Study Period Research Articles

A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy.

Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.

Retrospective evaluation of Penguin Cold Caps for chemotherapy-induced alopecia

BackgroundScalp cooling is an increasingly recognized non-pharmacologic approach to minimize chemotherapy-induced alopecia (CIA). Several commercially available machine-based and manual scalp cooling systems are available; however, literature reports of effectiveness are highly variable. The purpose of this study was to determine real-world tolerability and subjective effectiveness of a manual cold capping system in minimizing CIA across a variety of patient race and hair types. This study was a single-institution review of outcomes from manual cold capping.MethodsWe identified retrospective cohort of adult patients who presented to discuss cold capping between January 14, 2019, and March 31, 2022. Data collected from medical records included demographics, decision to pursue/continue cold capping, diagnoses, chemotherapy regimens, hair characteristics (length, thickness, coarseness, type), and subjective perception of percentage of hair retained. Those with successful vs. unsuccessful cold capping (≥ 50% vs. < 50% of hair retained) were compared based on the patient-level factors of interest.FindingsA total of 100 patients initiated cold capping during the study period, and 95% of them completed cold capping. The majority of patients who started cold capping completed it. The median-reported percentage of hair maintained was 75%, and 82/89 (92.1% of patients) had favorable results, defined as ≥ 50% of hair retained. The only patient-level factor associated with favorable response was chemotherapy regimen, with fewer patients receiving doxorubicin-containing regimens having successful hair retention compared to other chemotherapy types (71.4% successful results vs. 95.7% for those receiving paclitaxel-containing regimens and 96.6% for those receiving docetaxel-containing regimens (p = 0.018). There was no difference in success based on patient race/ethnicity or hair characteristics.InterpretationThe overall effectiveness (92.1%) in this study is consistent to higher than many literature reports. One possible reason for the high success in our cohort is compliance with cold capping protocols, meaning applying the cap in the appropriate manner and wearing the cap for the prescribed durations, which may impact effectiveness.

Central Line Repair in Pediatric Patients in the Pediatric Emergency Department by Emergency Physicians-A Single-Center Experience.

Central venous catheters are more common with advanced treatments for a variety of conditions. These catheters may need to be repaired after local damage. This has been performed by those more involved with catheter placement such as pediatric surgeons and interventional radiologists. Gastroenterologists who treat many of these patients have also been involved with catheter repair. Repair by pediatric emergency physicians has not been explored. Such repairs by the emergency physician may be time saving and avoid unnecessary admissions. This was a retrospective study of a single center's experience with catheter repair. The performers and outcomes were compared. During the study period, 52 catheter repairs were performed on 7 children. Forty of the repairs were performed by a pediatric emergency physician, 5 by pediatric surgeons, and 5 by interventional radiology. All but 1 repair was successful. Infectious complications were reported in 3 cases. None required catheter removal. The length of stay was significantly shorter for repair by emergency physician. Central line catheter repair can be performed successfully by pediatric emergency physician with minimal complications. A dedicated process of repair tutoring is required and may avoid infectious complications.

Emergency Department Sepsis Triage Scoring Tool Elements Associated With Hypotension Within 24 Hours in Children With Fever and Tachycardia.

Pediatric sepsis screening is becoming the standard of care for children presenting to the emergency department (ED) and has been shown to improve recognition of severe sepsis, but it is unknown if these screening tools can predict progression of disease. The objective of this study was to determine if any elements of a sepsis triage trigger tool were predictive of progression to hypotensive shock in children presenting to the ED with fever and tachycardia. This study is a retrospective case-control study of children ≤18 years presenting to an ED with fever and tachycardia, comparing those who went on to develop hypotensive shock in the subsequent 24 hours (case) to those who did not (control). Primary outcome was the proportion of encounters where the patient had specific abnormal vital signs or clinical signs as components of the sepsis triage score. The secondary outcomes were the proportion of encounters where the patient had a sepsis risk factor. During the study period, there were 94 patients who met case criteria and 186 controls selected. In the adjusted multivariable model, the 2 components of the sepsis triage score that were more common in case patients were the presence of severe cerebral palsy (adjusted odds ratio, 9.4 [3.7, 23.9]) and abnormal capillary refill at triage (adjusted odds ratio, 3.1 [1.4, 6.9]). Among children who present to a pediatric ED with fever and tachycardia, those with prolonged capillary refill at triage or severe cerebral palsy were more likely to progress to decompensated septic shock, despite routine ED care.

