As the coronavirus disease pandemic spread across the United States and protective measures to mitigate its impact were enacted, parents and children experienced widespread disruptions in daily life. ...Our objective with this national survey was to determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020.
In June 2020, we conducted a national survey of parents with children age <18 to measure changes in health status, insurance status, food security, use of public food assistance resources, child care, and use of health care services since the pandemic began.
Since March 2020, 27% of parents reported worsening mental health for themselves, and 14% reported worsening behavioral health for their children. The proportion of families with moderate or severe food insecurity increased from 6% before March 2020 to 8% after, employer-sponsored insurance coverage of children decreased from 63% to 60%, and 24% of parents reported a loss of regular child care. Worsening mental health for parents occurred alongside worsening behavioral health for children in nearly 1 in 10 families, among whom 48% reported loss of regular child care, 16% reported change in insurance status, and 11% reported worsening food security.
The coronavirus disease pandemic has had a substantial tandem impact on parents and children in the United States. As policy makers consider additional measures to mitigate the health and economic effects of the pandemic, they should consider the unique needs of families with children.
We present a hierarchical genome-assembly process (HGAP) for high-quality de novo microbial genome assemblies using only a single, long-insert shotgun DNA library in conjunction with Single Molecule, ...Real-Time (SMRT) DNA sequencing. Our method uses the longest reads as seeds to recruit all other reads for construction of highly accurate preassembled reads through a directed acyclic graph-based consensus procedure, which we follow with assembly using off-the-shelf long-read assemblers. In contrast to hybrid approaches, HGAP does not require highly accurate raw reads for error correction. We demonstrate efficient genome assembly for several microorganisms using as few as three SMRT Cell zero-mode waveguide arrays of sequencing and for BACs using just one SMRT Cell. Long repeat regions can be successfully resolved with this workflow. We also describe a consensus algorithm that incorporates SMRT sequencing primary quality values to produce de novo genome sequence exceeding 99.999% accuracy.
Opioid abuse among pregnant women has reached epidemic proportions and has influenced maternal and child health policy at the federal, state, and local levels. As a result, we review the current ...state of opioid use in pregnancy and evaluate recent legislative and health policy initiatives designed to combat opioid addiction in pregnancy. We emphasize the importance of safe and responsible opioid-prescribing practices, expanding the availability and accessibility of medication-assisted treatment and standardizing care for neonates at risk of neonatal abstinence syndrome. Efforts to penalize pregnant women and negative consequences for disclosing substance use to health care providers are harmful and may prevent women from seeking prenatal care and other beneficial health care services during pregnancy. Instead, health care providers should advocate for health policy informed by scientific research and evidence-based practice to reduce the burden of prenatal opioid abuse and optimize outcomes for mothers and their neonates.
To describe incidence, health care use, and cost trends for infants with neonatal abstinence syndrome (NAS) who are covered by Medicaid compared with other infants.
We used 2004-2014 hospital birth ...data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States (
= 13 102 793). Characteristics and trends among births impacted by NAS were examined by using univariate statistics and logistic regression.
Medicaid covered 73.7% of NAS-related births in 2004 (95% confidence interval CI, 68.9%-77.9%) and 82.0% of NAS-related births in 2014 (95% CI, 80.5%-83.5%). Among infants covered by Medicaid, NAS incidence increased more than fivefold during our study period, from 2.8 per 1000 births (95% CI, 2.1-3.6) in 2004 to 14.4 per 1000 births (95% CI, 12.9-15.8) in 2014. Infants with NAS who were covered by Medicaid were significantly more likely to be transferred to another hospital and have a longer length of stay than infants without NAS who were enrolled in Medicaid or infants with NAS who were covered by private insurance. Adjusting for inflation, total hospital costs for NAS births that were covered by Medicaid increased from $65.4 million in 2004 to $462 million in 2014. The proportion of neonatal hospital costs due to NAS increased from 1.6% in 2004 to 6.7% in 2014 among births that were covered by Medicaid.
The number of Medicaid-financed births that are impacted by NAS has risen substantially and totaled $462 million in hospital costs in 2014. Improving affordable health insurance coverage for low-income women before pregnancy would expand access to substance use disorder treatment and could reduce NAS-related morbidity and costs.
Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated ...with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS).
We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.
Of 112,029 pregnant women, 31,354 (28%) filled ≥ 1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P < .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P < .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of daily cigarettes smoked (P < .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 95% confidence interval: 1.67-2.60) were associated with greater risk of developing NAS.
Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS.
BACKGROUND:Variations in cardiac troponin concentrations by age, sex, and time between samples in patients with suspected myocardial infarction are not currently accounted for in diagnostic ...approaches. We aimed to combine these variables through machine learning to improve the assessment of risk for individual patients.
