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Migrant and seasonal farmworkers are a vulnerable population with a potentially high risk for hearing loss due to farm-related noise exposures. Occupational noise-induced hearing loss (NIHL) is permanent, and it is associated with an increased risk for injuries on the job, as well as communication difficulties, isolation, and depression. The México/US border region is one of the most productive agricultural regions in the country, however, no known studies have explored hearing loss among farmworkers in this area. This pilot study was a first step toward measuring and addressing hearing loss and noise exposure among this region's farmworkers. We conducted a cross-sectional survey to estimate the prevalence of subjective hearing difficulties among Yuma County, Arizona farmworkers. Survey interviews took place during a late-night farmworker health fair from 2 am to 6 am to accommodate local farms' labor schedules. Multivariable regression adjusted for demographic and work covariates estimated subjective hearing loss prevalence ratios. Among 132 farmworker participants, 36% reported they have or might have hearing loss, and 62% reported no hearing loss. Subjective hearing loss prevalence was lower in farmworkers who report not working in noise compared to prevalence in farmworkers who work in noise [prevalence ratio, 0.44 (95% CI 0.23–0.82)]. This report contributes to understanding the perception of hearing-related health and occupational exposures among farmworkers in the México-US Southwest border region. The information from this line of research will inform appropriate safety measures known to lower the risk of experiencing occupational NIHL. [ABSTRACT FROM AUTHOR]

Background There are limited data on whether hybrid immunity differs by count and order of immunity-conferring events (infection with severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] or vaccination against coronavirus disease 2019 [COVID-19]). From a multi-site cohort of frontline workers, we examined the heterogeneity of the effect of hybrid immunity on SARS-CoV-2 antibody levels. Methods Exposures included event count and event order, categorized into 7 permutations. Outcome was level of serum antibodies against receptor-binding domain (RBD) of the ancestral SARS-CoV-2 spike protein (total RBD-binding immunoglobulin). Means were examined up to 365 days after each of the first to seventh events. Results Analysis included 5793 participants measured from 7 August 2020 to 15 April 2023. Hybrid immunity from infection before 1 or 2 vaccine doses elicited modestly superior antibody responses after the second and third events (compared with infections or vaccine doses alone). This superiority was not repeated after additional events. Among adults infected before vaccination, adjusted geometric mean ratios (95% confidence interval [CI]) of anti-RBD early response (versus vaccinated only) were 1.23 (1.14–1.33), 1.09 (1.03–1.14), 0.87 (.81–.94), and 0.99 (.85–1.15) after the second to fifth events, respectively. Post-vaccination infections elicited superior responses; adjusted geometric mean ratios (95% CI) of anti-RBD early response (versus vaccinated only) were 0.93 (.75–1.17), 1.11 (1.06–1.16), 1.17 (1.11–1.24), and 1.20 (1.07–1.34) after the second to fifth events, respectively. Conclusions Evidence of heterogeneity in antibody levels by permutations of infection and vaccination history could inform COVID-19 vaccination policy. [ABSTRACT FROM AUTHOR]

Introduction/Aims Methods Results Discussion Fatigue is a common and debilitating symptom encountered in the neuromuscular clinic. The 7‐item Fatigue Severity Scale (FSS‐7) is a Rasch‐modified assessment validated in inflammatory neuropathies but not across a typical neuromuscular patient population. The aim of this study was to validate this measure in neuromuscular disorders and to compare between patient sex, age and diagnoses.The modified FSS‐7 was mailed to patients recruited from a specialist neuromuscular clinic at the Walton Centre. Responses were subjected to Rasch analysis and descriptive statistics were performed on the Rasch converted data.The mFSS‐7 met the Rasch model expectations with an overall Chi‐square probability of 0.4918, a strict unidimensional scale free from differential item functioning (DIF) that satisfied the model with substantial test–retest reliability using Lin's concordance correlation coefficient 0.71 (95% CI 0.63–0.77). A 15.7% ceiling effect was observed in this patient cohort. Post hoc analysis did not show any significant difference in fatigue between sex, age or neuromuscular diagnoses.The self‐completed Rasch mFSS‐7 showed acceptable test–retest reliability across patients with varied disorders under follow‐up in a specialist neuromuscular clinic. The ceiling effect constrains its use for those with the most severe fatigue. Future considerations could include assessment of the benefits of clinical interventions, particularly multidisciplinary team input or dedicated fatigue clinics. [ABSTRACT FROM AUTHOR]

Some children with autism spectrum disorder (ASD) experience seizures and associated staring episodes, loss of consciousness, weakened muscle tone, and myoclonic jerking. Data recording of seizure frequency, duration, and co-occurring behavior is necessary to document the effects of anti-epileptic medications, identify contextual influences on seizure expression, and differentiate seizures from other movement disorders. We describe the design and operation of a computer-assisted system for recording seizures among children with ASD in a social validity study that revealed uniform approval and acceptance of the system from practitioners, clinicians, and nurse (N = 22), parents (N = 11), and neurologists (N = 7). The objectives and benefits of targeting the social validity of technology-based seizure tracking are discussed are discussed. [ABSTRACT FROM AUTHOR]

