Search

Abstract Background Many patients with severe coronavirus disease 2019 pneumonia exhibit signs of microthrombosis. Previous studies discussed intravenous fibrinolytic agents as potential add-on therapy in these patients. Therefore, we propose the inhalative administration of fibrinolytics as a possible safer alternative. Case presentation This case series describes five white male patients, aged 51–78 years, treated with off-label inhalation of alteplase between November and December 2020. All patients suffered from severe severe acute respiratory syndrome coronavirus 2 infection with respiratory failure. Pulmonary embolism was ruled out by pulmonary angiogram in computed tomography scans, and all patients showed signs of coronavirus disease 2019 pneumonia. Four patients improved clinically, while one patient with advanced chronic diseases died due to multiple organ failure. No directly associated adverse effects were observed following inhalation of alteplase. Conclusion This case series warrants further attention to investigate inhalative alteplase as an additional treatment in patients with severe coronavirus disease 2019 infection.

Probability theory has extensive applications across various domains, such as statistics, computer science, and finance. In probability education, students are introduced to fundamental principles which may include mathematical topics such as combinatorics and symmetric sample spaces. Students pursuing degrees in computer science possess a robust foundation in programming, software engineering, and algorithmic thinking. Despite entering probability courses with a unique perspective and learning potential, these students encounter challenges in grasping combinatorial concepts. In this experiment, we challenged first-year postsecondary computer science students to program a simulation of a practical combinatorics problem. Students commented on whether and how this task helped them internalize the basic concepts of combinatorics. We aim to show how utilizing programming tasks may empower students with a deeper grasp of combinatorics.

Abstract Background The Manhattan Lupus Surveillance Program (MLSP), a population-based retrospective registry of patients with systemic lupus erythematosus (SLE), was used to investigate the prevalence of cardiovascular disease events (CVE) and compare rates among sex, age and race/ethnicity to population-based controls. Methods Patients with prevalent SLE in 2007 aged ≥ 20 years in the MLSP were included. CVE required documentation of a myocardial infarction or cerebrovascular accident. We calculated crude risk ratios and adjusted risk ratios (ARR) controlling for sex, age group, race and ethnicity, and years since diagnosis. Data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES) and the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) were used to calculate expected CVE prevalence by multiplying NHANES and NYC HANES estimates by strata-specific counts of patients with SLE. Crude prevalence ratios (PRs) using national and NYC estimates and age standardized prevalence ratios (ASPRs) using national estimates were calculated. Results CVE occurred in 13.9% of 1,285 MLSP patients with SLE, and risk was increased among men (ARR:1.7, 95%CI:1.2–2.5) and older adults (age > 60 ARR:2.5, 95%CI:1.7–3.8). Compared with non-Hispanic Asian patients, CVE risk was elevated among Hispanic/Latino (ARR:3.1, 95%CI:1.4-7.0) and non-Hispanic Black (ARR:3.5, 95%CI1.6-7.9) patients as well as those identified as non-Hispanic and in another or multiple racial groups (ARR:4.2, 95%CI:1.1–15.8). Overall, CVE prevalence was higher among patients with SLE than nationally (ASPR:3.1, 95%CI:3.0-3.1) but did not differ by sex. Compared with national race and ethnicity-stratified estimates, CVE among patients with SLE was highest among Hispanics/Latinos (ASPR:4.3, 95%CI:4.2–4.4). CVE was also elevated among SLE registry patients compared with all NYC residents. Comparisons with age-stratified national estimates revealed PRs of 6.4 (95%CI:6.2–6.5) among patients aged 20–49 years and 2.2 (95%CI:2.1–2.2) among those ≥ 50 years. Male (11.3, 95%CI:10.5–12.1), Hispanic/Latino (10.9, 95%CI:10.5–11.4) and non-Hispanic Black (6.2, 95%CI:6.0-6.4) SLE patients aged 20–49 had the highest CVE prevalence ratios. Conclusions These population-based estimates of CVE in a diverse registry of patients with SLE revealed increased rates among younger male, Hispanic/Latino and non-Hispanic Black patients. These findings reinforce the need to appropriately screen for CVD among all SLE patients but particularly among these high-risk patients.

