Search

Abstract Anomalous beliefs exist on a continuum ranging from conventional beliefs to delusions. Recent work proposes that delusions may be formed via acquiescence, in which intuitive beliefs arise and persist despite awareness that they conflict with rationality. Cognitive control theory can similarly explain how we fail to detect that delusional beliefs conflict with rationality, and/or marshal cognitive control (analytic) resources to override them. We measured intuitive processes using a decision-making task and analytic processes using Stroop and cognitive reflection (CRT) tasks. Stronger intuition and lower CRT/Stroop scores were associated with acquiescence. Importantly, those less prone to delusions were more likely to override their intuition as their analytic strength increased; however, for more delusion-prone participants, analytic strength predicted an increased likelihood of acquiescence. Findings highlight an interactive role of intuitive and analytic processes in anomalous beliefs, including delusions, such that cognitive resources may be rallied to rationalize intuitions.

Blood reference intervals (RIs) provide an indication of systemic health and are central to any baseline health survey. RIs are available for all sea turtle species, except for the flatback turtle Natator depressus. We developed the first nesting and foraging flatback turtle RIs from a healthy reference population of 211 individuals. We found flatback turtle RIs were generally similar to other published sea turtle RIs. For flatback turtles, we detected significant differences in blood reference values (RVs) by life stage (nesting vs. foraging), sex, and location, as well as by measurement technique (laboratory vs. field). Clinically significant differences justified the establishment of separate RIs for nesting and foraging flatback turtles and for laboratory and field techniques. Clinical application of these blood RIs for individuals in rehabilitation includes disease diagnosis, health monitoring, and the development of prognostic indicators. As sea turtles are regarded as sentinels of environmental health, flatback turtle baseline health data will also be useful for population health monitoring and as a reference for future studies where changes in RIs may indicate an environment in decline.

Abstract Background There has been a paradigm shift in the treatment of Hepatitis C (HCV) from the interferon-era to direct-acting antiviral (DAA) drugs. Cure of HCV for the key risk group, those with a history of injecting drug use, may provide a range of benefits to an individual’s quality of life that can be additional to that of a clinical cure. The interferon-era provided evidence that cure of HCV can be a turning point for those who use drugs, supporting a recovery journey. There remains a question if DAAs can provide the same opportunity. Methods We employed a scoping review methodology to consider the additional non-clinical benefits that HCV cure may provide. We used the theoretical construct of recovery capital to consider how these benefits may support a recovery journey in the DAA-era. Results Our search provided 2095 articles, from which 35 were included in the analysis. We developed a thematic synthesis of the non-clinical outcomes identified based on the four over-arching themes of recovery capital: physical, cultural, social and human capital. Our review suggests that identity change is a constituent part of each of the recovery capital domains in relation to HCV treatment. Conclusion We identified Social Identity Model Of Recovery (SIMOR) as a mechanism through which DAAs may provide non-clinical outcomes to increase recovery capital domains. Further research is required to develop an understanding of the impact a cure of HCV with DAAs may have on identity, overall health and wellbeing and social inclusion to support recovery journeys.

Abstract Microwave undulators (MUs) have great potential to be an alternative solution to permanent magnet undulators in a free electron laser (FEL) when shorter undulator periods are required. In this paper, the factors that affect the choice of the high-power drive sources were studied via a Ka-band cavity-type MU with a corrugated waveguide proposed for the CompactLight X-ray FEL. They include the technology of the high-power vacuum electronic devices, the quality factor of the MU cavity that was demonstrated by prototyping a short section of the MU structure, and the beam dynamic study of the electrons’ trajectories inside the MU. It showed that at high beam energy, a high-power oscillator is feasible to be used as the drive source. At low beam energy, the maximum transverse drift distance becomes larger therefore an amplifier has to be used to minimize the drift distance of the electrons by controlling the injection phase.

