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INTRODUCTION: Differences in healthcare utilization and medical expenditures associated with perinatal depression are estimated. METHODS: Using the MarketScan Multi-State Medicaid Database, the analytic cohort included individuals aged 15–44 years who had an inpatient live birth delivery hospitalization between January 1, 2017 and December 31, 2018. Multivariable negative binomial regression models were used to estimate the differences in utilization associated with perinatal depression, and multivariable generalized linear models were used to estimate the differences in expenditures associated with perinatal depression. Analyses were conducted in 2021. RESULTS: The cohort included 330,593 individuals. Nearly 17% had perinatal depression. Compared with individuals without perinatal depression individuals with perinatal depression had a larger number of inpatient admissions (0.19, 95% CI=0.18, 0.20), total inpatient days (0.95, 95% CI=0.92, 0.97), outpatient visits (14.02, 95% CI=13.81, 14.22), emergency department visits (1.70, 95% CI=1.66, 1.74), and weeks of drug therapy covered by a prescription (28.70, 95% CI=28.12, 29.28) and larger total expenditures ($5,078, 95% CI=$4,816, $5,340). Non-Hispanic Black individuals had larger differences in utilization and expenditures for inpatient services and outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. Hispanic individuals had larger differences in utilization for outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. CONCLUSIONS: Individuals with perinatal depression had more healthcare utilization and medical expenditures than individuals without perinatal depression, and differences varied by race/ethnicity. The findings highlight the need to ensure comprehensive and equitable mental health care to address perinatal depression.

To describe clinician screening practices for prior hypertensive disorders of pregnancy, knowledge of future risks associated with hypertensive disorders of pregnancy, barriers and facilitators to referrals for cardiovascular disease risk evaluation in women with prior hypertensive disorders of pregnancy, and variation by clinician- and practice-level characteristics.We used data from Fall DocStyles 2020, a cross-sectional, web-based panel survey of currently practicing U.S. clinicians. Of 2,231 primary care physicians, obstetrician-gynecologists (ob-gyns), nurse practitioners, and physician assistants invited to participate, 67.3% (n=1,502) completed the survey. We calculated the prevalence of screening, knowledge of future risks, and barriers and facilitators to referrals, and assessed differences by clinician type using χ2 tests. We evaluated associations between clinician- and practice-level characteristics and not screening using a multivariable log-binomial model.Overall, 73.6% of clinicians screened patients for a history of hypertensive disorders of pregnancy; ob-gyns reported the highest rate of screening (94.8%). Overall, 24.8% of clinicians correctly identified all cardiovascular risks associated with hypertensive disorders of pregnancy listed in the survey. Lack of patient follow-through (51.5%) and patient refusal (33.6%) were the most frequently cited barriers to referral. More referral options (42.9%), patient education materials (36.2%), and professional guidelines (34.1%) were the most frequently cited resources needed to facilitate referrals. In the multivariable model, primary care physicians and nurse practitioners, as well as physician assistants, were more likely than ob-gyns to report not screening (adjusted prevalence ratio 5.54, 95% CI 3.24-9.50, and adjusted prevalence ratio 7.42, 95% CI 4.27-12.88, respectively). Clinicians seeing fewer than 80 patients per week (adjusted prevalence ratio 1.81, 95% CI 1.43-2.28) were more likely to not screen relative to those seeing 110 or more patients per week.Three quarters of clinicians reported screening for a history of hypertensive disorders of pregnancy; however, only one out of four clinicians correctly identified all of the cardiovascular risks associated with hypertensive disorders of pregnancy listed in the survey.

A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatric ophthalmology clinic for routine follow-up. He was found to have a stable sensorimotor examination however dilated funduscopic examination of the right eye was significant for a dim foveal reflex with a new discrete, white, elevated retinal lesion superotemporal to the fovea with surrounding subretinal exudates. An examination under anesthesia (EUA) was performed two days later that revealed a subretinal posterior pole granuloma with hyperfluorescence and late leakage from the lesion without telangiectatic vessels on fluorescein angiography. A repeat EUA one month later demonstrated an increase in surrounding subretinal and overlying intraretinal fluid. The patient was started on topical 1% prednisolone with a presumed diagnosis of Toxocara granuloma. At EUA, three months later, the subretinal and intraretinal fluid had resolved. The topical steroids were tapered, and the patient continues to be followed closely.