Climate change is causing extreme heating events and can lead to more infectious disease outbreaks, putting species persistence at risk. The extent to which warming temperatures and infection may together impair host health is unclear. Using a meta-analysis of >190 effect sizes representing 101 ectothermic animal host-pathogen systems, we demonstrate that warming significantly increased the mortality of hosts infected by bacterial pathogens. Pathogens that have been evolutionarily established within the host species showed higher virulence under warmer temperatures. Conversely, the effect of warming on novel infections-from pathogens without a shared evolutionary history with the host species-were more pronounced with larger differences between compared temperatures. We found that compared to established infections, novel infections were more deadly at lower/baseline temperatures. Moreover, we revealed that the virulence of fungal pathogens increased only when temperatures were shifted upwards towards the pathogen thermal optimum. The magnitude of all these significant effects was not impacted by host life-stage, immune complexity, pathogen inoculation methods, or exposure time. Overall, our findings reveal distinct patterns in changes of pathogen virulence during warming. We highlight the importance of pathogen taxa, thermal optima, and evolutionary history in determining the impact of global change on infection outcomes.

Introdução/objetivos: No Brasil, o programa de prevenção da transmissão vertical do HIV (PPTV) alcançou vários marcos, no entanto, ainda existem várias barreiras para a promoção da saúde reprodutiva. Em um ambulatório de referência estadual para PPTV, objetivamos descrever características relacionadas à saúde reprodutiva de gestantes vivendo com HIV. Materiais e métodos: Estudo de coorte, em que foram incluídas todas as gestantes vivendo com HIV acompanhadas neste centro de referência, entre 2021-2023. Descrevemos a sua saúde reprodutiva e, para avaliar o impacto de possíveis medidas preventivas, comparamos àquelas que nunca usaram preservativo com as demais por meio de uma análise de regressão logística. Resultados: Foram acompanhadas um total de 242 mulheres, com idades compreendidas entre os 13 e os 45 anos. Um total de 72 já conheciam o seu estado de HIV e estavam em uso de anti-retrovirais. Entre as 242 gestantes, a carga viral (CV) estava disponível na visita de entrada para 108, e 39 (36%) tinham CV < 20 cópias/mL. Um total de 119 gestantes (55%) relataram nunca ter usado preservativos, embora apenas 74 (32%) quisessem engravidar (em média, estavam na sua segunda gravidez, variando entre a primeira e a décima gestação). Um total de 99 (42%) apresentavam outra doença sexualmente transmissível (DST) na visita de entrada: 70 com sífilis, 10 com lesões de condiloma, 4 com uretrites e 3 com lesões de herpes simples. Elas relataram em média 2 parceiros sexuais por ano (variando entre 1 e 50); 49 (21%) referiram que os seus parceiros viviam com o HIV, 87 parceiros (38%) tinham um teste sorológico de HIV não reagente e 94 (41%) não foram testados. Os fatores associados ao uso do preservativo foram: gravidez desejada (p = 0,01) e parceiro não soroconcordante (p = 0,01), mesmo ajustando para número de parceiros por ano, CV < 20 c/mL, uso de ARVs e presença de outras DSTs. Conclusões: Nesta população de gestantes vivendo com HIV, a adesão ao uso do preservativo é baixa. O uso do preservativo não se relacionou com o CV < 20 c/mL ou DSTs. Aquelas que desejavam engravidar, utilizavam preservativo, possivelmente na intenção de prevenção de outras DSTs no período. O período de cuidado pré-natal deve ser aproveitado para integrar outras medidas educativas e preventivas, como a saúde sexual e reprodutiva dos parceiros e da gestante. Palavras-chave: Prevenção do HIV, Populações-alvo, Saúde e direitos sexuais e reprodutivos. Conflitos de interesse: Não houve conflitos de interesse. Ética e financiamentos: Declaração de interesses: Nenhum.

Cigarette butts (CBs), of which around 4.5 trillion are discarded annually, are one of the most common types of litter worldwide. CBs contain various chemicals, including metals, nicotine, and polycyclic aromatic hydrocarbons, which can leach into water and pose a threat to aquatic organisms such as cyanobacteria and chytrid fungi. Chytrids, zoosporic fungi that parasitize cyanobacteria lethally, play a crucial role in regulating cyanobacteria blooms by delaying or suppressing bloom formation. Despite the prevalence of CBs in the environment, the impact of their leachates on cyanobacteria-chytrid interactions is not well understood. We assessed the effects of CB leachate on the interaction between the toxigenic cyanobacterium Planktothrix agardhii and its chytrid parasite Rhizophydium megarrhizum. CB leachate inhibited cyanobacterial growth in uninfected cultures. Infection prevalence decreased at 0.2, 2, and 10 CB L−1, with the two highest concentrations completely suppressing infection. Interestingly, at the highest CB concentration, cyanobacterial biomass in infected cultures was comparable to that of uninfected cultures not exposed to CB leachate, suggesting that the presence of chytrids mitigates the impact of the leachate. This study demonstrates that CB leachates are a potential environmental hazard that can enable cyanobacterial growth by inhibiting chytrid infections during epidemics. In addition, our research highlights the importance of assessing the effects of chemical mixtures, such as those leached from CBs, on multi-species interactions, such as host-parasite dynamics. These assessments are crucial to better understand the impact of pollutants on aquatic ecosystems.