Background: Several studies have demonstrated that females have a higher risk of arrhythmia recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF). There are limited data on sex‐based differences in PV reconnection rates at repeat ablation. We aimed to investigate sex‐based differences in electrophysiological findings and atrial arrhythmia recurrence after repeat AF ablation Methods: We conducted a retrospective study of 161 consecutive patients (32% female, age 65 ± 10 years) who underwent repeat AF ablation after index PV isolation between 2010 and 2022. Demographics, procedural characteristics and follow‐up data were collected. Recurrent atrial tachycardia (AT)/AF was defined as any atrial arrhythmia ≥30 s in duration. Results: Compared to males, females tended to be older and had a significantly higher prevalence of prior valve surgery (10 vs. 2%; P =.03). At repeat ablation, PV reconnection was found in 119 (74%) patients. Males were more likely to have PV reconnection at repeat ablation compared to females (81 vs. 59%; P =.004). Excluding repeat PV isolation, there were no significant differences in adjunctive ablation strategies performed at repeat ablation between females and males. During follow‐up, there were no significant differences in freedom from AT/AF recurrence between females and males after repeat ablation (63 vs. 59% at 2 years, respectively; P =.48). Conclusions: After initial PV isolation, significantly fewer females have evidence of PV reconnection at the time of repeat ablation for recurrent AF. Despite this difference, long‐term freedom from AT/AF was similar between females and males after repeat ablation. [ABSTRACT FROM AUTHOR]

Aims The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. Methods and results In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physician's confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. Conclusion The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy. [ABSTRACT FROM AUTHOR]

Background: The incidence of primary total ankle arthroplasty (TAA) is rising, with a corresponding increase in revision surgeries. Despite this, research on risk factors for revision TAA following primary TAA remains limited. Radiographic soft tissue thickness has been explored as a potential predictor for outcomes in hip, knee, and shoulder arthroplasty, but its role in TAA has not been assessed. This study aimed to assess the predictive value of radiographic soft tissue thickness for identifying patients at risk of requiring revision surgery following primary TAA. Methods: A retrospective study was conducted on 323 patients who underwent primary TAA between 2003 and 2019. Radiographic measurements of soft tissue thickness were obtained from preoperative radiographs. Two novel radiographic measures of soft tissue thickness were developed and assessed (tibial tissue thickness and talus tissue thickness). Clinical variables including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, diabetes, smoking status, primary diagnosis, and implant type were recorded. Logistic regression analysis was used to assess the predictive value of soft tissue thickness and BMI for revision TAA. Results: The rate of revision surgery was 4.3% (14 of 323 patients). Patients requiring revision had significantly greater tibial tissue (3.54 vs 2.48 cm; P = .02) and talus tissue (2.79 vs 2.42 cm; P = .02) thickness compared with those not requiring revision. Both the tibial tissue thickness (odds ratio 1.16 [1.12-1.20]; P < .01) and the talus tissue thickness (odds ratio: 1.10 [1.05-1.15]; P < .01) measurements were significant predictors of revision TAA in multivariable logistic regression models. However, BMI was not a significant predictor of revision TAA. The two metrics demonstrated excellent interrater reliability. Conclusion: Greater soft tissue thickness was a better predictor of revision TAA compared with BMI. These findings suggest that radiographic soft tissue thickness may be a valuable tool for assessing the risk of the need for revision TAA following primary TAA. Further research is needed to validate and explore the potential impact on clinical practice. [ABSTRACT FROM AUTHOR]

Aim: The inability to quickly react to an external event can lead to an increased risk for accidents (e.g., falls, car crashes) in patients with cirrhosis. The aim of this study was to determine whether a novel clinically feasible measure of simple reaction time (SRT) and reaction accuracy (RA)—a go/no‐go task occurring within 400 ms—could differentiate patients with cirrhosis from controls. Methods: This retrospective study included 160 patients with cirrhosis and 160 controls assessed between January 2010 and October 2022. SRT and RA were evaluated using a ruler drop paradigm and compared using propensity score matching. Factors distinguishing patients with cirrhosis from controls were assessed using logistic regression and receiver operating characteristics curve (ROC) analyses. Results: Propensity score matching identified 112 participants in each group with comparable baseline characteristics. As compared with controls, patients with cirrhosis exhibited significantly prolonged SRT (200 vs. 174 ms; P < 0.001) and diminished total RA (63% vs. 73%; P < 0.001). After adjustment for confounding factors, SRT and RA independently identified patients with cirrhosis. ROC analyses showed that SRT more effectively identified patients with cirrhosis than did the number‐connection test/trail‐making test‐B (area under the curve, 0.87 vs. 0.60; P < 0.001). Conclusions: Patients with cirrhosis demonstrated impairments in short‐latency cognitive function. Given that SRT and RA are associated with balance, falls, and response to perturbation, these parameters may present a task‐specific method to identify patients with cirrhosis at high risk of falls and motor vehicle crashes. Geriatr Gerontol Int 2024; 24: 25–31. [ABSTRACT FROM AUTHOR]

