Survival of infants born extremely preterm (EP) (<28 weeks' gestation) has increased since the early 1990s. It is necessary to know whether increased survival is accompanied by increased ...neurodevelopmental disability.
To examine changes in major (ie, moderate or severe) neurodevelopmental disability and survival free of major neurodevelopmental disability at 2 years in infants born EP.
Four prospective longitudinal cohort studies comprising all EP live births at 22 to 27 weeks' gestation from April 1, 2016, to March 31, 2017, and earlier eras (1991-1992, 1997, and 2005), and contemporaneous term-born controls in the state of Victoria, Australia. Among 1208 live births during the periods studied, data were available for analysis of 2-year outcomes in 1152 children: 422 (1991-1992), 215 (1997), 263 (2005), and 252 (2016-2017). Data analysis was performed from September 17, 2020, to April 15, 2021.
Extreme preterm live birth.
Survival, blindness, deafness, cerebral palsy, developmental delay, and neurodevelopmental disability at 2 years' corrected age. Developmental delay comprised a developmental quotient less than -1 SD relative to the control group means on the Bayley Scales for each era. Major neurodevelopmental disability comprised blindness, deafness, moderate to severe cerebral palsy, or a developmental quotient less than -2 SDs. Individual neurodevelopmental outcomes in each era were contrasted relative to the 2016-2017 cohort using logistic regression adjusted for gestational age, sex, birth weight z score, and sociodemographic variables. Changes in survival free of major neurodevelopmental disability over time were also assessed using logistic regression.
Survival to 2 years was highest in 2016-2017 (73% 215 of 293) compared with earlier eras (1991-1992: 53% 225 of 428; 1997: 70% 151 of 217; 2005: 63% 170 of 270). Blindness and deafness were uncommon (<3%). Cerebral palsy was less common in 2016-2017 (6%) than in earlier eras (1991-1992: 11%; 1997: 12%; 2005: 10%). There were no obvious changes in the rates of developmental quotient less than -2 SDs across eras (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or in rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%). Rates of survival free of major neurodevelopmental disability increased steadily over time: 42% (1991-1992), 51% (1997), 53% (2005), and 62% (2016-2017) (odds ratio, 1.30; 95% CI, 1.15-1.48 per decade; P < .001).
These findings suggest that survival free of major disability at age 2 years in children born EP has increased by an absolute 20% since the early 1990s. Increased survival has not been associated with increased neurodevelopmental disability.
Brain injury is highly associated with preterm birth. Complications of prematurity, including spontaneous or necrotizing enterocolitis (NEC)-associated intestinal perforations, are linked to lifelong ...neurologic impairment, yet the mechanisms are poorly understood. Early diagnosis of preterm brain injuries remains a significant challenge. Here, we identified subventricular zone echogenicity (SVE) on cranial ultrasound in preterm infants following intestinal perforations. The development of SVE was significantly associated with motor impairment at 2 years. SVE was replicated in a neonatal mouse model of intestinal perforation. Examination of the murine echogenic subventricular zone (SVZ) revealed NLRP3-inflammasome assembly in multiciliated FoxJ1+ ependymal cells and a loss of the ependymal border in this postnatal stem cell niche. These data suggest a mechanism of preterm brain injury localized to the SVZ that has not been adequately considered. Ultrasound detection of SVE may serve as an early biomarker for neurodevelopmental impairment after inflammatory disease in preterm infants.
Display omitted
•Subventricular zone echogenicity (SVE) is associated with intestinal perforations•SVE predicts motor impairment in preterm infants with intestinal perforation•Modeled intestinal perforation leads to ependymal inflammasome activation in mice•SVE is associated with permanent ependymal cell loss in the mouse subventricular zone
Epstein and Janos et al. have identified subventricular zone echogenicity (SVE) in preterm infants with intestinal perforations. SVE was predictive of future motor impairment in affected infants. Using a mouse model, SVE was associated with an inflammatory injury to the ependymal layer that was associated with stem cell niche dysfunction.
