Subsequent Outcomes Research Articles

Fetal and neonatal neuroimaging in twin-twin transfusion syndrome.

To describe the types of brain injury and subsequent neurodevelopmental outcome in fetuses and neonates from pregnancies with twin-twin transfusion syndrome (TTTS). Additionally, to determine risk factors for brain injury and to review the use of neuroimaging modalities in these cases. This was a retrospective cohort study of consecutive TTTS pregnancies treated with laser surgery in a single fetal therapy center between January 2010 and January 2020. The primary outcome was the incidence of brain injury, classified into predefined groups. Secondary outcomes included adverse outcome (perinatal mortality or neurodevelopmental impairment), risk factors for brain injury and the number of magnetic resonance imaging (MRI) scans. Cranial ultrasound was performed in all 466 TTTS pregnancies and in 685/749 (91%) liveborn neonates. MRI was performed in 3% of pregnancies and 4% of neonates. Brain injury was diagnosed in 16/935 (2%) fetuses and 37/685 (5%) neonates and all predefined injury groups were represented. Four fetal and four neonatal cases of cerebellar hemorrhage were detected. Among those with brain injury, perinatal mortality occurred in 11/16 (69%) fetuses and 8/37 (22%) neonates. Follow-up was available for 29/34 (85%) long-term survivors with brain injury and the mean age at follow-up was 46 months. Neurodevelopmental impairment was present in 9/29 (31%) survivors with brain injury. Adverse outcome occurred in 28/53 (53%) TTTS individuals with brain injury. The risk of brain injury was increased after recurrent TTTS/post-laser twin anemia-polycythemia sequence (TAPS) (odds ratio (OR), 3.095 (95% CI, 1.581-6.059); P = 0.001) and lower gestational age at birth (OR per 1-week decrease in gestational age, 1.381 (95% CI, 1.238-1.541); P < 0.001). Based on dedicated neurosonography and limited use of MRI, brain injury was diagnosed in 2% of fetuses and 5% of neonates with TTTS. Adverse outcome was seen in over half of cases with brain injury. Brain injury was related to recurrent TTTS/post-laser TAPS and a lower gestational age at birth. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A day in the life: Couples' everyday communication and subsequent relationship outcomes.

Understanding how communication processes contribute to well-functioning versus distressed couple relationships has relied largely on brief, laboratory-based conversations. Harnessing technological advancements, the present study extends the literature by capturing couples' naturalistic communication over one full day at Time 1 (T1). This study tested associations between data-driven categories of couple communication behaviors and relationship outcomes (i.e., relationship aggression, satisfaction, and dissolution) at Time 2 (T2), approximately 1 year later. Emerging adults in different-gender dating couples (n = 106 couples; 212 individuals; Mage = 22.57 ± 2.44; M relationship length = 30.49 months ± 24.05; 72.2% non-White) were each provided a smartphone programmed to audio record approximately 50% of a typical day. Interactions between partners were transcribed and coded for location, activity, affect, and a range of positive and negative communication behaviors for each partner. Even after controlling for T1 assessments of the relevant outcome, one's own hostility and one's partner's hostility at T1 were each positively associated with T2 relationship aggression and negatively associated with T2 relationship satisfaction. One's own withdrawal at T1 was positively associated with T2 relationship aggression perpetration, whereas one's partner's withdrawal was negatively linked to relationship satisfaction at T2. One's own playfulness, unexpectedly, was linked to lower subsequent relationship satisfaction. Withdrawal increased the likelihood of relationship dissolution, whereas warmth and playfulness decreased the likelihood of dissolution. The relevance of couples' ordinary, everyday communication for meaningful relationship outcomes is discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal Associations Between Optimism and Objective Measures of Physical Functioning in Women.

