Published: March 2023

Background:

There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, we developed a novel risk model for predicting dysphagia after tongue reconstruction.

Methods:

This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical group across 31 cancer centers and university hospitals in Japan. A total of 532 patients (390 [73.3%] men and 142 [26.7%] women; median age at surgery: 60 years [range, 15–88 years]) who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence.

Results:

Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation, and no functional teeth. In multivariate logistic regression analysis, age ≥58.5 years, postoperative radiation, wider tongue defect, and body mass index <21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15.

Conclusions:

Our risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction.
“Clinical Outcomes of Bilateral Cleft Lip and Palate Repair with Nasoalveolar Molding and Gingivoperiosteoplasty from Birth to Facial Maturity”
Authors: Rochlin Danielle H. , Park Jenn , Parsaei Yassmin , Kalra Aneesh , Staffenberg David A. , Cutting Court B. , Grayson Barry H. , Shetye Pradip R. , Flores Roberto L.
Published: March 2023

Background:

The long-term effect of nasoalveolar molding (NAM) on patients with bilateral cleft lip and palate (BCLP) are unknown. We report clinical outcomes of facially-mature patients with complete BCLP who underwent NAM and gingivoperiosteoplasty (GPP).

Methods”

A single-institution retrospective study of non-syndromic patients with complete BCLP who underwent NAM between 1991-2000 was performed. All study patients were followed to skeletal maturity, at which time a lateral cephalogram was obtained. Total number of cleft operations and cephalometric parameters were compared to a previously published external cohort of patients with complete and incomplete BCLP in which a minority (16.7%) underwent presurgical orthopedics prior to cleft lip repair without GPP.

Results:

Twenty-four patients with BCLP comprised the study cohort. All patients underwent GPP, 13 (54.2%) underwent alveolar bone graft, and 9 (37.5%) required speech surgery. The median number of operations per patient was 5 [interquartile range (IQR) 2], compared to 8 (IQR 3) in the external cohort (p<0.001). Average age at the time of lateral cephalogram was 18.64 (1.92) years. There was no significant difference between our cohort and the external cohort with respect to SNA [73 °(6°) vs. 75°(11°), p=0.186] or SNB [78°(6°) vs. 74°(9°), p=0.574]. Median ANB was -3°(5°) compared to -1°(7°; p=0.024). Twenty patients (83.3%) underwent orthognathic surgery.

Conclusions:

Patients with BCLP who underwent NAM and GPP were associated with significantly fewer total cleft operations and mixed midface growth outcomes at facial maturity compared to patients who did not undergo this treatment protocol.
The systematic and participatory development of a patient decision aid about terminal devices for people with upper limb absence: The PDA-TULA
Authors: Kerver Nienke , Boerema Laura , Brouwers Michael A. H. , van der Sluis Corry K. , van Twillert Sacha
Published: March 2023

Selecting an upper limb prosthesis seems to be a challenge considering the high rejection rates. A patient decision aid (PDA) could support the decision-making process by providing information about available options and clarifying the patients' values related to those options. This study aims to describe the developmental process of a PDA about terminal devices (TDs) for people with upper limb absence: PDA-TULA. The developmental process was based on The International Patient Decision Aid Standards. We aimed at adults with major unilateral upper limb absence. A steering group including patients, clinicians, researchers, software and implementation experts was composed. The content and design of the PDA were based on a qualitative literature meta-synthesis, focus groups with patients and clinicians, surveys among patients and prosthetists, a nationwide digital meeting with clinicians and prosthetists, and information from manufacturers. Information on features of TDs was systematically collected, ordered, and refined. Subsequently, drafts of the PDA-TULA were made, improved, integrated into the software, and alpha tested. The digital PDA-TULA consists of three parts: (1) information about TDs; (2) consideration of personal values regarding the TDs; (3) comparison of TD profiles with a personal profile based on indicated preferences. A summarizing overview is offered to patients and clinicians. To conclude, a digital PDA, which was integrated into the national working process of clinicians, was developed in a systematic co-creation process. The PDA enables patients and their significant others to consider and formulate their preferences about TDs during the prosthesis selection process.
Prelamination of Anterolateral Thigh Osseocutaneous Flap With Fibula for the Reconstruction of Zygomatic Arch Defects After Facial Trauma
Authors: Ma Zhongkai , Paka Lubamba Grace , Li Chunjie
Published: March 2023

