bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurocognitive Subgroups in Children at Familial High-risk of Schizophrenia or Bipolar disorder: Subgroup Membership Stability or Change From Age 7 to 11—The Danish High Risk and Resilience Study
Authors: Knudsen Christina Bruun , Greve Aja Neergaard , Jepsen Jens Richardt Møllegaard , Lambek Rikke , Andreassen Anna Krogh , Veddum Lotte , Brandt Julie Marie , Gregersen Maja , Krantz Mette Falkenberg , Søndergaard Anne , Carlsen Anders Helles , Steffensen Nanna Lawaetz , Bundgaard Anette Faurskov , Burton Birgitte Klee , Thorup Anne Amalie Elgaard , Nordentoft Merete , Mors Ole , Bliksted Vibeke Fuglsang , Hemager Nicoline
Published: October 2022

Background and Hypothesis

Subgroups with distinct levels of neurocognitive functioning exist in children of parents with schizophrenia or bipolar disorder. However, studies investigating the temporal stability of subgroup membership are currently lacking. We hypothesized that a minority of children at familial high-risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) would transition to a different neurocognitive subgroup from age 7 to 11 and that most transitions would be to a more impaired subgroup.

Study Design

Latent profile analysis was used to identify subgroups at two assessments (age 7 and 11) based on the performance of 320 children at FHR-SZ or FHR-BP across eight neurocognitive functions. Temporal stability in subgroup membership was evaluated with latent profile transition analysis. Population-based controls (age 7, n = 199; age 11, n = 178) were included as a reference group. Children transitioning to a more impaired subgroup were compared with nontransitioning children on sex, FHR-status, global functioning, and psychopathology.

Study Results

At both assessment points, we identified three subgroups based on neurocognitive performance: a moderately–severely impaired, a mildly impaired, and an above-average subgroup. A total of 12.8% of children transitioned to a different subgroup, of which the majority (85.2%) moved to a more impaired subgroup. Parental diagnosis of schizophrenia, but neither parental diagnosis of bipolar disorder, global functioning at age 7, psychopathology, nor sex significantly differentiated children transitioning to a more impaired subgroup from nontransitioning children.

Conclusions

During pre-adolescence, neurocognitive developmental lag is associated with being at FHR-SZ. Close attention to these children’s neurocognitive development is indicated.
The imprinted geneZac1regulates steatosis in developmental cadmium-induced nonalcoholic fatty liver disease
Authors: Riegl Sierra D , Starnes Cassie , Jima Dereje D , Baptissart Marine , Diehl Anna Mae , Belcher Scott M , Cowley Michael
Published: October 2022

Cadmium (Cd) exposure in adulthood is associated with nonalcoholic fatty liver disease (NAFLD), characterized by steatosis, inflammation, and fibrosis. The prevalence of NAFLD in children is increasing, suggesting a role for the developmental environment in programming susceptibility. However, the role of developmental Cd exposure in programming NAFLD and the underlying mechanisms remain unclear. We have proposed that imprinted genes are strong candidates for connecting the early life environment and later life disease. In support of this, we previously identified roles for the Imprinted Gene Network (IGN) and its regulator Zac1 in programming NAFLD in response to maternal metabolic dysfunction. Here, we test the hypothesis that developmental Cd exposure is sufficient to program NAFLD, and further, that this process is mediated by Zac1 and the IGN. Using mice, we show that developmental cadmium chloride (CdCl2) exposure leads to histological, biochemical, and molecular signatures of steatosis and fibrosis in juveniles. Transcriptomic analyses comparing livers of CdCl2-exposed and control mice show upregulation of Zac1 and the IGN coincident with disease presentation. Increased hepatic Zac1 expression is independent of promoter methylation and imprinting statuses. Finally, we show that over-expression of Zac1 in cultured hepatocytes is sufficient to induce lipid accumulation in a Pparγ-dependent manner and demonstrate direct binding of Zac1 to the Pparγ promoter. Our findings demonstrate that developmental Cd exposure is sufficient to program NAFLD in later life, and with our previous work, establish Zac1 and the IGN as key regulators of prosteatotic and profibrotic pathways, two of the major pathological hallmarks of NAFLD.
Haplotype assignment of longitudinal viral deep sequencing data using covariation of variant frequencies
Authors: Venturini Cristina , Pang Juanita , Tamuri Asif U , Roy Sunando , Atkinson Claire , Griffiths Paul , Breuer Judith , Goldstein Richard A
Published: October 2022

Longitudinal deep sequencing of viruses can provide detailed information about intra-host evolutionary dynamics including how viruses interact with and transmit between hosts. Many analyses require haplotype reconstruction, identifying which variants are co-located on the same genomic element. Most current methods to perform this reconstruction are based on a high density of variants and cannot perform this reconstruction for slowly evolving viruses. We present a new approach, HaROLD (HAplotype Reconstruction Of Longitudinal Deep sequencing data), which performs this reconstruction based on identifying co-varying variant frequencies using a probabilistic framework. We illustrate HaROLD on both RNA and DNA viruses with synthetic Illumina paired read data created from mixed human cytomegalovirus (HCMV) and norovirus genomes, and clinical datasets of HCMV and norovirus samples, demonstrating high accuracy, especially when longitudinal samples are available.
Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses
Authors: Roberts Lisa R. , Dubov Alex , Distelberg Brian , Peteet Bridgette , Abdul-Mutakabbir Jacinda C. , Montgomery Susanne , Patel Pranjal , Chrissian Ara A.
Published: October 2022

Purpose:

The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected.