Identifying factors contributing to sustained physical functioning is critical for the health and well-being of the aging population, especially as physical functioning may precede and predict subsequent health outcomes. Prior work suggests optimism may protect health, but less is known about the association between optimism and objective physical functioning measures as individuals age. To evaluate the longitudinal association between optimism and 3 physical functioning measures. This was a prospective cohort study using data from the Women's Health Initiative (WHI) with participants recruited from 1993 to 1998 and followed up over 6 years. Data analysis was conducted from January 2022 to July 2022. Participants included postmenopausal women older than 65 years recruited from 40 clinical centers in the US. Optimism was assessed at baseline using the Life Orientation Test-Revised. Physical functioning was measured at 4 time points across 6 years by study staff evaluating performance in grip strength, timed walk, and chair stands. The final analytic sample included 5930 women (mean [SD] age, 70 [4] years). Linear mixed-effects models controlling for demographics, depression, health status, and health behaviors showed that higher optimism was associated with higher grip strength (β = 0.36; 95% CI, 0.21-0.50) and number of chair stands (β = 0.05; 95% CI, 0.01-0.10) but not timed walk at baseline. Higher optimism was also associated with slower rates of decline in timed walk (β = -0.09; 95% CI, -0.13 to -0.04) and number of chair stands (β = 0.01; 95% CI, 0-0.03) but not grip strength over time. Cox proportional hazards models showed that higher optimism was associated with lower hazards of reaching clinically defined thresholds of impairment for all 3 outcomes over 6 years of follow-up. For example, in fully adjusted models, for a 1-SD increase in optimism, hazard ratios for reaching impairment thresholds were 0.86 (95% CI, 0.80-0.92) for grip strength, 0.94 (95% CI, 0.88-1.01) for timed walk, and 0.91 (95% CI, 0.85-0.98) for chair stands. In this cohort study of postmenopausal women, at baseline, higher optimism was associated with higher grip strength and number of chair stands but not with the time it took to walk 6 m. Higher optimism at baseline was also associated with maintaining healthier functioning on 2 of the 3 performance measures over time, including less decline in walking speed and in number of chair stands women could perform over 6 years of follow-up. Given experimental studies suggesting that optimism is modifiable, it may be a promising target for interventions to slow age-related declines in physical functioning. Future work should explore associations of optimism with maintenance of physical functioning in diverse populations.

Plasticity, symbionts and niche construction interact in shaping dung beetle development and evolution.

Developmental plasticity is an important product of evolutionary processes, allowing organisms to maintain high fitness in the face of environmental perturbations. Once evolved, plasticity also has the potential to influence subsequent evolutionary outcomes, for example, by shaping phenotypic variation visible to selection and facilitating the emergence of novel trait variants. Furthermore, organisms may not just respond to environmental conditions through plasticity but may also actively modify the abiotic and (sym)biotic environments to which they themselves respond, causing plasticity to interact in complex ways with niche construction. Here, we explore developmental mechanisms and evolutionary consequences of plasticity in horned dung beetles. First, we discuss how post-invasion evolution of plasticity in an introduced Onthophagus species facilitated rapid range expansion and concurrent local adaptation of life history and morphology to novel climatic conditions. Second, we discuss how, in addition to plastically responding to variation in nutritional conditions, dung beetles engage in behaviors that modify the environment that they themselves respond to during later development. We document that these environment-modifying behaviors mask heritable variation for life history traits within populations, thereby shielding genetic variants from selection. Such cryptic genetic variation may be released and become selectable when these behaviors are compromised. Together, this work documents the complex interactions between plasticity, symbionts and niche construction, and highlights the usefulness of an integrative Eco-Evo-Devo framework to study the varied mechanisms and consequences of plasticity in development and evolution.

The incidence of subsequent contralateral hip fracture and factors associated with increased risk: the IMPACT Contralateral Fracture Study.