The loss of a spouse is often cited as the most traumatic event in a person’s life. However, for most people, the severity of grief and its maladaptive effects subside over time via an understudied adaptive process. Like humans, socially monogamous prairie voles (Microtus ochrogaster) form opposite-sex pair bonds, and upon partner separation, show stress phenotypes that diminish over time. We test the hypothesis that extended partner separation diminishes pair bond-associated behaviors and causes pair bond transcriptional signatures to erode. Opposite-sex or same-sex paired males were cohoused for 2 weeks and then either remained paired or were separated for 48 hours or 4 weeks before collecting fresh nucleus accumbens tissue for RNAseq. In a separate cohort, we assessed partner-directed affiliation at these time points. We found that these behaviors persist despite prolonged separation in both same-sex and opposite-sex paired voles. Opposite-sex pair bonding led to changes in accumbal transcription that were stably maintained while animals remained paired but eroded following prolonged partner separation. Eroded genes are associated with gliogenesis and myelination, suggesting a previously undescribed role for glia in pair bonding and loss. Further, we pioneered neuron-specific translating ribosomal affinity purification in voles. Neuronally enriched transcriptional changes revealed dopaminergic-, mitochondrial-, and steroid hormone signaling-associated gene clusters sensitive to acute pair bond disruption and loss adaptation. Our results suggest that partner separation erodes transcriptomic signatures of pair bonding despite core behavioral features of the bond remaining intact, revealing potential molecular processes priming a vole to be able to form a new bond.

Emergency medical services (EMS) clinicians manage patients with traumatic pneumothoraxes. These may be simple pneumothoraxes that are less clinically impactful, or tension pneumothoraxes that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Furthermore, there is also ambiguity regarding EMS management of open pneumothoraxes. To provide evidence-based guidance on the management of traumatic pneumothoraxes in the EMS setting, the National Association of EMS Physicians (NAEMSP) performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.

Background: International Classification of Diseases (ICD)-10 code specificity is important for detailed diagnostic documentation. Insufficient coding granularity in plastic surgery may hinder accurate clinical documentation, impacting education, research, and patient care. This study examines ICD-10 code modification efforts by plastic surgeons and plastic surgery organizations within the last decade, subsequently detailing the formal proposal process and highlighting potential areas where coding modifications may be explored., Methods: A retrospective review of all modification proposals presented to the ICD Coordination and Maintenance Committee from March 2013 to March 2023 was conducted. Plastic surgery-related proposals were identified and evaluated for successful implementation. These results were compared to those of other specialties using Fisher exact tests and 2-tailed t tests., Results: A total of 472 unique proposals were identified and reviewed. Surgeons and/or surgical organizations contributed to 111 (23.5%) novel proposals, 41 (36.9%) of which were initiated by surgeons. Nine surgical specialties and 14 supporting organizations were represented. The success rate for all surgical-related proposals was 85.6%, with an average time to implementation of 24.7 months. Only 2 (1.8%) of all surgical-related proposals pertained to plastic surgery, both of which were successfully implemented., Conclusions: Though a few plastic surgeons have taken advantage of the ICD code revision process within the last decade, the high overall success rate for surgical-related proposals suggests that this seems to be a feasible method by which plastic surgeons and plastic surgery organizations can bring about useful coding changes that meaningfully impact clinical practice., Competing Interests: The authors have no financial or other conflicts of interest to disclose in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

The optical interfacing between a free-space channel and single-photon detectors (SPDs) can greatly impact the inherent performance of a free-space quantum key distribution receiver. Direct coupling to detectors creates engineering challenges, and a single-mode fiber requires adaptive optics. Using a multimode fiber (MMF) is common; however, larger core diameters limit the achievable bandwidth. We demonstrate a prototype multimode fiber-based photonic lantern that allows us to retain the benefits of the large multimode coupling while transitioning to multiple, less multimodal fibers, reducing bandwidth limitation.