Effect of aspirin on cardiovascular events in patients undergoing hemodialysis with hyperphosphatemia: A post hoc analysis of the LANDMARK trial.

The clinical benefits of aspirin in patients undergoing hemodialysis remain unclear. The secondary analysis of the LANDMARK trial investigated whether aspirin use was associated with cardiovascular events (CVEs) and all-cause mortality was performed. A total of 2135 patients at risk for vascular calcification were analyzed using a Cox proportional hazards model with propensity score matching. The risk of CVEs was comparable between participants with aspirin use at baseline and those without at baseline, between participants with aspirin use during the study period and those without during the study period, and between participants with new aspirin prescription and those without aspirin use during the study period. Aspirin use was not significantly associated with a lower risk of CVEs in participants undergoing hemodialysis patients at risk of vascular calcification.

Pulmonary hypertension in newly diagnosed obstructive sleep apnea-chronic obstructive pulmonary disease overlap syndrome patients attending a tertiary care centre-a cross-sectional analysis.

Overlap syndrome is the association of obstructive sleep apnea (OSA) with chronic obstructive pulmonary disorder and with other chronic respiratory diseases. Patients with overlap syndrome have a worse prognosis compared with chronic obstructive pulmonary disorder or OSA alone. Additionally, patients with combined chronic obstructive pulmonary disorder and OSA are more likely to develop pulmonary hypertension and right heart failure much earlier than those without overlap. To assess the occurrence of pulmonary hypertension (PH) in newly diagnosed OSA-chronic obstructive pulmonary disorder overlap syndrome patients attending a tertiary care centre. This cross-sectional study was conducted at Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, South India, among patients with OSA above 40years of age who were proactively evaluated to pick out those with undiagnosed overlap. A period of 6months after getting ethical clearance from June 2018 was selected as the study period. Among patients with symptoms suggestive of OSA above 40years of age who gave the informed consent were enrolled after screening with Standard Sleep questionnaires (Berlin questionnaire, STOP BANG and Epworth Sleepiness Scale). Enrolled patients underwent routine spirometry and sleep study using the standard Level 1 overnight polysomnography (Level1 OPSG). Patients were classified in to two groups as OSA patients (group I), having an apnea hypopnea index (AHI) > 5/hr alone and the second group as those OSA patients (group II), with an obstructive spirometry pattern who were the overlap group. Arterial blood gas analysis (a sample of radial arterial blood was drawn with the patient awake and supine, and was analyzed for pH, PaCO2 and PaO2) and echocardiography (ECHO) of the two groups were compared as a non-invasive method to assess pulmonary artery hypertension and results were analyzed in a systematic manner. Among the 84 patients enrolled, 16.7% had overlap syndrome and the rest had OSA alone. Statistically significant higher mean weight and BMI for those with overlap syndrome compared to the OSA group were observed. Mean FVC (forced vital capacity), FEV1 (forced expiratory volume 1s), and FEV1/FVC were lower in those with overlap syndrome compared to OSA group. The mean values of ABG parameters revealed higher PaCO2 and lower PaO2 among the group with overlap syndrome which were statistically significant. However, there was no significant difference in resting room air SaO2 value between the two groups. The mean values of sleep duration and efficiency were significantly lower in those with overlap syndrome with a p value < 0.001. The mean value of arousal and REM (rapid eye movement) sleep percentage were significantly higher among those with overlap syndrome (p < 0.001). Mean value of NREM (non-rapid eye movement) sleep percentage was lower among the group with overlap syndrome compared with the OSA group, and this difference was statistically significant. The mean AHI value of the overlap syndrome group was 39.79 ± 7.54 and this was significantly higher than the OSA group (p < 0.004). Among the 14 patients who had ECHO evidence of pulmonary hypertension, 9 (64.3%) belonged to the overlap group which shows that they are a highly vulnerable group for developing pulmonary hypertension (PH) and requires early detection and more rigorous treatment. This study confirms that OSA patients with modest daytime level of hypoxemia and mild-moderate chronic airflow limitation have a high prevalence of PH. Chronic airway obstruction may be asymptomatic in some subjects and this stresses the necessity of pulmonary function test in OSA.

