To determine the association between maternal health insurance type and birth outcomes prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission ...(Term/AGA-NICU) & composite birth outcomes (CBO) accounting for social determinants of health.
A cross-sectional study of maternal surveys and birth certificate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI).
1015 mothers M = 631, PI = 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI.
M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To determine intention to breastfeed (ITBF) rates among mothers exclusively using marijuana (eMJ) compared with electronic cigarettes (eEcig), tobacco products (eTob), or multisubstances (MS), ...nonusers (NU), and the influence of paternal presence and paternal substance use.
Cross-sectional study of parental survey responses merged with electronic birth certificates. Accounting for clinical and social determinants of health, analyses of ITBF included (1) all mothers, (2) single mothers, and (3) mothers with fathers.
Among all mothers (
= 1,073), eMJ, eTob, and MS users had lower odds of ITBF compared with NU. Only eMJ users had lower odds of ITBF for those without paternal presence. However, in those mothers with a paternal presence, odds of ITBF were similar to NU for eMJ, eTob, and MS users when accounting for paternal factors, including paternal substance use.
Women exclusively using MJ have lower ITBF compared with NU. However, paternal presence mitigated this effect, independent of parental MJ use. The presence of fathers may represent a unique predictor for increased ITBF in MJ using mothers.
Maternal race, marital status, and social environment impact risk of preterm delivery and size for gestational age. Although some paternal characteristics such as age are associated with pregnancy ...outcomes, the influence of the paternal presence, race/ethnicity and adverse life events is not well known. The objective of the study was to assess birth outcomes in mothers with a paternal presence compared to those without during the post-partum period. The secondary aim was to determine whether paternal race is associated with birth outcomes.
This was a cross-sectional study using parental surveys linked with birth certificate data from 2016 to 2018. Adverse birth composite outcomes (ABCO) including small for gestational age (SGA), prematurity or neonatal intensive care unit admission (NICU) were assessed.
A total of 695 parents were analyzed (239 single mothers and 228 mother-father pairs). Compared to mothers with a father present, mothers without a father present exhibited increased odds of ABCO, prematurity and NICU. Non-Hispanic Black fathers had increased odds of ABCO and NICU compared to Non-Hispanic Whites (NHW). Hispanic fathers had increased odds of NICU compared to NHW.
Paternal absence in the post-partum period and paternal race were both independently associated with ABCO and NICU. Assessment of paternal presence and paternal race in clinical practice may help identify opportunities for additional support necessary to optimize birth outcomes.
There is a variability regarding timing of consent and personnel used in patient recruitment for neonatal research. We explored the associations between the study personnel and timing of consent with ...parents' decisional conflict and ultimately their decision to enroll.
This was a multi-site, cross-sectional survey conducted between August 2015 and October 2017. Participants were parents approached to enroll their 24-28-week infant in a clinical trial. Parents completed an interviewer-administered 61-item questionnaire.
Overall, 163 surveys were completed; 105 by parents of enrolled infants and 58 by parents of non-enrolled infants (54.5% participation rate). Neither the individual requesting nor timing of consent was associated with parents' knowledge score, decisional conflict, or decision to enroll. Parents preferred to be approached prenatally and by their infant's doctor.
Study designers and IRBs may allow flexibility in personnel and timing of consent as it is respectful of parents and may enhance trial enrollment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Casitas B-lymphoma proto-oncogene-b (Cbl-b), a member of the Cbl family of RING finger E3 ubiquitin ligases, has been demonstrated to play a central role in regulating effector T-cell function. ...Multiple studies using gene-targeting approaches have provided direct evidence that Cbl-b negatively regulates T, B, and NK cell activation via a ubiquitin-mediated protein modulation. Thus, inhibition of Cbl-b ligase activity can lead to immune activation and has therapeutic potential in immuno-oncology. Herein, we describe the discovery and optimization of an arylpyridone series as Cbl-b inhibitors by structure-based drug discovery to afford compound 31. This compound binds to Cbl-b with an IC50 value of 30 nM and induces IL-2 production in T-cells with an EC50 value of 230 nM. Compound 31 also shows robust intracellular target engagement demonstrated through inhibition of Cbl-b autoubiquitination, inhibition of ubiquitin transfer to ZAP70, and the cellular modulation of phosphorylation of a downstream signal within the TCR axis.
We measured the cross-correlation between galaxy weak lensing data from the Kilo Degree Survey (KiDS-1000, DR4) and cosmic microwave background (CMB) lensing data from the Atacama Cosmology Telescope ...(ACT, DR4) and the Planck Legacy survey. We used two samples of source galaxies, selected with photometric redshifts, (0.1 < z(B) < 1.2) and (1.2 < z(B) < 2), which produce a combined detection significance of the CMB lensing and weak galaxy lensing cross-spectrum of 7.7σ. With the lower redshift galaxy sample, for which the cross-correlation was detected at a significance of 5.3σ, we present joint cosmological constraints on the matter density parameter, Ω(m), and the matter fluctuation amplitude parameter, σ(8), marginalising over three nuisance parameters that model our uncertainty in the redshift and shear calibration as well as the intrinsic alignment of galaxies. We find our measurement to be consistent with the best-fitting flat ΛCDM cosmological models from both Planck and KiDS-1000. We demonstrate the capacity of CMB weak lensing cross-correlations to set constraints on either the redshift or shear calibration by analysing a previously unused high-redshift KiDS galaxy sample (1.2 < z(B) < 2), with the cross-correlation detected at a significance of 7σ. This analysis provides an independent assessment for the accuracy of redshift measurements in a regime that is challenging to calibrate directly owing to known incompleteness in spectroscopic surveys.