West Nile virus (WNV) is a globally distributed mosquito-borne virus of great public health concern. The number of WNV human cases and mosquito infection patterns vary in space and time. Many ...statistical models have been developed to understand and predict WNV geographic and temporal dynamics. However, these modeling efforts have been disjointed with little model comparison and inconsistent validation. In this paper, we describe a framework to unify and standardize WNV modeling efforts nationwide. WNV risk, detection, or warning models for this review were solicited from active research groups working in different regions of the United States. A total of 13 models were selected and described. The spatial and temporal scales of each model were compared to guide the timing and the locations for mosquito and virus surveillance, to support mosquito vector control decisions, and to assist in conducting public health outreach campaigns at multiple scales of decision-making. Our overarching goal is to bridge the existing gap between model development, which is usually conducted as an academic exercise, and practical model applications, which occur at state, tribal, local, or territorial public health and mosquito control agency levels. The proposed model assessment and comparison framework helps clarify the value of individual models for decision-making and identifies the appropriate temporal and spatial scope of each model. This qualitative evaluation clearly identifies gaps in linking models to applied decisions and sets the stage for a quantitative comparison of models. Specifically, whereas many coarse-grained models (county resolution or greater) have been developed, the greatest need is for fine-grained, short-term planning models (m-km, days-weeks) that remain scarce. We further recommend quantifying the value of information for each decision to identify decisions that would benefit most from model input.
Abstract Introduction During a crisis, hospitals will struggle to meet the care needs of burn patients. Very few clinicians (1% of MDs and RNs) and few hospitals (2%) have burn care expertise. Due to ...these capacity limitations, patients with burns as large as 40% TBSA will likely have to remain outside of burn centers for days to weeks before reaching definitive care. Telemedicine technology (TT) is an effective way to connect a caregiver in any location to an expert burn clinician, however it remains underused for unknown reasons. Implementation science seeks to uncover the factors affecting the use of innovations like telemedicine with the goal of increasing uptake. Methods We administered a questionnaire to assess burn (BC) and emergency department (ED) clinician perceptions of the feasibility, acceptability, and intention to use TT across a network of 24 hospitals representing 4 of the 6 current ABA disaster response regions. We asked clinicians to respond to both crisis care (initial and ongoing) and routine acute. A Likert scale in the previously-validated acceptability of intervention measure (AIM), feasibility of intervention measure (FIM), and technology acceptance model tool (STAT) were used. Descriptive statistics were generated using SAS software. We received a total of 389 clinician responses, reflecting a 60% response rate from BC and a 7% response rate from ED staff. Results On average, clinician ratings of the acceptability of using TT for routine burn care were higher in the ED clinicians than those working in BCs (4.07, SD=0.87 vs 3.45, SD=1), and this trend was consistent for initial and ongoing care during a crisis (4.17; SD=0.77 vs 3.48; SD=0.96 and 3.83; SD=0.89 vs 3.71; SD=0.8, respectively). We observed similar trends by practice location in feasibility and intention to use during a crisis across the sample. There were consistently positive ratings in the STAT tool domains of intention, attitude, and perceived usefulness across all clinicians regardless of practice location, however ease of use and understanding the process were consistently rated lower. Conclusions BC and ED clinicians must work together to use telemedicine technology to treat and triage burn-injured patients during a crisis, however clinicians in burn centers currently rate its acceptability and feasibility, and their intention to use it lower than ED clinicians. Our results reveal that to improve the uptake of TT under usual care and during a crisis, attention to improving its ease of use and clinician understanding of the process is key Applicability of Research to Practice Results suggest that BCs need to partner closely with EDs so processes for the use of telemedicine can be established and supported. To realize the benefit of telemedicine technology in burn care, an implementation intervention that improves clinician perceptions of acceptability and feasibility is warranted, and that intervention should be tailored to fit the context where the clinicians practice.