Cropland abandonment between 1986 and 2018 across the United States: spatiotemporal patterns and current land uses

Knowing where and when croplands have been abandoned or otherwise removed from cultivation is fundamental to evaluating future uses of these areas, e.g. as sites for ecological restoration, recultivation, bioenergy production, or other uses. However, large uncertainties remain about the location and time of cropland abandonment and how this process and the availability of associated lands vary spatially and temporally across the United States. Here, we present a nationwide, 30 m resolution map of croplands abandoned throughout the period of 1986–2018 for the conterminous United States (CONUS). We mapped the location and time of abandonment from annual cropland layers we created in Google Earth Engine from 30 m resolution Landsat imagery using an automated classification method and training data from the U.S. Department of Agriculture Cropland Data Layer. Our abandonment map has overall accuracies of 0.91 and 0.65 for the location and time of abandonment, respectively. From 1986 to 2018, 12.3 (±2.87) million hectares (Mha) of croplands were abandoned across CONUS, with areas of greatest change over the Ogallala Aquifer, the southern Mississippi Alluvial Plain, the Atlantic Coast, North Dakota, northern Montana, and eastern Washington state. The average annual nationwide abandoned area across our study period was 0.51 Mha per year. Annual abandonment peaked between 1997 and 1999 at a rate of 0.63 Mha year−1, followed by a continuous decrease to 0.41 Mha year−1 in 2009–2011. Among the abandoned croplands, 53% (6.5 Mha) changed to grassland and pasture, 18.6% (2.28 Mha) to shrubland and forest, 8.4% (1.03 Mha) to wetlands, and 4.6% (0.56 Mha) to non-vegetated lands. Of the areas that we mapped as abandoned, 19.6% (2.41 Mha) were enrolled in the Conservation Reserve Program as of 2020. Our new map highlights the long-term dynamic nature of agricultural land use and its relation to various competitive pressures and land use policies in the United States.

No vaccine interference between bovine coronavirus and bovine herpesvirus-1 in a randomized trial when coadministrating two intranasal modified-live viral vaccines to neonatal calves.

Compare immune responses induced by 2 commercial intranasal (IN) modified-live viral (MLV) vaccines given individually or coadministered and evaluate prevention of infection and lung pathology following bovine herpesvirus-1 (BHV-1) challenge. 36 male Holstein calves (ages, 5 to 12 days). In a randomized complete block design, each calf received an IN injection of either vaccine diluent (Placebo), an MLV vaccine containing bovine herpesvirus-1 (BHV-1; N3), bovine coronavirus vaccine (BC), or both N3 and BC (BC + N3) with a booster 4 weeks later. Nasal secretions and blood were collected weekly. Three weeks after the booster, the calves were challenged with BHV-1, sampled for virus shedding, and euthanized 10 days later to quantify lung pathology. The study period was September 7, 2020, to April 6, 2021. Calves were seropositive for BHV-1 and BC before vaccination. No significant difference in BC-specific serum immunoglobin G and nasal immunoglobin A antibody responses in the BC versus BC + N3 group or BHV-1-specific serum immunoglobin G and nasal immunoglobin A antibody responses in the N3 versus BC + N3 group. Cytokine responses to BHV-1 and BC did not differ among groups. BHV-1 shedding after challenge was significantly reduced in N3 groups versus Placebo and BC. There was a significant reduction in lung pathology in the N3 + BC group versus Placebo. This study provides evidence an MLV vaccine containing BHV-1 and an MLV BC vaccine can be coadministered to neonatal calves without significantly altering immune responses to the 2 viruses or compromising the prevention of BHV-1 respiratory disease. Calves receiving the BC + N3 vaccine had a significant reduction in lung pathology after BHV-1 aerosol challenge.