Hip fractures are associated with high morbidity and mortality, and patients that sustain a subsequent contralateral fracture experience inferior outcomes. The risk of contralateral fracture is highest within the first year; however, the incidence and associated factors remain poorly understood. The aims were to investigate (i) the incidence of a subsequent contralateral hip fracture within the first year, (ii) identify factors associated with an increased risk of contralateral fracture and (iii) compare early mortality risk after index versus contralateral hip fracture. This study included all patients aged over 50years admitted to NHS hospitals in Scotland between 1st March 2020 and 31st December 2020 (n = 5566) as routine activity of the Scottish Hip Fracture Audit (SHFA). Multivariate logistic regression was used to examine factors associated with 30-day mortality, and cox regression was used to identify factors associated with a contralateral fracture. During the study period 2.5% (138/5566) of patients sustained a contralateral hip fracture within 12months of the index hip fracture. Socioeconomic deprivation was inversely associated with increased risk of contralateral fracture (odds ratio 2.64, p < 0.001), whilst advancing age (p = 0.427) and sex (p = 0.265) were not. After adjusting for significant cofounders, there was no significant difference in 30-day mortality following contralateral fracture compared to index fracture (OR 1.22, p = 0.433). One in 40 (2.5%) hip fracture patients sustained a contralateral fracture within 12months of their index fracture, and deprivation was associated with a reduced risk of contralateral fracture. No difference in 30-day mortality was found.

Consequences of kidney donation by age in Japanese living kidney donors: a single-center study.

Elderly living kidney donors (LKDs) are becoming increasingly important in countries with a high prevalence of living-donor kidney transplants and an aging society. This study explored the features of elderly LKDs, focusing on their subsequent outcomes. This single-center, retrospective, observational study included eligible LKDs who donated their kidneys between April 2008 and July 2022. LKDs were categorized into an elderly (≥70years at donation) or a non-elderly group (<70years). We examined pre-operative characteristics and post-operative outcomes, such as kidney function, complications, development of end-stage kidney disease (ESKD), and mortality. Of the 188 LKDs observed for a median of 5.7years, 31 were in the elderly group (16.5%) and 157 (83.5%) were in the non-elderly group (mean age 72.5±2.7 and 58.2±7.3years, respectively). No significant differences were observed in hospital stay length or peri-operative complications between groups. Both groups experienced a similar decline in post-donation estimated glomerular filtration rate (eGFR)-approximately 37%. In the elderly group, four LKDs died, and one progressed to ESKD. In the non-elderly group, two LKDs died, and none progressed to ESKD. The cause of death was not strongly suspected to be associated with the donation. eGFR was maintained even in elderly LKDs post-donation. Prioritizing LKDs' safety is paramount; however, donations from elderly people would be acceptable, considering their life expectancy. This can expand the pool of living kidney donors and address the growing demand for kidney transplants.

Identifying who benefits most from supportive versus expressive techniques in psychotherapy for depression: Moderators of within- versus between-individual effects.

A recent randomized controlled trial (RCT) indicated that individuals with higher levels of attachment anxiety exhibited better treatment outcomes in supportive-expressive therapy (SET) relative to supportive therapy (ST). But to gain insight into within-patient therapeutic changes, a within-individual design is required. The present study contrasts previous findings based on theory-driven between-patient moderators with data-driven moderators of within-patient processes to investigate whether findings converge or diverge across these two approaches. We used data of 118 patients from the pilot and active phases of a recent RCT for patients with major depressive disorder, comparing ST with SET, a time-limited psychodynamic therapy. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Supportive versus expressive techniques were rated based on patients' end-of-session perspective. We compared previous findings based on moderators of between-patient effects with a data-driven approach for identifying moderators of within-patient effects of techniques on subsequent outcome. After false discovery rate corrections, of 10 preselected moderators, patients' attachment anxiety and domineering style remained significant. Of these, bootstrap resampling revealed significant differences between ST and SET techniques for the attachment anxiety moderator: Those with higher attachment anxiety benefited more from greater use of ST than SET techniques in a particular session, as evidenced by lower levels of symptoms at the subsequent session. Our within-individual findings diverge from previously published between-individual analyses. This proof-of-concept study demonstrates the importance of complementing between-individuals with within-individual analyses to achieve better understanding of who benefits most from specific treatment techniques. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The natural history of aneurysms incompletely occluded by placement of a flow diverter: a multiinstitutional study.