Background: Anaemia in pregnancy is associated with poor maternal and foetal outcomes. Nonetheless, there is a paucity of recent literature on the predictors of anaemia during pregnancy in the context of northern Uganda, a region emerging out of decades of war. A study was undertaken to determine the prevalence and factors associated with anaemia among pregnant women in northern Uganda. Methods: In this cross-sectional study, 320 pregnant women seeking care at Lira Regional Referral Hospital were consecutively enrolled. Data were collected using a structured interviewer-administered questionnaire. Data collected included: demographic, obstetric, nutritional and dietary characteristics of study participants. Data analysis consisted of descriptive statistics, cross-tabulations and logistic regression with 95% confidence and a p-value of < 0.05 as significant using STATA version 14. Results: The mean age of the women was 25.3 ± 5.6 years while their mean gestational age was 25.4 ± 7.8 weeks. The overall prevalence of anaemia (Hb < 11 g/dl in the first and third trimesters and less than 10.5 g/dl in the second trimester) was 24.7%. Iron deficiency was prevalent in half of the women (50%) with anaemia. Factors independently associated with anaemia included taking antimalarial prophylaxis (AOR 0.44; 95% CI 0.19, 0.99) and consumption of legumes and cereals more than twice in the previous week (AOR 0.46; 95% CI 0.24, 0.89). Conclusion: One-quarter of pregnant women in this study population based in northern Uganda were anaemic. There is a need to strengthen interventions to control anaemia during pregnancy, particularly the intake of antimalarial prophylaxis and consumption of iron-rich locally available foods. [ABSTRACT FROM AUTHOR]

The Bigfoot Unity Diabetes Management System, a smart pen cap system cleared by the U.S. Food and Drug Administration in May 2021, incorporates continuous glucose monitoring data, real-time glycemic alerts, and clinician-directed dose recommendations. This study analyzed real-world clinical outcomes data for an initial cohort (n = 58, from 13 clinics) managing multiple daily injection insulin therapy using the pen cap system for 6 months. We examined glycemic control, including hypoglycemia events and interaction with and use of the pen cap system. In a cohort mainly consisting of adults with type 2 diabetes and an average age of 62 years, the results demonstrate close adherence to established glycemic targets, including a relatively short amount of time spent in the hypoglycemic range. [ABSTRACT FROM AUTHOR]

The article focuses on the development, feasibility, and initial evaluation of an Active Learning Module (PACE) designed for teaching pediatric ECG interpretation and Entrustable Professional Activities (EPAs) to clinical medical students. The innovative module, created by and for students, demonstrated feasibility, high satisfaction, increased ECG competency, and integration with general pediatrics EPAs and outlines the educational approach, participant details, and results.

Objective Umbilical cord blood (UCB) for admission laboratories is an approach to decrease anemia risk in very low birth weight (VLBW) neonates. We hypothesized that UCB use results in higher hemoglobin concentration [HgB] around 24 hours of life. Study Design A randomized control trial among VLBW infants whose admission laboratories were drawn from UCB (n = 39) or the infant (n = 41) in three U.S. military NICUs (clinicaltrials.gov#NCT02103296). Results No demographic differences were observed between groups. UCB infants had higher [HgB] at 12 to 24 hours of life (15.5 vs. 14.0 g/dL, p = 0.02). The median time to first transfusion was 17 days longer in the experimental group (p = 0.04), and at discharge, their number of donor exposures was lower (1.1 vs. 1.8, p = 0.04). Conclusion In the first 24 hours of life that is a period of higher risk for hemodynamic instability, UCB utilization for admission bloodwork in VLBW infants results in higher [HgB]. Key Points Umbilical cord blood laboratory work in preterm infants is feasible. Cord blood use for admission laboratories results in increased hemoglobin in the first 24 hours of life. Cord blood use for admission laboratories delays time to first transfusion in preterm infants. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of intimate partner violence (IPV) is alarmingly high among young adults. Alcohol use and depression have both been shown to increase risk for IPV. However, little is known about whether depression and alcohol may interact to predict IPV in couples. Methods: The current study utilized a sample of 81 racially and ethnically diverse young adult couples (91.4% between the ages of 18–24) to examine alcohol use and depressive symptoms as predictors of physical, sexual, and psychological IPV perpetration. Data were analyzed following an Actor-Partner Interdependence Model (APIM) framework, allowing for the examination of both actor and partner effects. Results: Results indicated that one's own alcohol use was associated with an increase in one's own psychological IPV perpetration, and one's own depressive symptoms were associated with an increase in one's own physical and psychological IPV perpetration. Although one's partner's alcohol use was associated with an increase in one's own physical IPV perpetration on average, a marginally significant statistical interaction with one's partner's depression suggested this association was moderated, such that high levels of one's partner's depressive symptoms weakened the relationship between one's partner's alcohol use and one's own physical IPV perpetration. Conclusions: Findings provide novel information on when depressive symptoms may be a risk factor for IPV in young adult couples. [ABSTRACT FROM AUTHOR]