Complex facial trauma usually results in significant physical, esthetical, functional, and psychological damage. Nowadays, tissue flap transfer is the most effective and common treatment for the reconstruction of facial defects. Among them, the prelaminated flap has a bigger role in reconstructing massive facial defects. In this report, the authors have described a case of a 48-year-old man who presented a complex defect of tissue and deformity in the oral and maxillofacial region because of traffic accident trauma. Given the complexity of this case, it was impossible to complete the reconstruction in a single operation. The authors used a vascularized fibula-free flap (VFFF) to reconstruct the right mandible during the first operation and implanted a segment of fibula into the subcutaneous tissue of the right anterolateral thigh, which was used during the second operation for the reconstruction of zygomatic arch. This individualized treatment plan achieved a final satisfactory surgical outcome.
Predictors of care discontinuity in geriatric trauma patients
Authors: Castillo-Angeles Manuel , Zogg Cheryl K. , Jarman Molly P. , Nitzschke Stephanie L. , Askari Reza , Cooper Zara , Salim Ali , Havens Joaquim M.
Published: March 2023

BACKGROUND

Readmission to a non–index hospital, or care discontinuity, has been shown to have worse outcomes among surgical patients. Little is known about its effect on geriatric trauma patients. Our goal was to determine predictors of care discontinuity and to evaluate its effect on mortality in this geriatric population.

METHODS

This was a retrospective analysis of Medicare inpatient claims (2014–2015) of geriatric trauma patients. Care discontinuity was defined as readmission within 30 days to a non–index hospital. Demographic and clinical characteristics (including readmission diagnosis category) were collected. Multivariate logistic regression analysis was performed to identify predictors of care discontinuity and to assess its association with mortality.

RESULTS

We included 754,313 geriatric trauma patients. Mean age was 82.13 years (SD, 0.50 years), 68% were male and 91% were White. There were 21,615 (2.87%) readmitted within 30 days of discharge. Of these, 34% were readmitted to a non–index hospital. Overall 30-day mortality after readmission was 25%. In unadjusted analysis, readmission to index hospitals was more likely to be due to surgical infection, GI complaints, or cardiac/vascular complaints. After adjusted analysis, predictors of care discontinuity included readmission diagnoses, patient- and hospital-level factors. Care discontinuity was not associated with mortality (OR, 0.93; 95% confidence interval, 0.86–1.01).

CONCLUSION

More than a third of geriatric trauma patients are readmitted to a non–index hospital, which is driven by readmission diagnosis, travel time and hospital characteristics. However, unlike other surgical settings, this care discontinuity is not associated with increased mortality. Further work is needed to understand the reasons for this and to determine which standardized processes of care can benefit this population.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
A Virtual Photovoice Study of Older African Americans Perceptions of Neurovascular Clinical Trials
Authors: Shaw Ashley R. , Lofton Saria , Vidoni Eric D.
Published: March 2023

Background:

Alzheimer disease (AD) poses a major public health crisis, especially among African Americans (AAs) who are up to 3 times more likely to develop AD compared with non-Hispanic Whites. Moreover, cardiovascular risk factors represent a precursor to cognitive decline, which contributes to racial/ethnic disparities seen within AD. Despite these disparities, AAs are underrepresented in neurovascular research. The purpose of this qualitative virtual photovoice project is to explore how older Midwestern AAs perceive neurovascular clinical trials.