Objective To examine the association between maternal mRNA covid-19 vaccination during the first trimester of pregnancy and the prevalence of major congenital anomalies in offspring.Design Population based cohort study with sibling matched analysis.Setting Multiple health administrative databases, linked and analysed at ICES, an independent, non-profit research institute that collects and analyses healthcare and demographic data, Ontario, Canada, from 16 October 2021 to 1 May 2023.Population 174 296 singleton live births >20 weeks' gestation with an expected birth date between 16 October 2021 and 1 May 2023: 34 181 (20%) born to mothers who received one or two doses of an mRNA covid-19 vaccine in the first trimester and 34 951 (20%) born to mothers who did not receive a vaccine before or during pregnancy. The sibling matched analysis included 13 312 infants exposed to a covid-19 vaccine in the first trimester and 15 089 matched older siblings with the same mother, with an expected birth date after 16 October 2016 and no reported in utero exposure to a covid-19 vaccine.Main outcome measures Major congenital anomalies, overall and grouped by specific organ systems, diagnosed within 28 days of birth.Results Major congenital anomalies were present in 832 (24.3 per 1000 live births) infants exposed to an mRNA covid-19 vaccine in the first trimester compared with 927 (26.5 per 1000 live births) infants not exposed to a vaccine, resulting in an adjusted prevalence ratio of 0.89 (95% confidence interval (CI) 0.79 to 1.01). Major congenital anomalies were present in 283 (21.3 per 1000 live births) and 343 (22.7 per 1000 live births) infants exposed to an mRNA covid-19 vaccine in the first trimester and their older siblings not exposed to a vaccine, respectively (adjusted prevalence ratio 0.91, 95% CI 0.77 to 1.07). First trimester vaccination was not associated with an increase in major congenital anomalies grouped by specific organ system in the primary or sibling matched analyses. Results were similar across a range of subgroup and sensitivity analyses.Conclusions In this large population based cohort study and sibling matched analysis, mRNA covid-19 vaccination during the first trimester of pregnancy was not associated with an increase in major congenital anomalies in offspring, overall or grouped by organ system.

Objectives To examine trends in pregnancy-associated non-fatal and fatal opioid toxicity and all-cause mortality, and identify associated factors. Approach We conducted a population-based study of 1,555,370 pregnancies in Ontario, Canada, 2013-2022. We analyzed linked administrative datasets, including coroner data, and calculated pregnancy-associated (during pregnancy or within one-year post-pregnancy) non-fatal/fatal opioid toxicity and all-cause mortality ratios per 100,000 livebirths by year and timing (pregnancy, post-pregnancy). Poisson regression models analyzed trends in outcomes and generated adjusted relative risks (aRR) of opioid toxicity by socio-demographic and clinical factors. Results Pregnancy-associated non-fatal opioid toxicity increased 220% between 2013 and 2020 (45.5-145.4/100,000 livebirths) before declining by 30% in 2021. Over the study period, fatal opioid toxicity increased 150% (6.8-17.5/100,000) and all-cause mortality increased 120% (32.8-71.2/100,000). Our methods did not identify any opioid toxicity deaths in pregnancy, and most non-fatal (66.6%) and fatal (88.9%) opioid toxicity and all-cause mortality (73.9%) occurred 43-365 days post-pregnancy. The percent of deaths attributed to opioids increased from 12.7% in 2015 to 25.0% in 2020. Substance use disorder (aRR 19.52, 95% CI 16.87-22.58), pre-pregnancy opioid toxicity (aRR 4.69, 3.81-5.78), mental illness (aRR 2.01, 1.75-2.29), high neighbourhood deprivation (aRR 1.45, 1.28-1.64), and social disadvantage (aRR 3.21, 2.77-3.71) were associated with elevated risk of opioid toxicity. Conclusions Pregnancy-associated opioid toxicity and mortality have increased substantially. In 2020, 1 in 4 pregnancy-associated deaths involved opioids. Implications Findings highlight the need for comprehensive care and perinatal harm reduction services. System-level improvements to reduce poor outcomes must include complete data capture of all pregnancy-associated deaths.