Methods:

This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them.

Results:

Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated (“vaccine hesitant”). The χ2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others.

Conclusion:

The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed.
Universal Gestational Diabetes Screening and Antepartum Stillbirth Rates in Austria—A Population-Based Study
Authors: Muin Dana A. , Pfeifer Bernhard , Helmer Hanns , Oberaigner Wilhelm , Leitner Hermann , Kiss Herbert , Neururer Sabrina
Published: October 2022

(Abstracted from Acta Obstet Gynecol Scand 2022;101:396–404)

Approximately 1 in 6 pregnancies are affected by gestational diabetes mellitus (GDM), a risk factor for preeclampsia, fetal macrosomia, neonatal hypoglycemia, and antepartum stillbirth. The incidence of antepartum stillbirth is approximately 4/1000 births in high-income countries, and the risk of fetal death recurrence can be as high as 22-fold.
Mode of Delivery Is an Independent Risk Factor for Maternal Mortality: A Case-Control Study
Authors: Balayla Jacques , Lasry Ariane , Badeghiesh Ahmad , Volodarsky-Perel Alexander , Gil Yaron
Published: October 2022

(Abstracted from J Matern Fetal Neonatal Med 2022;35:1962–1968)

In 2014, a systematic analysis by the World Health Organization found that the leading causes of maternal mortality were obstetric hemorrhage, hypertensive disorders, and pregnancy-related sepsis. However, in the United States, the leading causes of maternal death are cardiovascular conditions, noncardiovascular underlying medical conditions, and infection.
Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women
Authors: Feldman Noa , Maymon Ron , Jauniaux Eric , Manoach Danielle , Mor Matan , Marczak Ewa , Melcer Yaakov
Published: October 2022

(Abstracted from J Ultrasound Med 2022;41:917–923)

As cesarean delivery (CD) rates have exponentially increased worldwide during the last 2 decades, the development of a “niche,” or a CD scar defect (also called isthmocele), has arisen as a key factor associated with secondary gynecological and obstetrical complications. In terms of subsequent pregnancies, these defects have been indirectly associated with increased rates of placenta accreta, iatrogenic obstetric complications, and preterm birth.
Residual Risk for Clinically Significant Copy Number Variants in Low-Risk Pregnancies, Following Exclusion of Noninvasive Prenatal Screening–Detectable Findings
Authors: Maya Idit , Sheelo Liat Salzer , Brabbing-Goldstein Dana , Matar Reut , Kahana Sarit , Agmon-Fishman Ifaat , Klein Cochava , Gurevitch Merav , Basel-Salmon Lina , Sagi-Dain Lena
Published: October 2022

(Abstracted from Am J Obstet Gynecol 2022;226:562.e1–562.e8)

Recent developments in available techniques for prenatal genetic analysis have significantly changed genetic screening and diagnosis; these include chromosomal microarray analysis (CMA) and cell-free DNA (cfDNA) screening. However, both tests have benefits and drawbacks.
Human Papilloma Virus Vaccination and Cervical Cancer Screening Coverage in Managed Care Plans—United States, 2018
Authors: Richards Thomas B. , Lindley Megan C. , Byron Sepheen C. , Saraiya Mona
Published: October 2022

(Abstracted from Prev Med 2022;159:107019)

To prevent cervical cancer, vaccination against human papillomavirus (HPV) is recommended for adolescents aged 21 to 65 years and cervical cancer screening for women aged 21 to 65 years. The National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) evaluates managed care plan effectiveness of care for HPV vaccination and cervical cancer screening, allowing individual health plans to assess their preventive services performance rates compared with other plans.
Building a National Public Health System in the United States
Authors: Hamburg Margaret A. , Cohen Mandy , DeSalvo Karen , Gerberding Julie , Khaldun Joneigh , Lakey David , MacKenzie Ellen , Palacio Herminia , Shah Nirav R.
Published: October 2022

(Abstracted from N Engl J Med 2022;387:385–388)

This article presents the report of a blue-ribbon commission selected by the Commonwealth Fund. The first author of this report, Margaret Hamburg, is the chairman of the commission.
Levonorgestrel 52 mg Intrauterine System Efficacy and Safety Through 8 Years of Use
Authors: Creinin Mitchell D. , Schreiber Courtney A. , Turok David K. , Cwiak Carrie , Chen Beatrice A. , Olariu Andrea I.
Published: October 2022

(Abstracted from Am J Obstet Gynecol 2022; doi: 10.1016/j.ajog.2022.05.022)

Over the past several years, the longevity of use for long-acting reversible contraception (LARC) methods has increased. Increased duration of use is especially important for younger users desiring long-term birth prevention or spacing and for those who wish to postpone or avoid future childbearing.
Racial Inequities in Breastfeeding Counseling Among Pregnant People Who Use Cannabis
Authors: Nidey Nichole , Hoyt-Austin Adrienne , Chen Melissa J. , Bentley Brandie , Tabb Karen M. , Anyigbo Chidiogo , Wilder Christine , Terplan Mishka , McAllister Jennifer M. , Wexelblatt Scott L. , Murnan Aaron , Kair Laura R.
Published: October 2022