Collegiate student-athlete mental health symptom trajectories across a competitive season: do training load and resilience matter?

ABSTRACT Student-athlete mental health is an important and complex issue necessitating examination of variables that may explain changes in key outcomes during training and competition periods. Further, in-season changes in mental health may be predicted by student-athlete training load or psychological resilience and should be examined further. This longitudinal study assessed changes in mental health symptoms of depression, anxiety, and subjective well-being across a competitive season and examined potential interactive effects of resilience and training load in predicting mental health symptoms over time. Participants were 160 NCAA Division I student-athletes between 18–23 years old (mean age = 19.9 ± 1.3). We measured mental health symptoms and resilience at 3 timepoints (across 12 weeks) throughout a competitive season with psychometric questionnaires. Daily training loads were also collected and then used to calculate average acute to chronic workload ratios (ACWR). Positive mental health symptoms did not change across student-athletes; whereas, negative symptoms changed over time with the highest levels of symptoms occurring in the middle of the season. Resilience was positively associated with subjective well-being and negatively associated with anxiety and depression across the study period. ACWR was not associated with depression or anxiety symptom scores but a significant interaction between ACWR and resilience was found for subjective well-being symptoms. Specifically, resilience buffered against ACWR’s negative effect on positive mental health. Results suggest the importance of student-athlete resilience during the competition season and evaluation of depression and anxiety at pre-season with mid-season re-evaluation.

Association of exposure to extreme rainfall events with cause-specific mortality in North Carolina, US

Extreme rainfall events could influence human health. However, the associations between extreme rainfall events and mortality remain rarely explored. Here, we conducted a time-series study using county-level mortality data in North Carolina during 2015–2018 to estimate the associations between extreme rainfall events and cause-specific mortality. We defined an extreme rainfall event as a day when a county’s daily total precipitation exceeded the 95th percentile of daily rainfall measurements from all of North Carolina’s counties during the study period. We employed a two-stage analysis where we first estimated the associations for each county and then used the estimates to obtain the state-wide associations by meta-analysis. Exposure to an extreme rainfall event was significantly associated with an increase in total, non-accidental, cardiovascular disease, respiratory disease, and external mortality by 2.24% (95% CI: 0.67%, 3.83%), 2.38% (95% CI: 0.76%, 4.03%), 3.60% (95% CI: 0.69%, 6.60%), 6.58% (95% CI: 1.59%, 11.82%), and 6.92% (95% CI: 1.28%, 12.86%), respectively. We did not find significant differences in the mortality risks within age, sex, or race groups or by seasonality. Our findings suggest that extreme rainfall events may trigger the risk of mortality, especially from non-accidental diseases such as respiratory mortality.

Human Campylobacter spp. infections in Italy.