Objective: To determine whether thyroid nodule surveillance compliance is influenced by patient demographics or plan type. Study Design: Retrospective case series from 2010 to 2018. Setting: United States Military Health System. Methods: There were 481 patients with a thyroid nodule fine-needle aspiration classified as atypia of undetermined significance for whom treatment and follow-up information were available. Demographic information and surveillance plan type were extracted from the medical record and statistical analysis was performed to determine whether these characteristics influenced compliance rates. Results: A total of 289 nodules were surveilled and 192 diagnostic lobectomies were performed. An initial surveillance plan was documented in 93% (268/289) and 86% (231/268) complied. The most common plans were repeat biopsy in 78% (210/268) or ultrasound in 20% (53/268). A second plan was documented in 88% (204/231) of those who complied with the first. The most common second plans were ultrasound in 87% (178/204) or repeat biopsy in 8% (17/204). Compliance with the second plan was 64% (130/204), significantly lower than with the first (OR 3.6, 95% CI: [2.3, 5.6], P <.0001). Only 45% (130/289) were surveilled twice. Age and gender did not significantly affect compliance rates. Compliance with primary care ultrasound surveillance was 40% (21/52), significantly lower than with a specialist (77% [137/179]; OR 4.8, 95% CI: [2.5, 9.3, P <.0001). Conclusion: Compliance with surveillance of thyroid nodules classified as atypia of undetermined significance was poor in this military cohort. Ultrasound surveillance by a specialist may be more reliable than with primary care. [ABSTRACT FROM AUTHOR]

Purpose: Hypothyroidism has been reported at a prevalence of 6% in children and adolescents with Sickle cell anemia. In this study, we determined the prevalence and factors associated with hypothyroidism among children with Sickle cell anemia attending the Sickle Cell Clinic, in Mulago hospital, Uganda. Methods: A cross-sectional study was conducted among children aged 6 months − 17 years with a confirmed diagnosis of Sickle Cell Anemia, with no prior diagnosis of hypothyroidism and in steady state attending the Sickle Cell Clinic in Mulago hospital. Data was collected using a structured questionnaire and a blood sample was used to measure thyroid stimulating hormone and free thyroxine. Results: Of the 332 children enrolled, sixty (18.1%) participants had sub-clinical hypothyroidism (95% CI: 14.3 — 22.6). Factors associated with hypothyroidism included constipation [adjusted odds ratio: 3.1, 95% CI:1.0 — 9.0, p = 0.043] and male sex [adjusted odds ratio:2.0, 95% CI:1.1— 3.5, p = 0.025]. Conclusion: Approximately 1 in 5 children (18.1%) had sub-clinical hypothyroidism. Males and children who presented with constipation were more likely to have sub-clinical hypothyroidism. [ABSTRACT FROM AUTHOR]

Introduction: Left bundle branch area pacing (LBBP) has emerged as an alternative method for conduction system pacing. While initial experience with delivery systems for stylet‐driven and lumenless lead implantation for LBBP has been described, data comparing outcomes of stylet‐driven versus lumenless lead implantation for LBBP are limited. In this study, we compare success rates and outcomes of LBBP with stylet‐driven versus lumenless lead delivery systems. Methods: Eighty‐three consecutive patients (mean age 74.1 ± 11.2 years; 56 [68%] male) undergoing attempted LBBP at a single institution were identified. Cases were grouped by lead delivery systems used: stylet‐driven (n = 53) or lumenless (n = 30). Baseline characteristics and procedural findings were recorded and compared between the cohorts. Intermediate term follow‐up data on ventricular lead parameters were also compared. Results: Baseline characteristics were similar between groups. Successful LBBP was achieved in 77% of patients, with similar success rates between groups (76% in stylet‐driven, 80% in lumenless, p = 0.79), and rates of adjudicated LBB capture and other paced QRS parameters were also similar. Compared with the lumenless group, the stylet‐driven group had significantly shorter procedure times (90 ± 4 vs. 112 ± 31 min, p = 0.004) and fluoroscopy times (10 ± 5 vs. 15 ± 6 min, p = 0.003). Ventricular lead parameters at follow‐up were similar, and rates of procedural complications and need for lead revision were low in both groups. Conclusion: Delivery systems for stylet‐driven and for lumenless leads for LBBP have comparable acute success rates. Long‐term follow‐up of lead performance following use of the various delivery systems is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Short interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India. Methods: We used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12–17 months, 18–23 months (ref), 24–35 months, and 36–59 months] and five child health outcomes – neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations. Results: 3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05–1.18), stunting (OR: 1.13; 95% CI: 1.08–1.18) and underweight (OR: 1.06; 95% CI: 1.01–1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12–17 months and 36–59 months had higher odds of stunting, and IPI of 12–17 months was also associated with higher odds of underweight. Discussion: Our findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12–17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India. [ABSTRACT FROM AUTHOR]

