bluuebunny/crossref_metadata_2025 huggingface dataset:
Social inequality and cultural factors impact the awareness and reaction during the cryptic transmission period of pandemic
Authors: Jiang Zhuoren , Liu Xiaozhong , Kang Yangyang , Sun Changlong , Ahn Yong-Yeol , Bollen Johan
Published: February 2025

The World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern on 2020 January 31. However, rumors of a “mysterious virus” had already been circulating in China in 2019 December, possibly preceding the first confirmed COVID-19 case. Understanding how awareness about an emerging pandemic spreads through society is vital not only for enhancing disease surveillance, but also for mitigating demand shocks and social inequities, such as shortages of personal protective equipment and essential supplies. Here we leverage a massive e-commerce dataset comprising 150 billion online queries and purchase records from 94 million people to detect the traces of early awareness and public response during the cryptic transmission period of COVID-19. Our analysis focuses on identifying information gaps across different demographic cohorts, revealing significant social inequities and the role of cultural factors in shaping awareness diffusion and response behaviors. By modeling awareness diffusion in heterogeneous social networks and analyzing online shopping behavior, we uncover the evolving characteristics of vulnerable populations. Our findings expand the theoretical understanding of awareness spread and social inequality in the early stages of a pandemic, highlighting the critical importance of e-commerce data and social network data in effectively and timely addressing future pandemic challenges. We also provide actionable recommendations to better manage and mitigate dynamic social inequalities in public health crises.
The Impact of Experiences with COVID-19 on the 2020 Presidential Election and Support for Health Reform
Authors: Kavanagh Nolan M , Menon Anil
Published: February 2025

Health shocks may drive the public to support policies and candidates that protect health and well-being. Did the COVID-19 pandemic, as one such shock, shift preferences for health reform in the United States? Using nationally representative surveys of over 70,000 US adults between 2019 and 2020, we find that experiences with COVID-19—measured at both the individual and community levels—increased support for Medicare for All by multiple percentage points. Consistent with partisan entrenchment on health issues, independents and weak partisans drove the association at the individual level; these subgroup differences were not observed for community-level experiences. To reduce concerns about confounding, we use data from multiple points in time to establish the expected temporal relationship between experiences with COVID-19 and support for health reform. Finally, consistent with the importance of health issues in the 2020 presidential race, we find that changes in support for health reform were mirrored by a comparable shift in support away from the incumbent, President Trump, in the weeks leading up to the election. Even if short lived, these shifts may have influenced both the discourse and outcome of the election.
The Impact of the Opioid Crisis on Firm Value and Investment
Authors: Ouimet Paige , Simintzi Elena , Ye Kailei
Published: February 2025

We show a negative effect of opioid prescriptions on subsequent individual employment among employers in our sample using doctor-opioid-prescribing propensity as our instrument. This finding has implications for firms that must now contend with lower local labor supply. We find a negative relationship between opioid prescriptions and subsequent establishment growth. However, firms respond to labor shortages by investing more in technology, replacing the relatively scarcer labor with capital, especially when they are not financially constrained. We find positive abnormal returns, upon the passage of state laws intended to limit opioid prescriptions, that are driven by firms more reliant on labor. (JEL J21, G31, 033)
Development and multicenter validation of machine learning models for predicting postoperative pulmonary complications after neurosurgery
Authors: Xu Ming , Zhu Wenhao , Hou Siyu , Xu Hongzhi , Xia Jingwen , Lin Liyu , Fu Hao , You Mingyu , Wang Jiafeng , Xie Zhi , Wen Xiaohong , Wang Yingwei
Published: February 2025

Background:

Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery.

Methods:

PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed.

Results:

PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.84. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805–0.858) and a Brier score of 0.069, followed by logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model.

Conclusions:

The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes.

Trial registration:

ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj = 128279.
Concepts in Cutaneous Vasculitis
Authors: Fernandez-Flores Angel
Published: February 2025

Skin biopsy plays a fundamental role in the diagnosis of vasculitis. However, the general pathologist or dermatopathologist who encounters these diagnostic findings in their early stages often faces the paradox that the clinician requests the exclusion of various systemic diseases, when the biopsy only shows leukocytoclastic vasculitis. In other cases, even though the affected vessels are small, some of them seem deep within the biopsy, raising differential diagnosis with several entities of systemic repercussion. Lastly, although the dermatopathologist has a histological picture before them, they are often required to correlate it with laboratory data such as the presence of antineutrophil antibodies, for example. Therefore, the objective of this article is conceptual, emphasizing those basic aspects that can contribute to a better understanding and diagnosis of skin biopsy in vasculitis.
The History of Neuromodulators in Dermatologic Surgery
Authors: Cespedes Zablah Andrea , Matarasso Seth L. , Carruthers Jean
Published: February 2025

BACKGROUND

In 1817 and 1820, the German physician Justinus Kerner published a series of cases of lethal food poisoning that would unknowingly have a lasting impact on medical science. His compilation of over 75 cases linked the consumption of smoked sausages in the small town of Herrenberg in Württemberg, recounted a constellation of symptoms that today the authors call botulism. Now, over 2 centuries later, the discovery, study and refinement of the toxin causing clinical botulism has led to the acceptance of neuromodulators as a treatment for a wide variety of medical concerns.