Campylobacter is a frequent cause of enteric infections with common antimicrobial resistance issues. The most recent reports of campylobacteriosis in Italy include data from 2013 to 2016. We aimed to provide national epidemiological and microbiological data on human Campylobacter infections in Italy during the period 2017-2021. Data was collected from 19 Hospitals in 13 Italian Regions. Bacterial identification was performed by mass spectrometry. Antibiograms were determined with Etest or Kirby-Bauer (EUCAST criteria). In total, 5419 isolations of Campylobacter spp. were performed. The most common species were C. jejuni (n = 4535, 83.7%), followed by C. coli (n = 732, 13.5%) and C. fetus (n = 34, 0.6%). The mean age of patients was 34.61years and 57.1% were males. Outpatients accounted for 54% of the cases detected. Campylobacter were isolated from faeces in 97.3% of cases and in 2.7% from blood. C. fetus was mostly isolated from blood (88.2% of cases). We tested for antimicrobial susceptibility 4627 isolates (85.4%). Resistance to ciprofloxacin and tetracyclines was 75.5% and 54.8%, respectively; resistance to erythromycin was 4.8%; clarithromycin 2% and azithromycin 2%. 50% of C. jejuni and C. coli were resistant to ≥ 2 antibiotics. Over the study period, resistance to ciprofloxacin and tetracyclines significantly decreased (p < 0.005), while resistance to macrolides remained stable. Campylobacter resistance to fluoroquinolones and tetracyclines in Italy is decreasing but is still high, while macrolides retain good activity.

European Stop Tyrosine Kinase Inhibitor Trial (EURO-SKI) in Chronic Myeloid Leukemia: Final Analysis and Novel Prognostic Factors for Treatment-Free Remission.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The European Stop Kinase Inhibitors (EURO-SKI) study is the largest clinical trial for investigating the cessation of tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia in stable deep molecular remission (DMR). Among 728 patients, 434 patients (61%; 95% CI, 57 to 64) remained in major molecular response (MMR) at 6 months and 309 patients of 678 (46%; 95% CI, 42 to 49) at 36 months. Duration of TKI treatment and DMR before TKI stop were confirmed as significant factors for the prediction of MMR loss at 6 months. In addition, the type of BCR::ABL1 transcript was identified as a prognostic factor. For late MMR losses after 6 months, TKI treatment duration, percentage of blasts in peripheral blood, and platelet count at diagnosis were significant factors in multivariate analysis. For the entire study period of 36 months, multiple logistic regression models confirmed duration of treatment, blasts, and transcript type as independent factors for MMR maintenance. In addition to the duration of treatment, transcript type as well as blasts in peripheral blood at diagnosis should be considered as important factors to predict treatment-free remission.

Ethnic background as a risk factor for permanent brachial plexus birth injury: A population-based study.

Brachial plexus birth injury is the most common birth injury causing permanent disability in Finland. This study aimed to assess risk factors of a permanent brachial plexus birth injury and calculate the incidence. This is a retrospective population-based study including all deliveries between 2006 and 2022 in Southern Finland. The number of children born, obstetric data, and migrant status were gathered from the registries of the Finnish Institute for Health and Welfare, and Statistics Finland. Race of the mothers of children with a permanent brachial plexus birth injury was recorded. The severity of permanent brachial plexus birth injury was assessed using the 3-month Toronto test score. A lower score was indicative of a more severe injury (scored 0-10). One hundred of the 298 428 children born during the 17-year study period sustained a permanent brachial plexus birth injury (0.34 per 1000). Mothers of children with a permanent brachial plexus birth injury had a higher body mass index (29 vs. 24 kg/m2) and their pregnancies were more often complicated by diabetes (28% vs. 12%), shoulder dystocia (58% vs. 0.3%), and/or assisted deliveries (45% vs. 10%) compared with all other mothers (p < 0.001). Thirty two of the 52 725 children born to migrant mothers had a permanent brachial plexus birth injury (0.61 per 1000). The incidence of permanent brachial plexus birth injury was 5.7 times higher among children of Black migrants from Africa (18/11 738, 1.53 per 1000) compared with children of native mothers (0.27 per 1000). Black mothers had a higher body mass index at the start of pregnancy (29 vs. 26 kg/m2, p = 0.02) compared with Caucasians. Children of Black mothers had a more severe injury compared with all others (p = 0.007) with a mean 3-month Toronto test score of 4.2 (range 0.0-6.5, SD ±1.6) vs. 5.6 (range 0.0-9.3, SD ±2.2). Shoulder dystocia and assisted delivery are the most important risk factors for a permanent brachial plexus birth injury. Black race was associated with a higher rate and a more severe permanent brachial plexus birth injury.