Background: The Malerba calcaneal Z-osteotomy is an operative procedure to treat the hindfoot varus component of adult cavovarus deformity. Basic science studies support the corrective ability of this osteotomy. However, there have been no published midterm clinical and radiographic results. The purpose of this article is to describe the radiographic and clinical improvement in a series of patients treated with this osteotomy. Methods: A retrospective chart review identified 14 feet in 12 patients from January 2013 to August 2018 who met minimal follow-up criteria. Preoperative visual analog scale (VAS) scores, Foot Function Index (FFI) scores, and American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared with postoperative scores. Preoperative Meary angle, calcaneal pitch, and hindfoot alignment were also compared with postoperative measurements. Complications and radiographic union were recorded. Results: At a mean of 80 months, VAS, FFI, and AOFAS scores improved from 7.86 to 1.64, 57.78% to 18.11%, and 39.57 to 80.71, respectively (all P <.001). At a mean of 15 months, Meary angle, calcaneal pitch, and hindfoot alignment improved from 11.14 to 6.64 degrees (P <.001), 30.93 to 27.43 degrees (P =.005), and 19.83 degrees varus to 8.50 degrees varus (P <.001). There was 1 nonunion and 1 postoperative sural nerve neuralgia, but both patients ultimately did well clinically. There were no instances of postoperative tarsal tunnel syndrome. All patients stated that they would have the procedure done again. Conclusion: The calcaneal Z-osteotomy is an effective method to treat adult hindfoot cavovarus deformity. All patients had good clinical outcomes with minimal complications. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Equity is widely held to be fundamental to the ethics of healthcare. In the context of clinical decision-making, it rests on the comparative fidelity of the intelligence – evidence-based or intuitive – guiding the management of each individual patient. Though brought to recent attention by the individuating power of contemporary machine learning, such epistemic equity arises in the context of any decision guidance, whether traditional or innovative. Yet no general framework for its quantification, let alone assurance, currently exists. Here we formulate epistemic equity in terms of model fidelity evaluated over learnt multidimensional representations of identity crafted to maximise the captured diversity of the population, introducing a comprehensive framework for Representational Ethical Model Calibration. We demonstrate the use of the framework on large-scale multimodal data from UK Biobank to derive diverse representations of the population, quantify model performance, and institute responsive remediation. We offer our approach as a principled solution to quantifying and assuring epistemic equity in healthcare, with applications across the research, clinical, and regulatory domains. [ABSTRACT FROM AUTHOR]

Objective: The objective was to assess for an association between chemotherapy‐induced peripheral neuropathy (CIPN) onset and development of depression and anxiety in breast cancer (BrCa) survivors. Methods: A retrospective observational cohort was used and identified from Optum's De‐identified Clinformatics® Data Mart Database years 2012–2015. Three groups of women were derived based on BrCa and CIPN status: BrCa+/CIPN+ (n = 244), BrCa+/CIPN− (n = 8870), and BrCa−/CIPN− (n = 1,125,711). The ratio of the prevalence ratios (RPR) determined if the change in risk of depression and anxiety from the 12‐month preindex period to postindex period I (0–6 months) and II (7–12 months) was different for BrCa+/CIPN+ compared to BrCa+/CIPN− and BrCa−/CIPN−. Results: The adjusted RPR for depression was significantly elevated for BrCa+/CIPN+ compared to BrCa+/CIPN− and BrCa−/CIPN− for postindex periods I (RPR = 1.35 [1.10,1.65] and 1.33 [1.08,1.63], respectively) and II (RPR = 1.53 [1.21,1.94] and 1.50 [1.17,1.93], respectively). The RPR for anxiety was significantly elevated for BrCa+/CIPN+ compared to BrCa+/CIPN− and BrCa−/CIPN− for postindex periods I (RPR = 1.37 [1.12,1.67] and 1.31 [1.06,1.61], respectively) and II (RPR = 1.41 [1.13,1.76] and 1.28 [1.02,1.62], respectively). Conclusions: Among BrCa survivors, CIPN onset is associated with a subsequent increased 12‐month risk of depression and anxiety. Depression and anxiety screening should be considered in BrCa+/CIPN+ survivors, particularly given their known impact on fall risk. The observed association between CIPN and an increased risk of depression and anxiety should be further studied in prospective studies. [ABSTRACT FROM AUTHOR]