METHODS:A machine learning algorithm (myocardial-ischemic-injury-index MI) incorporating age, sex, and paired high-sensitivity cardiac troponin I concentrations, was trained on 3013 patients and tested on 7998 patients with suspected myocardial infarction. MI uses gradient boosting to compute a value (0–100) reflecting an individual’s likelihood of a diagnosis of type 1 myocardial infarction and estimates the sensitivity, negative predictive value, specificity and positive predictive value for that individual. Assessment was by calibration and area under the receiver operating characteristic curve. Secondary analysis evaluated example MI thresholds from the training set that identified patients as low risk (99% sensitivity) and high risk (75% positive predictive value), and performance at these thresholds was compared in the test set to the 99th percentile and European Society of Cardiology rule-out pathways.
RESULTS:Myocardial infarction occurred in 404 (13.4%) patients in the training set and 849 (10.6%) patients in the test set. MI was well calibrated with a very high area under the receiver operating characteristic curve of 0.963 0.956–0.971 in the test set and similar performance in early and late presenters. Example MI thresholds identifying low- and high-risk patients in the training set were 1.6 and 49.7, respectively. In the test set, MI values were <1.6 in 69.5% with a negative predictive value of 99.7% (99.5–99.8%) and sensitivity of 97.8% (96.7–98.7%), and were ≥49.7 in 10.6% with a positive predictive value of 71.8% (68.9–75.0%) and specificity of 96.7% (96.3–97.1%). Using these thresholds, MI performed better than the European Society of Cardiology 0/3-hour pathway (sensitivity, 82.5% 74.5–88.8%; specificity, 92.2% 90.7–93.5%) and the 99th percentile at any time point (sensitivity, 89.6% 87.4–91.6%); specificity, 89.3% 88.6–90.0%).
CONCLUSIONS:Using machine learning, MI provides an individualized and objective assessment of the likelihood of myocardial infarction, which can be used to identify low- and high-risk patients who may benefit from earlier clinical decisions.
CLINICAL TRIAL REGISTRATION:URLhttps://www.anzctr.org.au. Unique identifierACTRN12616001441404.
The use of opioids during pregnancy has grown rapidly in the past decade. As opioid use during pregnancy increased, so did complications from their use, including neonatal abstinence syndrome. ...Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs. A public health response, rather than a punitive approach to the opioid epidemic and substance use during pregnancy, is critical, including the following: a focus on preventing unintended pregnancies and improving access to contraception; universal screening for alcohol and other drug use in women of childbearing age; knowledge and informed consent of maternal drug testing and reporting practices; improved access to comprehensive obstetric care, including opioid-replacement therapy; gender-specific substance use treatment programs; and improved funding for social services and child welfare systems. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool (December 2016).
From 1999 to 2014, the number of pregnant women diagnosed with opioid use disorder grew more than fourfold,2 and the number ofinfants diagnosed with neonatal opioid withdrawal grew nearly sevenfold.3 ...The opioid crisis is exposing gaps in our public health system, and there is an urgent need for a comprehensive response that includes the needs of pregnant women and children. ...policies, which were also employed in the crack cocaine epidemic of the early 1980s through the early 1990s, have not proven effective; they stigmatize pregnant women, creating an incentive to avoid needed care.5 We should focus on improving care for infants by keeping the infant and mother together, reducing variability in care, and providing a smooth transition to home. Because opioid use disorder is a chronic medical condition involving a likelihood of relapse, our responsibility to mothers and infants does not end at hospital discharge. ...the services strategy includes improving access to family-centric treatment and developmental services (e.g., early intervention).
Disparities in verbal ability, a major predictor of later life outcomes, have generated widespread debate, but few studies have been able to isolate neighborhood-level causes in a developmentally and ...ecologically appropriate way. This study presents longitudinal evidence from a large-scale study of >2,000 children ages 6-12 living in Chicago, along with their caretakers, who were followed wherever they moved in the U.S. for up to 7 years. African-American children are exposed in such disproportionate numbers to concentrated disadvantage that white and Latino children cannot be reliably compared, calling into question traditional research strategies assuming common points of overlap in ecological risk. We therefore focus on trajectories of verbal ability among African-American children, extending recently developed counterfactual methods for time-varying causes and outcomes to adjust for a wide range of predictors of selection into and out of neighborhoods. The results indicate that living in a severely disadvantaged neighborhood reduces the later verbal ability of black children on average by almost equal to 4 points, a magnitude that rivals missing a year or more of schooling.
Drug-tolerant persister cells (persisters) evade apoptosis upon targeted and conventional cancer therapies and represent a major non-genetic barrier to effective cancer treatment. Here, we show that ...cells that survive treatment with pro-apoptotic BH3 mimetics display a persister phenotype that includes colonization and metastasis in vivo and increased sensitivity toward ferroptosis by GPX4 inhibition. We found that sublethal mitochondrial outer membrane permeabilization (MOMP) and holocytochrome c release are key requirements for the generation of the persister phenotype. The generation of persisters is independent of apoptosome formation and caspase activation, but instead, cytosolic cytochrome c induces the activation of heme-regulated inhibitor (HRI) kinase and engagement of the integrated stress response (ISR) with the consequent synthesis of ATF4, all of which are required for the persister phenotype. Our results reveal that sublethal cytochrome c release couples sublethal MOMP to caspase-independent initiation of an ATF4-dependent, drug-tolerant persister phenotype.
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