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The purpose of this paper was to elicit attitudes, beliefs, and feelings about testing for curable STDs outside of clinic settings. Telephone interviews were conducted with 120 black, Latino, and white young adults aged 18 to 25 years. Data were analyzed with descriptive frequencies and content analyses. Most (73%) reported people their age would use self-test urine STD kits if available. Perceived advantages were privacy and convenience. Disadvantages included not having an immediate 'face-to-face' discussion with a medical professional about positive tests. Young adults report a range of attitudes, beliefs, and feelings that may influence the success of efforts to screen for curable STDs in nonclinic settings. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the racial and ethnic distribution of sperm donors contributing to US sperm banks differs from the demographics of the US population and those of US donor sperm recipients undergoing treatment with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI)., Design: Cross-sectional study., Setting: United States donor sperm banks, US Census, and fertility clinics reporting to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System., Patients: Sperm donors from 18 banks, men aged 18-39 years on the basis of the 2021 Census Current Population Survey, and recipients of donor sperm for IVF and ICSI treatments in clinics reporting to the Assisted Reproductive Technology Clinic Outcome Reporting System from January 1, 2018, to December 31, 2020., Intervention: None., Main Outcome Measure: Proportions of sperm donors and donor sperm recipients undergoing IVF and ICSI treatments identifying as each racial and ethnic group., Results: Eighteen donor sperm banks were identified, encompassing 1,503 donors. Of these donors, 60.9% identified as White compared with 55.1% of the US male population and 67.7% of donor sperm recipients. Proportions of donors identifying as Asian or 2 or more races were larger than those of US men and donor sperm recipients (Asian: 18.6% vs. 6.5%, and 18.6% vs. 10.2%; 2 or more races: 11.6% vs. 2.2%, and 11.6% vs. 1.7%). In contrast, Black donors were underrepresented when compared with the US population of men and donor sperm recipients (2.8% vs. 12.9% and 2.8% vs. 13.0%). Hispanic donors were underrepresented when compared with the US population of men (6.0% vs. 22.2%). The percentages of Hispanic sperm donors and donor sperm recipients were similar (6.0% vs. 7.0%)., Conclusion: The racial and ethnic distribution of sperm donors differs significantly from the demographics of the US male population and donor sperm recipients undergoing IVF and ICSI treatments. These findings suggest a need for targeted recruitment efforts for Black sperm donors., Competing Interests: Declaration of Interests C.L.H. has nothing to disclose. A.K.G. has nothing to disclose. S.S. has nothing to disclose. S.T. has nothing to disclose. F.E. has nothing to disclose. C.R. has nothing to disclose. J.L.E. has nothing to disclose., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The obstetrics and gynecology (OB/GYN) hospitalist model designates obstetricians/gynecologists focused on hospitalized women's care. OB/GYN hospitalists engage in diverse activities, encompassing patient care, teaching, research, and inpatient leadership. Primarily, they manage obstetric and gynecologic patients in the hospital, handling emergencies and providing urgent care. Hospitalists oversee the entire continuum of patient care, from the emergency department to post-acute follow-up. This model emphasizes the traditional academic attending physician's role, particularly that of the gynecologic hospitalist, who excels in acute inpatient obstetric and gynecologic medicine, advancing skills in urgent care and medical education, and ensuring quality and safety metrics., Competing Interests: Disclosure J. Eaton has served on membership/advisory committee or review panels for Organon., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Preterm birth is a leading cause of neonatal mortality and presents significant public health concerns. Environmental chemical exposures during pregnancy may be partially to blame for disrupted delivery timing. Polycyclic aromatic hydrocarbons (PAHs) are products of incomplete combustion, exposure to which occurs via inhalation of cigarette smoke and automobile exhaust, and ingestion of charred meats. Exposure to PAHs in the US population is widespread, and pregnant women represent a susceptible population to adverse effects of PAHs. We aimed to investigate associations between gestational exposure to PAHs and birth outcomes, including timing of delivery and infant birth size. We utilized data from the PROTECT birth cohort where pregnant women provided spot urine samples at up to three study visits (median 16, 20, and 24 weeks gestation). Urine samples were assayed for eight hydroxylated PAH concentrations. Associations between PAHs and birth outcomes were calculated using linear/logistic regression models, with adjustment for maternal age, education, pre-pregnancy BMI, and daily exposure to environmental tobacco smoke. Models accounted for urine dilution using specific gravity. We also explored effect modification by infant sex. Interquartile range (IQR) increases in all averaged PAH exposures during the second trimester were associated with reduced gestational age at delivery and increased odds of overall PTB, although these associations were not statistically significant (p > 0.05). Most PAHs at the second study visit were most strongly associated with earlier delivery and increased odds of overall and spontaneous PTB, with visit 2 2-hydroxynapthalene (2-NAP) being significantly associated with increased odds of overall PTB (OR:1.55; 95 %CI: 1.05,2.29). Some PAHs resulted in earlier timing of delivery among only female fetuses, specifically 2-NAP on overall PTB (female OR:1.52 95 %CI: 1.02,2.27; male OR:0.78, 95 %CI: 0.53,1.15). Future work should more deeply investigate differential physiological impacts of PAH exposure between pregnancies with male and female fetuses, and on varying developmental processes occurring at different points through pregnancy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p  < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p  < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p  < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p  < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.