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FMFMET, NUK, UL, UM, UPUK
Summary A 32-year-old Caucasian male presented to the emergency department with a one-day history of acute severe bilateral lower limb weakness, three days after competing in a bodybuilding ...competition. He consumed large quantities of carbohydrate-rich foods following the competition. His past medical history was significant for anxiety, and family history was non-contributory. Examination was normal except for reduced power and hyporeflexia in both legs, despite his muscular physique. He was noted to have severe hypokalaemia (K+= 1.9 mmol/L). His thyroid function tests were consistent with thyrotoxicosis. He reported taking thyroxine and several other agents to facilitate muscle mass generation before the bodybuilding competition. His presentation was reminiscent of thyrotoxic periodic paralysis, albeit uncommon with Caucasian ethnicity. He also had transient hyperglycaemia at presentation with concomitant hyperinsulinaemia, which could be attributed to the carbohydrate load and may have exacerbated his hypokalaemia through a transcellular shift. Urine toxicology screen subsequently ruled out the use of diuretics but confirmed the presence of a long-acting beta agonist (clenbuterol) which, along with other substances, may have aggravated the hypokalaemia further. After 12 h of i.v. replacement, the potassium level normalised and leg weakness resolved. The patient agreed to stop taking thyroxine and beta agonists and was well during the clinic visit at one month follow-up. This case highlights the potential for thyrotoxicosis factitia to exacerbate hypokalaemia and muscle weakness from other causes in bodybuilders presenting with acute severe weakness, irrespective of ethnicity. Learning points In patients presenting with muscle weakness and hypokalaemia, early consideration of thyrotoxicosis is essential, even in the absence of a past history of thyroid disease or specific symptoms of thyrotoxicosis, in order to allow prompt initiation of appropriate treatment and to prevent recurrence. Bodybuilders may constitute a uniquely ‘at-risk’ group for thyrotoxic periodic paralysis secondary to thyrotoxicosis factitia, especially where there is concomitant use of beta-adrenergic agonists, even in the absence of diuretic use. Although rare and usually described in patients of Asian or Polynesian ethnicity, this case highlights that thyrotoxic periodic paralysis secondary to thyrotoxicosis factitia can also occur in patients with Caucasian ethnicity. We speculate that consuming large quantities of carbohydrates may induce hyperinsulinaemia, which could theoretically contribute to worse hypokalaemia, though mechanistic studies would be needed to explore this further.
We present Weak Gravitational Lensing measurements of a sample of 157 clusters within the Kilo Degree Survey (KiDS), detected with a > 5
σ
thermal Sunyaev-Zel’dovich (SZ) signal by the Atacama ...Cosmology Telescope (ACT). Using a halo-model approach, we constrained the average total cluster mass,
M
WL
, accounting for the ACT cluster selection function of the full sample. We find that the SZ cluster mass estimate
M
SZ
, which was calibrated using X-ray observations, is biased with
M
SZ
/
M
WL
= (1 −
b
SZ
) = 0.65 ± 0.05. Separating the sample into six mass bins, we find no evidence of a strong mass dependency for the mass bias, (1 −
b
SZ
). Adopting this ACT-KiDS SZ mass calibration would bring the
Planck
SZ cluster count into agreement with the counts expected from the
Planck
cosmic microwave background ΛCDM cosmological model, although it should be noted that the cluster sample considered in this work has a lower average mass
M
SZ, uncor
= 3.64 × 10
14
M
⊙
compared to the
Planck
cluster sample which has an average mass in the range
M
SZ, uncor
= (5.5 − 8.5)×10
14
M
⊙
, depending on the sub-sample used.
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To decide clinical and research priorities on pain features and psychological factors in persons with patellofemoral pain.
Consensus development process.
We undertook a 3-stage process consisting of ...(1) updating 2 systematic reviews on quantitative sensory testing of pain features and psychological factors in patellofemoral pain, (2) an online survey of health care professionals and persons with patellofemoral pain, and (3) a consensus meeting with expert health care professionals. Participants responded that they agreed, disagreed, or were unsure that a pain feature or psychological factor was important in clinical practice or as a research priority. Greater than 70% participant agreement was required for an item to be considered important in clinical practice or a research priority.
Thirty-five health care professionals completed the survey, 20 of whom attended the consensus meeting. Thirty persons with patellofemoral pain also completed the survey. The review identified 5 pain features and 9 psychological factors-none reached 70% agreement in the patient survey, so all were considered at the meeting. After the meeting, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy were the only factors considered clinically important. All but the thermal pain tests and 3 psychological factors were considered research priorities.
Pain catastrophizing, pain self-efficacy, and fear-avoidance beliefs were factors considered important in treatment planning, clinical examination, and prognostication. Quantitative sensory tests for pain were not regarded as clinically important but were deemed to be research priorities, as were most psychological factors.
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