In this study, hospital discharge data from the 2016–2017 Healthcare Cost and Utilization Project were analyzed to describe national and, where data were available, state-specific prevalences of chronic hypertension and pregnancy-associated hypertension at delivery hospitalization. In 2016–2017, the prevalence of chronic hypertension was 216 per 10,000 delivery hospitalizations nationwide, ranging from 125 to 400 per 10,000 delivery hospitalizations in individual states. The prevalence of pregnancy-associated hypertension was 1021 per 10,000 delivery hospitalizations nationwide, ranging from 693 to 1382 per 10,000 delivery hospitalizations in individual states. The burden of hypertensive disorders in pregnancy remains high and varies considerably by jurisdiction.

Purpose This article is the second in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. The purpose of this article was to apply and explore the validity of newly developed Transtheoretical measures for adolescents who stutter. Method The online survey was completed by a national sample of 173 adolescents who stutter between the ages of 13 and 21 years. The multipart survey included a Stage of Change scale, Decisional Balance scale, and Situational Self-Efficacy scale. Participants also completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES), either the teenage or adult version depending on the participant's age, so preliminary construct validity of the new scales could be examined. Exploratory factor analyses were conducted to determine model fit and reduce the scales to the most meaningful items. External validity of the three-part survey was examined by comparing OASES scores across stage of change as well as evaluating the functional relations between the three scales. Results Adolescents' readiness to manage stuttering could be clearly described with five discrete stages, although most of the respondents reported being in the Maintenance stage. The pros of managing stuttering reliably predicted stage placement. Internal consistency of the scales ranged from good to excellent. OASES scores differed across stages of readiness in complex but predictable ways. Conclusions These findings suggest that the Transtheoretical Model fits the target behaviors involved stuttering management among adolescents. Further examination of the application of the model to validate a stage-based framework for change among individuals who stutter is warranted.

Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used ...

Objectives: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August–October 2021. Methods: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. Results: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non–food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. Conclusions: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.

Interprofessional education (IPE) has been promoted as one way to prepare healthcare students for interprofessional encounters they might experience in the workplace. However, the link between IPE, interprofessional care in the workforce, and better patient outcomes is tenuous, perhaps in part due to the inability of IPE programs to adequately address barriers associated with interprofessional care (e.g., power differentials, role disputes). Empathy, or understanding the experiences of others, has emerged as a critical tool to breaking down barriers inherent to working in teams. Given the evidence connecting empathy to stronger team collaboration and better patient care, researchers significantly revamped programming from a prior training called Interprofessional Education for Complex Neurological Cases (IPE Neuro) to enhance empathy, foster stronger team collaboration, and improve information integration among participants. In this improved three-session program, participants from seven different professions were grouped into teams, assessed a patient volunteer with neurological disorder, and created and presented an integrated, patient-centric treatment plan. Students (N = 31) were asked to report general empathy levels, as well as attitudes, team skills, and readiness toward interprofessional care, before and after the program. We conducted paired samples t-tests and thematic analysis to analyze the data. Results showed that participants reported higher empathy levels, more positive attitudes, and greater team skills pre- to posttest with moderate to large effects. Results bolster IPE Neuro programming as one approach to prepare students for interprofessional care while underscoring the potential implications of IPE to improve empathy levels of healthcare professionals.

Introduction: Hypertension is a leading risk factor for cardiovascular disease in the US. Approximately one in ten to one in six women of reproductive age (WRA; aged 18-44 years) have hypertension. Control of hypertension through lifestyle behaviors and anti-hypertensive medication can prevent complications across the life course. Characterizing the current use of anti-hypertensive medication among WRA by urban/rural status offers opportunities to inform public health action. Methods: Data from 59,407 WRA responding to the 2019 Behavioral Risk Factor Surveillance System was used to determine hypertension prevalence from 49 states (New Jersey did not meet data collection standards), District of Columbia, Guam, and Puerto Rico. Among the subset of 6,855 who self-reported hypertension, estimates of current anti-hypertensive medication use were calculated. Prevalence ratios were used to estimate the association between urban/rural status and self-reported use of anti-hypertensive medications, adjusting for age, race/ethnicity, education, and insurance status. Results: The estimated hypertension prevalence among WRA was 10.7% (95%CI:10.3%-11.1%) with 14.0% (95%CI:12.7%-15.5%) in rural and 10.4% (95%CI:10.0%-10.9%) in urban counties. An estimated 45.1% (95%CI:43.1%-47.2%) of WRA with hypertension reported currently using anti-hypertensive medication with estimates of 57.1% (95%CI:51.9%-62.1%) in rural and 44.0% (95%CI:41.9%-46.2%) in urban counties. WRA with hypertension living in rural counties were 1.29 times (95%CI:1.17-1.41) more likely to report currently using anti-hypertensive medication compared to those living in urban counties. Conclusion: Less than half of WRA with hypertension were currently using anti-hypertensive medication. Living in rural counties was associated with a higher frequency of use of anti-hypertensive medication. Ensuring appropriate blood pressure control through engagement in healthy lifestyle behaviors and appropriate use of medication when needed in WRA can improve cardiovascular health and reduce disparities.

