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Abstract Background High levels of maternal morbidity and mortality persist in low- and middle-income countries, despite increases in coverage of facility delivery and skilled assistance at delivery. We compared levels of facility birth to a summary delivery care measure and quantified gaps. Methods We approximated a delivery care score from type of delivery (home, lower-level facility, or hospital), skilled attendant at delivery, a stay of 24-or-more-hours after delivery, and a health check within 48-h after delivery. Data were obtained from 333,316 women aged 15–49 who had a live birth in the previous 2 years, and from 71 countries with nationally representative surveys between 2013 and 2020. We computed facility delivery and delivery care coverage estimates to assess the gap. We stratified the analysis by country characteristics, including the national maternal mortality ratio (MMR), to assess the size of coverage gaps, and we assessed missed opportunities through coverage cascades. We looked at the association between MMR and delivery care coverage. Results Delivery care coverage varied by country, ranging from 24% in Sudan to 100% in Cuba. Median coverage was 70% with an interquartile range of 30 percentage points (55% and 85%). The cascade showed that while 76% of women delivered in a facility, only 41% received all four interventions. Coverage gaps exist across all MMR levels. Gaps between highest and lowest wealth quintiles were greatest in countries with MMR levels of 100 or higher, and the gap narrowed in countries with MMR levels below 100. The delivery care indicator had a negative association with MMR. Conclusions In addition to providing high-quality evidenced-based care to women during birth and the postpartum period, there is also a need to address gaps in delivery care, which occur within and between countries, wealth quintiles, and MMR phases.

Abstract Background As U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state. Methods We included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state. Results Of 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state. Conclusions In evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.

Introduction: Infants are at a higher risk of severe illness with COVID-19 infection compared to older children. While COVID-19 vaccination is not recommended for young infants, they can acquire maternally-derived anti-SARS-CoV-2 antibodies passively through the placenta and breastmilk. We described the persistence of infection-induced maternal antibodies in infant circulation at 9–12 months of age. Methodology: This was a cross-sectional study nested within the INTERCOVID multinational cohort study. For each COVID positive pregnant woman, two unmatched consecutive COVID negative pregnant women were enrolled between April and September 2020. Women with a positive PCR test, radiographic signs consistent with COVID-19, or at least 2 predefined symptoms of COVID-19 were considered as COVID positive. For this nested cross-sectional study, all COVID positive and either one of the COVID negative participants recruited from the Aga Khan University, Pakistan were approached 9–12 months after delivery, and maternal and infant sera were collected for antibody detection. Results: Altogether, 83 mothers provided consent, of whom 32 (38.6 %) were COVID positive and 51 (61.4 %) were COVID negative during pregnancy. Anti-SARS-CoV-2 antibodies were present in 13 (41 %) infants born to COVID positive and 19 (39 %) infants born to COVID negative mothers (p = 0.87). The presence of reactive antibodies in infants at follow-up was associated with maternal antibodies at follow-up (OR:9.50, 95 % CI:2.03–44.42; p = 0.004). COVID infection occurred in 3 (6 %) infants born to COVID negative mothers while no infant born to a COVID positive mother had a history of infection (p = 0.27). Conclusion: The presence of reactive anti-SARS-CoV-2 antibodies in infants at 9–12 months of age is associated with maternal seropositivity 9–12 months after delivery rather than maternal infection during pregnancy. Further studies are required to validate these findings and assess whether passive immunity in infants is protective against COVID-19 infection.

The Fraser Health Authority (FHA) has established a framework of commitments to guide a range of issues from incorporating diversity, equity, and inclusion in clinical and policy decisions and responding to the historical and continuing discrimination against First Nations, Métis, and Inuit peoples, to creating psychologically safe environments, and dealing with harassment, bullying and other disrespectful behaviours. FHA Ethics Services hosted a workshop as part of the 2023 Canadian Bioethics Society-Société canadienne de bioéthique (CBS-SCB) Workshop and Community Forum to create an opportunity for critical reflection and discuss strategic responses for the organization to live up to these commitments. This paper summarizes the workshop and identifies key insights and issues that emerged as areas that should be addressed in responding to diversity and inequality in the health system.