Treatment of intracranial aneurysms by flow diversion is safe and effective and is increasingly popular. However, the correct treatment paradigm for aneurysms incompletely treated by initial placement of a flow diverter has not been established, nor have the subsequent natural history and occlusion rates of such aneurysms. The authors sought to outline the natural history of such aneurysms, which to date have been considered partially treated. The authors retrospectively reviewed consecutive cases from 6 high-volume neurointerventional services, including all cases in which the first follow-up imaging after placement of a flow diverter showed incomplete occlusion of the aneurysm, and for which subsequent clinical and/or radiological follow-up was available. All included patients were treated with the Pipeline Flex embolization device or the Pipeline Flex embolization device with Shield Technology. Subsequent radiographic and clinical outcome data were collected and analyzed using the Kaplan-Meier survival function. A total of 263 patients with persistently patent aneurysms on first follow-up imaging after flow diversion were identified. Of these, 204 had clinical follow-up and 152 had additional imaging follow-up. Of this final cohort, 148 aneurysms were unruptured, and 4 were ruptured. The average aneurysm size by maximum dimension was 10.8 mm. The average recorded follow-up was 27.8 months in the cohort, with some patients followed for as long as 9 years from treatment. Over the course of 403 person-years of follow-up, no delayed aneurysm ruptures were recorded. Both with and without retreatment, aneurysms showed a trend toward progressive occlusion over time. Complications related to device placement were low. Aneurysms that have been incompletely treated by flow diversion have a benign natural history with progression toward occlusion over time, with or without retreatment.

A Bayesian Bernoulli-Exponential joint model for binary longitudinal outcomes and informative time with applications to bladder cancer recurrence data

BackgroundA variety of methods exist for the analysis of longitudinal data, many of which are characterized with the assumption of fixed visit time points for study individuals. This, however is not always a tenable assumption. Phenomenon that alter subject visit patterns such as adverse events due to investigative treatment administered, travel or any other emergencies may result in unbalanced data and varying individual visit time points. Visit times can be considered informative, because subsequent or current subject outcomes can change or be adapted due to previous subject outcomes.MethodsIn this paper, a Bayesian Bernoulli-Exponential model for analyzing joint binary outcomes and exponentially distributed informative visit times is developed. Via statistical simulations, the influence of controlled variations in visit patterns, prior and sample size schemes on model performance is assessed. As an application example, the proposed model is applied to a Bladder Cancer Recurrence data.Results and conclusionsResults from the simulation analysis indicated that the Bayesian Bernoulli-Exponential joint model converged in stationarity, and performed relatively better for small to medium sample size scenarios with less varying time sequences regardless of the choice of prior. In larger samples, the model performed better for less varying time sequences. This model’s application to the bladder cancer data showed a statistically significant effect of prior tumor recurrence on the probability of subsequent recurrences.

The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: protocol for a prospective, multicentre cohort study.