Background Most hospitals use traditional infection prevention (IP) methods for outbreak detection. We developed the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT), which combines whole-genome sequencing (WGS) surveillance and machine learning (ML) of the electronic health record (EHR) to identify undetected outbreaks and the responsible transmission routes, respectively. Methods We performed WGS surveillance of healthcare-associated bacterial pathogens from November 2016 to November 2018. EHR ML was used to identify the transmission routes for WGS-detected outbreaks, which were investigated by an IP expert. Potential infections prevented were estimated and compared with traditional IP practice during the same period. Results Of 3165 isolates, there were 2752 unique patient isolates in 99 clusters involving 297 (10.8%) patient isolates identified by WGS; clusters ranged from 2–14 patients. At least 1 transmission route was detected for 65.7% of clusters. During the same time, traditional IP investigation prompted WGS for 15 suspected outbreaks involving 133 patients, for which transmission events were identified for 5 (3.8%). If EDS-HAT had been running in real time, 25–63 transmissions could have been prevented. EDS-HAT was found to be cost-saving and more effective than traditional IP practice, with overall savings of $192 408–$692 532. Conclusions EDS-HAT detected multiple outbreaks not identified using traditional IP methods, correctly identified the transmission routes for most outbreaks, and would save the hospital substantial costs. Traditional IP practice misidentified outbreaks for which transmission did not occur. WGS surveillance combined with EHR ML has the potential to save costs and enhance patient safety. [ABSTRACT FROM AUTHOR]

Many children with autism spectrum disorder (ASD) have gastrointestinal (GI) problems and associated fecal incontinence, constipation, and diarrhea. We describe the design and operation of a computer‐assisted health monitoring system for tracking and recording bowel movements at a residential school. Implementation integrity of the system by care providers was 100% for six targeted students with ASD and GI difficulties. The utility, objectives, and effectiveness of the system were rated positively by supervisory professionals, parents, and GI physicians. Our discussion focuses on the advantages of computer‐assisted data recording and instrumentation technology for documenting health measures such as bowel movement frequency and quality in children with ASD. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are several tests recommended by the American Thoracic Society (ATS) to evaluate for airway hyper-responsiveness (AHR), one of which is methacholine challenge testing (MCT). Few studies have examined the correlation of baseline spirometry to predict AHR in MCT, especially in the younger, relatively healthy military population under clinical evaluation for symptoms of exertional dyspnea. The study aim was to retrospectively correlate baseline spirometry values with MCT responsiveness. METHODS: This study is a retrospective review of all MCT performed at Brooke Army Medical Center/Wilford Hall Medical Center over a 12-y period; all completed studies were obtained from electronic databases. The following parameters were analyzed from the studies: baseline FEV1, FVC, FEV1/FVC, mid-expiratory flow (FEV25-75%), FEV25-75%/FVC. Studies were categorized based on baseline obstruction, restriction, FEF25-75% lower limit of normal, and response to bronchodilator testing (if completed); these values were compared based on methacholine reactivity and severity. RESULTS: Methacholine challenge studies (n = 1,933) were reviewed and categorized into reactive (n = 577) and nonreactive (n = 1,356) as determined by ATS guidelines. The mean baseline FEV1 (% predicted) with MCT reactivity was 88.0 6 13.0% versus no MCT reactivity was 92.7 6 13.0% (P < .001). The mean baseline FVC (% predicted) was 93.1 ± 13.7% versus 95.3 ± 13.5% (P < .001). The mean baseline FEV25-75% (% predicted) was 80.0 ± 22.1% versus 89.0 ± 23.4% (P < .001). Based on partition analysis, methacholine reactivity was most prevalent with baseline obstruction, n = 115 (43%), and in the absence of obstruction, when the FEF25-75% (% predicted) was below 0.70, n = 111 (40%). The negative predictive value with normal spirometry was 73%. CONCLUSIONS: The analysis of baseline spirometry prior to MCT proved useful in the evaluation of exertional dyspnea in a military population. The presence of airways obstruction (FEV1/FVC < lower limit of the normal range) followed by a reduction in FEV25-75% < 70% predicted showed a positive correlation with underlying AHR. In patients with exertional dyspnea and normal baseline spirometry, the use of the FEF25-75% may be a useful surrogate measurement to predict reactivity during MCT and consideration for additional testing or treatment [ABSTRACT FROM AUTHOR]