Oocyte donation has greatly expanded in the past several decades since the first procedure was performed in 1983. According to the Centers for Disease Control, the number of cycles using donor oocytes increased from 18,011 cycles in 2010 to 27,131 cycles in 2019. Oocyte donation has become an important reproductive option for women with diminished ovarian reserve, recurrent failed in vitro fertilization, or heritable genetic conditions. It is also particularly important for single men, same-sex male couples, and men with a transgender woman partner. More recently, societal changes accompanying the expansion of social media and broader access to direct-to-consumer DNA testing have raised concerns about privacy and anonymity. In this article, we review two specific aspects of donor privacy: privacy related to personal identifiers provided by clinics or donor egg bank websites and privacy related to direct-to-consumer genetic testing. We also provide clinical recommendations specific to the United States for working with oocyte donors and donor oocyte recipients., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Fertility preservation (FP) is the use of a specific medical intervention to protect the fertility of individuals whose disease or disease treatment may lead to infertility. These medical interventions include the cryopreservation of oocytes, embryos, ovarian tissue, sperm, and testicular tissue; oocyte and embryo cryopreservation are the most widely used interventions in the United States. Although guidelines recommend FP prior to undergoing gonadotoxic treatments, cost barriers are high. For example, the average cost of an oocyte cryopreservation cycle in the United States exceeds $10,000. High cost and lack of insurance coverage are two of the most cited reasons explaining the low Reproductive Endocrinology and Infertility (REI) referral rates and limited FP utilization. Broadening insurance mandates for FP prior to gonadotoxic treatments could improve utilization and provide cancer survivors with improved quality of life post treatment.

Significant ethnic and racial disparities exist in the utilization and outcomes of assisted reproductive technology (ART) in the United States. The popularity of fertility preservation (FP) procedures, a specific application of ART for those desiring to delay childbearing, has increased; however, many minority populations have seen a less rapid uptake of these services. Minority patients pursuing ART are more likely to have poorer in vitro fertilization (IVF) and pregnancy outcomes. These outcomes are used to predict success after FP and may lessen the appeal of such procedures in these populations. Suboptimal outcomes are further compounded by challenges with receiving referrals to, accessing, and paying for FP services. Resolving these disparities in minority populations will require culturally appropriate education surrounding the benefits of ART and FP, the demonstration of favorable outcomes in ART and FP through continued research engaging minority participants, and continued advocacy for expanded access to care for patients.

Background: To examine the association between maternal education and adverse maternal and neonatal outcomes in women who conceived using medically assisted reproduction, which included fertility medications, intrauterine insemination, or in vitro fertilization., Methods: We conducted a retrospective cohort study utilizing the US Vital Statistics data set on national birth certificates from 2016 to 2020. Women with live, non-anomalous singletons who conceived using MAR and had education status of the birthing female partner recorded were included. Patients were stratified into two groups: bachelor's degree or higher, or less than a bachelor's degree. The primary outcome was a composite of maternal adverse outcomes: intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, or blood transfusion. The secondary outcome was a composite of neonatal adverse outcomes: neonatal ICU admission, ventilator support, or seizure. Multivariable modified Poisson regression models with robust error variance adjusted for maternal age, race, marital status, prenatal care, smoking during pregnancy, neonatal sex, and birth year estimated the relative risk (RR) of outcomes with a 95% confidence interval (CI)., Results: 190,444 patients met the inclusion criteria: 142,943 had a bachelor's degree or higher and 47,501 were without a bachelor's degree. Composite maternal adverse outcomes were similar among patients with a bachelor's degree (10.1 per 1,000 live births) and those without a bachelor's degree (9.4 per 1,000 live births); ARR 1.05, 95% CI (0.94-1.17). However, composite adverse neonatal outcomes were significantly lower in women with a bachelor's degree or higher (94.1 per 1,000 live births) compared to women without a bachelor's degree (105.9 per 1,000 live births); ARR 0.91, 95% CI (0.88-0.94)., Conclusions: Our study demonstrated that lower maternal education level was not associated with maternal adverse outcomes in patients who conceived using MAR but was associated with increased rates of neonatal adverse outcomes. As access to infertility care increases, patients who conceive with MAR may be counseled that education level is not associated with maternal morbidity. Further research into the association between maternal education level and neonatal morbidity is indicated., (© 2023. The Author(s).)

Objective: To evaluate the association between body mass index (BMI) and good perinatal outcomes after in vitro fertilization (IVF) among women with polycystic ovary syndrome (PCOS)., Design: Retrospective cohort study using 2012-2015 Society for Assisted Reproductive Technology Clinic Outcomes Reporting System data., Setting: Fertility clinics., Patients: To identify patients most likely to have PCOS, we included women with a diagnosis of ovulation disorder and serum antimüllerian hormone >4.45 ng/mL. Exclusion criteria included age ≥ 41 years, secondary diagnosis of diminished ovarian reserve, preimplantation genetic testing, and missing BMI or primary outcome data., Interventions: None., Main Outcome Measures: Good perinatal outcome, defined as a singleton live birth at ≥ 37 weeks with birth weight ≥ 2,500 g and ≤ 4,000 g., Results: The analysis included 9,521 fresh, autologous IVF cycles from 8,351 women. Among women with PCOS, the proportion of cycles with a good perinatal outcome was inversely associated with BMI: underweight 25.1%, normal weight 22.7%, overweight 18.9%, class I 18.4%, class II 14.9%, and class III or super obesity 12.2%. After adjusting for confounders, women in the highest BMI category had 51% reduced odds of a good perinatal outcome compared with normal weight women (adjusted odds ratio 0.49, 95% confidence interval 0.36-0.67)., Conclusions: Among women with PCOS undergoing fresh, autologous IVF, the odds of a good perinatal outcome decline with increasing BMI. Women with PCOS should be counseled that the odds of achieving a good perinatal outcome decrease as their weight increases., (© 2022 The Authors.)