Inspiring New Science to Guide Healthcare in Turner Syndrome (InsighTS) Registry is a national, multicenter registry for individuals with Turner syndrome (TS) designed to collect and store validated ...longitudinal clinical data from a diverse cohort of patients with TS. Herein, we describe the rationale, design, and approach used to develop the InsighTS registry, as well as the demographics of the initial participants to illustrate the registry's diversity and future utility. Multiple stakeholder groups have been involved from project conceptualization through dissemination, ensuring the registry serves the priorities of the TS community. Key features of InsighTS include recruitment strategies to facilitate enrollment of participants that appropriately reflect the population of individuals with TS receiving care in the US, clarity of data ownership and sharing, and sustainability of this resource. The registry gathers clinical data on diagnosis, treatment, comorbidities, health care utilization, clinical practices, and quality of life with the goal of improving health outcomes for this population. Future directions include multiple patient-centered clinical-translational research projects that will use the InsighTS platform. This thorough and thoughtful planning will ensure InsighTS is a valuable and sustainable resource for the TS community for decades to come.
Objective: Transitional work (TW) for veterans with psychiatric disabilities is the predominant model of vocational rehabilitation in the Veterans Health Administration (VA). Although, on average, TW ...employment outcomes have been demonstrated to be inferior to supported employment, little is known about the potential subgroup of veterans for which TW may be most effective. This study of veterans with posttraumatic stress disorder (PTSD) examines differences in competitive employment outcomes and identifies characteristics of veterans who chose to engage in TW compared with those who did not. Method: A post hoc comparative subgroup analysis of veterans with PTSD randomly assigned to TW as part of a randomized controlled trial was conducted. Veterans were divided into 2 subgroups: those who engaged in TW (n = 141) and nonengagers (n = 129). Differences in baseline characteristics were examined and 18-month employment outcomes were compared. Results: There were no differences in 18-month employment outcomes between TW engagers and nonengagers. Compared with TW engagers, those that did not engage in TW were 2.5 times more likely to get a competitive job within the first 6 months and were less likely to obtain lower skilled jobs. Younger age, adequate housing, personal means of transportation, and recent work history factor into the odds of gaining and maintaining competitive work. Conclusions and Implications for Practice: Consistent with past research, engagement in TW did not result in improved long-term competitive employment outcomes for veterans with PTSD. Those who did not engage in TW were more likely to gain a competitive job within the first 6 months.
Impact and Implications
Transitional work (TW) is the predominant model of vocational rehabilitation for veterans with psychiatric disabilities in the Veterans Health Administration. This study of veterans with posttraumatic stress disorder (PTSD) seeking competitive employment indicates that on average TW does not lead to better employment outcomes than receiving no TW vocational service at all, but suggests that younger age, adequate housing, personal means of transportation, and prior work history enhance the chances of gaining and maintaining competitive employment. Further, almost half of veterans assigned to TW in this study chose not to engage in TW, preferring to job seek independently. Veterans Health Administration (VHA) should offer a range of services for veterans with PTSD that allow for greater choice and improved employment outcomes.
Understanding factors that influence observation processes is critical for accurate assessment of underlying ecological processes. When indirect methods of detection, such as environmental DNA, are ...used to determine species presence, additional levels of uncertainty from observation processes need to be accounted for. We conducted a field trial to evaluate observation processes of a terrestrial invasive species (wild pigs‐ Sus scrofa) from DNA in water bodies. We used a multi‐scale occupancy analysis to estimate different levels of observation processes (detection, p): the probability DNA is available per sample (θ), the probability of capturing DNA per extraction (γ), and the probability of amplification per qPCR run (δ). We selected four sites for each of three water body types and collected 10 samples per water body during two months (September and October 2016) in central Texas. Our methodology can be used to guide sampling adaptively to minimize costs while improving inference of species distributions. Using a removal sampling approach was more efficient than pooling samples and was unbiased. Availability of DNA varied by month, was considerably higher when water pH was near neutral, and was higher in ephemeral streams relative to wildlife guzzlers and ponds. To achieve a cumulative detection probability >90% (including availability, capture, and amplification), future studies should collect 20 water samples per site, conduct at least two extractions per sample, and conduct five qPCR replicates per extraction. Accounting for multiple levels of uncertainty of observation processes improved estimation of the ecological processes and provided guidance for future sampling designs.