OBJECTIVE

The aim of this article is to understand the many historical advances in the mechanism of action of botulinum neurotoxins, the wide range of indications that are currently available and Dermatologic Surgery's role in this evolution.

MATERIALS AND METHODS

A PubMed retrospective search to identify literature on the history of botulinum toxin was undertaken.

RESULTS

Botulinum toxin is the newest therapeutic generational drug with over 30 approved indications in 90 countries. There are now 7 FDA (food and drug administration) approved neuromodulators with several more under current review. CONCLUSION
Dermatologic Surgery has had a seminal role in the advancement of neuromodulators and publishing associated literature.
Therapeutic Applications of Hair Follicle Transplantation Beyond Hair Restoration
Authors: Laufer-Britva Rimma , Vathananai Wipawan , Jimenez Francisco
Published: February 2025

BACKGROUND

Hair follicle (HF) transplantation, especially through follicular unit excision (FUE), is renowned for treating androgenetic alopecia. Recent advancements have expanded its use in dermatology and plastic surgery.

OBJECTIVE

This review explores FUE's broader applications beyond hair restoration, including its efficacy in treating chronic ulcers, axillary hyperhidrosis, bromhidrosis, vitiligo, and scar remodeling.

METHODS

A comprehensive literature review was conducted using key medical databases, focusing on clinical research such as randomized controlled trials, retrospective studies, case series, and reports, while excluding review articles and commentaries.

RESULTS

Hair follicle transplantation using the FUE technique has shown significant promise in enhancing healing in chronic ulcers and difficult to heal wounds, with cases demonstrating complete wound healing across various ulcer types. The method of sweat gland removal using FUE micropunches substantially reduced sweating and malodor in patients with axillary hyperhidrosis and bromhidrosis. In vitiligo treatment, FUE combined with other therapies showed promising repigmentation results.

CONCLUSION

Follicular unit excision emerges as a versatile surgical technique demonstrating potential in various conditions beyond alopecia. The minimal complications associated with FUE across various applications highlight its safety profile. Its expanding scope in medical applications calls for further research and clinical trials to optimize its use and understand its full therapeutic potential.
Mechanically Powered Negative Pressure Dressing Enhances Surgical Incision Cosmesis: A Randomized Trial
Authors: Williams Brian , Gupta Abhinav , Martucci Jordan , Swinford Aubrey , Cologne Kyle G. , Koller Sarah E. , Shin Joongho
Published: February 2025

Background:

Cosmetic appearance of incisions remains one of the most important aspects of the patient recovery experience. Despite advances in surgery, scar prevention is the gold standard in improved results. Closed-incision negative pressure wound therapy has shown promise in decreasing surgical site infection and healing time. This study aimed to assess outcomes of primarily closed surgical incisions with mechanically powered negative pressure dressings (MP-NPDs) compared with standard dressings.

Methods:

This study was a single-center, within-subjects, randomized controlled trial, in which each patient served as both the control and experimental arms. Laparoscopic/robotic port site incisions were randomized to control dressing or MP-NPD. Primary outcomes were cosmetic results at first clinic visit by blinded physicians and nonphysician observers.

Results:

Forty patients with a total of 80 incisions were included in the analysis. The average scores for scar spread, erythema, dyspigmentation, scar hypertrophy, and overall impression were lower for the MP-NPD wounds. The only individual variable of the Scar Cosmesis Assessment Rating scale, in which there was no difference noted between the 2 groups, was the presence of suture marks. The average total Scar Cosmesis Assessment Rating score was significantly lower (more favorable) for the MP-NPD wounds compared with the control wounds (3.39 ± 3.18 versus 4.79 ± 3.18, respectively; P < 0.001).

Conclusions:

The use of closed-incision negative pressure wound therapy with the application of a novel MP-NPD over surgical incisions resulted in clinical and statistically significant improvement in scar cosmesis in the early/intermediate postoperative period according to both physician and nonphysician observers.
Cost Determinants of Mandibular Distraction Osteogenesis in Infants With Robin Sequence
Authors: Danis David O’Neil , Zaccardelli Alessandra , Singla Arnav K. , Meyer Aiden , Scott Andrew R.
Published: February 2025

Background:

Robin sequence is an anomaly of micrognathia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) performed in early infancy relieves airway obstruction and improves feeding difficulties. Though clinical outcomes data for MDO are strong, studies examining the cost drivers of the procedure are scarce.

Methods:

A retrospective 10-year single-institution chart review examined medical and billing records of infants undergoing MDO at an urban tertiary care center. Data included hospital charges, patient characteristics, comorbidities/complications, intubation duration, and length of stay (LOS). Multivariate regression analysis determined significant cost contributors over the course of admission. Conclusions from this smaller sample were compared with analyses from a larger, less detailed, population-based inpatient registry using the Kids’ Inpatient Database (2016 and 2019).