We examined how breastfeeding advice in the context of cannabis use differed by race and ethnicity. Data from the 2017–2018 PRAMS (Pregnancy Risk Assessment Monitoring System) survey were used to assess differences in breastfeeding guidance related to cannabis use among 1,213 individuals who self-reported cannabis use 3 months before or during pregnancy. A multivariable logistic regression model was specified to examine the extent to which the odds of receiving prenatal advice against breastfeeding if using cannabis differed by self-reported race and ethnicity. We found that non-Hispanic Black people were four times more likely than non-Hispanic White people to be advised against breastfeeding if using cannabis (adjusted odds ratio 4.1, 95% CI 2.1–8.2). Pregnant non-Hispanic Black people were disproportionately advised not to breastfeed if using cannabis.
Trends in and Outcomes of Deliveries Complicated by Cystic Fibrosis
Authors: Schmidt Christina N. , Friedman Alexander M. , DiMango Emily A. , Linder Alice H. , Sobhani Nasim C. , D'Alton Mary E. , Wen Timothy
Published: October 2022

OBJECTIVE:

To characterize current trends and outcomes in pregnancies complicated by cystic fibrosis (CF) that resulted in delivery.

METHODS:

This repeated cross-sectional study used the U.S. National Inpatient Sample to identify delivery hospitalizations of patients with CF between 2000 and 2019. Trends in delivery hospitalizations of patients with CF were assessed using joinpoint regression to determine the average annual percent change (AAPC). The risk of adverse maternal and obstetric outcomes was compared between patients with and without CF using adjusted logistic regression models accounting for demographic, clinical, and hospital characteristics, with adjusted odds ratios (aORs) with 95% CIs as measures of association. The proportion of patients with CF and other chronic conditions such as pregestational diabetes was analyzed over time.

RESULTS:

From 2000 to 2019, the prevalence of CF at delivery increased from 2.1 to 10.4 per 100,000 deliveries (AAPC 6.7%, 95% CI 5.7–8.2%). The proportion of patients with CF and other chronic conditions increased from 18.0% to 37.3% (AAPC 3.1%, 95% CI 1.0–5.3%). Patients with CF were more likely to experience severe maternal morbidity (aOR 2.61, 95% CI 1.71–3.97), respiratory complications (aOR 17.45, 95% CI 11.85–25.68), venous thromboembolism (aOR 3.59, 95% CI 1.33–9.69), preterm delivery (aOR 2.15, 95% CI 1.79–2.59), abruption and antepartum hemorrhage (aOR 1.63, 95% CI 1.10–2.41), and gestational diabetes (aOR 2.47, 95% CI 2.47–3.70).

CONCLUSION:

Although still infrequent (approximately 1 in 10,000), deliveries complicated by CF increased approximately fivefold over the study period. The proportion of patients with CF and other chronic conditions is increasing. Patients with CF are at increased risk for a broad range of adverse outcomes.
Text Message–Based Breastfeeding Support Compared With Usual Care
Authors: Bender Whitney , Levine Lisa , Durnwald Celeste
Published: October 2022

OBJECTIVE:

To evaluate whether a postpartum text message–based communication platform improves breastfeeding rates.

METHODS:

In a randomized controlled trial, a control group receiving weekly text messages inquiring about infant feeding method was compared with an intervention group receiving educational text messages and personalized, text message–based breastfeeding support. The primary outcome was breastfeeding exclusivity at 6 weeks postpartum. Secondary outcomes included any breastfeeding and formula supplementation at 6 weeks postpartum. A sample size of 190 was planned to achieve 80% power to detect a 50% change in breastfeeding exclusivity from 40% baseline, with a two-sided alpha of 5%. Race was noted to be an effect modifier; therefore, results are presented overall and stratified by self-reported Black race compared with non-Black race.

RESULTS:

From January 2020 to January 2021, 300 patients were enrolled and 216 were randomized as follows: 110 to control and 106 to intervention. In the cohort, 52.8% were Black, 45.4% had public insurance, and 46.3% were nulliparous. There were no differences in demographic, delivery, or postpartum characteristics between groups. Among the 185 patients (85.6%) with data available for the primary outcome, there was no difference in breastfeeding exclusivity by treatment group (intervention 48.4% vs usual care 41.3%, P=.33). When stratified by race, Black patients in the intervention arm had 2.6 times higher odds of exclusively breastfeeding at 6 weeks postpartum compared with Black patients in the control arm (39.5% vs 20.0%, odds ratio 2.62, 95% CI 1.04–6.59). Enrollment in the intervention arm decreased the Black–non-Black disparity in the primary outcome (20.0% vs 66.7%, P<.001in usual care arm vs 39.5% vs 56.0%, P=.11 in intervention arm). There were no differences in other secondary outcomes.

CONCLUSION:

A text message–based communication platform was not associated with breastfeeding exclusivity at 6 weeks postpartum compared with usual care.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04108533.
Fetal Autopsy Rates in the United States
Authors: Oliver Emily A. , Finneran Matthew M. , Rood Kara M. , Ma'ayeh Marwan , Berghella Vincenzo , Silver Robert M.
Published: October 2022

OBJECTIVE:

To identify rates of fetal autopsy in the United States as well as demographic and clinical characteristics related to consent to autopsy after stillbirth.