Objective: The objective of our study was to assess the association between AMH and live birth among women with elevated AMH undergoing first fresh IVF. Serum antimüllerian hormone (AMH) correlates with oocyte yield during in vitro fertilization (IVF). However, there are limited data regarding IVF outcomes in women with elevated AMH levels., Design: Retrospective cohort study using the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System database from 2012-2014., Setting: Fertility clinics reporting to Society for Assisted Reproductive Technology., Patients: First, fresh, autologous IVF cycles with elevated AMH levels (≥5.0 ng/mL). Subanalyses were performed to examine patients with or without polycystic ovary syndrome (PCOS)., Interventions: None., Main Outcome Measures: Odds of live birth., Results: Our cohort included 10,615 patients with elevated an AMH level, including 2,707 patients with PCOS only. The adjusted odds of live birth per initiated cycle were significantly lower per each unit increase in the AMH level (odds ratio, 0.97; 95% confidence interval, 0.96-0.98). Increasing AMH level was associated with increased cancellation of fresh transfer (odds ratio, 1.12; 95% confidence interval, 1.10-1.15) up to an AMH level of 12 ng/mL. The decrease in the live birth rate appears to be caused by the increasing incidence of cancellation of fresh transfer because the live birth rate per completed transfer was maintained. Similar trends were observed in the PCOS and non-PCOS subanalyses., Conclusions: Among patients with AMH levels of ≥5 ng/mL undergoing fresh, autologous IVF, each unit increase in AMH level is associated with a 3% decrease in odds of live birth because of the increased incidence of fresh embryo transfer cancellation., (© 2022 The Authors.)

Background: Glyphosate is a widely used herbicide in global agriculture. Glyphosate and its primary environmental degradate, aminomethyl phosphonic acid (AMPA), have been shown to disrupt endocrine function and induce oxidative stress in in vitro and animal studies. To our knowledge, these relationships have not been previously characterized in epidemiological settings. Elevated urinary levels of glyphosate and AMPA may be indicative of health effects caused by previous exposure via multiple mechanisms including oxidative stress., Methods: Glyphosate and AMPA were measured in 347 urine samples collected between 16 and 20 weeks gestation and 24-28 weeks gestation from pregnant women in the PROTECT birth cohort. Urinary biomarkers of oxidative stress, comprising 8-isoprostane-prostaglandin-F2α (8-iso-PGF2α), its metabolite 2,3-dinor-5,6-dihydro-15-F 2 t -isoprostane (8-isoprostane metabolite) and prostaglandin-F2α (PGF2α), were also measured. Linear mixed effect models assessed the association between exposures and oxidative stress adjusting for maternal age, smoking status, alcohol consumption, household income and specific gravity. Potential nonlinear trends were also assessed using tertiles of glyphosate and AMPA exposure levels., Results: No significant differences in exposure or oxidative stress biomarker concentrations were observed between study visits. An interquartile range (IQR) increase in AMPA was associated with 9.5% (95% CI: 0.5-19.3%) higher 8-iso-PGF2α metabolite concentrations. Significant linear trends were also identified when examining tertiles of exposure variables. Compared to the lowest exposure group, the second and third tertiles of AMPA were significantly associated with 12.8% (0.6-26.5%) and 15.2% (1.8-30.3%) higher 8-isoprostane metabolite, respectively. An IQR increase in glyphosate was suggestively associated with 4.7% (-0.9 to 10.7%) higher 8-iso-PGF2α., Conclusions: Urinary concentrations of the main environmental degradate of glyphosate, AMPA, were associated with higher levels of certain oxidative stress biomarkers. Associations with glyphosate reflected similar trends, although findings were not as strong. Additional research is required to better characterize the association between glyphosate exposure and biomarkers of oxidative stress, as well as potential downstream health consequences., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether racial and ethnic distributions of oocyte donors contributing to US oocyte banks differ from the demographics of US women and donor oocyte recipients., Design: Cross-sectional study., Setting: United States donor oocyte banks, US census, and fertility clinics reporting to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System., Patients: Oocyte donors from 12 banks, women aged 18-44 years based on the 2019 census, and US recipients of cryopreserved donor oocytes from 2012 to 2015., Intervention: None., Main Outcome Measure: Proportions of donors identifying as each racial and ethnic group., Results: Of the 1,574 oocyte donors, 678 (43.1%) identified as white compared with 54.8% of US women and 69.1% of donor oocyte recipients. Proportions of donors identifying as Hispanic or two or more races were larger than those of US women and donor oocyte recipients (Hispanic: 24.1% vs. 20.8%, and 24.1% vs. 8.8%, respectively; two or more races: 16.1% vs. 2.3%, and 16.1% vs. 0.5%, respectively). African American donors were underrepresented compared with US women (8.9% vs. 14.0%) and oocyte recipients (8.9% vs. 10.8%). Although the proportion of Asian donors was similar to that of US women (7.7% vs. 7.1%), Asian donors were underrepresented compared with donor oocyte recipients (7.7% vs. 10.6%)., Conclusion: Racial and ethnic distribution of oocyte donors differs significantly from the demographics of US women and cryopreserved donor oocyte recipients. These data suggest a need for targeted recruitment of African American and Asian oocyte donors., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate knowledge of age-related fertility decline and oocyte cryopreservation among resident physicians in obstetrics and gynecology (ob-gyn) compared to residents in other specialties., Methods: An online survey was sent to the US residency program directors for ob-gyn, internal medicine, emergency medicine, family medicine, general surgery, pediatrics, and psychiatry. They were asked to forward the survey to their respective residents. The survey consisted of three sections: fertility knowledge, oocyte cryopreservation knowledge, and attitudes toward family building and fertility preservation. Multivariable logistic regression models were used to compare outcomes between ob-gyn and non-ob-gyn residents., Results: Of the 2,828 completed surveys, 450 (15.9%) were by ob-gyn residents and 2,378 (84.1%) were by residents in other specialties. 66.3% of respondents were female. The median number of correct answers was 2 out of 5 on the fertility knowledge section and 1 out of 3 on the oocyte cryopreservation knowledge section among both ob-gyn and non-ob-gyn residents. After adjusting for covariates, residents in ob-gyn were no more likely to answer these questions correctly than residents in other specialties (fertility knowledge, adjusted OR .97, 95% CI .88-1.08; oocyte cryopreservation knowledge, adjusted OR 1.05, 95% CI .92-1.19). Ob-gyn residents were significantly more likely than non-ob-gyn residents to feel "somewhat supported" or "very supported" by their program to pursue family building goals (83.5% vs. 75.8%, OR 1.62, 95% CI 1.23-2.14)., Conclusions: Resident physicians, regardless of specialty, have limited knowledge of natural fertility decline and the opportunity to cryopreserve oocytes. These data suggest need for improved fertility education., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Objective: To examine the association between serum antimüllerian hormone (AMH) and live birth among women aged ≥41 years undergoing in vitro fertilization (IVF)., Design: Retrospective cohort study using the 2012-2014 Society for Assisted Reproductive Technology Clinic Outcome Reporting System database., Setting: Fertility clinics reporting to the Society for Assisted Reproductive Technology., Patients: The analysis included 7,819 patients aged ≥41 years who underwent a first fresh, autologous IVF cycle during the study period. Cycles with preimplantation genetic testing were excluded., Interventions: None., Main Outcome Measures: Live birth rate., Results: The empirical distribution of AMH was examined, and extreme values were observed. Therefore, the natural logarithm transformation of AMH (log-AMH) was used in all analyses. Before adjustment for covariates, a one-unit increase in log-AMH was associated with doubling of the odds of live birth up to a log-AMH of -0.34 (equivalently, AMH, 0.71 ng/mL; odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.46). Above an AMH level of 0.71 ng/mL, the odds of live birth increased by only 40% with each unit increase in log-AMH (OR, 1.40; 95% CI, 1.22-1.61). After adjusting for covariates, the odds of live birth increased by 91% with each unit increase in log-AMH up to -0.34 (AMH, 0.71 ng/mL; OR, 1.91; 95% CI, 1.56-2.34). Above an AMH level of 0.71 ng/mL, the odds of live birth increased by only 32% with each unit increase in log-AMH (OR, 1.32; 95% CI, 1.15-1.53)., Conclusions: Among women aged ≥41 years undergoing fresh, autologous IVF, the odds of live birth significantly increase with increasing serum AMH level. As the AMH level increases above 0.71 ng/mL, the association maintains statistical significance, but the effect size is diminished., (© 2021 The Authors.)