Results:

In the single-institution analysis, 29 cases were identified with a mean age of 12 days at hospital admission. Mean postoperative and overall LOS were 19 ± 10 and 31 ± 13 days, respectively. Mean total charges were $287K–$118K. The most significant driver of total charges was floor charges (P < 0.01). LOS was a proxy for floor charges, as they were highly correlated (r = 0.98). LOS was significantly driven by intubation duration (P = 0.01). In the nationwide analysis, 165 weighted cases were identified; mean age was 2 months at hospital admission. Mechanical ventilation >96 hours was associated with increased LOS and hospitalization costs.

Conclusions:

Of infants with Robin sequence undergoing MDO, the most significant driver of total charges was LOS. Intubation duration was highly associated with LOS.
Clinical Insights into a Large Cohort of Phakomatosis Pigmentovascularis
Authors: Kolipaka Gowri Pratinya , Molleti Deepthi , Krishnamurthy Rashmi , Rao Aparna , Mandal Anil K. , Senthil Sirisha
Published: February 2025

Precis:

Phakomatosis pigmentovascularis, a multisystem disorder, exhibited male predominance, with Phakomatosis cesioflammea as the most prevalent type. Glaucoma affected 88% of eyes, with three-quarters requiring surgery. Systemic issues, notably epilepsy and anaemia, were prevalent in over half of all subjects.

Purpose:

To report the clinical profile and demographic characteristics of a large cohort with Phakomatosis pigmentovascularis (PPV).

Participants:

Included 119 eyes of 60 patients with PPV between January 1996 and January 2023 (27 y).

Methods:

This is a retrospective multi-centric study involving 4 tertiary network institutes in India. The diagnosis of PPV was established based on the concurrent presence of pigmentary nevi and capillary malformation, with classification conducted according to the Happle classification system. Demographic information, clinical features at the time of diagnosis (both ocular and systemic), the prevalence of glaucoma, details of management strategies employed, and the subsequent outcomes were meticulously documented.

Main Outcome Measures:

Key outcome measures included the prevalence of glaucoma among patients, the frequency of systemic abnormalities noted, and the various surgical interventions performed along with their respective success rates.

Results:

The cohort had male preponderance (male: female ratio of 67%:33%), with median age of presentation at 0.48 (range=0.12, 7.77) years. Glaucoma was observed in 105 eyes (88.2%), with bilateral involvement present in 75% of cases. The most prevalent phenotype observed within the cohort was Phakomatosis cesioflammea (Type iib), affecting 65% of patients. Systemic abnormalities were noted in 51.6% of cases, with epilepsy (45%) and anaemia (36%) being the most frequently documented conditions. Surgical intervention was required for 64.7% of eyes for intraocular pressure control, with combined trabeculotomy and trabeculectomy being the predominant procedure employed. Surgical success was noted in 87% of eyes, and 19.4% eyes had complications.

Conclusion:

Phakomatosis cesioflammea (Type iib) was the most common subgroup noted. Majority of patients had glaucoma, often bilateral, with two-thirds requiring surgical intervention for IOP control. Systemic abnormalities were common, emphasizing the need for comprehensive multisystem evaluation in these patients.
Opportunities to Advance Maternal Immunization Research
Authors: Mastroianni Anna C. , Henry Leslie Meltzer
Published: February 2025

In the last decade, there has been a notable surge in efforts to address longstanding obstacles to the conduct of clinical trials during pregnancy. This brief report draws attention to recent initiatives in vaccine and pregnancy-related research and highlights opportunities for researchers and clinicians to advance maternal immunization research, benefiting the health of pregnant women, fetuses and neonates.
Safe in Pregnancy and Safe in Children: Global Living Systematic Reviews and Meta-analyses Hub for Emergency Vaccines
Authors: Berrueta Mabel , Ciapponi Agustín , Bardach Ariel , Ballivan Jamile , Brizuela Martin , Castellana Noelia , Comande Daniel , Mazzoni Agustina , Parker Edward P. K. , Sambade Juan M. , Kampmann Beate , Stegelmann Katharina , Xiong Xu , Stergachis Andy , Munoz Flor M. , Buekens Pierre
Published: February 2025

The coronavirus disease 2019 pandemic encouraged rapid vaccine development, with a fast-evolving evidence base pre- and post-implementation. We developed a comprehensive web hub to promote swift information synthesis for present and future threats. By expanding our coronavirus disease 2019 periodically updated living systematic review to Chikungunya, Lassa fever, and Disease X, we will continuously capture data on vaccine safety and effectiveness.
A Qualitative, Patient-led Exploration of Vaccination Communication Preferences Among a Diverse Sample of Pregnant, Postpartum, Breastfeeding Canadians
Authors: Castrellon Pardo Maria , Bruce Marcia , Surti Monica Santosh , Myers-Stewart Medea , Donald Maoliosa , Patey Andrea M. , Castillo Eliana
Published: February 2025

Background:

Vaccination during pregnancy is recommended to protect pregnant individuals and their fetus from vaccine-preventable diseases and to protect infants during the vulnerable postnatal period. However, vaccine uptake in pregnancy remains low. This study explores how pregnant, postpartum and breastfeeding individuals living in Canada prefer to communicate about vaccination during pregnancy.