Background: Acne, or acne vulgaris, a chronic inflammatory disorder of the pilosebaceous unit of the skin, can severely affect an individual’s social and psychological functioning, progressing into psychiatric morbidity including anxiety, depression, and decreased self-esteem. The objective of this study was to determine the frequency of Anxiety, Depression and Low Self-esteem in patients with Acne Vulgaris visiting dermatology clinics at tertiary care hospitals in Karachi. Methods: This cross-sectional study was conducted on 215 patients with acne vulgaris of both genders, > 13 years recruited from Dermatology clinics at two tertiary care hospitals in Karachi, from July 2011-February 2012. Anxiety, depression and self-esteem were evaluated using, Anxiety and Depression Scale (HADS) and Rosenberg self-esteem scale (RSES). The severity of acne was assessed by three grades (Mild, Moderate and Severe) according to American academy of dermatology. Data was analyzed using SPSS and a p-value of < 0.05 was considered statistically significant. Results: Out of 215 patients (113 males, 102 females), 107 participants were from private hospital and 108 from public hospital. Patients with mild, moderate and severe acne were 41.4%, 42.8% and 15.8% respectively. Similarly, anxious, depressed and low self-esteem was found 67%, 40% and 69.3% respectively. Most acne patients were young adults (61.4%) between 19-24 years, followed by adolescents (20.9%). between 13-18 years of age. Conclusion: Overall the patients with moderate acne were found with highest anxiety, depression and low self-esteem, but the results were not significant. The physicians should treat acne with early intervention and holistic management. Keywords: Acne Vulgaris; Depression; Anxiety.

Greater transcultural and transdisciplinary engagement within Muslim contexts and deliberate inclusion of diverse Muslim voices in the development of international guidelines is required to improve understanding of the state of stem cell science, strengthen thinking about attendant ethical complexities, enhance compliance, deepen public deliberation, increase trust, and strengthen practice standards.

Objective: This study investigates the effects of a behavioral lifestyle intervention on inflammatory cytokines and frailty in older adults (≥ 65 years) with type 2 diabetes (T2D). Method: We conducted a single-arm, 6-month intervention supplemented with diet and activity self-monitoring technology. We assessed frailty using Fried criteria and quantified inflammatory cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating-factor [GM-CSF], interferon [IFN-γ], tumor necrosis factor [TNF-α]) using a multiplex assay. We used paired t-tests with significance at P

Objective: To evaluate the impact of a quality improvement (QI) initiative, which included a Fluconazole prophylaxis protocol and provider education on neonatal Candidiasis. Study Design: Retrospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit (NICU), Aga Khan University, Karachi Pakistan, from Apr 2015 to Dec 2019. Methodology: All extremely low birth weight neonates (ELBW) neonates admitted to the NICU between April 2015 and March 2017 were included in the pre-implementation phase. All ELBW neonates admitted between April 2017 and December 2019 were included in the post-implementation phase. Data were collected from medical records. The primary outcome was the frequency of Invasive Candidiasis (IC) before and after the QI initiative. Results: Altogether, 272 neonates were included in the study, with 115 neonates in the Pre-Implementation Group and 157 neonates in the Post-Implementation Group. The frequency of IC was 6(5.2%) in the pre-implementation and 1(0.6%) in the post-implementation period, (p=0.044). Candida parapsilosis 2(40%) and Candida glabrata 2(40%) were the organisms most commonly isolated from blood cultures. All organisms were sensitive to Fluconazole in both the pre-and post-implementation cohorts. There was no difference in mortality (54(50.5%) vs. 69(44.2%), p=0.32) or length of stay (19.6±13.3 vs. 23.4±18.4 days,p=0.061) before and after Fluconazole prophylaxis. Conclusion: The frequency of invasive Candidiasis in ELBW neonates was successfully reduced by introducing a Fluconazole prophylaxis protocol in the NICU as a QI initiative. A team-based approach and provider education ensured high compliance.

Objective: To analyze the functional outcome of cases with Pott’s disease treated solely by antitubercular drugs. Methods: This observational study was conducted at the Department of Orthopedics of a tertiary care medical college. Sixty patients with Pott’s disease were included in this study based on predefined inclusion and exclusion criteria. All patients received antitubercular drugs for nine months. The Modified McCormick Scale (MSS) was used to assess the outcome of patients. Results: Out of 60 patients, 37 (61.67%) were females, and 23 (38.33%) were males, with an M: F ratio of 1:0.62. Most patients had some or the other risk factors and belonged to low socioeconomic status. The most common presenting complaint was low back pain, and the thoracolumbar spine was most commonly involved. There was a significant improvement in the patient’s functional status as assessed by the MSS score. Conclusion: If diagnosed early, patients with Pott’s disease can be treated solely by antitubercular treatment with excellent outcomes.

CPVT is a rare inherited arrhythmogenic disorder characterized by bidirectional, polymorphic ventricular arrhythmias triggered by catecholamines released during exercise, stress, or sudden emotion in individuals with a normal resting electrocardiogram and structurally normal heart. Mutations in the ryanodine receptor 2 gene are the most common known etiology of this disorder. The c.1195A > G(p.Met399Val) variant in Exon 14 of RyR2 is currently classified as a Variant of Uncertain Significance. We present a case of CPVT caused by this novel disease-causing RyR2 variant and discuss its pathophysiology. The role of SSRIs in treating patients with CPVT unresponsive to mainstream therapies is also highlighted.