Methods:

Five photovoice sessions were held virtually over a 3-month period. Participants took photos each week that captured the salient features of their environment that described their perceptions and experiences related to neurovascular clinical trials. Structured discussion using the SHOWED method was used to generate new understandings about the perspectives and experiences in neurovascular clinical trials. Data was analyzed using strategies in participatory visual research.

Results:

A total of 10 AAs aged 55 years and older participated and a total of 6 themes emerged from the photovoice group discussions.

Conclusion:

Findings from this study inform the development of culturally appropriate research protocols and effective recruitment strategies to enhance participation among older AAs in neurovascular clinical trials.
Creatinine Clearance May Predict Goal Enoxaparin Dose in Trauma
Authors: Park Greigory , Dhillon Navpreet K , Fierro Nicole M , Drevets Peter , Stupinski John , Ley Eric J
Published: March 2023

Background:

Guidelines for enoxaparin dosing after trauma recommend an initial dose of 40mg twice daily for most patients and then adjusting by anti-Xa levels. Previous studies indicated higher enoxaparin doses are necessary with higher creatinine clearance levels (CrCl). We sought to determine if the goal enoxaparin dose correlates with the admission CrCl to reduce the reliance on measuring anti-Xa levels.

Study Design:

A retrospective review was conducted of patients admitted to an urban, academic Level 1 trauma center from April 2017 to February 2020. Patients started on enoxaparin who reached goal anti-Xa trough levels were included, and patients were excluded if they did not reach goal anti-Xa levels. Data collection included patient demographics, injury characteristics, admission CrCl, and the final enoxaparin dose. CrCl was then correlated with the final enoxaparin dose.

Results:

Of the 421 patients included, mean age was 46.6 years and 73% were male. The median goal enoxaparin dose was 40mg twice daily. Mean CrCl significantly increased with increasing doses of enoxaparin (20 mg twice daily: 69.2 mL/min, 30 mg twice daily: 89mL/min, 40 mg twice daily:112.8 mL/min, 50 mg twice daily:140.5mL/min, 60 mg twice daily: 147.4 mL/min, and 70mg twice daily: 140 mL/min 69.2.0 mL/min; p<0.01).

Conclusions:

Admission CrCl may predict the enoxaparin dose required to achieve adequate anti-Xa levels. Our data indicate that CrCl of approximately 70mL/min, 90mL/min, 110mL/min, 140ml/min and 150ml/min may predict the twice daily enoxaparin doses of 20mg, 30mg, 40mg, 50mg, and 60mg respectively. CrCl dosing guidance may reduce the time to goal anti-Xa levels and reduce the frequency of anti-Xa measurements. Further research is necessary, and enoxaparin dosing should continue to be monitored by anti-Xa levels.
Two-fluid dynamics and micron-thin boundary layers shape cytoplasmic flows in earlyDrosophilaembryos
Authors: López Claudio Hernández , Puliafito Alberto , Xu Yitong , Lu Ziqi , Talia Stefano Di , Vergassola Massimo
Published: March 2023

Cytoplasmic flows are widely emerging as key functional players in development. In earlyDrosophilaembryos, flows drive the spreading of nuclei across the embryo. Here, we combine hydrodynamic modeling with quantitative imaging to develop a two-fluid model that features an active actomyosin gel and a passive viscous cytosol. Gel contractility is controlled by the cell cycle oscillator, the two fluids being coupled by friction. In addition to recapitulating experimental flow patterns, our model explains observations that remained elusive, and makes a series of new predictions. First, the model captures the vorticity of cytosolic flows, which highlights deviations from Stokes’ flow that were observed experimentally but remained unexplained. Second, the model reveals strong differences in the gel and cytosol motion. In particular, a micron-sized boundary layer is predicted close to the cortex, where the gel slides tangentially whilst the cytosolic flow cannot slip. Third, the model unveils a mechanism that stabilizes the spreading of nuclei with respect to perturbations of their initial positions. This self-correcting mechanism is argued to be functionally important for proper nuclear spreading. Fourth, we use our model to analyze the effects of flows on the transport of the morphogen Bicoid, and the establishment of its gradients. Finally, the model predicts that the flow strength should be reduced if the shape of the domain is more round, which is experimentally confirmed inDrosophilamutants. Thus, our two-fluid model explains flows and nuclear positioning in earlyDrosophila, while making predictions that suggest novel future experiments.
Universal recording of cell-cell contactsin vivofor interaction-based transcriptomics
Authors: Nakandakari-Higa Sandra , Canesso Maria C. C. , Walker Sarah , Chudnovskiy Aleksey , Jacobsen Johanne T. , Bilanovic Jana , Parigi S. Martina , Fiedorczuk Karol , Fuchs Elaine , Bilate Angelina M. , Pasqual Giulia , Mucida Daniel , Pritykin Yuri , Victora Gabriel D.
Published: March 2023