Methods:

We used peer-to-peer, patient-oriented research to conduct an exploratory qualitative descriptive study using focus groups and semistructured in-depth interviews to enquire about vaccination in pregnancy communication preferences, including preferred provider and communication timing. We coded deductively using direct content analysis and inductively while remaining sensitive to themes arising during the interviews.

Results:

Fourteen individuals from diverse cultural backgrounds living in Canada who self-identified as women and either as being pregnant, recently postpartum, or breastfeeding participated. Most preferred a participatory approach to vaccine communications combined with clear guidance. A trusted relationship with their provider mattered more than the healthcare provider’s profession. Participants wanted to discuss vaccines early and often to allow them time to find answers and discuss with their partners before making decisions. Participants also shared the importance of mutual respect, maintaining their autonomy and not feeling forced or coerced.

Conclusions:

Pregnant individuals want to play an active role in decision-making regarding vaccination during pregnancy. Their preference is to have open communication with familiar, trusted providers where they can express their questions and receive a clear recommendation which takes into consideration their unique circumstances so they can evaluate their options before making a decision.
DECIDE, A Pregnancy-specific Patient-provider Communication Approach: Multi-method and Codesign
Authors: Myers-Stewart Medea , Surti Monica Santosh , Kennedy Madison , Bruce Marcia , Castrellon Pardo Maria , Patey Andrea M. , Donald Maoliosa , Jamal Zaileen , Santana Maria J. , Castillo Eliana
Published: February 2025

Background:

Vaccination in pregnancy is recommended for preventing maternal and infant morbidity, but uptake is low. Existing presumptive and participatory vaccine communication approaches for childhood vaccinations may not encompass the nuanced decision-making during pregnancy.

Methods:

We employed a multi-method study using the double diamond design framework to codesign a pregnancy-specific, person-centered communication approach. Key activities of each double diamond phase are listed below:

Discover: Conducted a scoping review, a survey assessing psychological antecedents of (n = 237) pregnant or lactating individuals, qualitative interviews with (n = 169) patients and (n = 47) healthcare providers (HCPs) and gathered insights through (n = 20) community outreach events to understand the problem.

Define: Synthesized findings through thematic analysis and key informant interviews, to validate our understanding of the problem.

Develop: Prototyped solutions through role-playing, iterative feedback with patient partners and HCPs, and qualitative inquiry into parental preferences.

Deliver: Finalized the communication approach after iterative usability testing with (n = 15) HCPs and feedback-driven refinement with (n = 9) patient partners.

Results:

We confirmed the need for a pregnancy-specific communication approach and identified key gaps. We then built a prototype where perinatal HCPs could use either a presumptive if acceptant or participatory if hesitant approach but questioned the applicability of vaccine hesitancy to pregnancy. We abandoned a solely presumptive approach given parental insights: it is normal to “question” during pregnancy and developed a balanced approach. The final DECIDE (determine, elicit, consent, interactive discussion, deliver, empower) communication approach balances shared decision-making with a clear recommendation. It addresses pregnant individuals’ desire for autonomy and support, and HCPs call for simple tools to improve their confidence and communication skills without alienating their patients.

Conclusion and Next Steps:

DECIDE is a pregnancy-specific vaccine communication approach potentially applicable to other interventions beyond vaccination.
Prevalence and Predictors of Adverse Birth Outcomes and Their Implications in Assessing the Safety of New Maternal Vaccines in Kenya
Authors: Nyiro Joyce U. , Bukusi Elizabeth , Mureithi Marianne W. , Walumbe David , Nyaguara Amek , Kipkoech Collins , Nyawanda Bryan , Bigogo Godfrey , Otieno Nancy , Aol George , Audi Allan , Murunga Nickson , Berkley James A. , Nokes D. James , Munywoki Patrick K.
Published: February 2025

Background:

Successful introduction, high uptake and program effectiveness of new maternal vaccines aimed to prevent disease among infants require prior knowledge of their safety during pregnancy. We aimed to identify background adverse birth outcomes and their predictors in Kenya by which to aid future interpretation of outcomes for new maternal vaccination programs.

Methods:

A cross-sectional survey was conducted to assess birth outcomes from women residents within the health and demographic surveillance systems of Kilifi, Siaya and Nairobi, Kenya. All selected women had pregnancies registered in the years 2017–2020 through census rounds and had a birth outcome recorded by the time of data collection. They were traced at home for interviews and abstraction of birth outcome records from mother and child health booklets. Multivariable logistic regression was used to identify independent predictors of adverse birth outcomes.

Results:

A total of 2702 women were interviewed. Adverse birth outcomes occurred in 788/2702 (29.2%) of pregnancies: 433 (16.0%) were preterm (gestational age <37 weeks), 298 (11.0%) low birth weight (<2500 g), 99 (3.7%) macrosomic (>4000 g) and 41 (1.5%) stillbirths. Predictors of adverse birth outcomes were gestational diabetes [adjusted Odds Ratio (aOR): 3.32 (1.53–7.20)], malaria during pregnancy [aOR: 1.74 (1.23–2.48)], not attending antenatal care [aOR: 12.89 (2.17–76.68)] and home delivery [aOR: 1.58 (1.18–2.12)].