Objectives/Approach We linked the Ontario Social Assistance (OSA) Benefit Unit file from the Ministry of Children, Community and Social Services to provincial health administrative datasets housed at ICES to examine the impact of COVID-19 on Mental Health and Addictions (MHA) service use among OSA recipients. Those receiving OSA benefits for February 2020 were matched to Ontario residents not receiving benefits based on age (±1 year), sex, income, expected resource utilization, and area of residence (N=771,891 matched pairs). We computed rates of MHA-related emergency department (ED) visits and hospitalizations in the 16-month period before (November 2018-February 2020) and after (March 2020-June 2021) pandemic onset. Results MHA-related ED visit rates were much greater among OSA recipients (8.82 per 1,000 person-months) compared with matched controls (1.83 per 1,000 person-months) in the post-COVID period (Relative Rate [RR]=4.82; 95% Confidence Interval [95%CI] 4.75-4.89). Comparatively, MHA-related ED visit rates were also greater among OSA recipients (9.85 per 1,000 person-months) compared with controls (2.38 per 1,000 person-months) during the pre-COVID period (RR=4.13; 95%CI 4.08-4.18). The pre-COVID and post-COVID period RRs comparing OSA recipients and matched controls were significantly different (p

Objective There is growing recognition of the importance of community data governance to build accountability of research institutions to communities. Our organization, a steward of health and administrative population-level data, has previously implemented community governance structures for Indigenous data. This scoping initiative explores development and implementation of an additional community governance structure for race-related data. Approach We conducted a scoping review of peer-reviewed and grey literature to identify existing practices of community data governance. We also conducted key informant interviews with thirteen racialized community stakeholders, who addressed open-ended questions on potential co-design processes as well as governance mandates, scopes, barriers, and facilitators. Results The scoping review identified eight community data governance examples. Two of these pertained to race-related data, while the remaining six pertained to other data that identified “community” geographically, by disease condition, life stage, and/or economic circumstance. Governance structures were diverse, ranging from one-time crowd-design of a data-sharing agreement to quarterly meetings of a governing board to review project-level data requests. Key informant interviews provided four themes to guide implementation in the context of our organization: exploring organizational readiness, considering who should be involved, defining the scope and mandate, and drafting an approach and process. Conclusion We are committed to implementing a community governance structure for race-related, population-level data. However, there are limited examples of similar structures in the existing literature. Implications The identified examples and the advice of community stakeholders will guide co-design of a preliminary structure, scope, and mandate for community governance of race-related, population-level data.

Objectives Our understanding of the contribution of new presentations versus pre-existing eating disorders during the COVID-19 pandemic is limited. This study aims to evaluate rates of emergency department (ED) visits and hospitalizations for eating disorders among adolescents and young adults (YA) new to care and those with pre-existing eating disorders during the pandemic. Approach We conducted a population-based cross-sectional study using linked health administrative data for Ontario residents aged 10-26 during the pre-pandemic (Jan. 1, 2017-Feb. 29, 2020) and pandemic periods (Mar. 1, 2020-Jun. 30, 2022). We used Poisson generalized estimating equations models to predict expected overall and monthly rates of eating disorder-related ED visits and hospitalizations among those with a new and pre-existing eating disorder. Results Compared with expected rates, ED visits increased during the pandemic among only adolescents with new eating disorders (adolescent RR 2.12, 95% CI [1.84,2.45]). Additionally, both adolescents and YA with pre-existing eating disorders experienced an increase in ED visits (RR 2.78, 95% CI [2.28, 3.38] and RR 1.52, 95% CI [1.25, 1.85], respectively). Similarly, hospitalizations for new presentations increased solely for adolescents (RR 1.48, 95% CI [1.34,1.64]), while hospitalizations for pre-existing eating disorders increased for both adolescents (RR 1.82, 95% CI [1.43,2.32]) and YA (RR 1.12, 95% CI [1.01,1.23]). Conclusions There was an increase in acute care visits for eating disorders during the pandemic, especially among adolescents and YA with pre-existing conditions. This differentiation is important in advancing our understanding of the pandemic's effects on adolescents and YA and the healthcare system receiving them.