Background: Artificial intelligence (AI) has transformative potential to support prehospital clinicians, emergency physicians, and trauma surgeons in acute traumatic injury care. This scoping review examines the literature evaluating AI models using prehospital features to support early traumatic injury care., Methods: We conducted a systematic search in August 2023 of PubMed, Embase, and Web of Science. Two independent reviewers screened titles/abstracts, with a third reviewer for adjudication, followed by a full-text analysis. We included original research and conference presentations evaluating AI models-machine learning (ML), deep learning (DL), and natural language processing (NLP)-that used prehospital features or features available immediately upon emergency department arrival. Review articles were excluded. The same investigators extracted data and systematically categorized outcomes to ensure consistency and transparency. We calculated kappa for interrater reliability and descriptive statistics., Results: We identified 1050 unique publications, with 49 meeting inclusion criteria after title and abstract review (kappa 0.58) and full-text review. Publications increased annually from 2 in 2007 to 10 in 2022. Geographic analysis revealed a 61% focus on data from the United States. Studies were predominantly retrospective (88%), used local (45%) or national level (41%) data, focused on adults only (59%) or did not specify adults or pediatrics (27%), and 57% encompassed both blunt and penetrating injury mechanisms. The majority used machine learning (88%) alone or in conjunction with DL or NLP, and the top three algorithms used were support vector machine, logistic regression, and random forest. The most common study objectives were to predict the need for critical care and life-saving interventions (29%), assist in triage (22%), and predict survival (20%)., Conclusions: A small but growing body of literature described AI models based on prehospital features that may support decisions made by dispatchers, Emergency Medical Services clinicians, and trauma teams in early traumatic injury care., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Objective: This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair., Design: A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques., Setting: All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists., Patients: The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison., Intervention: Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards., Main Outcome Measures: Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence., Results: The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group., Conclusions: Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Satellite and aerial platforms are critical in the deployment of global quantum communications networks. Currently, there remain significant challenges including operation during daytime and robustness to visibility limiting conditions. In this work we investigate, through simulation, the impact of visibility limiting conditions on low-Earth orbit CubeSat dimensioned satellites, small satellites and high-altitude platform implementations. Three different operational wavelengths were considered: currently used near-infrared (at 850 nm); next-generation short-wave infrared (at 1550 nm); and a candidate longer wavelength (at 2133 nm). We present channel attenuation and consider quantum key distribution (QKD) system performance parameters. Results indicate that the "best wavelength" for an implementation depends on the minimum visibility rated and the single-photon detector technology utilized. In the cases where tolerated meteorological visibility is short, 1550 nm and 2133 nm wavelengths provide better performance. In cases when the visibility is long, the operational wavelength of 850 nm provides better QKD system performance.

Introduction: Integrated plastic surgery residency is one of the most competitive medical specialties. Although previous studies have surveyed integrated plastic surgery residency program directors regarding desired applicant characteristics, there is a paucity of literature assessing detailed application characteristics and reported match outcomes from applicants in recent application cycles. This study examines application characteristics associated with matching into integrated plastic surgery residency from 2017 to 2023., Methods: The authors accessed the Texas Seeking Transparency in Application to Residency database, which contains survey information from graduating medical students nationwide regarding residency application characteristics and specialties/programs to which applications were submitted. Characteristics of matched versus unmatched applicants between 2017 and 2023 were compared using χ 2 and 2-sided, independent t tests. Univariate logistic regression models