METHODS:

This is a population-based retrospective cohort study using U.S. fetal death certificates for stillborn fetuses (20 weeks of gestation or more) delivered between January 2014 and December 2016. Multiple gestations were excluded. Fetal autopsy rates were calculated by gestational age, maternal age, self-reported race and ethnicity, education, and having at least one living child. Multivariate logistic regression to adjust for potential confounders was performed.

RESULTS:

There were 60,328 stillbirths meeting inclusion criteria. Overall, fetal autopsy was performed in 20.9% of stillbirths. Non-Hispanic Black women had the highest rate of fetal autopsy (22.9%, 95% CI 22.3–23.6%), compared with non-Hispanic White women (20.4%, 95% CI 20.0–20.9%) and Hispanic women (19.6%, 95% CI 19.0–20.3%) (P<.001). After adjusting for potential confounders, maternal non-Hispanic Black race (adjusted odds ratio [aOR] 1.22, 95% CI 1.16–1.29), higher education (graduate degree: aOR 1.62, 95% CI 1.47–1.79), and higher gestational age (term: aOR 2.08, 95% CI 1.95–2.23) were associated with increased aORs for fetal autopsy. Maternal age 40 years or older (aOR 0.77 95% CI 0.63–0.92) and having at least one living child (aOR 0.74, 95% CI 0.71–0.78) were associated with a decreased aOR of having a fetal autopsy. Women of American Indian or Alaska Native decent had decreased uptake of fetal autopsy compared with non-Hispanic White women (aOR 0.72, 95% CI 0.58–0.90).

CONCLUSION:

Fetal autopsy rates are low throughout the United States. The reasons for low autopsy rates warrant further exploration to inform strategies to increase availability and uptake.
Incidence and Outcome of Pneumomediastinum in Non-ICU Hospitalized COVID-19 Patients*
Authors: Muley Moises , Finamore Panaiotis , Pedone Claudio , Margiotta Domenico Paolo Emanuele , Gilardi Emanuele , Sambuco Federica , De Vincentis Antonio , Vespasiani-Gentilucci Umberto , Travaglino Francesco , Antonelli-Incalzi Raffaele
Published: October 2022

OBJECTIVES:

Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia.

DESIGN:

Retrospective observational study.

SETTING:

Population-based, single-setting, tertiary-care level COVID treatment center.

PATIENTS:

Individuals hospitalized with a diagnosis of COVID-19 pneumonia and severe to critical illness were included. Those hospitalized without respiratory failure, observed for less than 24 hours, or admitted from an ICU were excluded.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

All patients underwent a complete clinical assessment and chest CT scan, and were followed up from hospitalization to discharge or death. The outcome was the number of cases of PNM, defined as the presence of free air in the mediastinal tissues diagnosed by chest CT scan, in non-ICU hospitalized patients and the subsequent risk of intubation and mortality. PNM occurred in 48 out of 331 participants. The incidence was 14.5% (95% CI, 10.9–18.8%). A CT-Scan Severity score greater than 15 was positively associated with PNM (odds ratio [OR], 4.09; p = 0.002) and was observed in 35.2% of the participants (95% CI, 26.2–44.9%). Noninvasive ventilation was also positively associated with PNM (OR, 4.46; p = 0.005), but there was no positive association with airway pressures. Fifty patients (15%) were intubated, and 88 (27%) died. Both the risk for intubation and mortality were higher in patients with PNM, with a hazard ratio of 3.72 (p < 0.001) and 3.27 (p < 0.001), respectively.

CONCLUSIONS:

Non-ICU hospitalized patients with COVID-19 have a high incidence of PNM, increasing the risk for intubation and mortality three- to four-fold, particularly in those with extensive lung damage. These findings help define the risk and outcome of PNM in severe-to-critical COVID-19 pneumonia in a non-ICU setting.
Functional Recovery Groups in Critically Ill COVID-19 Patients and Their Associated Factors: From ICU to Hospital Discharge*
Authors: Stripari Schujmann Debora , Claudia Lunardi Adriana , Neri Peso Claudia , Pompeu José Eduardo , Annoni Raquel , Miura Mieko Claudia , Maschio de Censo Caroline , Noriko Takahashi Taniguchi Luzia , de Moraes Regenga Marisa , Cristina de Campos Elaine , Fraga Righetti Renato , Pereira Yamaguti Wellington , May Moran de Brito Christina , Lourenço Adriana , Castaldi Aguera Sabrina , Tanaka Clarice , Fu Carolina
Published: October 2022

OBJECTIVES:

To analyze functional recovery groups of critically ill COVID-19 survivors during their hospital stay and to identify the associated factors.

DESIGN:

Prospective observational multicenter study.

SETTING:

Demographic, clinical, and therapeutic variables were collected, and physical and functional status were evaluated. The Barthel index was evaluated at three time points: 15 days before hospitalization, at ICU discharge, and at hospital discharge from the ward.

PATIENTS:

Patients with functional independence before COVID-19 diagnosis were recruited from four hospitals and followed up until hospital discharge.