Exposures to phthalate compounds have been linked to adverse birth outcomes, potentially through oxidative stress mechanisms. We explored associations between mixtures of biomarkers of phthalate and phthalate replacement metabolites and oxidative stress using lipid peroxidation biomarker 8-iso-prostaglandin-F2α (8-iso-PGF2α). As 8-iso-PGF2α can be generated via both chemical (nonenzymatic) and enzymatic lipid peroxidation pathways, we calculated the ratio of 8-iso-PGF2α/prostaglandin F2α in an attempt to distinguish the potential contributions of the two pathways. Urinary biomarker measurements were taken from 775 pregnant women in the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) longitudinal birth cohort at up to three time points during gestation (16-20, 20-24, and 24-28 weeks gestation). Adaptive elastic net with pairwise linear interaction terms (adENET-I) was used to determine individual phthalate metabolites and phthalate interactions that were predictive of lipid oxidative stress biomarkers, and to subsequently create environmental risk scores (ERS) to represent weighted sums of phthalate exposure for each individual at each study visit. Repeated ERS were then used in linear mixed effects models to test for associations between biomarkers of phthalate mixtures and biomarkers of oxidative stress. We also used Bayesian kernel machine regression (BKMR) to explore nonlinearity and interactions between phthalate metabolites within the mixture. An increase from the first to fourth quartile of phthalate ERS derived from adENET-I was associated with a 96.7% increase (95% CI: 74.0, 122) in the hypothesized chemical fraction of 8-iso-PGF2α and a 268% increase (95% CI: 139, 465) in the hypothesized enzymatic fraction of 8-iso-PGF2α. BKMR analyses also suggested strong linear associations between the phthalate mixture and biomarkers of lipid oxidative stress. Various phthalates displayed nonlinear relationships with both chemical and enzymatic fractions of 8-iso-PGF2α, and we observed some evidence of interactions between metabolites in the mixture. In conclusion, exposure to phthalate mixtures was strongly associated with linear increases in biomarkers of lipid oxidative stress, and differences observed between hypothesized chemical and enzymatic lipid peroxidation outcomes highlight the need to critically assess pathways of 8-iso-PGF2α generation in relation to environmental exposures., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Tuberculosis (TB) is one of the deadliest infectious diseases in the world. The metabolic disease type 2 diabetes (T2D) significantly increases the risk of developing active TB. Effective new TB vaccine candidates and novel therapeutic interventions are required to meet the challenges of global TB eradication. Recent evidence suggests that the microbiota plays a significant role in how the host responds to infection, injury and neoplastic changes. Animal models that closely reflect human physiology are crucial in assessing new treatments and to decipher the underlying immunological defects responsible for increased TB susceptibility in comorbid patients. In this study, using a diet-induced murine T2D model that reflects the etiopathogenesis of clinical T2D and increased TB susceptibility, we investigated how the intestinal microbiota may impact the development of T2D, and how the gut microbial composition changes following a very low-dose aerosol infection with Mycobacterium tuberculosis ( Mtb ). Our data revealed a substantial intestinal microbiota dysbiosis in T2D mice compared to non-diabetic animals. The observed differences were comparable to previous clinical reports in TB patients, in which it was shown that Mtb infection causes rapid loss of microbial diversity. Furthermore, diversity index and principle component analyses demonstrated distinct clustering of Mtb -infected non-diabetic mice vs. Mtb -infected T2D mice. Our findings support a broad applicability of T2D mice as a tractable small animal model for studying distinct immune parameters, microbiota and the immune-metabolome of TB/T2D comorbidity. This model may also enable answers to be found to critical outstanding questions about targeted interventions of the gut microbiota and the gut-lung axis., Competing Interests: The authors declare no conflicts of interest., (© 2021 The Authors. Animal Models and Experimental Medicine published by John Wiley & Sons Australia, Ltd on behalf of The Chinese Association for Laboratory Animal Sciences.)