Objective: To determine quality-adjusted life years (QALYs) over 3 years after transcervical fibroid ablation (TFA) with the Sonata System. Methods: The SONATA trial was a prospective multicenter interventional trial that assessed the safety and efficacy of TFA for treatment of women with symptomatic uterine fibroids. Change in generic health status was assessed with the EuroQol 5-Dimension questionnaire (0–1 scale). Fibroid-specific quality of life (QOL) was measured on a 0 to 100 scale with the health-related quality of life subscale of the Uterine Fibroid Symptom and Quality-of-Life (UFS-QOL). The number of QALYs gained relative to baseline and cumulative QALYs were calculated using the area under the curve at each follow-up visit over 3 years. Results: Among 147 women receiving TFA, fibroid-specific QOL increased from 40 ± 21 at baseline to 84 ± 19 at 1 year and 83 ± 23 at 3 years (p < 0.001). Generic QOL increased from 0.72 ± 0.21 at baseline to 0.89 ± 0.12 at 1 year and 0.88 ± 0.16 at 3 years (p < 0.001). Over 3 years, TFA resulted in 1.24 ± 0.64 QALYs gained when using fibroid-specific health utility scores and 0.49 ± 0.61 QALYs gained when using generic health utility scores. Cumulative QALYs experienced at 3 years as a percentage of perfect health were 82% with fibroid-specific scores and 88% with generic health scores. Conclusions: Women treated by TFA with the Sonata System for symptomatic uterine fibroids reported durable improvements in generic and fibroid-specific QOL, as well as clinically meaningful increases in QALYs over 3 years. Clinical Trials.gov ID: NCT02228174. (J GYNECOL SURG 38:143) [ABSTRACT FROM AUTHOR]

Optimal treatment of full‐thickness skin injuries requires dermal and epidermal replacement. To spare donor dermis, dermal substitutes can be used ahead of split‐thickness skin graft (STSG) application. However, this two‐stage procedure requires an additional general anaesthetic, often prolongs hospitalisation, and increases outpatient services. Although a few case series have described successful single‐stage reconstructions, with application of both STSG and dermal substitute at the index operation, we have little understanding of how the physical characteristics of dermal substitutes affects the success of a single‐stage procedure. Here, we evaluated several dermal substitutes to optimise single‐stage skin replacement in a preclinical porcine model. A porcine full‐thickness excisional wound model was used to evaluate the following dermal substitutes: autologous dermal graft (ADG; thicknesses 0.15‐0.60 mm), Integra (0.4‐0.8 mm), Alloderm (0.9‐1.6 mm), and chitosan‐based hydrogel (0.1‐0.2 mm). After excision, each wound was treated with either a dermal substitute followed by STSG or STSG alone (control). Endpoints included graft take at postoperative days (PODs) 7 and 14, wound closure at POD 28, and wound contracture from POD 28‐120. Graft take was highest in the STSG alone and hydrogel groups at POD 14 (86.9% ± 19.5% and 81.3% ± 12.3%, respectively; P <.001). There were no differences in graft take at POD 7 or in wound closure at POD 28, though highest rates of wound closure were seen in the STSG alone and hydrogel groups (93.6% ± 9.1% and 99.8% ± 0.5%, respectively). ADG‐treated wounds demonstrated the least amount of wound contracture at each time point. Increase dermal substitute thickness was associated with worse percent graft take at PODs 14 and 28 (Spearman ρ of −0.50 and −0.45, respectively; P <.001). In this preclinical single‐stage skin reconstruction model, thinner ADG and hydrogel dermal substitutes outperformed thicker dermal substitutes. Both substitute thickness and composition affect treatment success. Further preclinical and clinical studies to optimise this treatment modality are warranted. [ABSTRACT FROM AUTHOR]

Child sexual abuse offences (CSOs) represent a severe ethical and socioeconomic burden for society. Juveniles with a sexual preference for prepubescent children (PP) commit a large percentage of CSOs, but have been widely neglected in neuroscience research. Aberrant neural responses to face stimuli have been observed in men with pedophilic interest. Thus far, it is unknown whether such aberrations exist already in PP. A passive face-viewing paradigm, including the presentation of child and adult faces, was deployed and high-density electroencephalography data were recorded. The study group comprised 25 PP and the control group involved 22 juveniles with age-adequate sexual preference. Attractiveness ratings and evoked brain responses were obtained for the face stimuli. An aberrant pattern of attractiveness ratings for child vs. adult faces was found in the PP group. Moreover, elevated occipital P1 amplitudes were observed for adult vs. child faces in both groups. At longer latency (340–426 ms), a stronger negative deflection to child vs. adult faces, which was source localized in higher visual, parietal and frontal regions, was specifically observed in the PP group. Our study provides evidence for enhanced neural processing of child face stimuli in PP, which might reflect elevated attention capture of face stimuli depicting members from the sexually preferred age group. This study expands our understanding of the neural foundations underlying sexual interest in prepubescent children and provides a promising path for the uncovering of objective biomarkers of sexual responsiveness to childlike body schemes in juveniles. [ABSTRACT FROM AUTHOR]