Routinely collected health data (RCD) including electronic health records, disease registries, health administrative data and wearables data are not specifically collected for research purposes. Analysis of these data poses unique methodological challenges that must be addressed when conducting research, particularly as availability and use increase. This scoping review aimed to identify methodological challenges in research using RCD from existing literature (registered protocol: https://doi.org/10.17605/OSF.IO/EBM4D). We searched 6 electronic databases, including medical, health economics, nursing and psychology research databases, between Jan 2015 and Jan 2023, combining multiple “RCD” and “research” search terms (e.g., epidemiologic, informatics, pharmaceutical research). After screening abstracts and full-texts, we doubly extracted methodological themes, categorizing them into different study stages. We screened more than 23,000 records and included 430 papers. Bias and confounding were the most common methodological issues identified, discussed in relation to both study design and data analysis. Data quality, including data accuracy, validation, completeness, timeliness and cleaning, also posed substantial challenges, particularly during data processing stage. Record linkage and conducting analyses using distributed health networks also pose unique methodological challenges. Heterogeneity, incorporating social determinants of health and statistical models that address methodological challenges are also described in the literature. External validity and reporting are important considerations for RCD research. Our review identified several methodological challenges facing researchers using RCD. These issues should be addressed to ensure methodologically sound research. These findings will inform the development of a standardized protocol template and accompanying educational platform aimed at enhancing methodological quality and transparency when conducting research using RCD.

Background Psychiatric conditions are common amongst hospitalized children. Co-occurring psychiatric conditions for medical hospitalizations contribute to length of stay, costs, and readmissions. We sought to measure trends over 20 years in pediatric hospitalizations for co-occurring medical and psychiatric conditions and compare with those without psychiatric comorbidity, overall and in free-standing children’s hospitals. Methods We identified all 3- to 17-year-olds hospitalized in Ontario, Canada between April 1, 2003 and March 31, 2022. Using health record discharge diagnoses, hospitalizations were assigned to 1 of 4 groups: 1) medical-diagnosis-only, 2) psychiatric-diagnosis-only, 3) primary medical diagnosis with psychiatric comorbidity, and 4) primary psychiatric diagnosis with medical comorbidity. Hospitalization trends for 1) all hospitals, and 2) free-standing children’s hospitals were described and compared. Results From 2003 to 2022, medical-diagnosis-only hospitalizations declined 39% (41,909 to 25,486 hospitalizations), psychiatric-diagnosis-only hospitalizations increased 96% (3227 to 6337), medical hospitalizations with psychiatric comorbidity increased 127% (977 to 2221) and psychiatric hospitalizations with medical comorbidity increased 100% (2051 to 4096). Among pediatric hospitals, medical-diagnosis-only hospitalizations increased 23% (12,430 to 15,318), psychiatric-diagnosis-only hospitalizations increased 420% (271 to 1408), psychiatric hospitalizations with medical comorbidity increased 172% (539 to 1468) and medical hospitalizations with psychiatric comorbidity increased 235% (478 to 1599). Conclusions Hospitals have experienced large absolute and relative increases in volumes for psychiatric conditions both with and without co-occurring medical conditions, particularly among free-standing children’s hospitals. Healthcare provider training, hospital resourcing, and health system planning must consider how best to accommodate the increasing acute psychiatric care needs of hospitalized children and adolescents.