were used to assess predictors of a successful match., Results: A total of 381 integrated plastic surgery residency applicants responded to the Texas Seeking Transparency in Application to Residency survey from 2017 to 2023. Mean United States Medical Licensing Exam Step 2 CK scores; the number of away rotations, interview offers, and honored clerkships; and Alpha Omega Alpha membership rate were significantly associated with and predictive of matching. Preference signaling of programs was associated with an increased interview offer rate., Conclusions: Higher board examination scores, increasing numbers of honored clerkships, away rotations, and Alpha Omega Alpha membership were identified as statistically significant predictors of matching into integrated plastic surgery residency. Prospective applicants should use this information to help guide their efforts in these areas that appear to be associated with a successful transition to residency., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Background and Objective: Considering the rapidly evolving treatment landscape of renal cell carcinoma (RCC), recent descriptions of the RCC population in the UK are lacking, as are real-world data on treatment and patient outcomes. To analyse the demographic and clinical characteristics, treatment patterns, and overall survival of patients with RCC using national data sets in England., Patients and Methods: This was a retrospective cohort study of patients diagnosed with RCC (all stages) between 2014-2018 using demographic, clinical, cancer registration, and treatment data. Patients were followed until death or study end (December 31, 2020). Treatments administered in each line were described to understand treatment sequencing. Kaplan-Meier methods were used for time-to-event analyses. Factors associated with discontinuation and survival were identified using Cox proportional hazard models., Results and Limitations: Among 32,577 included patients, the median age at diagnosis was 66 years, 63.4% were male, and 6,786 (20.8%) had metastatic RCC at diagnosis. Tyrosine kinase inhibitor (TKI) monotherapy was the most common treatment class across lines. Over three quarters of patients (78.5% [95% CI: 78.0-78.9]) were alive one year after diagnosis (93.2% in the non-metastatic at diagnosis subgroup and 37.1% among patients with metastases at diagnosis). At three years post initial diagnosis, 18.0% patients were alive in the metastatic at diagnosis subgroup. Rapid evolution of the treatment landscape limits the results regarding lines of therapy., Conclusion: This large-scale study provides insight on characteristics of patients with RCC, and it highlights the need for better treatment options to improve survival., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Research years during medical school are becoming increasingly common amongst applicants to competitive residency programs. As many of these positions are unpaid, it is important to consider the financial implications of these experiences and the feasibility of participation from students of all backgrounds. This study aims to quantify the cost of a research year during medical school., Design/setting: We identified the top 50 NIH-funded medical schools of 2022 and obtained cost-of-living information for each of their respective counties. Estimated loan interest accrual resulting from a research year was calculated using information on the cost of attendance to medical school and annual interest rates for federal education loans. Cost-of-living calculations were stratified by geographic region, and interest accrual calculations by timing of research year and attendance at public versus private medical schools., Results: Top 50 NIH-funded medical schools in the West are located in counties with the highest mean and median costs of living, each approaching nearly $45,000 per year. Medical schools in the Midwest are located in counties with the lowest mean and median cost of living, at less than $36,000 annually. Estimated loan interest accrual resulting from a research year ranges from $3177 to $17,789, depending on timing of the research year and type of medical school attended., Conclusions: This study exemplifies the significant financial burden that a research year can impose on medical students. As more residency applicants pursuing competitive specialties opt for research years during medical school, it is important to consider the associated financial implications. Many research year opportunities are unpaid or underpaid, which may prevent interested individuals from participating; this is especially the case for those who are from lower socioeconomic backgrounds. Moving forward, it is imperative that we ensure the availability of equitable and funded research year opportunities for students of all backgrounds., (Copyright © 2024. Published by Elsevier Inc.)