Background: Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. While extensive research exists on illness perceptions, less is known about illness perceptions of multimorbidity. Methods: The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n = 17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n = 116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics. Results: Overall, participants were mostly female (71 %), self-reported as Hispanic (35 %), Black (33 %), White (27 %), or Asian (5 %). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants’ socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions. Conclusions: Participants prioritized the impact of multimorbidity on their wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused approaches, addressing the holistic needs of older adults with multimorbidity.

BackgroundFatigue is a strong predictor of negative health outcomes in older adults. Kynurenine, a metabolite of tryptophan, is strongly associated with fatigue. Reductions in fatigue are observed with exercise; however, exercise training does not completely alleviate symptoms. Branched-chain amino acids (BCAAs) have been shown to have advantageous effects on exercise performance and compete with kynurenine for transport into the central nervous system. Thus, the combination of BCAA and exercise may exert synergized effects of mental and physical fatigue. Therefore, we hypothesize that BCAA added to exercise will shift kynurenine metabolism toward enhanced synthesis of kynurenic acid, thereby reducing fatigue. ObjectiveThis randomized, double-blind, placebo-controlled trial aims to compare the effects of acute (approximately 45 min) and chronic (8 wk) exercise with and without BCAA supplementation on mental and physical fatigue and assess whether the hypothesized outcomes are modulated by changes in kynurenine metabolism in 30 older adults (n=15, 50% per group). MethodsOlder adults (aged 60-80 y) who do not exercise >2 days per week and self-report fatigue (≥3 on a scale of 1-10) will be recruited. Participants will be randomized to either the exercise+BCAA group or exercise+placebo group. Participants will engage in high-volume, moderate-intensity, whole-body exercise training (aerobic and resistance exercise; either in-person or web-based sessions) 3 times per week for 8 weeks. In addition, participants will consume daily either 100 mg/kg body weight of BCAA (2:1:1 leucine:isoleucine:valine) or placebo (maltodextrin) throughout the 8-week intervention. BCAA and placebo powders will be identical in color and dissolved in 400 mL of water and 2.5 g of a calorie-free water flavor enhancer. Muscle biopsies will be collected before and after the intervention after a 12-hour fast to examine changes in the biomarkers of tryptophan metabolism and inflammation. Our primary outcomes include changes in mental and physical fatigue and metabolism after the 8-week exercise training between the 2 groups. Mental and physical fatigue will be measured before and after the intervention. Mental fatigue will be subjectively assessed through the completion of validated questionnaires. Physical fatigue will be measured by isometric handgrip, 1-repetition maximum, chair rise, 400-meter walk, and cardiopulmonary exercise tests. ResultsThe study was funded in March 2022, with an anticipated projected data collection period lasting from January 2023 through December 2023. ConclusionsThe discovery that kynurenine concentrations are associated with fatigue and are responsive to BCAA supplementation during exercise training could have important implications for the development of future interventions, both lifestyle and pharmacologic, to treat fatigue in older adults. Trial RegistrationClinicalTrials.gov NCT05484661; https://www.clinicaltrials.gov/study/NCT05484661 International Registered Report Identifier (IRRID)DERR1-10.2196/52199

Abstract An improved version of quantitative protein array platform utilizing linear Quantum dot signaling for systematically measuring protein levels and phosphorylation states is presented. The signals are amplified linearly by a confocal laser Quantum dot scanner resulting in ~1000-fold more sensitivity than traditional Western blots, but are not linear by the enzyme-based amplification. Software is developed to facilitate the quantitative readouts of signaling network activities. Kinetics of EGFRvIII mutant signaling was analyzed to quantify cross-talks between EGFR and other signaling pathways.

Abstract Digital interventions have the potential to alleviate mental health disparities for marginalized and minoritized communities. The current study examined whether disparities in access and utilization of meditation in the United States (US) were reduced for a freely available meditation app. We analyzed demographic and usage data from US-based users of the Healthy Minds Program (HMP; N = 66,482) between October 2019 and July 2022. College education was associated with a greater likelihood of accessing (65.0% of users vs. 32.9% of the US population) and continuing to utilize the app (β = 0.11–0.17). Conversely, identifying as African American was associated lower likelihood of accessing (5.3% vs. 13.4% of the US population) and continuing to utilize the app (β = −0.02–0.03). African Americans were more likely to access content from an African American meditation teacher, but this did not appear to increase utilization. Additional efforts are warranted to identify factors that might reduce disparities.