Conclusions:

In 3 Kenyan settings, almost a third of pregnancies had adverse birth outcomes. Recognizing this baseline prevalence and the factors associated with adverse birth outcomes will be important in validating the safety of new maternal vaccines.
Trends in Neonatal Vaccination: A Ten-year Retrospective Study in a Large Delivery Center
Authors: Mourão Maria Laura , Baca-Arzaga Adrian , Castellanos Marianna , Johnstone Rhys , Miedema David , Ozonoff Al , Odumade Oludare A. , Angelidou Asimenia
Published: February 2025

Background:

Newborns are at increased risk of vaccine preventable morbidity and mortality. The American Academy of Pediatrics recommends administering the birth dose of the hepatitis B vaccine (HBV) between 0 and 30 days of life [based on birth weight (BW) < 2000 g vs. ≥ 2000 g], followed by several vaccines at 2 months of age (regardless of the BW) including the first dose of the pneumococcal vaccine (PCV). However, adherence to these guidelines is often suboptimal, resulting in incomplete or delayed vaccination.

Methods:

This is a 10-year retrospective, single-center observational study examining the rates and timeliness of HBV and PCV vaccination of infants admitted to the mother-baby unit and neonatal intensive care unit (NICU) from 2013 to 2023. Multinomial logistic regression was used to examine factors associated with vaccination status.

Results:

HBV vaccination of infants admitted to the neonatal intensive care unit (n = 4935) was significantly more likely to diverge from American Academy of Pediatrics recommendations versus HBV vaccination of infants admitted to the mother-baby unit (n = 49,857). Factors associated with higher relative risk of delayed HBV vaccination included administration in the pre-COVID prepandemic era, prematurity, BW ≥ 2000 g and Black/African American race, with the latter two also being associated with incomplete vaccination at discharge. For PCV, Hispanic patients were more likely to be discharged with incomplete vaccination compared with non-Hispanic patients.

Conclusions:

Postpandemic, there were lower rates of delayed vaccinations, possibly reflecting increased vaccine awareness among parents and providers. Preterm status was a key factor influencing HBV vaccination timeliness. Perceptions and attitudes toward early-life vaccination, including potential racial biases, should be examined as potential contributors to differing vaccine administration practices.
Vaccine Confidence During Pregnancy and the Impact of the COVID-19 Pandemic: A Wide Variety of Views Across the European Union
Authors: De Brabandere Larissa , Hanning Nikita , Hendrickx Greet , Van Damme Pierre , Maertens Kirsten
Published: February 2025

Background:

There is a wide variety of vaccination programs during pregnancy implemented in different European Union (EU) countries. The recent coronavirus disease 2019 (COVID-19) pandemic emphasized the need for efficient interventions to increase vaccine confidence during pregnancy since pregnant women were less likely to accept COVID-19 vaccination compared with nonpregnant women. This survey investigated the influence of the COVID-19 pandemic on vaccine confidence during pregnancy in 11 European countries.

Methods:

An online survey with questions on maternal vaccine confidence was distributed in 10 EU countries between March 29 and April 6, 2022. Via convenience sampling, 25 eligible participants per country were recruited. Subsequently, the survey was distributed in Flanders (Belgium) between October 14 and 26, 2022, delivering 480 eligible respondents. All participants were either pregnant or gave birth in the last 2 years.

Results:

Across all countries, vaccine confidence during pregnancy was found to be lower than vaccine confidence in general. Safety concerns were indicated as the most important reason to refuse vaccination during pregnancy. Participants with higher education and who were above 30 years old showed more confidence toward vaccination during pregnancy. A total of 15% of the participants indicated that the COVID-19 pandemic negatively impacted their confidence toward vaccines.

Conclusions:

Vaccine confidence during pregnancy varies widely across the EU. However, across all surveyed countries, vaccine confidence during pregnancy is lower than vaccine confidence in general, and safety concerns appear to be the main driver of this. The COVID-19 pandemic negatively impacted the view on vaccination in a significant proportion of participants, indicating that vaccine implementation in a next pandemic should be tackled differently.
Heterologous Effects of Pertussis and Influenza Vaccines During Pregnancy on Maternal and Infant Innate Immune Responses: A Pilot Study
Authors: Islam Khaleda , Sancho-Shimizu Vanessa , Kampmann Beate , Diavatopoulos Dimitri , Holder Beth , Rice Thomas F.
Published: February 2025

Background:

Research has demonstrated that some vaccines may have effects on the immune system beyond their intended targets. These heterologous effects of vaccination occur through reprogramming of innate immune cells, resulting in enhanced cytokine responses to unrelated pathogens and have been observed most evidently following Bacillus Calmette–Guérin vaccination. Pregnant women in the United Kingdom are offered influenza and acellular pertussis (Tdap) vaccines to protect the mother and infant, respectively, from infection. Little is known about the potential heterologous effects of vaccines given during pregnancy on the maternal and infant immune systems.