Background The COVID-19 pandemic has affected mental health and created barriers to healthcare. In this study, we sought to elucidate the pandemic's effects on mental health and access to care for perinatal individuals. Methods This cross-sectional study of individuals in Massachusetts who were pregnant or up to three months postpartum with a history of depressive symptoms examined associations between demographics and psychiatric symptoms (via validated mental health screening instruments) and the COVID-19 pandemic's effects on mental health and access to care. Chi-square associations and multivariate regression models were used. Results Of 163 participants, 80.8% perceived increased symptoms of depression and 88.8% of anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD at time of interview, higher education, and income were associated with increased symptoms of depression and anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD were also associated with perceived changes in access to mental healthcare. Compared to non-Hispanic White participants, participants of color (Black, Asian, Multiracial, and/or Hispanic/Latinx) were more likely to report that the pandemic changed their mental healthcare access (aOR:3.25, 95%CI:1.23, 8.59). Limitations Limitations included study generalizability, given that participants have a history of depressive symptoms, and cross-sectional design. Conclusions The pandemic has increased symptoms of perinatal depression and anxiety and impacted perceived access to care. Self-reported increases in depression and anxiety and changes to healthcare access varied by education, race/ethnicity, income, and positive screens. Understanding these differences is important to address perinatal mental health and provide equitable care.

Introduction: Tumor specific MHC class II (tsMHC-II) expression impacts tumor microenvironmental immunity. tsMHC-II positive cancer cells act as surrogate antigen presenting cells and targets for CD4+ T cell-mediated lysis. In colorectal cancer (CRC), tsMHC-II negativity is common and in cell lines is attributable to CIITA promoter methylation. To clarify mechanisms of tsMHC-II repression in CRC we analyzed CRC organoids which are epigenetically faithful to tissue of origin. Methods: 15 primary CRC organoids were treated with IFNγ +/- epigenetic modifiers. Flow cytometry was used to assess for tsMHC-II inducibility. RT-qPCR, total RNAseq, nanopore sequencing, bisulfite conversion/pyrosequencing and western blotting were used to quantitate CIITA, STAT1, IRF1 and JAK1 expression, gene structure and promoter methylation and ChIP-PCR to quantitate H3K9ac, H3K9Me2 and EZH2 occupancy at CIITA. Results: We define three types of tsMHC-II response to IFNγ in CRC: strong- (≥50%), delayed/weak- (11-49%) and non-inducibility (≤10%). 8/15 demonstrated strong expression, 4/15 delayed/weak: although it was possible to overcome this weak expression with prolonged IFNγ exposure in 3/15 without additional pharmacological treatment. In 1/15 organoid, expression was restricted even with prolonged exposure due to IFNγ-mediated EZH2 occupancy at CIITA: tsMHC-II expression was enhanced by EZH2 and HDAC inhibition. Non-inducibility is seen in 3 CMS1 organoids due to JAK1 mutation. These demonstrated low level (11%) JAK1 promoter methylation, but tsMHC-II inducibility was not rescued with DNMT inhibition. No organoid demonstrated CIITA promoter methylation, despite confirming the presence in previously described 2D cell lines, suggesting this is acquired through culture methods and not reflective of disease biology. Conclusion: We demonstrate using epigenetically appropriate models the individual variation in pharmacologic tractability of epigenetic modification in CRC. Providing IFNγ signaling is intact, most CRC organoids are class II inducible. Up-regulation of restricted tsMHC-II through targeted epigenetic therapy is seen in 1/15 organoid. These data may explain some of the disappointing results of immuno-epigenetic approaches in the clinic. Citation Format: Oliver J. Pickles, Kasun Wanigasooriya, Anetta Ptasinska, Akshay J. Patel, Helen L. Robbins, Claire Bryer, Celina M. Whalley, Louise Tee, Neeraj Lal, Maria Pinna, Nahla Elzefzafy, Phillipe Taniere, Andrew D. Beggs, Gary W. Middleton. Colorectal cancer displays three patterns of tumor-specific MHC-II inducibility and dynamics, with implications for combining epigenetic therapy with immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2989.