Objective: To compare the odds of a good perinatal outcome between cryopreserved and fresh donor oocytes., Methods: We used the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System to conduct a retrospective cohort study of women undergoing donor oocyte in vitro fertilization (IVF) from 2012 to 2015. Cycles using cryopreserved embryos, a gestational carrier, or preimplantation genetic testing were excluded. The primary outcome was a good perinatal outcome, defined as a singleton live birth at 37 weeks of gestation or more with birth weight at or within 2,500 g and 4,000 g. Secondary outcomes included live birth, multiple birth, and prematurity. Generalized estimating equation models were used to test the effect of oocyte type on the primary outcome while accounting for covariates and the correlation induced by repeated cycles within a patient., Results: Of the 36,925 cycles included in the analysis, 8,381 (22.7%) used cryopreserved and 28,544 (77.3%) used fresh oocytes. The odds of a good perinatal outcome were marginally but significantly lower with cryopreserved than with fresh oocytes before and after covariate adjustment (22.0% vs 24.1%, unadjusted odds ratio [OR] 0.90, 95% CI 0.85-0.96, adjusted OR 0.88, 95% CI 0.81-0.95). Compared with fresh oocytes, cryopreserved oocytes were associated with lower rates of live birth (39.6% vs 47.7%, OR 0.75, 95% CI 0.72-0.79), multiple birth (22.3% vs 31.2%, OR 0.63, 95% CI 0.58-0.69), and prematurity (27.6% vs 30.6%, OR 0.86, 95% CI 0.79-0.94)., Conclusion: This retrospective national study demonstrated that the use of cryopreserved compared with fresh donor oocytes in IVF cycles is associated with marginally lower odds of a good perinatal outcome.

Objective: We examined relationships between employee safety climate and patient safety culture. Because employee safety may be a precondition for the development of patient safety, we hypothesized that employee safety culture would be strongly and positively related to patient safety culture., Methods: An employee safety climate survey was administered in 2010 and assessed employees' views and experiences of safety for employees. The patient safety survey administered in 2011 assessed the safety culture for patients. We performed Pearson correlations and multiple regression analysis to examine the relationships between a composite measure of employee safety with subdimensions of patient safety culture. The regression models controlled for size, geographic characteristics, and teaching affiliation. Analyses were conducted at the group level using data from 132 medical centers., Results: Higher employee safety climate composite scores were positively associated with all 9 patient safety culture measures examined. Standardized multivariate regression coefficients ranged from 0.44 to 0.64., Conclusions: Medical facilities where staff have more positive perceptions of health care workplace safety climate tended to have more positive assessments of patient safety culture. This suggests that patient safety culture and employee safety climate could be mutually reinforcing, such that investments and improvements in one domain positively impacts the other. Further research is needed to better understand the nexus between health care employee and patient safety to generalize and act upon findings.

Embryoid bodies (EBs) can serve as a system for evaluating pluripotency, cellular differentiation, and tissue morphogenesis. In this study, we use EBs derived from mouse embryonic stem cells (mESCs) and human amniocyte-derived induced pluripotent stem cells (hAdiPSCs) as a model for ovarian granulosa cell (GC) development and steroidogenic cell commitment. We demonstrated that spontaneously differentiated murine EBs (mEBs) and human EBs (hEBs) displayed ovarian GC markers, such as aromatase (CYP19A1), FOXL2, AMHR2, FSHR, and GJA1. Comparative microarray analysis identified both shared and unique gene expression between mEBs and the maturing mouse ovary. Gene sets related to gonadogenesis, lipid metabolism, and ovarian development were significantly overrepresented in EBs. Of the 29 genes, 15 that were differentially regulated in steroidogenic mEBs displayed temporal expression changes between embryonic, postnatal, and mature ovarian tissues by polymerase chain reaction. Importantly, both mEBs and hEBs were capable of gonadotropin-responsive estradiol (E2) synthesis in vitro (217-759 pg/mL). Live fluorescence-activated cell sorting-sorted AMHR2 + granulosa-like cells from mEBs continued to produce E2 after purification (15.3 pg/mL) and secreted significantly more E2 than AMHR2 - cells (8.6 pg/mL, P < .05). We conclude that spontaneously differentiated EBs of both mESC and hAdiPSC origin can serve as a biologically relevant model for ovarian GC differentiation and steroidogenic cell commitment. These cells should be further investigated for therapeutic uses, such as stem cell-based hormone replacement therapy and in vitro maturation of oocytes.

Background: We investigated whether information in ClinicalTrials.gov would impact the conclusions of five ongoing systematic reviews., Method: We considered five reviews that included 495 studies total. Each review team conducted a search of ClinicalTrials.gov up to the date of the review's last literature search, screened the records using the review's eligibility criteria, extracted information, and assessed risk of bias and applicability. Each team then evaluated the impact of the evidence found in ClinicalTrials.gov on the conclusions in the review., Results: Across the five reviews, the number of studies that had both a registry record and a publication varied widely, from none in one review to 43% of all studies identified in another. Among the studies with both a record and publication, there was also wide variability in the match between published outcomes and those listed in ClinicalTrials.gov. Of the 173 total ClinicalTrials.gov records identified across the five projects, between 11 and 43% did not have an associated publication. In the 14% of records that contained results, the new data provided in the ClinicalTrials.gov records did not change the results or conclusions of the reviews. Finally, a large number of published studies were not registered in ClinicalTrials.gov, but many of these were published before ClinicalTrials.gov's inception date of 2000., Conclusion: Improved prospective registration of trials and consistent reporting of results in ClinicalTrials.gov would help make ClinicalTrials.gov records more useful in finding unpublished information and identifying potential biases. In addition, consistent indexing in databases, such as MEDLINE, would allow for better matching of records and publications, leading to increased utility of these searches for systematic review projects.