Our aim in this review was to ascertain rates of breast reconstruction among South Asian patients and identify attitudes towards breast cancer, survivorship, and breast reconstruction. Mastectomy rates for South Asian patients ranged from 52% to 77% and reconstruction following mastectomy varied from 0% to 14%. A negative perception of cancer, fears of social isolation, and taboos around breasts can prevent South Asian women from receiving surgical care after a breast cancer diagnosis., (© 2024 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.)

Optical beaconing is an important part of the acquisition, pointing and tracking system necessary for free-space quantum key distribution (QKD). However, uplink beacon back-reflections from the receiver architecture can result in noise. Wavelength- and time-division multiplexing has been used, but neither is yet sufficient to make back-reflection negligible. The use of additional telescopes increases complexity and pointing error. Here, we propose the use of a 2-by-2 multicore fiber, to act as an optical uplink beacon source. This spatially separates the QKD channel and optical uplink beacon. Up to 50 dB improvement in noise rejection over a purely spectrally divided system was demonstrated. The route to further improvements through greater fiber core separation is described. Beacon systems designed in this way could provide a combination of reduced complexity and improved noise performance to free-space and satellite QKD and optical communications.

Background: There are limited data describing adverse infant outcomes in infants born to women with a low risk of complications during pregnancy, such as those who may be enrolled in maternal immunization trials. This retrospective study estimated incidence proportions of infant outcomes in different cohorts of liveborn infants in England between 2005 and 2017., Methods: The incidence proportions of 10 infant outcomes were calculated for liveborn infants from pregnancies represented in the Clinical Practice Research Datalink (CPRD) Mother-Baby Link (MBL) and linkage to Hospital Episode Statistics (HES). Three infant cohorts were designed: (1) the all pregnancies infants cohort (N = 185,119), (2) the all pregnancies with a gestational age (GA) ≥ 24 weeks infants cohort (N = 183,869), and (3) the low-risk pregnancies infants cohort (LR infants cohort, N = 121,871), which included pregnancies with a GA ≥ 24 weeks and no diagnosis of predefined high-risk medical conditions until 24 weeks GA., Results: The most common adverse infant outcome in the three infant cohorts was macrosomia (e.g., 1,085.9/10,000 live births in the LR infants cohort), followed by minor congenital anomalies (e.g., 800.6/10,000 in the LR infants cohort), very low/low birth weight (e.g., 400.6/10,000 in the LR infants cohort), and major congenital anomalies (e.g., 270.4/10,000 in the LR infants cohort). The incidence proportions for early-onset sepsis, very low/low birth weight, and minor and major congenital anomalies were lower in the LR infants than in the other cohorts (non-overlapping confidence intervals [CIs]). The incidence proportions of neonatal death, infant death, late-onset sepsis, macrosomia, small for GA, and large for GA were similar between cohorts (overlapping CIs)., Conclusions: This study generated background rates of adverse infant outcomes from liveborn infants of all and low-risk pregnancies represented in the CPRD Pregnancy Register MBL and linkage to HES. The results indicate lower incidence proportions of several adverse infant outcomes in infants from low-risk pregnancies compared to all pregnancies, illustrating the importance of considering maternal risk factors. These background rates may facilitate the interpretation of safety data from maternal immunization trials and of pharmacovigilance data from maternal vaccines. They may also be of interest for other interventions studied in pregnant women., (© 2023. The Author(s).)

The secure nature of Quantum Key Distribution (QKD) protocols makes it necessary to ensure that the single photon sources are indistinguishable. Any spectral, temporal or spatial discrepancy between the sources would lead to a breach in the security proofs of the QKD protocols. Traditional, weak-coherent pulse implementations of polarization-based QKD protocols have relied on identical photon sources obtained through tight temperature control and spectral filtering. However, it can be challenging to keep the temperature of the sources stable over time, particularly in a real-world setting, meaning photon sources can become distinguishable. In this work, we present an experimental demonstration of a QKD system capable of achieving spectral indistinguishability, over a 10°C range, using a combination of broadband sources, super-luminescent light emitting diodes (SLEDs), along with a narrow band-pass filter. The temperature stability could be useful in a satellite implementation, where there may be temperature gradients over the payload, particularly on a CubeSat.

The full time-jitter response of a single-photon detector can make a significant contribution to the quantum bit error rate (QBER) of high repetition rate quantum key distribution (QKD) implementations. Although there have been studies into understanding the contribution for single-mode optical fiber coupled single-photon detectors, the contribution of larger, multimode core diameters to the QBER have not been explored in detail. With the growing importance of free-space QKD, which typically use multimode fibers to reduce coupling loss, it is vitally important to understand how the multimode fiber coupling will impact the total QBER. This work studies the impact of the time-jitter contribution to QBER when coupling a commercial off-the-shelf silicon single-photon avalanche diode with various multimode fibers while simulating operating at 1 GHz with empirical measurements taken at 1 MHz repetition rate. It was found that step-index multimode fibers can significantly increase the QBER, while graded-index fibers can provide an QBER contribution similar to a single-mode fiber. The results highlight that there is a significant benefit in using graded index multimode fibers for a free-space QKD receiver, particularly for high repetition rate applications.

Free-space quantum key distribution (QKD) has been gaining popularity in recent years due to its advantages in creating networking options for the quantum internet. One of the main challenges to be addressed in QKD is the achievable secret key rate, which must meet current and future demand. Some of the existing solutions include the use of higher bandwidth electronics, untrusted relay architectures such as Twin-Field QKD, or high dimensional QKD. In this work, we proposed the use of a combination of spatial-multiplexing and time-division techniques, together with the use of 2D single-photon avalanche diode arrays to increase the final throughput. The main challenge in a free-space scenario is the effects introduced by turbulence. This paper demonstrates how appropriate time-division of the spatial-modes can reduce the quantum bit error rate due to optical crosstalk from 36% to 0%. With this technique, we believe the future need for superconducting nanowires single photon detectors, in some free-space QKD applications, can be relaxed, obtaining more cost-effective receiver systems.