MEASUREMENTS AND MAIN RESULTS:

Three groups of functional recovery were described for 328 patients: functional independence (n = 144; 44%), which included patients who preserved their functional status during hospitalization; recovered functionality (n = 109; 33.2%), which included patients who showed dependence at ICU discharge but recovered their independence by hospital discharge; and functional dependency (n = 75; 22.8%), which included patients who were dependent at ICU discharge and had not recovered their functional status at hospital discharge. The factors associated with becoming functionally dependent at ICU discharge were time to out-of-bed patient mobilization (odds ratio [OR], 1.20; 95% CI, 1.11–1.29), age (OR, 1.02; 95% CI, 1.01–1.04), hyperglycemia (OR, 2.52; 95% CI, 1.56–4.07), and Simplified Acute Physiology Score (OR, 1.022; 95% CI, 1.01–1.04). Recovery to baseline independence during ward stays was associated with ICU length of stay (OR, 0.97; 95% CI, 0.94–0.99) and muscle strength (Medical Research Council test) at ICU discharge (OR, 1.13; 95% CI, 1.08–1.18).

CONCLUSIONS:

Age, hyperglycemia, and time for patient mobilization out of bed were independent factors associated with becoming physically dependent after their ICU stay. Recovery of physical function at hospital discharge was associated with muscle strength at ICU discharge and length of ICU stay.
Selective Endothelialectomy in Peters Anomaly: A Novel Surgical Technique and Its Clinical Outcomes in Children
Authors: Ramappa Muralidhar , Chaurasia Sunita , Mohamed Ashik , Ramya Achanta Divya Sree , Mandal Anil Kumar , Edward Deepak Paul , Gokhale Nikhil , Swarup Rishi , Nischal Ken K.
Published: October 2022

Purpose:

This study describes the surgical outcomes of selective endothelialectomy in Peters anomaly (SEPA), a relatively new technique to manage Peters anomaly (PA).

Methods:

This study included 34 eyes of 28 children who had a visually significant posterior corneal defect due to PA and underwent SEPA between 2012 and 2019. A selective endothelialectomy from the posterior corneal defect was performed while preserving Descemet membrane. The primary outcome measure was the resolution of corneal opacification. The secondary outcome measures were functional vision, complications, and risk factors for failure.

Results:

At a mean postoperative follow-up of 0.96 ± 0.20 years, 29 eyes (85.3%) maintained a successful outcome. Mean preoperative and postoperative best-corrected visual acuities were 2.55 ± 0.13 and 1.78 ± 0.13 (P < 0.0001), respectively. Ambulatory functional visual improvement was seen in 97%, and 23% attained vision ranging between 20/190 and 20/50. Corneal opacification failed to clear in 5 eyes (15%). Risk factors associated with surgical failure were female sex (P = 0.006), disease severity (P < 0.0001), glaucoma (P = 0.001), and additional interventions after SEPA (P = 0.002). In multivariate analysis, only disease severity (ie, a type 2 PA) was a significant risk factor for the failure of SEPA. There were no sight-threatening complications.

Conclusions:

SEPA is a safe and effective technique in select cases of posterior corneal defect due to PA. SEPA could be a potential surgical alternative to pediatric keratoplasty or optical iridectomy in children with central corneal opacification smaller than 7 mm due to PA.
The Evolving Curriculum in Quality Improvement and Patient Safety in Undergraduate and Graduate Medical Education: A Scoping Review
Authors: Li Chris J. , Nash David B.
Published: October 2022

Quality Improvement and Patient Safety (QIPS) has become an increasingly important area of focus within undergraduate and graduate medical education. A variety of different QIPS curriculums have been developed, but standardization and effectiveness of these curriculums is largely unknown. The authors conducted a scoping review to explore the status of undergraduate and graduate nondegree QIPS curriculum in the United States. A scoping review was performed using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model as a guide. Two databases were screened from January 2019 to March 2022 to identify relevant articles. Forty-seven articles met eligibility criteria, with most articles (n = 38) focused on graduate medical education. Of those 38, 86.8% (33/38) were developed as curriculum specific to a particular specialty. The article highlights similarities and differences in structure, evaluation metrics, and outcomes, and subsequently offers insight into curriculum components that should help guide standardization of successful curriculum development moving forward.
A High-reliability Organization Mindset
Authors: Merchant Naseema B. , O’Neal Jessica , Dealino-Perez Celeste , Xiang Jenny , Montoya Alfred , Murray John S.
Published: October 2022

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.
Mortality Associated With Occupational Exposure in Helsinki, Finland—A 24-Year Follow-up
Authors: Jalasto Juuso , Luukkonen Ritva , Lindqvist Ari , Langhammer Arnulf , Kankaanranta Hannu , Backman Helena , Rönmark Eva , Sovijärvi Anssi , Kauppi Paula , Piirilä Päivi
Published: October 2022

Objectives

Our objective was to study mortality related to different obstructive lung diseases, occupational exposure, and their potential joint effect in a large, randomized population-based cohort.

Methods

We divided the participants based on the answers to asthma and chronic obstructive pulmonary disease (COPD) diagnoses and occupational exposure and used a combined effects model and compared the results to no asthma or COPD with no occupational exposure.

Results

High exposure had a hazards ratio (HR) of 1.34 (1.11–1.62) and asthma and COPD coexistence of 1.58 (1.10–2.27). The combined effects of intermediate exposure and coexistence had an HR of 2.20 (1.18–4.09), high exposure with coexistence of 1.94 (1.10–3.42) for overall mortality, and sub-HR for respiratory-related mortality of 3.21 (1.87–5.50).