Background: US healthcare organizations increasingly use physician satisfaction and attitudes as a key performance indicator. Further, many health care organizations also have an academically oriented mission. Physician involvement in research and teaching may lead to more positive workplace attitudes, with subsequent decreases in turnover and beneficial impact on patient care. This article aimed to understand the influence of time spent on academic activities and perceived quality of care in relation to job attitudes among internal medicine physicians in the Veterans Health Administration (VHA)., Methods: A cross-sectional survey was conducted with inpatient attending physicians from 36 Veterans Affairs Medical Centers. Participants were surveyed regarding demographics, practice settings, workplace staffing, perceived quality of care, and job attitudes. Job attitudes consisted of three measures: overall job satisfaction, intent to leave the organization, and burnout. Analysis used a two-level hierarchical model to account for the nesting of physicians within medical centers. The regression models included organizational-level characteristics: inpatient bed size, urban or rural location, hospital teaching affiliation, and performance-based compensation., Results: A total of 373 physicians provided useable survey responses. The majority (72%) of respondents reported some level of teaching involvement. Almost half (46%) of the sample reported some level of research involvement. Degree of research involvement was a significant predictor of favorable ratings on physician job satisfaction and intent to leave. Teaching involvement did not have a significant impact on outcomes. Perceived quality of care was the strongest predictor of physician job satisfaction and intent to leave. Perceived levels of adequate physician staffing was a significant contributor to all three job attitude measures., Conclusions: Expanding opportunities for physician involvement with research may lead to more positive work experiences, which could potentially reduce turnover and improve system performance.

Objective: To describe development and validation of the work-related well-being (WRWB) index., Methods: Principal components analysis was performed using Federal Employee Viewpoint Survey (FEVS) data (N = 392,752) to extract variables representing worker well-being constructs. Confirmatory factor analysis was performed to verify factor structure. To validate the WRWB index, we used multiple regression analysis to examine relationships with burnout associated outcomes., Results: Principal Components Analysis identified three positive psychology constructs: "Work Positivity", "Co-worker Relationships", and "Work Mastery". An 11 item index explaining 63.5% of variance was achieved. The structural equation model provided a very good fit to the data. Higher WRWB scores were positively associated with all three employee experience measures examined in regression models., Conclusions: The new WRWB index shows promise as a valid and widely accessible instrument to assess worker well-being.

Objective: To examine the prevalence of prematurity and low birth weight (LBW) among singletons conceived with intracytoplasmic sperm injection (ICSI) compared with those conceived with conventional in vitro fertilization (IVF)., Methods: Using the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System, we conducted a retrospective cohort study of women undergoing a first, fresh autologous ICSI or conventional IVF cycle from 2004 to 2013. Singleton live births were included in the analysis. Primary outcomes were preterm delivery and LBW. Secondary outcomes were very preterm delivery, preterm LBW, term LBW, and very LBW. Logistic regression models and propensity score matching were used to compare perinatal outcomes between ICSI and IVF cycles. Subset analyses were performed after stratification by sperm source, male factor infertility, and female prognosis., Results: Of the 90,401 cycles included in the analysis, ICSI was used in 60,719 (67.2%) and conventional IVF was used in 29,682 (32.8%). After propensity score matching and covariate adjustment, the two groups had similar odds of preterm delivery (adjusted odds ratio [OR] 1.02, 95% CI 0.89-1.18) and LBW (adjusted OR 0.92, 95% CI 0.78-1.10). Using the matched data set, subset analyses demonstrated no significant association between the method of fertilization and the examined perinatal outcomes., Conclusion: Rates of preterm delivery and LBW were similar between pregnancies conceived with ICSI and conventional IVF after propensity score matching and stratifying by baseline patient characteristics. Previously reported differences in these outcomes were likely secondary to patients' inherent risk factors rather than the fertilization procedure itself.

Background: Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM)., Aims: To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training., Methods: Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed., Results: 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers., Conclusions: The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners., (Published by Oxford University Press on behalf of The Society of Occupational Medicine 2017.)

OBJECTIVE To identify predictors of influenza vaccine acceptance among VHA healthcare workers (HCWs), with emphasis on modifiable factors related to promotion campaigns. DESIGN Survey. SETTING National single-payer healthcare system with 140 hospitals and 321,000 HCWs. PARTICIPANTS National voluntary sample of HCWs in the Veterans Health Administration (VHA) system. METHODS We invited a random sample of 5% of all VHA HCWs to participate. An 18-item intranet-based survey inquired about occupation, vaccination status, employer policy, and local campaign efforts. RESULTS The response rate was 17.4%. Of 2,502 initial respondents, 2,406 (96.2%) provided usable data. This sample includes respondents from all 140 VA hospitals. Self-reported influenza vaccination rates were highest among physicians (95.6%) and licensed independent providers (88.3%). Nonclinical staff (80.7%) reported vaccine uptake similar to other certified but nonlicensed providers (81.2%). The strongest predictor of vaccine acceptance among VHA HCWs was individual awareness of organizational policy. Vaccine acceptance was also higher among HCWs who reported more options for access to vaccination and among those in facilities with more education activities. CONCLUSIONS Influenza vaccine acceptance varied significantly by employee awareness of employer policy and on-site access to vaccine. Employer-sponsored activities to increase access continue to show positive returns across occupations. Local influenza campaign efforts to educate HCWs may have reached saturation in this target group. These results suggest that focused communications to increase HCW awareness and understanding of employer policy can drive further increase in influenza vaccination acceptance. Infect Control Hosp Epidemiol 2017;38:970-975.