Introduction: Patients with hypertrophic cardiomyopathy (HCM) are at risk for lethal ventricular arrhythmia, but the electrophysiological substrate behind this is not well-understood. We used non-invasive electrocardiographic imaging to characterize patients with HCM, including cardiac arrest survivors.Methods: HCM patients surviving ventricular fibrillation or hemodynamically unstable ventricular tachycardia (n = 17) were compared to HCM patients without a personal history of potentially lethal arrhythmia (n = 20) and a pooled control group with structurally normal hearts. Subjects underwent exercise testing by non-invasive electrocardiographic imaging to estimate epicardial electrophysiology.Results: Visual inspection of reconstructed epicardial HCM maps revealed isolated patches of late activation time (AT), prolonged activation-recovery intervals (ARIs), as well as reversal of apico-basal trends in T-wave inversion and ARI compared to controls (p < 0.005 for all). AT and ARI were compared between groups. The pooled HCM group had longer mean AT (60.1 ms vs. 52.2 ms, p < 0.001), activation dispersion (55.2 ms vs. 48.6 ms, p = 0.026), and mean ARI (227 ms vs. 217 ms, p = 0.016) than structurally normal heart controls. HCM ventricular arrhythmia survivors could be differentiated from HCM patients without a personal history of life-threatening arrhythmia by longer mean AT (63.2 ms vs. 57.4 ms, p = 0.007), steeper activation gradients (0.45 ms/mm vs. 0.36 ms/mm, p = 0.011), and longer mean ARI (234.0 ms vs. 221.4 ms, p = 0.026). A logistic regression model including whole heart mean activation time and activation recovery interval could identify ventricular arrhythmia survivors from the HCM cohort, producing a C statistic of 0.76 (95% confidence interval 0.72–0.81), with an optimal sensitivity of 78.6% and a specificity of 79.8%.Discussion: The HCM epicardial electrotype is characterized by delayed, dispersed conduction and prolonged, dispersed activation-recovery intervals. Combination of electrophysiologic measures with logistic regression can improve differentiation over single variables. Future studies could test such models prospectively for risk stratification of sudden death due to HCM.

Objective To assess reported community engagement in the design and conduct of health equity-focused articles published in high-impact journals.Design Scoping review follows guidance from the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sources We selected the three highest-ranked journals from the ‘Medicine—General and Internal’ category including the Journal of the American Medical Association (JAMA), The Lancet and The New England Journal of Medicine (NEJM) along with all journals under their family of subspecialty journals (JAMA Network, The Lancet Group and the NEJM Group). Ovid MEDLINE was searched between 1 January 2021 to 22 September 2022.Eligibility criteria We included health equity-focused articles and assessed for the reporting of community engagement at each stage of the research process.Data extraction and synthesis Two independent reviewers extracted data from articles that met the inclusionary criteria. Inter-rater reliability was assessed using Cohen’s kappa to measure the agreement between two independent reviewers. Disagreements were adjudicated by a third independent reviewer.Results 7616 articles were screened, 626 (8.2%) met our inclusion criteria: 457 (3.8%) were published by the JAMA Network; 167 (2.4%) by The Lancet Group; and 2 (0.2%) by the NEJM group. Most articles were from USA (68.4%) and focused on adult populations (57.7%). The majority of the articles focused on the topic of race/ethnicity (n=176, 28.1%), socioeconomic status (n=114, 18.2%) or multiple equity topics (n=111, 17.7%). The use of community engagement approaches was reported in 97 (15.5%) articles, of which 13 articles (13.4%) reported engagement at all stages. The most common form of reported engagement was in the acknowledgement or additional contribution section (n=86, 88.7%).Conclusions Community engagement is infrequently reported in health equity-focused research published in high-impact medical journals.

Introduction Removing a child from their family is the option of last resort for social services. However, decisions to place children into care are occurring more frequently and earlier in children's lives, with newborn discharge to social services being a particular concern due to the effects of mother-newborn separations on child development. Women with disabilities face negative assumptions about their parenting capacity, but little is known about their rates of newborn discharge to social services. Objectives To examine the risk of discharge to social services among newborns of women with and without disabilities. Methods We conducted a population-based cohort study of singleton livebirths in Ontario, Canada, 2008-2019. We used modified Poisson regression to estimate the relative risk (RR) of discharge to social services immediately after the birth hospital stay, comparing newborns of women with physical (n = 114,685), sensory (n = 38,268), intellectual/developmental (n = 2,094), and multiple disabilities (n = 8,075) to newborns of women without a disability (n = 1,221,765). Within each group, we also examined maternal sociodemographic, health, health care, and pregnancy-related characteristics associated with the outcome. Results Compared to newborns of women without disabilities (0.2%), newborns of women with physical (0.5%; aRR 1.53, 95% CI 1.39-1.69), sensory (0.4%; aRR 1.34, 95% CI 1.12-1.59), intellectual/developmental (5.6%; aRR 5.34, 95% CI 4.36-6.53), and multiple disabilities (1.7%; aRR 3.09, 95% CI 2.56-3.72) had increased risk of being discharged to social services after the birth hospital stay. Within each group, the strongest predictors of the outcome were young maternal age, low income quintile, social assistance, maternal mental illness and substance use disorders, inadequate prenatal care, and neonatal morbidity. Conclusions Newborns of women with disabilities are at increased risk of being discharged to social services after the birth hospital stay. These findings can be used to inform the development of tailored supports for new mothers with disabilities and their infants.