Conclusions

High occupational exposure increased overall but not respiratory-related mortality hazards, while coexisting asthma and COPD overall and respiratory-related hazards of mortality.
Visuospatial Cognitive Dysfunction in Patients with Vestibular Loss
Authors: Ahmad Maimuna , Bola Lukasz , Boutabla Anissa , King Susan , Lewis Richard F. , Chari Divya A.
Published: October 2022

Objective

To characterize visuospatial and nonvisuospatial cognitive domains affected by vestibular loss and determine whether patient-reported outcomes measures (PROMs) correlate with performance on neuropsychological tests.

Study Design

Cross-sectional study.

Setting

University-based tertiary medical center.

Patients

Sixty-nine age-matched subjects: 25 patients with bilateral vestibular loss (BVL), 14 patients with unilateral vestibular loss (UVL), and 30 normal controls (NC).

Interventions

Neuropsychological tests used to assess visuospatial and auditory short-term and working memory, number magnitude representation, executive function, and attention. Validated PROMs used to evaluate quality of life and subjective cognitive impairment.

Main Outcome Measures

Performance on neuropsychological tests and scores on PROM surveys.

Results

BVL and UVL patients performed significantly worse than NC subjects on tasks requiring visuospatial representation compared with NC subjects (p < 0.01). BVL patients demonstrated decreased performance on spatial representation tasks compared with UVL and NC subjects (p < 0.05 and p < 0.05, respectively). All subject groups performed similarly on tasks assessing nonvisuospatial cognitive domains, such as auditory short-term and working memory, executive function, and attention. PROMs did not seem to correlate with performance on neuropsychological tasks.

Conclusion

Patients with vestibular loss exhibit impairments in tasks requiring visuospatial representation but perform similarly to NC subjects in tasks of auditory working memory, executive function, or attention. Currently available questionnaires may be insufficient to screen patients for cognitive deficits.
Vestibular Function and Clinical Presentation of Dizziness: Are They Similar in Patients With Different Types of Migraine?
Authors: Faim Aline Emer , Carvalho Gabriela Ferreira , Grossi Debora Bevilaqua , Dach Fabiola , Oliveira Andreia Ardevino , Carneiro Camila de Giacomo
Published: October 2022

Objective

To compare the vestibular function and clinical aspects (vestibular and migraine symptoms) of patients divided into three groups—migraine without aura, migraine with aura, and chronic migraine—and a control group by using electronystagmography and a design questionnaire.

Study design

Case-control study.

Setting

Tertiary referral center.

Patients

Women aged between 18 and 55 years diagnosed with migraine with aura, migraine without aura, or chronic migraine according to the International Classification of Headache Disorders ICHD—third edition; diagnosis was made by a headache specialist. The control group consisted of patients' family members and hospital employees without a personal history of headache.

Main Outcome Measures

Application of a questionnaire regarding vestibular symptoms and their relation to migraine aspects. Assessment of the vestibular function by electronystagmography.

Results

This study evaluated 120 female patients. Dizziness was the most prevalent vestibular symptom in all the migraine groups, with higher prevalence in the episodic migraine with aura and chronic migraine groups. Phonophobia and photophobia during vestibular symptoms also had greater prevalence in the latter groups. Electronystagmography tests did not reveal differences among the groups, but clinical stratification showed that tests with mixed etiology abnormalities were more prevalent in the episodic migraine with aura and chronic migraine groups.

Conclusion

The prevalence of vestibular symptoms in the migraine groups and the etiology of vestibular impairment highlight that migraine affects the vestibular system. Our findings suggest that symptom progression and vestibular impact are related to migraine chronicity and presence of aura.
Cochlear Implantation in Patients With Known Cognitive Impairment: What Are the Benefits?
Authors: Babajanian Eric E. , Carmichael Erin C. , Gordon Steven A. , Patel Neil S. , Gurgel Richard K.
Published: October 2022

Objective

To evaluate the outcomes of cochlear implantation (CI) in adults with preoperatively diagnosed cognitive impairment.

Study Design

Retrospective cohort study.

Setting

Tertiary-care academic center.

Patients

Adults undergoing CI with preexisting cognitive impairment.

Interventions

Cochlear implantation.

Main Outcome Measures

1) Hearing improvement after CI; 2) morbidity and mortality associated with surgery.

Results

Eight patients met inclusion criteria with mean age 77.8 years (SD, 9.6 y) at time of implantation; 7 were included in subsequent analysis as one did not have speech recognition scores. Average preoperative MoCA cognitive score of 22.6 (SD, 3.9, ≤25 demonstrates cognitive impairment). Average follow-up was 29.0 months (SD, 33.3 mo). Two patients passed away at an average 58.0 months (SD, 31.1 mo) after surgery. Median preoperative pure tone average was 86.3 dB HL ( interquartile range 31.3 dB HL) compared with 33.8 dB HL (IQR 5.0 dB HL) postoperatively (p = <0.001). Median preoperative speech testing score (AzBio/HINT) was 21% (IQR, 24%) compared with 44% (IQR, 21%) postoperatively (p = <0.001). There were no observed surgical complications during the follow-up period.

Conclusions

This study demonstrates that patients with cognitive impairment before CI can experience improved hearing, no increased risk of complications, and good longevity after CI. Further prospective studies are needed to further define the utility of CI in patients with impaired cognition.
Dizziness After Traumatic Brain Injury: A Prospective TRACK-TBI Analysis of Risk Factors, Quality of Life, and Neurocognitive Effects
Authors: Chae Ricky , Barber Jason , Temkin Nancy R. , Sharon Jeffrey D. ,   the TRACK-TBI Investigators
Published: October 2022

Objective

To determine the longitudinal incidence of dizziness and its association with demographic factors, neurocognitive effects, functionality, and quality of life.