Objective: To examine the association between state-mandated insurance coverage for in vitro fertilization (IVF) and the incidence of multiple birth while controlling for differences in baseline patient characteristics., Methods: We conducted a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System from 2007 to 2011 to examine the association between state-mandated insurance coverage for IVF and the incidence of multiple birth while controlling for differences in baseline patient characteristics. Analyses were stratified according to patient age and day of embryo transfer (3 or 5)., Results: Of the 173,968 cycles included in the analysis, 45,011 (25.9%) were performed in mandated states and 128,957 (74.1%) in nonmandated states. The multiple birth rate was significantly lower in mandated states (29.0% compared with 32.8%, adjusted odds ratio [OR] 0.87, 99.95% confidence interval [CI] 0.80-0.94). After stratification, this association remained statistically significant only in women younger than 35 years old who underwent transfer on day 5 (33.1% compared with 38.6%, adjusted OR 0.81, 99.95% CI 0.71-0.92). Among women younger than 35 years with day 5 transfer, the elective single embryo transfer rate was significantly higher in mandated states (21.8% compared with 13.1%, adjusted OR 2.36, 99.95% CI 2.09-2.67)., Conclusion: State-mandated insurance coverage for IVF is associated with decreased odds of multiple birth. This relationship is driven by increased use of elective single embryo transfer among young women undergoing day 5 transfer.

Objective: To examine the association between first-trimester bleeding and live-birth rates in twin pregnancies conceived with in vitro fertilization (IVF)., Design: Retrospective cohort study., Setting: Academic infertility practice., Patient(s): Women with two gestational sacs on first-trimester ultrasound after transfer of fresh embryos derived from autologous oocytes between January 1, 1999, and December 31, 2010., Intervention(s): None., Main Outcome Measure(s): Live-birth rate., Result(s): Sixty-five women reported vaginal bleeding, and 288 did not. The baseline characteristics were similar between the two groups, except for an increased prevalence of subchorionic hematoma in women with first-trimester vaginal bleeding (26.2% vs. 1.7%). Live-birth rates were similar between women with bleeding and those with no bleeding (87.7% vs. 91.7%, adjusted odds ratio [OR] 0.73; 95% confidence interval [CI], 0.31-1.73). Two hundred eighty-eight women gave birth to live twins. Among the women who delivered twins, those with first-trimester bleeding had an increased risk of low birth weight of at least one twin (75.0% vs. 59.7%). The association between bleeding and low birth weight persisted after controlling for possible confounders with logistic regression (adjusted OR 2.33, 95% CI, 1.14-4.74)., Conclusion(s): Live-birth rates are high in IVF twin gestations, regardless of the presence of first-trimester bleeding. Among women giving birth to IVF twins, however, first-trimester bleeding is associated with increased odds of low birth weight., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The study examined organizational culture, structural supports, and employee health program integration influence on registered nurse (RN) outcomes., Methods: An organizational health survey, employee health clinical operations survey, employee attitudes survey, and administration data were collected. Multivariate regression models examined outcomes of sick leave, leave without pay, voluntary turnover, intention to leave, and organizational culture using 122 medical centers., Results: Lower staffing ratios were associated with greater sick leave, higher turnover, and intention to leave. Safety climate was favorably associated with each of the five outcomes. Both onsite employee occupational health services and a robust health promotion program were associated with more positive organizational culture perceptions., Conclusions: Findings highlight the positive influence of integrating employee health and health promotion services on organizational health outcomes. Attention to promoting employee health may benefit organizations in multiple, synergistic ways.

Here, for the first time, the expression of estrogen receptor beta (ERβ) is characterized in the brains of the highly prosocial prairie vole (Microtus ochrogaster). ERβ immunoreactivity was compared in weanlings (postnatal Day 21) and adult males and females. The results indicate several major findings. First, unlike ERα, ERβ expression is not sexually dimorphic. Second, the adult pattern of ERβ-IR is established at the time of weaning, as there were no age-dependent effects on distribution. Finally, ERβ does not appear to be as widely distributed in voles compared with rats and mice. High levels of ERβ-IR were observed in several regions/nuclei within the medial pre-optic area, ventrolateral pre-optic nuclei, and in the hypothalamus, especially in the paraventricular and supraoptic nuclei. The visualization of ERβ in prairie voles is important as the socially monogamous prairie vole functions as a human relevant model system for studying the expression of social behavior and social deficit disorders. Future studies will now be able to determine the effect of treatments on the expression and/or development of ERβ in this highly social species., (© 2015 Wiley Periodicals, Inc.)