Despite a UK 5-year breast cancer survival rate of 86.6%, patients may develop breast cancer recurrence within the same breast after breast conserving surgery, as well as in the remaining skin or chest wall after mastectomy or in the ipsilateral lymph glands. These recurrences, collectively termed locoregional recurrence (LRR), occur in around 8% of patients within 10 years of their original diagnosis. Currently, there is a lack of robust information on the presentation and prevalence of LRR with no UK-specific clinical guidelines available for the optimal management of this patient group. Additionally, there is a need to identify patterns of LRR presentation and their progression, which will enable prognostic factors to be determined. This will subsequently enable the tailoring of treatment and improve patient outcome. The MARECA study is a prospective, multicentre cohort study recruiting patients diagnosed with breast cancer LRR +/- associated distant metastases. Over 50 UK breast units are participating in the study with the aim of recruiting at least 500 patients over a recruitment period of 24 months. The data collected will detail the tumour pathology, imaging results, surgical treatment, radiotherapy and systemic therapy of the primary and recurrent breast cancer. Study follow-up will be for up to 5 years following LRR diagnosis to determine subsequent oncological outcomes and evaluate potential prognostic factors. This study will address the current knowledge gap and identify subgroups of patients who have less successful treatment outcomes. The results will determine the current management of LRR and the prognosis of patients diagnosed with breast cancer LRR +/- distant metastases in the UK, with the aim of establishing best practice and informing future national guidelines. The results will direct future research and inform the design of additional interventional trials and translational studies.

Is detection of enteropathogens and human or animal faecal markers in the environment associated with subsequent child enteric infections and growth: an individual participant data meta-analysis

Quantifying contributions of environmental faecal contamination to child diarrhoea and growth faltering can illuminate causal mechanisms behind modest health benefits in recent water, sanitation, and hygiene (WASH) trials. We aimed to assess associations between environmental detection of enteropathogens and human or animal microbial source tracking markers (MSTM) and subsequent child health outcomes. In this individual participant data meta-analysis we searched we searched PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus for WASH intervention studies with a prospective design and concurrent control that measured enteropathogens or MSTM in environmental samples, or both, and subsequently measured enteric infections, diarrhoea, or height-for-age Z-scores (HAZ) in children younger than 5 years. We excluded studies that only measured faecal indicator bacteria. The initial search was done on Jan 19, 2021, and updated on March 22, 2023. One reviewer (AM) screened abstracts, and two independent reviewers (AM and RT) examined the full texts of short-listed articles. All included studies include at least one author that also contributed as an author to the present Article. Our primary outcomes were the 7-day prevalence of caregiver-reported diarrhoea and HAZ in children. For specific enteropathogens in the environment, primary outcomes also included subsequent child infection with the same pathogen ascertained by stool testing. We estimated associations using covariate-adjusted regressions and pooled estimates across studies. Data from nine published reports from five interventions studies, which included 8603 children (4302 girls and 4301 boys), were included in the meta-analysis. Environmental pathogen detection was associated with increased infection prevalence with the same pathogen and lower HAZ (ΔHAZ -0·09 [95% CI -0·17 to -0·01]) but not diarrhoea (prevalence ratio 1·22 [95% CI 0·95 to 1·58]), except during wet seasons. Detection of MSTM was not associated with diarrhoea (no pooled estimate) or HAZ (ΔHAZ -0·01 [-0·13 to 0·11] for human markers and ΔHAZ -0·02 [-0·24 to 0·21] for animal markers). Soil, children's hands, and stored drinking water were major transmission pathways. Our findings support a causal chain from pathogens in the environment to infection to growth faltering, indicating that the lack of WASH intervention effects on child growth might stem from insufficient reductions in environmental pathogen prevalence. Studies measuring enteropathogens in the environment should subsequently measure the same pathogens in stool to further examine theories of change between WASH, faecal contamination, and health. Given that environmental pathogen detection was predictive of infection, programmes targeting specific pathogens (eg, vaccinations and elimination efforts) can environmentally monitor the pathogens of interest for population-level surveillance instead of collecting individual biospecimens. The Bill & Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.