Background Access to sufficient, safe, culturally appropriate, and nutritious food is essential for maintaining both physical and mental health. Despite a growing body of evidence suggesting that sexual minority (SM) people experience significant disparities in socioeconomic and material resource security, there remains a paucity of empirical studies examining the prevalence of food insecurity among SM people relative to their heterosexual peers. Objectives To determine the prevalence of adult and household food insecurity across sexual orientation groups in the United States after adjusting for multiple covariates. Methods We combined 7 cycles of US NHANES, 2003–2016 (N  = 21,300) to examine sexual orientation–based disparities in adult food security among lesbian/gay (n  = 373), bisexual (n  = 606), same-sex experienced (SSE, n  = 693), other sexual minorities (OSMs, n  = 88), and heterosexual (n  = 19,540) people. Food (in)security was measured using the US Food Security Survey Module and categorized as secure, marginally insecure, moderately insecure, and severely insecure. Results Severe adult food insecurity was higher among bisexuals (17.16%; 95% CI: 14.36, 20.38), SSE (13.71%; 95% CI: 11.34, 16.48), OSMs (12.50%; 95% CI: 7.04, 21.24), and lesbians/gays (13.14%; 95% CI: 10.07, 16.97) compared with heterosexuals (8.23%; 95% CI: 7.85, 8.62). Multivariable multinomial logistic regression analysis adjusting for gender, race/ethnicity, age, citizenship, education, household size, income, cycle year, emergency food use, and Supplemental Nutrition Assistance Program participation showed that bisexuals, OSMs, SSE, and lesbians/gays were more likely to experience moderate to severe food insecurity compared with heterosexuals. Conclusions SM people are significantly more likely to experience increased likelihood of food insecurity relative to their heterosexual peers. [ABSTRACT FROM AUTHOR]

Although prominent theories of intimate relationships, and couples themselves, often conceive of relationships as fluctuating widely in their degree of closeness, longitudinal studies generally describe partners' satisfaction as stable and continuous or as steadily declining over time. The increasing use of group-based trajectory models (GBTMs) to identify distinct classes of change has reinforced this characterization, but these models fail to account for individual differences within classes and within-person variability across classes and may thus misrepresent how couples' satisfaction changes. The goal of the current analyses was to determine whether accounting for these additional sources of variance through growth mixture models (GMMs) alters characterizations of satisfaction changes over time. Applied to longitudinal data from 12 independent studies of first-married couples (combined N = 1,249 couples), GMMs that allowed for class-specific individual differences and within-person variability fit the data better than the GBTMs that constrained these to be equal across classes. Most notably, considerable within-person variability was evident within each class, consistent with the idea that spouses do indeed fluctuate in their satisfaction. Spouses who dissolved their marriages were 3.8-5.7 times more likely to be in classes characterized by greater volatility in satisfaction. Because the early years of marriage appear to be characterized by within-person fluctuations in satisfaction, timevarying correlates of these fluctuations are likely to be at least as important as time-invariant correlates in explaining why some marriages thrive where others falter. [ABSTRACT FROM AUTHOR]

Immunotherapy and targeted BRAF/MEK inhibitors (i) have revolutionised the systemic management of advanced melanoma. Given the role of stereotactic radiosurgery (SRS) in the local management of brain metastases, we sought to evaluate clinical outcomes in patients with melanoma brain metastases (MBM) treated with SRS and various systemic therapies. Patients were included if MBM were diagnosed and treated with SRS within 3 months of receiving anti-PD-1 + CTLA-4 therapy, anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK-i, BRAF-i, or conventional chemotherapy. Comparisons between groups were made for overall survival (OS), distant MBM control, local MBM, systemic progression-free survival (sPFS), and neurotoxicity. In total, 257 patients with 1048 MBM treated over 368 SRS sessions between 2011 and 2020 were identified. On MVA, treatment with anti-PD1 + anti-CTLA-4, anti-PD-1, and BRAF/MEK-i improved distant intracranial control over conventional chemotherapy. No significant differences were noted in local control (LC) between groups (p = 0.78). Kaplan–Meier OS at 12 months for anti-PD-1 + CTLA-4 therapy, anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK-i, BRAF-i, and conventional chemotherapy was 68%, 59%, 45%, 62%, 21%, and 15%, respectively (p = <0.0001). The sPFS rates at 12 months were 57%, 53%, 42%, 45%, 14%, and 6% (p = <0.0001). No significant differences were noted in rates of radiation necrosis (p = 0.93). This is among the largest series evaluating MBM treated with SRS and various systemic therapy regimens. Our analysis noted significant differences in OS, distant MBM control, and sPFS by systemic therapy. No differences in LC or radiation necrosis risk were noted. • Survival was significantly different after SRS based on systemic therapy. • Significant differences noted in distant intracranial control after radiosurgery. • No differences were noted in radiation necrosis between cohorts. [ABSTRACT FROM AUTHOR]