Hospital-Level Care at Home for Patients with Cirrhosis.

Patients with cirrhosis have a 30-day readmission rate of over 30%. Novel care delivery models are needed to reduce healthcare costs and utilization associated with cirrhosis care. One such model is Home Hospital (HH), which provides inpatient-level care at home. Limited evidence currently exists supporting HH for cirrhosis patients. The aims of this study were to characterize patients with cirrhosis who received hospital-level care at home in a two-site clinical trial and to describe the care they received. Secondary aims included describing their outcomes, including adverse events, readmissions and mortality. We identified all patients with cirrhosis who enrolled in HH as part of a two-site clinical trial between 2017 and 2022. HH services include daily clinician visits, intravenous and oral medications, continuous vital sign monitoring, and telehealth specialist consultation. We collected sociodemographic data and analyzed HH stays, including interventions, outcomes, adverse events, and follow-up. 22 patients with cirrhosis (45% Hispanic; 50% limited English proficiency, median MELD-Na 12) enrolled in HH during the study period. Interventions included lab chemistries (82%), intravenous medications (77%), specialist consultation (23%), and advanced diagnostics/procedures (23%). The median length of stay was 7days (IQR 4-12); 186 bed-days were saved. Two patients (9%) experienced adverse events (AKI). No patients required escalation of care; 9% were readmitted within 30days. In this two-site study, HH was feasible for patients with cirrhosis, holding promise as a hepatology delivery model. Future randomized trials are needed to further evaluate the efficacy of HH for patients with cirrhosis.

Spatial-temporal evolution and driving factors of rural resilience in the urban agglomerations in the middle reaches of the Yangtze River, China.

How to maintain the balanced stability and resilient development of rural systems is an important issue that needs urgent attention in the field of sustainable rural development at present. In this paper, the entropy method, spatial autocorrelation model, and Geodetector were used to explore the rural resilience level, spatial distribution characteristics, and driving factors of 31 cities in the urban agglomerations in the middle reaches of the Yangtze River (UAMRYR), and to put forward corresponding policy suggestions. The results are as follows: (1) From 2005 to 2020, rural resilience in the UAMRYR showed an upward trend with an average annual growth rate of 8.26%. The ranking of the three major urban agglomerations is Changsha-Zhuzhou-Xiangtan urban agglomerations > Wuhan urban agglomerations > Poyang Lake urban agglomerations. (2) During the study period, the spatial distribution of rural resilience gradually developed from a negative correlation to a strong positive correlation and generally showed the characteristics of high in the west and low in the east. (3) The urbanization rate, the size and structure of the economy, the difference in consumption and income between urban and rural areas, the local fiscal revenue, and the number of village committees are the key factors affecting the level of rural resilience. On this basis, we proposed policy recommendations to improve the economic, social, and ecological resilience of rural areas in the UAMRYR. The findings of this paper are expected to provide insights into the policy formulation of China's rural revitalization strategy.

Prevalence, trends, and characteristics of metabolic dysfunction-associated steatotic liver disease among the US population aged 12-79 years.