Objective:

To investigate heterologous innate immune responses in mothers and infants from pertussis-vaccinated and pertussis/influenza double-vaccinated pregnancies compared with unvaccinated pregnancies, in a pilot cohort.

Methods:

In this pilot study, samples collected as part of 2 maternal immunization studies were utilized. Maternal and cord peripheral blood mononuclear cells (PBMCs) were collected at birth from women who had received both Tdap and influenza vaccination, only the Tdap vaccine or no vaccines during pregnancy. To further investigate the effect of influenza vaccination alone, PBMCs were collected from nonpregnant women before and after seasonal influenza vaccination. PBMCs were incubated with pattern recognition receptor (PRR) ligands, vaccine adjuvants or CRM197 for 24 hours and cytokine responses were quantified in supernatants by enzyme-linked immunosorbent assay.

Results:

PBMC from women who received both Tdap and influenza vaccines had reduced IL-1β, IL-6 and IL-8 cytokine responses to PRR ligand stimulation, compared with those from women who received Tdap alone. Maternal vaccine status during pregnancy did not impact cytokine responses to PRR stimulation in cord PBMCs. Seasonal influenza vaccination did not alter cytokine responses to PRR ligands in nonpregnant women.

Conclusions:

Our pilot study suggests that PBMC from women receiving combined Tdap and influenza vaccination during pregnancy may have reduced in vitro cytokine responses to nonpertussis stimuli. Larger cohorts of mother-infant pairs need to be studied to confirm these findings, study the potential mechanisms and control for potential confounders.
Toward an Electronic Pregnancy Registry in The Gambia: Linking up Maternal and Newborn Health Data Using the Smart Paper Technology
Authors: Prauseová Jana , Nkereuwem Oluwatosin , Okomo Uduak , Bittaye Mustapha , Marena Musa , Fofana Sidat , Cham Mamady , Jarju Gibril , Nabiev Rustam , Longley Ashley T. , Kampmann Beate
Published: February 2025

Smart Paper Technology, an innovative paper-to-digital system implemented at Bundung Maternal and Child Health Hospital in The Gambia links maternal and newborn health information with immunization records. In 9 months, Smart Paper Technology facilitated over 3500 mother–child connections, replacing traditional paper-based registers and ensuring DHIS2 interoperability. This pilot enhances reporting and data availability, advancing maternal vaccine safety surveillance in resource-limited settings.
Access to Ear and Hearing Care Globally: A Survey of Stakeholder Perceptions from the Lancet Commission on Global Hearing Loss
Authors: Patterson Rolvix H. , McMahon Catherine , Waterworth Chris , Morton Sarah , Platt Alyssa , Chadha Shelly , Xu Mary Jue , Der Carolina , Nakku Doreen , Seguya Amina , Frost Robert , Jaffer Ali , Robler Samantha Kleindienst , Emmett Susan D.
Published: February 2025

Objective

Characterize global access to ear and hearing care (EHC) to inform future policy recommendations.

Study Design

Survey using convenience sampling.

Setting

Subjects were surveyed via contact lists of the World Health Organization, Global Otolaryngology–Head and Neck Surgery Initiative, and Global HEAR Collaborative.

Participants

Otolaryngologists, audiologists, other health care professionals, adults with hearing loss, parents/caregivers of children with hearing loss, and policymakers.

Intervention

None.

Main Outcome and Measure(s)

Responses to questions regarding EHC screening programs, workforce, supports, access to care, and government priority by World Bank income group.

Results

There were 125 included survey responses from EHC stakeholders representing 59 countries: 71% from low- and middle-income countries (LMICs) and 29% from high-income countries (HICs). Compared with respondents from LMICs, those from HICs more frequently indicated that their country had adequate numbers of ENTs, audiologists, SLPs, and EHC community health workers. This trend was consistent across questions regarding number of training programs for EHC workforce, presence of hearing screening programs, cost of hearing aids and cochlear implants, availability of EHC supports and services, affordability of EHC, government funding or investment, and inclusion of EHC in national health strategy.

Conclusion

Globally, EHC is limited by systems-level barriers that disproportionately affect LMICs. Urgent policy development and intervention is needed to eliminate these barriers and improve EHC around the world.
Gene Therapy for Hearing Loss: Which Genes Next?
Authors: Carlson Ryan J. , Taiber Shahar , Rubinstein Jay T.
Published: February 2025

Introduction

Hearing loss is the most common sensory deficit in humans, and roughly half of childhood-onset sensorineural hearing loss is genetic. Advances in gene therapy techniques have led to the first clinical trials for OTOF-associated hearing loss DFNB9. Therapies for other hearing loss genes are in various stages of development, and therefore a comprehensive evaluation of potential candidate genes can help to prioritize and guide these efforts.

Methods

A list of 93 nonsyndromic hearing loss genes with consensus support was generated. Critical factors for evaluation were identified as gene size, timing of cochlear degradation, cell type(s) of primary expression, availability of mouse models and efficacy of adeno-associated virus experiments in those mice, and human hearing loss severity, onset, and prevalence. Each factor was addressed with gene-specific PubMed searches for applicable studies.