Study Design

Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) is a prospective, longitudinal cohort study in which TBI patients were assessed at the emergency department and 2-week, 3-month, 6-month, and 12-month follow-up via telephone and/or in-person visits.

Setting

Multicenter study in emergency departments of 18 academic medical centers in the United States.

Patients

A total of 1,514 patients 17 years or older with a diagnosis of TBI, injury occurrence within 24 hours of admission, fluency in English or Spanish, and completed Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 12 months were enrolled between February 2014 and August 2018.

Main Outcome Measure

RPQ, Short Form-12 Version 2, Wechsler Adult Intelligence Scale IV, Trail Making Test, Patient Health Questionnaire-9, PROMIS-PAIN, and Glasgow Outcome Scale–Extended Revised. The primary outcome measure was a self-report of “feelings of dizziness” on RPQ at 12 months post-TBI.

Results

Of the 1,514 participants, 1,002 (66%) were male and 512 (34%) were female. The mean age was 41.6 (SD, 17.4) years. At 12 months, 26% experienced dizziness, with 9% experiencing moderate or severe dizziness. Dizziness was strongly associated with headache (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.92–4.07; p < 0.001), nausea (OR, 4.43; 95% CI, 3.45–5.69; p < 0.001), worse hearing (OR, 3.57; 95% CI, 2.64–4.82; p < 0.001), noise sensitivity (OR, 3.02; 95% CI, 2.54–3.59; p < 0.001), and light sensitivity (OR, 3.51; 95% CI, 2.91–4.23; p < 0.001). In multivariable regression models, participants with severe dizziness demonstrated lower performance compared with those without new or worse dizziness on the Wechsler Adult Intelligence Scale IV (−6.64; p < 0.001), Trail Making Test part A (7.90; p = 0.003) and part B (19.77; p = 0.028), and Short Form-12 physical (−13.60; p < 0.001) and mental health (−11.17; p < 0.001), after controlling for age, sex, education, and TBI severity.

Conclusion

Dizziness is common among TBI patients and relates to quality of life and neurocognitive performance.
Guidelines for Cystic Fibrosis Carrier Screening in the Prenatal/Preconception Period
Authors: Hopkins Maeve K. , Dugoff Lorraine , Kuller Jeffrey A.
Published: October 2022

Importance

Cystic fibrosis (CF) is one of the most common autosomal recessive disorders. Carrier screening for CF should be offered to all women considering becoming pregnant or who are pregnant. Understanding the available screening tests, their limitations, and the benefits of screening is of paramount importance to the obstetrician-gynecologist.

Objective

The objective is to review the current guidelines for CF carrier screening including the options for carrier screening, the potential complexities associated with carrier screening for CF, and indications for referral to certified genetic counselors or maternal-fetal medicine specialists.

Evidence Acquisition

A MEDLINE search of “cystic fibrosis,” “cystic fibrosis carrier screening pregnancy,” and “inheritance of cystic fibrosis” in the review was performed.

Results

The evidence cited in this review includes 2 medical society committee opinions and 15 additional peer-reviewed journal articles that were original research or expert opinion summaries.

Conclusions and Relevance

The American College of Obstetricians and Gynecologists recommends that obstetricians offer CF carrier screening to all pregnant women or women considering becoming pregnant. Based on recent guidelines from ACMG, additional expanded carrier screening can be recommended to patients in the future, with additional CF variants and other autosomal or X-linked recessive conditions. It is important for the prenatal care provider to understand the guidelines for carrier screening as well as the potential complexities associated with carrier screening due to the multiple pathogenic variants in the CFTR gene that may be associated with varying phenotypes. With the options for CF carrier screening, screening performance in different populations, a basic understanding of the disease and interpretation of carrier screening results is of paramount importance to the prenatal care provider.

Target Audience

Obstetrician-gynecologist, family medicine, or other practitioner(s) providing prenatal care

Learning Objectives

After participating in this activity, physicians should be better able to define indications and the current guidelines for carrier testing for CF; compare types of CF carrier screening and describe potential results of the screening; propose patient counseling strategies regarding residual risk after negative CF carrier screening; and explain appropriate referral measures for patients with positive CF carrier screening results.
Accuracy of Surgeon Self-Reflection on Hysterectomy Quality Metrics
Authors: Milman Tal , Murji Ally , Matelski John , Shirreff Lindsay
Published: October 2022

(Abstracted from Obstet Gynecol 2022;140:39–47)

Assessing surgical performance and tracking quality metrics has the potential to improve patient care and safety, reducing perioperative morbidity and mortality. A number of studies have suggested that surgeons inaccurately judge their own performance, especially with respect to self-reflection on surgical proficiency.
Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes
Authors: Fell Deshayne B. , Dhinsa Tavleen , Alton Gillian D. , Török Eszter , Dimanlig-Cruz Sheryll , Regan Annette K. , Sprague Ann E. , Buchan Sarah A. , Kwong Jeffrey C. , Wilson Sarah E. , Håberg Siri E. , Gravel Christopher A. , Wilson Kumanan , El-Chaâr Darine , Walker Mark C. , Barrett Jon , MacDonald Shannon E. , Okun Nannette , Shah Prakesh S. , Dougan Shelley D. , Dunn Sandra , Bisnaire Lise
Published: October 2022