The National Museum of Transylvanian History in Cluj-Napoca, Romania, features a History of Pharmacy Collection that documents the evolution of pharmacies in the region since the 16th century. Within the “Pharmatrans” project (2021–2023), we investigated the chemical composition of ointments from fourteen historical pharmaceutical containers dating back to the 18th and 19th centuries. Most samples were from an aristocratic traveling medicine chest, a key artifact in the collection. This study marks the first extensive analysis of historical pharmaceutical formulations in Romania, enhancing our understanding of these valuable items. The main ingredients of formulations were characterized using gas chromatography–mass spectrometry (GC–MS), solid-phase microextraction–GC–MS (SPME–GC–MS), and pyrolysis–GC–MS (Py–GC–MS). Additionally, high-performance liquid chromatography coupled with high-resolution mass spectrometry (HPLC-ESI-Q-ToF) was employed for the detailed analysis of lipid materials and polar compounds. Elemental analysis was conducted using field emission gun–scanning electron microscope (FEG–SEM) with energy-dispersive spectroscopy (EDS). The results revealed that twelve out of fourteen mixtures contained interpretable organic content, often aligning with the vessels’ labels. The findings indicate that Transylvanian elites in the late 18th century had access to both rare drugs and traditional remedies, reflecting contemporary trends in pharmacy.

Background: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). Methods: An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. Results: One hundred and thirty-five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return-to-learn protocol in place and 90% reported having a return-to-play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty-seven percent of respondents believed that PPM158 improves student well-being. Conclusions: Identified implementation barriers and facilitators can inform concussion policy practices to improve student well-being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools.

The basic principle of electron beam melting (EBM) technology is the additive generation of structures by the selective melting of metal powder layer by layer with an electron beam under vacuum conditions. The cooling rate of the EBM process can be reduced drastically by increasing the temperature of the powder bed to avoid the formation of solidification cracks by brittle materials such as tungsten (W). This refractory metal is a promising candidate as plasma facing material for future fusion reactors. The selection of tungsten is owing to its physical properties such as the melting point of 3420 °C, the high strength and high thermal conductivity, the low thermal expansion and low erosion rate. Disadvantages are the low ductility, and fracture toughness at room temperature. Furthermore, the manufacturing by mechanical machining, such as milling and turning, is extremely cost and time consuming. An interesting alternative process route to conventional manufacturing technologies is EBM. It allows the near-net shape fabrication of prototype structures with geometrical freedom and has proven its capability for mass production by the manufacturing of hip prostheses made of titanium.This manuscript describes the fabrication of tungsten parts via electron beam melting, with application to the manufacturing of divertor armour. The investigation comprises the microstructure examination, crystallographic texture, as well as mechanical characterization via tensile and Charpy impact testing. This is followed by the presentation of process routes to fabricate mock-ups with different designs and copper cooling structures.Furthermore, the different mock-ups were exposed to high heat flux (HHF) applying transient thermal loads to assess thermal shock and thermal fatigue performance of EBM tungsten.Post mortem analyses were performed quantifying the occurring damage with respect to reference tungsten grades by microscopical means.The achieved results demonstrate the high potential to process tungsten via electron beam melting.

Summary: Background: Immigrants in high-income countries experienced inequities in COVID-19 severe outcomes. We examined hospitalization and death throughout the pandemic, and change during the vaccine era, in Ontario, Canada. Methods: We conducted a population-based study using linked immigration and health data, following two cohorts for 20 months from January 1, 2020 (pre-vaccine) and September 1, 2021 (vaccine era). We used multivariable Poisson generalized estimating equation regression to estimate adjusted rate ratios (aRR) with 95% confidence intervals (CI), accounting for age, sex and co-morbidities. We calculated age-standardized years of life lost (ASYRs) rates by immigrant category. Findings: Of 11,692,387 community-dwelling adults in the pre-vaccine era cohort and 11,878,304 community-dwelling adults in the vaccine era cohort, 21.6% and 21.4% of adults in each era respectively were immigrants. Females accounted for 57.9% and 57.8% of sponsored family, and 68.4% and 67.6% of economic caregivers, in each era respectively. Compared to other Ontarians in the pre-vaccine era cohort, hospitalization rates were highest for refugees (aRR [95% CI] 3.41 [3.39–3.44]) and caregivers (3.13 [3.07–3.18]), followed by sponsored family and other economic immigrants. Compared to other Ontarians, aRRs were highest for immigrants from Central America (5.00 [4.92–5.09]), parts of South Asia (3.95 [3.89–4.01]) and Jamaica (3.56 [3.51–3.61]) with East Asians having lower aRRs. Mortality aRRs were similar to hospitalization aRRs. In the vaccine era, all aRRs were attenuated and most were similar to or lower than other Ontarians, with refugees and a few regions maintaining higher rates. In the pre-vaccine era ASYRs were higher for all immigrant groups. ASYRs dropped in the vaccine era with only refugees continuing to have higher rates. Interpretation: Immigrants, particularly refugees, experienced greater premature mortality. aRRs for most immigrant groups dropped substantially after high vaccine coverage was achieved. Vaccine outreach and improvements in the social determinants of health are needed. Funding: Canadian Institutes of Health Research, Canada Research Chairs Program.