Exploring the Antioxidant Properties of Citrus limon (Lemon) Peel Ultrasound Extract after the Cloud Point Extraction Method

Each year, a substantial amount of food is discarded around the globe. A significant portion of this waste consists of by-products derived from Citrus fruits such as lemons. The purpose of this research is to examine the polyphenol extraction and the antioxidant ability of lemon peel using cloud point extraction (CPE), a sustainable approach. CPE was conducted using three steps with a 20% w/v concentration of Span 20 as the surfactant, which has a critical micellar concentration of 6.13 × 10−5 mol/L. The pH was set at 7 and a salt concentration of 20% was maintained at 45 °C for 20 min. The subsequent outcomes of the analysis were obtained: total polyphenol content (TPC): 526.32 mg gallic acid equivalents per liter; total flavonoid content (TFC): 90.22 mg rutin equivalents per liter; FRAP, DPPH, and hydrogen peroxide assays: 2.40, 2.68 and 1.03 mmol ascorbic acid equivalents per liter, respectively, and 168.63 mg/L ascorbic acid content. The quantification of the polyphenolic compounds through High-Performance Liquid Chromatography showed that the most abundant compounds in the lemon peels are eriocitrin (159.43 mg/L) and hesperidin (135.21 mg/L). The results indicate that the proposed CPE technique is successful in extracting antioxidant compounds from lemon peels. The generated extracts have the potential to be exploited as dietary additives to enhance human health and can also be utilized for nutraceuticals or pharmaceutical purposes.

Intrauterine adhesions treated with hysteroscopic adhesiolysis and subsequent obstetric outcome: A retrospective matched cohort study.

To examine whether a history of hysteroscopic adhesiolysis (HA)-treated intrauterine adhesions (IUAs) was associated with an increased risk of adverse obstetrical outcomes in subsequent pregnancies. Retrospective cohort study. A tertiary-care hospital in Shanghai, China. A cohort of 114 142 pregnant women who were issued an antenatal card and received routine antenatal care in Shanghai First Maternity and Infant Hospital, between January 2016 and October 2021. From the cohort of 114 142 pregnant women, each woman with a history of HA-treated IUA prior to the current pregnancy (n = 780) was matched with four women without a history of IUAs (n = 3010) using propensity score matching. The matching variables were maternal age and parity, mode of conception, pre-pregnancy body mass index and prior history of abortion. Pregnancy complications, placental abnormalities, postpartum haemorrhage and adverse birth outcomes. Compared with women with no history of IUAs, women with a history of HA-treated IUAs were at higher risk of pre-eclampsia (RR 1.69, 95% CI 1.23-2.33), placenta accreta spectrum (RR 4.72, 95% CI 3.9-5.73), placenta praevia (RR 4.23, 95% CI 2.85-6.30), postpartum haemorrhage (RR 2.86, 95% CI 1.94-4.23), preterm premature rupture of membranes (RR 3.02, 95% CI 1.97-4.64) and iatrogenic preterm birth (RR 2.86, 95% CI 2.14-3.81). Those women were also more likely to receive cervical cerclage (RR 5.63, 95% CI 3.95-8.02) during pregnancy and haemostatic therapies after delivery (RR 2.17, 95% CI 1.75-2.69). Moreover, we observed that the RRs of those adverse obstetrical outcomes increased with the increasing number of hysteroscopic surgeries. This study found that a history of HA-treated IUAs, especially a history of repeated HAs, was associated with an increased risk of adverse obstetrical outcomes.

Changes in baPWV and the risk of clinical outcomes: a cohort study of Chinese community-based population.

It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35-0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94-0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.

Preconception anti-annexin A5 antibodies are associated with subsequent live birth in women with recurrent miscarriage: A retrospective study from China.