Accounting for multiple levels of observation error associated with using environmental DNA (eDNA) to detect terrestrial mammals results in better estimates of occupancy and provides critical information for designing eDNA studies. We estimated detection probability for an invasive terrestrial mammal at the water sample level, extraction level, and qPCR level and determine factors associated with observation error at those levels to provide unbiased estimates of occupancy.
Sixteen borate glass compositions comprising K
2
O and SrO were screened, using a design of mixtures approach, to model compositional effects on dissolution, CT imageability, and MRI relaxivity (R
2
...). Based on the characteristics of each network, together with dose determination and toxicological risk, the composition identified as BKSA16 was selected as a preferred composition for pre-clinical evaluations related to geniculate artery embolization (GAE). Accordingly, BKSA16 particles were subjected to a flame spheroidization process and recharacterized, including the evaluation of residual mass at 72 h in physiologically representative media along with clinical determinations of suspension time (ease of use). For both the irregular particles and microspheres residual mass was present at 72 h in physiologically representative media. Additionally, both the microspheres and irregular particles achieved suspension times deemed to be acceptable for clinical use. The collective data confirms that BKSA16 microspheres have a range of beneficial features (specifically both degradable and imageable) suited to GAE.
The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known.
To assess the ...lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO).
PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020.
All randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time were included.
Patient-level data regarding presenting clinical and imaging features and functional outcomes were pooled from the 7 retrieved randomized clinical trials of stent retriever thrombectomy devices (entirely or predominantly) vs medical therapy. All 7 identified trials published in a peer-reviewed journal (by August 1, 2020) contributed data. Detailed time metrics were collected including last known well-to-door (LKWTD) time; last known well/onset-to-puncture (LKWTP) time; last known well-to-reperfusion (LKWR) time; door-to-puncture (DTP) time; and door-to-reperfusion (DTR) time.
Change in healthy life-years measured as disability-adjusted life-years (DALYs). DALYs were calculated as the sum of years of life lost (YLL) owing to premature mortality and years of healthy life lost because of disability (YLD). Disability weights were assigned using the utility-weighted modified Rankin Scale. Age-specific life expectancies without stroke were calculated from 2017 US National Vital Statistics.
Among the 781 EVT-treated patients, 406 (52.0%) were early-treated (LKWTP ≤4 hours) and 375 (48.0%) were late-treated (LKWTP >4-12 hours). In early-treated patients, LKWTD was 188 minutes (interquartile range, 151.3-214.8 minutes) and DTP 105 minutes (interquartile range, 76-135 minutes). Among the 298 of 380 (78.4%) patients with substantial reperfusion, median DTR time was 145.0 minutes (interquartile range, 111.5-185.5 minutes). Care process delays were associated with worse clinical outcomes in LKW-to-intervention intervals in early-treated patients and in door-to-intervention intervals in early-treated and late-treated patients, and not associated with LKWTD intervals, eg, in early-treated patients, for each 10-minute delay, healthy life-years lost were DTP 1.8 months vs LKWTD 0.0 months; P < .001. Considering granular time increments, the amount of healthy life-time lost associated with each 1 second of delay was DTP 2.2 hours and DTR 2.4 hours.
In this study, care delays were associated with loss of healthy life-years in patients with acute ischemic stroke treated with EVT, particularly in the postarrival time period. The finding that every 1 second of delay was associated with loss of 2.2 hours of healthy life may encourage continuous quality improvement in door-to-treatment times.
PDF
