Objective
To test the hypothesis that potential missed opportunities for antenatal corticosteroids increase as gestational age decreases and are associated with adverse outcomes.
Design
Observational ...cohort study.
Setting
Twenty‐four US centers in the Neonatal Research Network.
Population
Actively treated infants at 22–25 weeks of gestation and with birthweight 401–1000 g, without major birth defects, born 2006–18.
Methods
Potential missed opportunity was defined as no antenatal corticosteroids but did have prenatal antibiotics, and/or magnesium sulphate, and/or prolonged rupture of membranes. Poisson regression models adjusted for baseline characteristics.
Main outcome measures
Antenatal corticosteroid exposure, mortality and severe intracranial haemorrhage or periventricular leucomalacia.
Results
A total of 6966 (87.5%) infants were exposed to antenatal corticosteroids, 454 (5.7%) had no exposure but potential missed opportunities for antenatal corticosteroid exposure, and 537 (6.7%) had no exposure and no evidence of potential missed opportunities. Compared with infants born at 25 weeks, potential missed opportunities for antenatal corticosteroid exposure were more likely at 22 weeks (adjusted relative risk aRR 11.06, 95% confidence interval CI 7.52–16.27) and 23 weeks (aRR 3.24, 95% CI 2.44–4.29) but did not differ at 24 weeks (aRR 1.08, 95% CI 0.82–1.42). Potential missed opportunities for antenatal corticosteroids decreased over time at 22–23 weeks of gestation. Antenatal‐corticosteroid‐exposed infants had lower risk of death (31.0% versus 54.8%; aRR 0.77, 95% CI 0.70–0.84) and survivors had lower risk of severe brain injury (25.0% versus 44.5%; aRR 0.64, 95% CI 0.55–0.73) compared with infants with potential missed opportunities.
Conclusion
Potential missed opportunities for antenatal corticosteroid exposure increased with decreasing gestational age and were associated with higher rates of death and severe brain injury among actively treated periviable births.
Tweetable
Missed opportunities for antenatal steroids among periviable births are associated with death and brain injury.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Pediatric hearing loss is an increasingly recognized problem with significant implications. Increasing our quantitative understanding of potentially modifiable environmental risk factors for hearing ...loss may form the foundation for prevention and screening programs.
To determine whether specific threshold exposure levels of personally modifiable risk factors for hearing loss have been defined, with the overarching goal of providing actionable guidance for the prevention of pediatric hearing loss.
A systematic review was performed. Computerized searches of PubMed, EMBASE, and the Cochrane Library were completed and supplemented with manual searches.
Inclusion/exclusion criteria were designed to determine specific threshold values of personally modifiable risk factors on hearing loss in the pediatric population. Searches and data extraction were performed by independent reviewers.
There were 38 criterion-meeting studies, including a total of 50,651 subjects. Threshold noise exposures significantly associated with hearing loss in youth included: (1) more than 4 hours per week or more than 5 years of personal headphone usage, (2) more than 4 visits per month to a discotheque, and (3) working on a mechanized farm. Quantified tobacco levels of concern included any level of in utero smoke exposure as well as secondhand exposure sufficient to elevate serum cotinine.
Specific thresholds analyses are limited. Future studies would ideally focus on stratifying risk according to clearly defined levels of exposure, in order to provide actionable guidance for children and families.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: The factors influencing parents' willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents' willingness to enroll their children, and ...their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. Methods: This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one of three consent and data-sharing scenarios. Results: In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50-59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one's child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. Conclusions: Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks.
Abstract
Background
Rapid multiplex polymerase chain reaction (mPCR) point-of-care tests detect a variety of viral respiratory pathogens. The impact of mPCR results on antibiotic prescribing in the ...ED or downstream is not well understood. The purpose of this study was to assess the impact of positive viral mPCR results on antibiotic prescribing for patients presenting with respiratory symptomsin the ED.
Methods
This retrospective cohort study included adult patients presenting to the ED with respiratory symptoms and a positive rapid upper RTI mPCR for a non-SARs-CoV-2 viral pathogen between 11/1/2021 and 10/31/2022. The primary objective was to describe the proportion of patients with appropriate antibiotic management within 24 hours of positive mPCR result. Appropriate management was defined as patients without risk factors for bacterial co-infection who did not receive or continue antibiotic therapy. Those with co-infection risk factors prescribed antibiotic therapy were also considered appropriate. This was determined through independent pharmacist and ID physician review. Secondary objectives compared patient outcomes of those appropriately vs inappropriately managed and admitted vs discharged home from ED. Risk factors for inappropriate antibiotic decisions were also evaluated using logistic regression.