A patient presented with acute onset of double vision during the start of the COVID-19 pandemic when elective medical care was restricted. Initially declining an in-person evaluation, she was examined using a telehealth video visit, incorporating multiple technological modalities to ascertain ophthalmic examination elements. Her findings prompted emergent neuroimaging, revealing a giant internal carotid artery aneurysm, which was successfully embolized to prevent debilitating and possibly fatal intracranial haemorrhage. This case report illustrates the successful use of telemedicine and remote patient data acquisition to make a life-saving diagnosis.

The endocannabinoid system is a highly conserved and ubiquitous signalling pathway with broad-ranging effects. Despite critical pathway functions, gene variants have not previously been conclusively linked to human disease. We identified nine children from eight families with heterozygous, de novo truncating variants in the last exon of DAGLA with a neuro-ocular phenotype characterized by developmental delay, ataxia and complex oculomotor abnormality. All children displayed paroxysms of nystagmus or eye deviation accompanied by compensatory head posture and worsened incoordination most frequently after waking. RNA sequencing showed clear expression of the truncated transcript and no differences were found between mutant and wild-type DAGLA activity. Immunofluorescence staining of patient-derived fibroblasts and HEK cells expressing the mutant protein showed distinct perinuclear aggregation not detected in control samples. This report establishes truncating variants in the last DAGLA exon as the cause of a unique paediatric syndrome. Because enzymatic activity was preserved, the observed mislocalization of the truncated protein may account for the observed phenotype. Potential mechanisms include DAGLA haploinsufficiency at the plasma membrane or dominant negative effect. To our knowledge, this is the first report directly linking an endocannabinoid system component with human genetic disease and sets the stage for potential future therapeutic avenues.

The present study used an ecologically-valid approach to address the lack of understanding of similarities and differences in social network size and social interaction quality, and links to affect, among same- and different-gender couples. People in couples who self-identified as a woman with a woman ( n = 48), man with a man ( n = 40), woman with a man ( n = 33), and man with a woman ( n = 33) completed a single measure of social network size, and momentary assessments of social interaction quality and affect throughout their days over two weekends. Women reported lower interaction quality, less positive, and more negative affect (actor effects); similar results were also found for those who were partnered with a woman (partner effects). However, results showed an interaction of actor and partner gender, such that people in different-gender couples experienced lower interaction quality, less positive, and more negative affect than same-gender couples. Overall, results provide preliminary evidence of a honing framework, where people in same-gender couples hone their social networks down to high-quality interaction partners, more than people in different-gender couples, and experience similar links between social interactions and affect compared to people in different-gender couples.

Reappraisal is an effective emotion regulation strategy that draws on cognitive processes–like changing one’s thoughts to change one’s feelings–that are similar to those implicated in humor. Yet, very little is known about the links between the dispositional tendency to use reappraisal and individuals’ humor styles (e. g. aggressive, affiliative, self-deprecating, self-enhancing). Importantly, there are gender differences both in emotion regulatory processes and in the use of humor styles. We examined gender differences in reported use of humor styles, the associations between reappraisal and humor styles, and whether gender moderated those associations. Participants (N=250) were recruited through Amazon Mechanical Turk and self-reported their dispositional use of reappraisal and four humor styles. Men reported greater use of aggressive humor compared to women. Dispositional use of reappraisal was positively associated with self-enhancing humor. In addition, reappraisal use was positively related to greater use of affiliative humor, and this association was stronger for men than women. For men, greater use of reappraisal was associated with greater use of self-defeating humor, but reappraisal was negatively associated with self-defeating humor for women. Findings extend insight from prior work and suggest that both reappraisal and specific ways of using humor draw on aspects of self-regulatory competence rooted in cognitive change abilities, and the patterns of association differ in interesting ways for men and women.