Introduction: Children with type 1 diabetes require close monitoring with visits every 3–4 months. COVID-19-induced telemedicine expansion may alleviate the challenge of high visit frequency that children with type 1 diabetes face. However, telemedicine’s impact on access to care may be limited if patients lack adequate support for telemedicine. The purpose of this study was to evaluate the impact of telemedicine care coordination services on visit frequency in an urban medical center without care coordination services versus a rural outreach program with established care coordination services serviced by the same providers. Methods: We evaluated EHR data from 790 children receiving care between July 2018 and December 2021 at a single academic center in Oregon. We estimated differences in likelihood of adequately timed monitoring care over time by patient care coordination services status using Generalized Estimating Equations. Results: Just prior to telemedicine expansion, patients receiving care coordination services were 25.6 % less likely to receive adequately timed monitoring care (95 % CI: 51.6 %, 114 %). Following telemedicine expansion, likelihood of adequately timed monitoring care increased from 28.8 % to 58.2 % among those receiving care coordination services and decreased from 38.7 % to 22.0 % among those not receiving care coordination services; increases in adequately timed monitoring care were 3.55 times greater in patients receiving care coordination services relative to those not (95 % CI: 2.10, 6.01). Discussion: For pediatric patients with type 1 diabetes, telemedicine care coordination may be an important factor for increasing visit adherence and may increase the number of patients meeting goal visit frequency beyond levels seen prior to widespread telemedicine availability.

Background: Surgeon visual estimation of shoulder range of motion (ROM) is commonplace in the outpatient office setting and routinely reported in clinical research, but the reliability and accuracy of this practice remain unclear. The purpose of this study is to establish the reliability and accuracy of remote visual estimation of shoulder ROM in healthy volunteers and symptomatic patients among a large group of shoulder surgeons. Our hypothesis is that remote visual estimation would be reliable and accurate compared with the digital goniometer method. Methods: Fifty shoulder surgeon members of the PacWest Shoulder and Elbow Society independently determined the active shoulder forward flexion (FF), internal rotation at 90° abduction (IR90), external rotation at 90° abduction, external rotation at the side , and maximal spinal level reached with internal rotation (IRspine) through visual estimation of video recordings taken from 10 healthy volunteers and 10 symptomatic patients. Variations in measurements were quantified using the interobserver reliability through calculation of the intraclass correlation coefficient. Accuracy was determined through comparison with digital goniometer measurements obtained with an on-screen protractor application using Bland–Altman mean differences and 95% limits of agreement. Results: The interobserver reliability among examiners showed moderate to excellent correlation, with intraclass correlation coefficient ranging from 0.768 to 0.928 for the healthy volunteers and 0.739 to 0.878 for the symptomatic patients. Accuracy was limited, with upper limits of agreement exceeding the established minimal clinically important differences (MCIDs) for FF (20° vs. MCID of 14°) and IR90 (25° vs. 18°) in the healthy volunteers and for FF (33° vs. 16°), external rotation at 90° abduction (21° vs. 18°), and IR90 (31° vs. 20°) in the symptomatic patients. Conclusion: Despite generally high intersurgeon reliability in the visual estimation of shoulder ROM, there was questionable accuracy when compared to digital goniometer measurements,with measurement errors often exceeding established MCID values. Given the potential implications for the clinical response to treatment and the significance of research findings, the adoption of validated instruments to measure ROM and the standardization of examination procedures should be considered.