Results
250 patients were included, 206 (82.4%) with appropriate management and 44 (17.6%) with inappropriate management. 164 (65.5%) patients were not prescribed empiric or definitive antibiotics. 39 (15.6%) patients empirically received antibiotics prior to mPCR; 9 (23%) were discontinued following positive viral result. Patients discharged home from the ED were more likely to have appropriate antibiotic management than those admitted (87.5% vs 77.7%, p=0.042). Patients with inappropriate antibiotic management were more likely to be readmitted to the hospital within 30 days (14% vs 3.5%, p=0.005). Purulent sputum (OR 3.61 95% CI 1.64-8) and unilobar infiltrate (OR 3.03 1.22-7.58) were independent risk factors for inappropriate antibiotic management.
Conclusion
Rapid viral RTI mPCR testing in the ED resulted in a high level of appropriate antibiotic management, with most patients not being prescribed antibiotics.
Disclosures
All Authors: No reported disclosures
When Darwin visited the Galapagos archipelago, he observed that, in spite of the islands' physical similarity, members of species that had dispersed to them recently were beginning to diverge from ...each other. He postulated that these divergences must have resulted primarily from interactions with sets of other species that had also diverged across these otherwise similar islands. By extrapolation, if Darwin is correct, such complex interactions must be driving species divergences across all ecosystems. However, many current general ecological theories that predict observed distributions of species in ecosystems do not take the details of between-species interactions into account. Here we quantify, in sixteen forest diversity plots (FDPs) worldwide, highly significant negative density-dependent (NDD) components of both conspecific and heterospecific between-tree interactions that affect the trees' distributions, growth, recruitment, and mortality. These interactions decline smoothly in significance with increasing physical distance between trees. They also tend to decline in significance with increasing phylogenetic distance between the trees, but each FDP exhibits its own unique pattern of exceptions to this overall decline. Unique patterns of between-species interactions in ecosystems, of the general type that Darwin postulated, are likely to have contributed to the exceptions. We test the power of our null-model method by using a deliberately modified data set, and show that the method easily identifies the modifications. We examine how some of the exceptions, at the Wind River (USA) FDP, reveal new details of a known allelopathic effect of one of the Wind River gymnosperm species. Finally, we explore how similar analyses can be used to investigate details of many types of interactions in these complex ecosystems, and can provide clues to the evolution of these interactions.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Increasing evidence suggests the built environment can impact occupants’ attitudes, behavior, and health. However, few studies have examined these links with large samples in controlled settings. To ...address this gap, we conducted an experiment (N = 413) with varied physical features (i.e., materials, windows, and artwork representing diverse identities) to test their effects on biopsychosocial indicators of well-being including belonging, stress, creativity, and pro-environmental concern, measured through physiological sensors and self-reported assessments. Consistent with our hypotheses, participants exposed to natural materials and windows during a stress-inducing task had lower negative stress impacts across various metrics. For certain subgroups, exposure to natural materials also resulted in increased divergent creativity while exposure to windows resulted in increased charitable donations. Finally, participants exposed to diverse representations reported lower stress levels. We discuss the implications of these findings, including methodological challenges surrounding the design, experimentation, and operation of human-centered built environments.
●Between-subjects (N = 413) study examining impact of physical workplace on well-being●Tested eight combinations of two types of materials, windows, and representations●Belonging, stress, creativity, and environmental concern were measured●The presence of natural materials and of a window reduced stress in participants●Trends observed in natural materials improving creativity and diverse icons lowering stress
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In 2018, the American Psychological Association (APA) published the Guidelines for Psychological Practice With Men and Boys based on research compiled by the Society for the Psychological Study of ...Men and Masculinities (Division 51 of the APA). These guidelines were intended for a professional audience to guide research, practice, and training; however, in the months following their release, they became a focus of media debate in the United States. Because the guidelines reflect the core epistemological and theoretical foundations of the psychology of men and masculinities, understanding media discussing the guidelines may illuminate how fundamental perspectives of the discipline were received by the public. Accordingly, we conducted a directed content analysis of 77 print media pieces mentioning the guidelines in the months following their release. We developed a list of 12 content domains: social constructionism (including counter perspectives of essentialism and biological bases of behavior), feminism (including related concepts of misogyny, misandry, and equality), traditional masculinity (including concepts of toxic and positive masculinity), research, and therapy. Results of chi-square analyses and Spearman rank-order correlations indicated that articles supporting the guidelines generally mentioned and supported core perspectives such as social constructionism, feminism, and the existence of traditional masculinity. By contrast, articles opposing the guidelines generally rejected these perspectives in favor of gender essentialism. Except for a recognition of the problems facing boys and men and the value of therapy, there was very little agreement between articles opposing or supporting the guidelines. Recommendations for the 2028 revision of the guidelines are discussed.
Public Significance Statement
The American Psychological Association's Guidelines for Psychological Practice With Men and Boys helped spark a national debate about the nature and meaning of masculinity. The present study is the first to unpack some of that debate via a directed content analysis of media opposition to and support for these guidelines and provide recommendations for their revision in 2028.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
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