Clinical observation revealed an increase in metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence among adults and adolescents and young adults (AYA). However, its prevalence trend in specific subgroups and its characteristics are unclear. This cross-sectional study included adults and AYA aged 20-79 and 12-19 years, respectively, from the National Health and Nutrition Examination Survey from 1999 to 2018. MASLD was defined as US Fatty Liver Index ≥30 in adults and alanine amino transaminase elevation and obesity in AYA. Joinpoint and logistic regression were used to evaluate the MASLD prevalence trend and its associated characteristics. MASLD was diagnosed in 17 156 892 of 51 109 914 (33.6%) adults and 1 705 586 of 29 278 666 AYA (5.8%). During the study period, MASLD prevalence significantly increased from 30.8% to 37.7% ( P < 0.01) in adults and in subgroups of female participants, individuals aged 20-45 and 61-79 years, and non-Hispanic white individuals. Conversely, MASLD prevalence did not significantly change in AYA (from 5.1% to 5.2%, P = 0.139), except in the subgroup of Mexican Americans (from 8.2% to 10.8%, P = 0.01). Among adults, high MASLD prevalence was associated with male sex, Mexican American ethnicity, age >50 years, being unmarried, poverty income ratio <130, poor or fair health condition, obesity or overweight, and chronic conditions. Among AYA, high MASLD prevalence was associated with male sex, poverty income ratio <130, and education. Accordingly, we concluded that health care providers should prevent and treat conditions associated with MASLD by raising awareness of the increasing trend of MASLD.

Efficacy and safety evaluation of alcohol-containing and alcohol-free mouth rinses: A clinical study

Background: This clinical study aims to evaluate the efficacy and safety of alcohol-containing and alcohol-free mouth rinses in a controlled setting. With oral hygiene being a crucial aspect of overall health, it is essential to determine which type of mouth rinse is more effective and safer for daily use. Materials and Methods: A randomized, double-blind, parallel-group study was conducted with 150 adult participants. They were divided into two groups: one using an alcohol-containing mouth rinse, and the other using an alcohol-free alternative. Participants followed a standardized oral hygiene regimen for four weeks, using their respective mouth rinses twice daily. Key parameters such as plaque reduction, gingival health, and adverse effects were assessed at baseline and after the study period. Results: The results indicated a significant reduction in plaque accumulation in both groups, with the alcohol-containing mouth rinse group showing a mean reduction of 25.4% and the alcohol-free group showing a mean reduction of 23.1%. In terms of gingival health, both groups demonstrated improvement, with the alcohol-containing mouth rinse group showing a mean reduction of gingival inflammation by 19.2%, while the alcohol-free group exhibited a reduction of 18.5%. Importantly, the alcohol-free mouth rinse group reported fewer cases of adverse effects such as dry mouth and irritation compared to the alcohol-containing group. Conclusion: This clinical study suggests that both alcohol-containing and alcohol-free mouth rinses are effective in reducing plaque accumulation and improving gingival health when used as part of a daily oral hygiene routine. However, the alcohol-free mouth rinse demonstrated a lower incidence of adverse effects, making it a potentially safer choice for individuals with sensitivity or a history of irritation. Further long-term studies are needed to confirm these findings. Bangladesh Journal of Medical Science Vol.23 (Special Issue) 2024 p.S97-S100

Taxonomic and functional-trait metrics track recovery of demersal fish and shrimp communities following system collapse

Monitoring programs that integrate both structural and functional ecosystem components play integral roles in ecosystem management and conservation planning. In the early 1990’s, the marine ecosystem of the waters surrounding Newfoundland and Labrador (NL) underwent a regime shift. Several demersal and pelagic fish stocks collapsed simultaneously, and this had significant ecological and socioeconomic consequences. As this regime shift impacted numerous commercial and non-commercial species, assessments based on individual species would be insufficient. We explored a variety of metrics that capture different facets of diversity across multiple species to provide a more robust ecosystem assessment. These were species richness, evenness, community-weighted means of maximum body length and trophic level (i.e., the mean maximum body size or trophic level of the species present in a community), and functional dispersion (FDis). The objectives of this study were 1) to assess trends in community structure of the NL demersal community during the post-collapse period (1995-2018), 2) explore how the various community-level metrics differ or are redundant, and 3) investigate how these metrics are associated with important covariates. Several metrics were redundant and displayed strongly positive, temporal trends being consistent with expectations for a recovery encompassing the entire demersal community. In particular, unweighted community-weighted means of body length and trophic level displayed nearly equal temporal patterns, showing increasing trends throughout the study period which were most prominent in the northern study area and within a limited depth range at the upper shelf break. Corresponding biomass-weighted metrics were also correlated with each other but only showed similar increasing tendencies after the first decade. In contrast, species richness did not show any temporal increase. Evenness and biomass-weighted FDis showed similar temporal patterns, decreasing during the first decade followed by strong increases during subsequent years, patterns that were directly linked to variation in Northern shrimp and Atlantic cod biomass. This study demonstrates how a variety of community metrics can provide insight into different aspects of the post-collapse recovery of the demersal community and help us better understand the complexity of the changes the ecosystem is undergoing.