Cellular interactions are essential for tissue organization and functionality. In particular, immune cells rely on direct and usually transient interactions with other immune and non-immune populations to specify and regulate their function. To study these “kiss-and-run” interactions directlyin vivo, we previously developed LIPSTIC (Labeling Immune Partnerships by SorTagging Intercellular Contacts), an approach that uses enzymatic transfer of a labeled substrate between the molecular partners CD40L and CD40 to label interacting cells. Reliance on this pathway limited the use of LIPSTIC to measuring interactions between CD4+helper T cells and antigen presenting cells, however. Here, we report the development of a universal version of LIPSTIC (uLIPSTIC), which can record physical interactions both among immune cells and between immune and non-immune populations irrespective of the receptors and ligands involved. We show that uLIPSTIC can be used, among other things, to monitor the priming of CD8+T cells by dendritic cells, reveal the cellular partners of regulatory T cells in steady state, and identify germinal center (GC)-resident T follicular helper (Tfh) cells based on their ability to interact cognately with GC B cells. By coupling uLIPSTIC with single-cell transcriptomics, we build a catalog of the immune populations that physically interact with intestinal epithelial cells (IECs) and find evidence of stepwise acquisition of the ability to interact with IECs as CD4+T cells adapt to residence in the intestinal tissue. Thus, uLIPSTIC provides a broadly useful technology for measuring and understanding cell–cell interactions across multiple biological systems.
Direct Comparison of Lysine vs. Site-specific Protein Surface Immobilization in Single-molecule Mechanical Assays
Authors: Liu Haipei , Liu Zhaowei , Santos Mariana Sá , Nash Michael A.
Published: March 2023

Single-molecule force spectroscopy (SMFS) is a powerful method for studying folding states and mechanical properties of proteins, however, it requires surface immobilization of proteins onto force-transducing probes such as cantilevers or microscale beads. A common immobilization method relies on coupling surface-exposed lysine residues to carboxylated surfaces using 1-ethyl-3-(3-dimethyl-aminopropyl) carbodiimide and N-hydroxysuccinimide (EDC/NHS). Because proteins typically contain many lysine groups, this strategy results in a heterogeneous distribution of tether positions in the molecule. Genetically encoded peptide tags (e.g., ybbR) provide alternative chemistries for achieving site-specific immobilization, but thus far a direct comparison of site-specific vs. lysine-based immobilization strategies to assess effects on the observed mechanical properties was lacking. Here, we directly compared lysine- vs. ybbR-based protein immobilization in SMFS assays using several model polyprotein systems. Our results show that lysine-based immobilization results in significant signal deterioration for monomeric streptavidin-biotin interactions, and loss of the ability to correctly classify unfolding pathways in a multipathway Cohesin-Dockerin system. We developed a mixed immobilization approach where a site-specifically tethered ligand was used to probe surface-bound proteins immobilized through lysine groups, and found partial recovery of specific signals. The mixed immobilization approach represents a viable alternative for mechanical assays onin vivo-derived samples or other proteins of interest where genetically encoded tags are not feasible.