(Abstracted from JAMA 2022;327:1478–1487)

Pregnant individuals with COVID-19 infection are at higher risk for hospitalization, intensive care unit (ICU admission), and death. After SARS-CoV-2 infection during pregnancy, significantly higher rates of adverse pregnancy outcomes such as preterm birth and stillbirth have also been observed.
Stromal Cell Senescence Contributes to Impaired Endometrial Decidualization and Defective Interaction With Trophoblast Cells
Authors: Deryabin P. I. , Borodkina A. V.
Published: October 2022

(Abstracted from Hum Reprod 2022;37:1505–1524)

The term senescence refers to the cellular state wherein cells preserve viability and metabolic activity while ceasing proliferation. Senescence-associated secretory phenotype (SASP) secretions produced by senescent cells have been shown to facilitate tumor development and play a positive role in cancer progression.
Psychosocial characteristics of patients evaluated for kidney, liver, or heart transplantation
Authors: Gronewold Nadine , Schunn Fabian , Ihrig Andreas , Mayer Gwendolyn , Wohnsland Sascha , Wagenlechner Petra , Leuschner Maren , Kreusser Michael M. , Sommerer Claudia , Rupp Christian , Friederich Hans-Christoph , Schultz Jobst-Hendrik , Bruns Bastian
Published: October 2022

Objective

Psychosocial parameters play a pivotal role in organ recipient evaluation before waitlisting for transplantation due to their impact on organ and patient outcome. Patients in need of heart- (HTx), liver- (LTx), or kidney transplantation (KTx) face distinct physical and psychological challenges. This study compares the psychosocial characteristics and preferences for additional therapy of patients undergoing assessment for these three types of organ transplantation to optimize patient-tailored psychological, social and other supportive interventions.

Methods

We conducted a cross-sectional, observational study with 1110 potential transplantation candidates (LTx n = 544, KTx n = 330, HTx n = 236), psychosocial status was determined for depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), health related quality of life (SF-36), perceived social support (F-SozU), sense of coherence (SoC) (SoC-L9), self-efficacy (ASKU), and body image (FKB-20). Preferences for additional supportive therapy were assessed dichotomously. Data were analyzed using MANCOVA and Chi-squared tests.

Results

Patient groups differed significantly regarding depression (F
(2,1107) = 35.283, p < .001, partial ƞ2 = .01), anxiety (F
(2,1107) = 15.027, p < .001, partial ƞ2 = .03), health related quality of life (physical: F
(2,1107) = 96.772, p < .001, partial ƞ2 = .15; mental: F
(2,1107) = 11.442, p < .001, partial ƞ2 = .02), perceived social support (F
(2,1107) = 20.813, p < .001, partial ƞ2 = .04), sense of coherence (F
(2,1107) = 12.920, p < .001, partial ƞ2 = .02), self-efficacy (F
(2,1107) = 17.308, p < .001, partial ƞ2 = .03) and body image (rejecting body evaluation: F
(2,1107) = 5.006, p = .007, partial ƞ2 = .01; vital body dynamics: F
(2,1107) = 40.216, p < .001, partial ƞ2 = .07). Patients evaluated for HTx showed the highest psychosocial impairment and the highest inclination regarding additional supportive therapy.

Conclusions

Patients evaluated for HTx, LTx, and KTx have distinct psychosocial characteristics and treatment preferences. HTx patients display the highest psychosocial impairment. We suggest psycho-cardiological treatment structures for optimal outcome.
Antidepressant use and risk of myocardial infarction A long:itudinal investigation of sex-specific associations in the HUNT study
Authors: Karlsen Håvard Rudi , Løchen Maja-Lisa , Langvik Eva
Published: October 2022

Objective

Antidepressants are thought to affect risk of cardiovascular disease (CVD), though the nature of the association is unclear. Men and women have unique cardiovascular risk factors, and sex differences in depression as well as the efficacy of antidepressants are important to consider. We examined whether antidepressant use was associated with risk of having a myocardial infarction (MI), and whether this association was sex-specific.

Methods

Data from the HUNT study were used, gathered from a population in Norway (N = 31 765), collected from 1995 to 2008. These data were combined with the Norwegian Cause of Death Registry and the Norwegian Prescription Database. We performed logistic regression models to examine the association of antidepressant use on risk of having a fatal or non-fatal MI, adjusting for depression, anxiety, diabetes, systolic blood pressure, cholesterol, waist-hip ratio, smoking, age, and sex. Results are presented as odds ratios (OR) and 95% confidence intervals in parentheses.

Results

The results indicated that antidepressant use was associated with a reduced risk of having MI at a later date (OR = 0.49 [0.38, 0.64]). Although this association was somewhat stronger for women (OR = 0.46 [0.31, 0.68]) compared to men (OR = 0.53 [0.37, 0.75]), analysis did not identify a sex-specific association of antidepressant use on MI. Follow-up analyses on different sub-types of antidepressants, showed that both SSRI and TCA were associated with reduced risk of MI.

Conclusions

In this population study, the use of antidepressants was associated with a reduced risk of MI. This association was stronger for women, though we detected no interaction between sex and antidepressant use in terms of reduced risk of MI. Although limitations apply regarding causality, especially concerning a dose-response relationship, the results suggest that antidepressant use might reduce the risk of MI among both men and women.