Examining trends in emergency medicine journals' publications about racism.

In recent years, the academic medicine community has produced numerous statements and calls to action condemning racism. Though health equity work examining health disparities has expanded, few studies specifically name racism as an operational construct. As emergency departments serve a high proportion of patients with social and economic disadvantage rooted in structural racism, it is critically important that racism be a focus of our academic discourse. This study examines the frequency at which four prominent emergency medicine journals, Annals of Emergency Medicine, Academic Emergency Medicine, the American Journal of Emergency Medicine, and the Western Journal of Emergency Medicine, publish on health disparities and racism. This is a descriptive analysis measuring the frequency of publications on health disparities and racism in U.S.-based emergency medicine journals from 2014 to 2021. The search strategies for the concepts of "racism" and "health disparities" used a combination of MeSH and keywords. These search strategies were developed based on prior literature and the MEDLINE/PubMed Health Disparities and Minority Health Search Strategy. Articles identified through the PubMed search were then reviewed by two authors for final inclusion. Since 2014, a total of 6248 articles were published by the four emergency medicine journals over the 8-year study period. Of those, 82 research papers that focused on health disparities were identified and only 16 that focused on racism. Most emergency medicine publications on racism and health disparities were in 2021. Our findings suggest that the national discourse on racism and calls to action within emergency medicine were followed by an increase in publications on health disparities and racism. Continued investigation is needed to evaluate these trends moving forward.

Low-risk pneumatosis intestinalis in the pediatric surgical population.

Pneumatosis intestinalis (PI, presence of air in bowel wall) develops in a variety of settings and due to a variety of insults which is then characterized by varying severity and clinical course. Anecdotally, many of these cases are benign with few clinical sequelae; however, we lack evidence-based guidelines to help guide management of such lower-risk cases. We aimed to describe the clinical entity of low-risk PI, characterize the population of children who develop this form of PI, determine if management approach or clinical outcomes differed depending on the managing physician's field of practice, and finally determine if a shortened course of NPO and antibiotics was safe in the population of children with low-risk PI. We performed a retrospective review of all children over age 1year treated at Children's Hospital Colorado (CHCO), between 2009 and 2019 with a diagnosis of PI who did not also have a diagnosis of cancer or history of bone marrow transplant (BMT). Data including demographic variables, clinical course, and outcomes were obtained from the electronic medical record. Low-risk criteria included no need for ICU admission, vasopressor use, or urgent surgical intervention. Ninety-one children were treated for their first episode of PI during the study period, 72 of whom met our low-risk criteria. Among the low-risk group, rates of complications including hemodynamic decompensation during treatment, PI recurrence, Clostridium difficile colitis, and death did not differ between those who received 3days or less of antibiotics and those who received more than 3days of antibiotics. Outcomes also did not differ between children cared for by surgeons or pediatricians. Here, we define low-risk PI as that which occurs in children over age 1 who do not have a prior diagnosis of cancer or prior BMT and who do not require ICU admission, vasopressor administration, or urgent surgical intervention. It is likely safe to treat these children with only 3days of antibiotic therapy and NPO. Level III.