To evaluate the correlation between the antiannexin A5 antibodies (aAnxA5) multiples of median (MOM) and subsequent pregnancy outcomes in women with recurrent miscarriage (RM). Totally, 310 RM women were included in this study and grouped into tertiles according to their MOM of preconception aAnxA5 circulating levels determined by ELISA. The effect of aAnxA5 on the pregnancy outcomes was performed using multiple logistic regression. The outcomes included early miscarriage (before 10weeks of gestation), late miscarriage (between 10 and 24weeks), ongoing pregnancy (beyond 10weeks), and live birth (after 24weeks) characterized by pregnancy with fetal heartbeat. For each unit increase in aAnxA5 MOM, the odds of live birth after 24weeks and ongoing pregnancy were reduced by 40.2% (OR= .598; 95%CI 0.406-0.882, P= .010) and 38.1% (OR= .619; 95%CI 0.424-0.904, P= .013), respectively, after adjusting for demographic and clinical characteristics. The rise in aAnxA5 MOM was associated with an increased risk of early miscarriage (OR=1.616; 95%CI 1.106-2.361, P= .013) and miscarriage (early + late miscarriage) (OR=1.671; 95%CI 1.134-2.464, P= .010). Further subgroup analyses showed a decreased risk of live birth rates after 24weeks of gestation in the two subgroups: maternal age ≥35 years (OR= .131; 95%CI 0.026-0.652), and previous pregnancy loss ≥ 3 (OR= .381; 95%CI 0.173-0.837). Higher preconception aAnxA5 MOM levels in women with RM may be linked with a decreased risk of live birth after 24weeks and an increased risk of early miscarriage, especially in individuals aged ≥35 years or with previous pregnancy losses ≥3.

Barriers and enablers to care-leavers engagement with multi-agency support: A scoping review

BackgroundMany care-leavers experience poor individual and social outcomes. Care-leavers involvement with decision making and consistent supportive relationships with professionals can facilitate a more successful transition to independent living, including better well-being and social outcomes. PurposeNot all care-leavers engage with or participate in after-care services. There has been little systematic or structured modelling of what effective enablement through multi-agency support looks like, and the enablers and barriers to care-leaver engagement have not been identified. Design/methodologyA scoping review of the international literature was conducted. Eighteen papers were identified, and a thematic synthesis used to derive themes associated with barriers and enablers to care-leavers engagement with services, and subsequent outcomes. The findings were used to populate a logic model illustrating the relationship between the mechanisms contributing to better outcomes for care-leavers: including inputs, activities, and outputs. FindingsBarriers to engagement included: identity, independence, trust in services and inadequate support. Enablers included persistent and consistent support, time and turning points, and having an authentic trusted professional within the service. The key findings focused on the need for flexible and accessible services, a gradual introduction to the after-care concept and a proactive approach by professionals, especially immediately after leaving care. OriginalityThis research co-produced with care-leavers contributes to a better understanding of the nature of enablers and barriers to engagement with multi- agency support services. The initial logic model derived from the literature will inform the development and measurement of a practice model and toolkit for professionals.

Physician Estimates and Patient-Reported Health Status in Atrial Fibrillation

A primary objective in managing atrial fibrillation (AF) is to optimize patients' health status, which can be done only if physicians accurately quantify the outcomes associated with AF in patients' lives. To explore physicians' estimation of the health status of patients with AF and its association with subsequent care and outcomes. A multicenter, prospective cohort study was conducted in 2 outpatient practices in Tokyo, Japan. Participants included patients with newly diagnosed AF or those referred for initial treatment of AF at outpatient practices and treating physicians from November 8, 2018, to April 1, 2020. Data analysis was performed from December 22, 2022, to July 7, 2023. Participating patients completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, a 20-item tool covering 4 domains with a 7-point Likert scale; 3 domains (symptoms, daily activities, and treatment concerns) were used in this study. Blinded to patients' responses, treating physicians answered a 3-item questionnaire quantifying each patient's AFEQT domain with a single item. Patients' mean Likert scale responses within each AFEQT domain were subtracted from the physicians' assessments so that higher scores (≥0.5 points) indicate physician underestimation, while lower scores (≤0.5 points) indicate physician overestimation of the health status of patients with AF. The independent association of physician-patient concordance with treatment escalation (alteration or initiation of antiarrhythmic drugs, cardioversion, or catheter ablation) and 1-year adjusted changes in AFEQT scores. Among 330 patients (238 [72.1%] men; mean [SD] age, 67.9 [11.9] years; 163 [49.4%] with paroxysmal AF), physicians correctly estimated health status in 112 patients (33.9%), underestimated it in 42 patients (12.7%), and overestimated it in 176 patients (53.3%). Treatment escalation occurred in 63.6% of patients whose health status was correctly estimated, 47.6% of those whose health status was underestimated, and 66.3% of patients whose health status was overestimated. After multivariable adjustment, underestimation of health status was independently associated with less treatment escalation (adjusted odds ratio, 0.43; 95% CI, 0.20-0.90) and less frequent AFEQT overall summary score improvement at 1 year (underestimated, 2.5 [95% CI, -1.6 to 6.7] vs correctly and overestimated health status, 8.4 [95% CI, 7.0-9.9] points; P = .01). In this cohort study, physician underestimation of the health status of patients with AF was common and associated with less aggressive treatment and less health status improvement at 1 year.