Results

Each gene was evaluated according to the above factors, with favorable results indicating the most promising candidates for gene therapy. Genes that satisfied all the above conditions included TMPRSS3, PCDH15, and TMC1. Other genes, such as LOXHD1 and MYO6, had not yet had gene replacement attempts in a mouse model but otherwise satisfied all conditions and were likewise identified as promising candidates.

Conclusion

Based on this analysis, hearing loss genes vary widely in terms of their favorability for treatment by gene therapy approaches. Targeting development efforts to promising candidates will ensure the highest likelihood of clinical success. Several genes were identified as appealing next targets, signaling an increasing role of gene therapies in hearing loss care moving forward.
Navigating variants of uncertain significance in genetic dyslipidemia: how to assess and counsel patients
Authors: Ison Hannah E. , Helm Benjamin , Kringlen Gabriel , Crawford Paul
Published: February 2025

Purpose of review

Genetic testing has become an integral component of clinical care when an inherited condition is suspected. However, the interpretation of variants identified with this testing can be nuanced. Variants of uncertain significance (VUS) are variants for which there is not enough data currently available to determine if the variant is causal for disease (i.e. pathogenic) or is benign. VUS can exist on a spectrum with some leaning towards suspected pathogenicity and others leaning towards likely benign. Clinician understanding of variant interpretation can improve clinical care by providing more context around how suspicious a VUS is, determining whether additional steps should be taken to further evaluate the variant in question, and ensuring patient understanding of these results.

Recent findings

Research on this topic highlights the complexities around VUS interpretation and counseling. VUS are not static: interpretations of pathogenicity change as new information is uncovered.

This review aims to summarize this literature and provide insight into variant interpretation, practical steps clinicians can take to further assess a VUS, and considerations when counseling patients on these results.
Development of a screening tool for reduced vision among inpatients of hospital rehabilitation units
Authors: Stalin Amritha , Khan Shamrozé , Labreche Tammy , Narayan Abhishek , Christian Lisa W. T. , Stanberry Andre , Leat Susan J.
Published: February 2025

SIGNIFICANCE

This study developed a practical screening tool to identify reduced habitual vision (RHV) in hospital rehabilitation units. This tool would enhance patient care by enabling timely interventions in resource-limited settings.

PURPOSE

The study aimed to develop a practical and implementable screening tool to identify patients with RHV in hospital rehabilitation units. Potential vision measures, screening questions, and demographic variables were considered to determine the optimum combination.

METHODS

The cross-sectional study recruited 112 adult inpatients (aged 18+ years) from three rehabilitation units in an acute care hospital in Ontario, Canada, between October 2018 and February 2019. Data included an oral questionnaire on demographics, health status, and self-reported vision function, alongside vision assessments (distance visual acuity [VA], contrast sensitivity [CS], visual fields [VFs], and stereopsis). Univariate and multivariate logistic regression analyses were conducted to identify significant predictors of RHV, defined by VA >0.3 logMAR, CS <1.40 logCS, or any VF defect.

RESULTS

The average age of participants was 74.5 years (±14.3 years), and RHV was present in 48.7%. Significant predictors of RHV included self-reported “happiness” with vision with current spectacles and difficulty reading a newspaper. The optimal predictive factors were VA and VF testing (96% sensitivity), but for practical implementation, the combination of three self-reported questions (happiness with vision, difficulty reading a newspaper, and difficulty distinguishing facial expressions) demonstrated 74% sensitivity.

CONCLUSIONS

The study highlights that a combination of self-reported questions can effectively identify patients with RHV, providing a feasible alternative to direct vision assessments in resource-limited settings. Implementing this screening tool could improve patient care by enabling timely adaptations and referrals for eye care, ultimately enhancing rehabilitation outcomes and reducing falls risk. Further research is needed to refine the tool's sensitivity and explore its applicability in broader hospital and primary care settings.
Early Axial Spondyloarthritis Detection
Authors: Hellamand Pasoon , van de Sande Marleen G.H. , van Bentum Rianne E. , Verbraak Frank D. , Twisk Jos W.R. , van der Horst Bruinsma Irene
Published: February 2025

Objective

In the previous Spondyloarthritis EYE study, we confirmed the potential of a screening strategy for early axial spondyloarthritis (axSpA) detection using acute anterior uveitis (AAU) and chronic back pain (CBP) as referral criteria. This follow-up study assessed changes in diagnostic categories (definite, suspected, and no axSpA) over 2 years and identified baseline factors predicting axSpA diagnosis at 24 months.

Methods

Patients with AAU and CBP were categorized into 3 groups: definite axSpA, suspected of axSpA, and no axSpA, based on clinical and radiographic data within 6 months after baseline. Suspected cases were monitored for 24 months, with the possibility of reclassification. A competing risk analysis was used to estimate the probability of transitioning from “suspected of axSpA” to “definite axSpA” or “no axSpA,” and logistic regression analysis was employed to determine if baseline factors could predict definite axSpA at 24 months.