Introduction: Linaclotide is approved for adults with moderate-to-severe irritable bowel syndrome (IBS) with constipation (IBS-C). Linaclotide is not indicated for weight loss or for patients with inflammatory bowel disease (IBD); it is contraindicated in patients with mechanical bowel obstruction (MBO). Some patients with obesity or eating disorders (ED) may use linaclotide off-label for weight loss or as a laxative., Objectives: To describe the use of linaclotide in clinical practice, including patients with potential for off-label use or misuse., Methods: Post-authorization safety study conducted in three databases from the linaclotide launch date to 2017: the Clinical Practice Research Datalink in the United Kingdom (UK), the Information System for Research in Primary Care database in Spain and the linked Patient, Prescription and Causes of Death Registries in Sweden. Cohorts of patients were identified as having IBS using diagnostic and treatment codes; IBS subtypes were identified using symptoms and treatment codes; patients with obesity, ED, MBO, and IBD were identified using diagnostic codes or body mass index., Results: There were 1319, 1981, and 5081 linaclotide users from the United Kingdom, Spain, and Sweden with a median age of 45, 57, and 51 years, respectively; most were females. In the United Kingdom, Spain, and Sweden, respectively: 59.0%, 60.3%, and 31.3% of linaclotide users had an IBS diagnosis recorded, and among those, 68.8%, 61.3%, and 92.7% were classified as IBS-C. The proportions of linaclotide users considered at risk for potential off-label use for weight loss or as a laxative were 17.1%, 29.7%, and 1.7%, and the proportions of users considered at risk of misuse due to a history of MBO or IBD were 3.5%, 4.6%, and 5.7% in the United Kingdom, Spain, and Sweden, respectively., Conclusions: Potential linaclotide off-label use and misuse appears limited, as evidenced by the small sizes of the patient subgroups at risk for off-label use and misuse., Competing Interests: Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JCR, MD, YL, MRC, and RD are employees of Evidera that received funding to conduct this research. AS was an employee of Evidera at the time of contributing to this study. AGL, DO, MGS, and RM are employees of IDIAPJGol and worked on other projects funded by pharmaceutical companies in the institution, which were not related to this study and with no personal profit., (© The Author(s), 2022.)

Background: Maternal characteristics like medical history and health-related risk factors can influence the incidence of pregnancy outcomes and pregnancy-related events of interest (EIs). Data on the incidence of these endpoints in low-risk pregnant women are needed for appropriate external safety comparisons in maternal immunization trials. To address this need, this study estimated the incidence proportions of pregnancy outcomes and pregnancy-related EIs in different pregnancy cohorts (including low-risk pregnancies) in England, contained in the Clinical Practice Research Datalink (CPRD) Pregnancy Register linked to Hospital Episode Statistics (HES) between 2005 and 2017., Methods: The incidence proportions of 7 pregnancy outcomes and 15 EIs were calculated for: (1) all pregnancies (AP) represented in the CPRD Pregnancy Register linked to HES (AP cohort; N = 298 155), (2) all pregnancies with a gestational age (GA) ≥ 24 weeks (AP24+ cohort; N = 208 328), and (3) low-risk pregnancies (LR cohort; N = 137 932) with a GA ≥ 24 weeks and no diagnosis of predefined high-risk medical conditions until 24 weeks GA., Results: Miscarriage was the most common adverse pregnancy outcome in the AP cohort (1 379.5 per 10 000 pregnancies) but could not be assessed in the other cohorts because these only included pregnancies with a GA ≥ 24 weeks, and miscarriages with GA ≥ 24 weeks were reclassified as stillbirths. Preterm delivery (< 37 weeks GA) was the most common adverse pregnancy outcome in the AP24+ and LR cohorts (742.9 and 680.0 per 10 000 pregnancies, respectively). Focusing on the cohorts with a GA ≥ 24 weeks, the most common pregnancy-related EIs in the AP24+ and LR cohorts were fetal/perinatal distress or asphyxia (1 824.3 and 1 833.0 per 10 000 pregnancies), vaginal/intrauterine hemorrhage (799.2 and 729.0 per 10 000 pregnancies), and labor protraction/arrest disorders (752.4 and 774.5 per 10 000 pregnancies)., Conclusions: This study generated incidence proportions of pregnancy outcomes and pregnancy-related EIs from the CPRD for different pregnancy cohorts, including low-risk pregnancies. The reported incidence proportions of pregnancy outcomes and pregnancy-related EIs are largely consistent with external estimates. These results may facilitate the interpretation of safety data from maternal immunization trials and the safety monitoring of maternal vaccines. They may also be of interest for any intervention studied in populations of pregnant women., (© 2022. The Author(s).)