Objective: To examine the effect of body mass index (BMI) on IVF outcomes in fresh autologous cycles., Design: Retrospective cohort study., Setting: Not applicable., Patient(s): A total of 239,127 fresh IVF cycles from the 2008-2010 Society for Assisted Reproductive Technology registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal BMI (18.5-24.9 kg/m(2)) were used as the reference group (REF). Subanalyses were performed on cycles reporting purely polycystic ovary syndrome (PCOS)-related infertility and those with purely male-factor infertility (34,137 and 89,354 cycles, respectively)., Intervention(s): None., Main Outcome Measure(s): Implantation rate, clinical pregnancy rate, pregnancy loss rate, and live birth rate., Result(s): Success rates and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for all pregnancy outcomes were most favorable in cohorts with low and normal BMIs and progressively worsened as BMI increased. Obesity also had a negative impact on IVF outcomes in cycles performed for PCOS and male-factor infertility, although it did not always reach statistical significance., Conclusion(s): Success rates in fresh autologous cycles, including those done for specifically PCOS or male-factor infertility, are highest in those with low and normal BMIs. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMIs. More research is needed to determine the causes and extent of the influence of BMI on IVF success rates in other patient populations., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Genetic studies of intellectual disability and identification of monogenic causes of obesity in humans have made immense contribution toward the understanding of the brain and control of body mass. The leptin > melanocortin > SIM1 pathway is dysregulated in multiple monogenic human obesity syndromes but its downstream targets are still unknown. In ten individuals from six families, with overlapping 6q16.1 deletions, we describe a disorder of variable developmental delay, intellectual disability, and susceptibility to obesity and hyperphagia. The 6q16.1 deletions segregated with the phenotype in multiplex families and were shown to be de novo in four families, and there was dramatic phenotypic overlap among affected individuals who were independently ascertained without bias from clinical features. Analysis of the deletions revealed a ∼350 kb critical region on chromosome 6q16.1 that encompasses a gene for proneuronal transcription factor POU3F2, which is important for hypothalamic development and function. Using morpholino and mutant zebrafish models, we show that POU3F2 lies downstream of SIM1 and controls oxytocin expression in the hypothalamic neuroendocrine preoptic area. We show that this finding is consistent with the expression patterns of POU3F2 and related genes in the human brain. Our work helps to further delineate the neuro-endocrine control of energy balance/body mass and demonstrates that this molecular pathway is conserved across multiple species., (Copyright © 2016 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the effect of recipient body mass index (BMI) on IVF outcomes in fresh donor oocyte cycles., Design: Retrospective cohort study., Setting: Not applicable., Patient(s): A total of 22,317 donor oocyte cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal recipient BMI (18.5-24.9) were used as the reference group., Intervention(s): None., Main Outcome Measure(s): Implantation rate, clinical pregnancy rate (PR), pregnancy loss rate, live birth rate., Result(s): Success rates and adjusted odds ratios with 95% confidence intervals for all pregnancy outcomes were most favorable in cohorts of recipients with low and normal BMI, but progressively worsened as BMI increased., Conclusion(s): Success rates in recipient cycles are highest in those with low and normal BMI. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMI with respect to clinical pregnancy and live birth rate., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To study the impact of controlled ovarian stimulation on ectopic pregnancy (EP) rate as a function of the number of oocytes retrieved, using donor IVF cycles as a control., Design: Retrospective cohort study using a large national database., Setting: Not applicable., Patient(s): Data from 109,140 cycles from the 2008-2010 SART registry, including 91,504 autologous cycles and 17,636 donor cycles in patients with non-tubal infertility., Intervention(s): Varying amounts of oocytes retrieved in autologous and donor IVF., Main Outcome Measure(s): Ectopic pregnancy rates., Result(s): In autologous cycles, the EP rate significantly increased as oocyte yield increased. This association was not found in oocyte recipients., Conclusion(s): In autologous IVF cycles, increasing oocyte yield is correlated with a significantly increased EP rate. This association is not found in oocyte recipients, indicating that the increased EP rate may be due to the supraphysiologic hormone levels achieved with controlled ovarian hyperstimulation., (Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The study examined the relationship between onsite occupational health practice characteristics, provider choice, and workers' compensation outcome metrics., Methods: Cross-sectional survey of 140 medical center occupational health clinics within the Department of Veterans Affairs. Multivariate regression models examined how specific clinical quality factors influenced provider choice and workers' compensation measures., Results: Several practice characteristics were associated with higher rates of in-house care selection-longer hours of operation, greater availability of workers' compensation-related medical services, clinic administration by a board certified physician, physician tenure, and adherence to clinical practice guidelines. Access to onsite, occupational and environmental medicine certified physician-directed care was associated with reductions in disability duration among injured healthcare workers., Conclusions: These findings suggest that occupational medicine board certification can positively impact provider choice among fully insured patients, which may have implications for other healthcare systems.

Objective: Occupational and environmental medicine (OEM) physician specialty practices continue to grow in scope and intensity across the Veterans Health Administration. This study characterizes the implementation of a novel, nationwide telemedicine program that provides OEM specialty consultation to providers across the Veterans Health Administration., Methods: We examined provider requests and specialist responses for a 6-month pilot from May to October 2013. Characteristics of consult users, determinants of case complexity, and specific applications of OEM specialty expertise were identified., Results: Over a 6-month period, employee occupational health providers consulted the OEM telemedicine pilot a total of 65 times. Employee occupational health providers without formal training repeatedly identified complex cases related to work and disability., Conclusions: The program has created a new system management solution to deliver expert, in-depth consultation and real-time provider education in OEM.

Embryonic stem (ES) cells provide a potentially useful in vitro model for the study of in vivo tissue differentiation. We used mouse and human ES cells to investigate whether the lens regulatory genes Pax6 and Six3 could induce lens cell fate in vitro. To help assess the onset of lens differentiation, we derived a new mES cell line (Pax6-GFP mES) that expresses a GFP reporter under the control of the Pax6 P0 promoter and lens ectoderm enhancer. Pax6 or Six3 expression vectors were introduced into mES or hES cells by transfection or lentiviral infection and the differentiating ES cells analyzed for lens marker expression. Transfection of mES cells with Pax6 or Six3 but not with other genes induced the expression of lens cell markers and up-regulated GFP reporter expression in Pax6-GFP mES cells by 3 days post-transfection. By 7 days post-transfection, mES cell cultures exhibited a>10-fold increase over controls in the number of colonies expressing γA-crystallin, a lens fiber cell differentiation marker. RT-PCR and immunostaining revealed induction of additional lens epithelial or fiber cell differentiation markers including Foxe3, Prox1, α- and β-crystallins, and Tdrd7. Moreover, γA-crystallin- or Prox1-expressing lentoid bodies formed by 30 days in culture. In hES cells, Pax6 or Six3 lentiviral vectors also induced lens marker expression. mES cells that express lens markers reside close to but are distinct from the Pax6 or Six3 transduced cells, suggesting that the latter induce nearby undifferentiated ES cells to adopt a lens fate by non-cell autonomous mechanisms. In sum, we describe a novel mES cell GFP reporter line that is useful for monitoring induction of lens fate, and demonstrate that Pax6 or Six3 is sufficient to induce ES cells to adopt a lens fate, potentially via non-cell autonomous mechanisms. These findings should facilitate investigations of lens development.