The consequences of high‐fatality school shootings for surviving students

AbstractThis paper examines the impact of high‐fatality school shootings on the subsequent outcomes of the survivors of those events. We focus specifically on the shootings at Columbine High School (Littleton, CO), Sandy Hook Elementary (Newtown, CT), and Marjorie Stoneman Douglas High School (Parkland, FL). We assess the subsequent educational record, including attendance and test scores, and the long‐term health consequences of surviving students. In all analyses, we treat the timing and location of these events as random, enabling us to identify causal effects. Our results indicate that these high‐fatality school shootings led to substantial reductions in attendance and test scores. These educational effects appear to be larger than the effects of shootings with fewer fatalities estimated by others. Children who survived the Columbine shooting were more likely to die by age 30, particularly among boys. They experienced higher levels of suicide and accidental poisonings (overdoses).

Energetic trade-offs in migration decision-making, reproductive effort and subsequent parental care in a long-distance migratory bird.

Migratory species trade-off long-distance movement with survival and reproduction, but the spatio-temporal scales at which these decisions occur are relatively unknown. Technological and statistical advances allow fine-scale study of animal decision-making, improving our understanding of possible causes and therefore conservation management. We quantified effects of reproductive preparation during spring migration on subsequent breeding outcomes, breeding outcomes on autumn migration characteristics and autumn migration characteristics on subsequent parental survival in Greenland white-fronted geese (Anser albifrons flavirostris). These are long-distance migratory birds with an approximately 50% population decline from 1999 to 2022. We deployed GPS-acceleration devices on adult females to quantify up to 5 years of individual decision-making throughout the annual cycle. Weather and habitat-use affected time spent feeding and overall dynamic body acceleration (i.e. energy expenditure) during spring and autumn. Geese that expended less energy and fed longer during spring were more likely to successfully reproduce. Geese with offspring expended more energy and fed for less time during autumn, potentially representing adverse fitness consequences of breeding. These behavioural comparisons among Greenland white-fronted geese improve our understanding of fitness trade-offs underlying abundance. We provide a reproducible framework for full annual cycle modelling using location and behaviour data, applicable to similarly studied migratory animals.

Definitions and Measurement Tools for Assessing Parental Reactions to LGB People Coming Out: A Critical Review

ABSTRACT Parental responses to young people’s coming out as lesbian, gay or bisexual (LGB) are a crucial experience in identity formation and subsequent mental health outcomes. However, how parents react to coming out varies and remains relatively imprecise in the literature. The aim of the present critical review was to explore and discuss the different definitions and measurement tools used in studies assessing perceived parental reactions to the coming out of LGB people aged 18 years and over. Following PRISMA guidelines, a review of 14 selected articles was carried out to examine the different tools used. Then, based on this selection of articles, a review of the different proposed definitions of parental reactions was carried out. Analysis revealed that the Perceived Parental Reactions Scale emerged as the most widely used and most appropriate international scale for capturing the diversity of perceived parental reactions. Then, parental responses were often addressed in a dichotomous manner, focusing primarily on acceptance or rejection. Future studies will need to consider a more nuanced approach to understanding parental reactions to coming out.