Results

Among 81 patients, 26 were classified as no axSpA, 36 as suspected of axSpA, and 19 as definite axSpA. At 24 months, suspected patients had an 18% probability to transition to definite axSpA (4 cases) and a 60% to no axSpA (15 cases). Significant predictors of axSpA diagnosis included the following: HLA-B27 positivity, good response to nonsteroidal anti-inflammatory drugs, inflammatory back pain, increasing C-reactive protein levels, buttock pain, and higher Bath Ankylosing Spondylitis Metrology Index scores.

Conclusions

Our screening strategy identified approximately one third of previously undiagnosed axSpA cases among patients with AAU and CBP, mostly at baseline, with few additional cases at follow-up. The predictors revealed in this study could aid physicians in estimating axSpA disease probability.
A Prediction Nomogram for Long-Term Facial Nerve Function Following Large Vestibular Schwannoma Resection
Authors: Guan Haonan , Yu Aiping , Shi Zhifeng , Wang Daohe , Ding Wei
Published: February 2025

Objective:

The purpose of this study was to generate a nomogram for predicting long-term facial nerve (FN) function at 3 months following large vestibular schwannoma (VS) resection.

Materials and Methods:

Retrospective data were evaluated from patients who underwent VS resection from May 2014 to May 2023 at Huashan Hospital. The nomogram was conducted based on the results of univariate and multivariate logistic regression analysis of the risk factors for poor long-term FN function after VS resection.

Results:

A total of 166 cases were finally included in this study. The univariate and multivariate logistic regression analysis showed that tumor size [P=0.022, odds ratio (OR): 1.11, 95% CI: 1.02–1.22), intraoperative stimulation threshold (ST) (P=0.005, OR: 12.17, 95% CI: 2.10–70.68), tumor type (P=0.009, OR: 7.46, 95% CI: 1.64–33.86) and 3-month postoperative HB grade (P=0.005, OR: 0.883, 95% CI: 0.062–12.61) were independent risk factors for poor long-term FN function. A nomogram was conducted based on these indicators, which demonstrated good discrimination and favorable calibration.

Conclusion:

A nomogram based on 4 indicators was conducted to predict long-term FN function at 3 months following large VS resection. Patients presented with little chance of long-term FN recovery are candidates for early intervention.
Metabolomic profiling and chemical marker identification in medicinal plants of Atractylodes
Authors: Zhang Chengcai , Wang Sheng , Li Qi , Zhang Yan , He Yali , Yan Binbin , Zhou Li , Guo Lanping
Published: February 2025

Background

The genus Atractylodes, native to East Asia, encompasses several species that serve as sources for the widely used traditional Chinese medicines Atractylodis Macrocephalae Rhizoma and Atractylodis Rhizoma. However, the international trade arouses concern regarding potential confusion and misidentification of Atractylodes species.

Objective

A comprehensive understanding of the chemical diversity is crucial for ensuring the quality and exploring the potential variations in medicinal efficacy of Atractylodes.

Methods

The GC/MS-MS-based metabolomics and multivariate statistical analysis identified 589 differentially accumulated metabolites across 5 Atractylodes species.

Results

A total of 150 metabolites were predicted as potential chemical markers for species differentiation and quality assessment of Atractylodes. According to the metabolic profiles, the species of Atractylodes can be roughly classified into three categories: A. lancea and A. coreana with the volatile oil components being mainly atractylodin and β-eudesmol; A. macrocephala with the biomarker being atractylon; and A. japonica and A. carlinoides lying between the two categories above.

Conclusions

Metabolomic results indicated that the metabolic profiles of A. carlinoides and A. macrocephala were similar and distinct from those of the other three species. Sesquiterpenoids were the main chemical components in the rhizome of A. carlinoides, which indicated the potential medicinal value of this plant.
The elastic stored energy of initially strained, or stressed, materials: restrictions and third-order expansions
Authors: Gower Artur L. , Shearer Tom , Ciarletta Pasquale , Destrade Michel
Published: February 2025

A large variety of engineering and biological materials have a non-zero internal stress distribution, even in the absence of applied forces. These stresses can arise from thermal expansion or volumetric growth, for example, in the production of the material. There are two approaches to modelling such materials that appear similar but are, in fact, distinct. The first defines a function,

W
~

(

F

,
τ
)

, associated with a
fixed reference configuration
,

B

, say, where each value of

τ

corresponds to the initial stress in a
different elastic material
that occupies

B

(each with a different elastic constitutive equation, effectively). The second defines a function,

W
¯

(

F

,
τ
)

, associated with a
single, fixed, initially stressed, elastic material
(with a single constitutive equation), where each value of

τ

represents the stress in a
different configuration
of that material. Here, we discuss why stored energy functions of the latter type, and similar functions that are written in terms of an initial
strain
, need to satisfy some restrictions to avoid unphysical behaviours. To illustrate their need, we perform an asymptotic expansion to prove that these restrictions are required for consistency with strain energy functions of classical third-order weakly nonlinear elasticity.