This feasibility study employed a new approach to capturing pain disclosure in face-to-face and online interactions, using a newly developed tool. In Study 1, 13 rheumatoid arthritis and 52 breast cancer patients wore the Electronically Activated Recorder to acoustically sample participants’ natural conversations. Study 2 obtained data from two publicly available online social networks: fibromyalgia (343,439 posts) and rheumatoid arthritis (12,430 posts). Pain disclosure, versus non-pain disclosure, posts had a greater number of replies, and greater engagement indexed by language style matching. These studies yielded novel, multimethod evidence of how pain disclosure unfolds in naturally occurring social contexts in everyday life.

Objectives To investigate prenatal imaging findings supporting a diagnosis of suspected septo-optic dysplasia (SOD) by fetal ultrasound (US), magnetic resonance imaging (MRI), or both. Methods A retrospective review identified 11 patients with SOD: 9 had a clinical diagnosis of SOD postnatally, and 2 were terminated on the basis of suspicious prenatal imaging. Prenatal and neonatal imaging of the cavum septi pellucidi (CSP), frontal horns (FHs), and lateral ventricles was evaluated. Results The appearance of the CSP varied on US and MRI. Complete ("fused") FHs or partial absence of the CSP was reported in 6 of 11 patients by fetal US and 7 of 8 patients by fetal MRI. The diagnosis of SOD was prospectively suspected prenatally in 6 of 11 and in an additional 5 of 11 cases retrospectively. Fetal MRI incorrectly initially reported normal morphologic abnormalities for 2 cases with partial absence of the CSP, whereas US accurately identified the morphologic abnormalities in 1 of these cases before MRI. Imaging features were first suggested at anatomic US (4 patients) and follow-up prenatal US (2 patients). Neonatal imaging was concordant in all 9 live births: 5 completely absent CSP, 3 partially absent CSP, and 1 completely present CSP. Clinical manifestations included optic nerve hypoplasia (9 of 9), panhypopituitarism (5 of 9), and neurodevelopmental delays. Conclusions Primary imaging features of SOD are "continuous" FHs with complete or partial absence of the CSP. Septo-optic dysplasia can be suspected in utero and can appear isolated but has substantial associated central nervous system anomalies identified on fetal MRI or after birth. Partial absence of the CSP can be a prenatal sign of suspected SOD, although fetal MRI lacked the spatial resolution to identify it accurately in all cases.

Understanding the factors that affect explosive sensitivity is paramount to the safe handling and development of new explosives molecules. Erythritol tetranitrate (ETN) is an explosive that recently has attracted significant attention in the explosives community because of its ease of synthesis and physical properties. Herein, we report the synthesis of ETN derivatives using azide, nitramine, and nitrate ester functional groups. Impact, spark, and friction sensitivity measurements, computationally calculated explosive properties, and the crystal structure analysis of the ETN derivatives are reported. Mixing explosive functional groups led to changes in the explosive sensitivity, explosive performance as well as physical properties including melting point and physical state at room temperature. Overall, we have demonstrated that combining functional groups can enable the tuning of explosive and physical properties of a molecule. This tunability can potentially aid in the development of new explosives in which characteristics are varied to meet certain specifications.

The majority of condition monitoring techniques employed today consider the acquisitioning and analysis of structural responses as a means of profiling machine condition and performing fault detection. Modern research and newer technologies are driving towards non-contact and non-invasive methods for better machine characterisation. Yet current literature lacks investigations into the monitoring and detection of anomalous conditions using fluid dynamic behaviour. If one considers unshrouded rotors which are exposed to a full field of fluid interaction such as helicopter rotors and wind turbines amongst others, such an approach could potentially be beneficial. In this work, time-dependent fluid dynamic data is numerically simulated around a helicopter tail rotor blade using URANS CFD with the Open FOAM software package. Pressures are probed at locations in the field of the rotor and compared to results attained in an experimental investigation where good correlation is seen between the results. A blade is modelled with a seeded fault in the form of a single blade out of plane by 4°. Comparisons are drawn between the blade in its ‘healthy’ and ‘faulty’ configurations. It is observed that the fault can be detected by deviations in the amplitudes of the pressure signals for a single revolution at the probed locations in the field. These deviations manifest as increases in the frequency spectrum at frequencies equivalent to the rotational rate (1 per revolution frequencies). The results described are assessed for their fidelity when the pressure is probed at different locations in the domain of the rotor. Deviations in the pressure profiles over the surface of the blades are also seen for the asymmetric rotor configuration, but may prove too sensitive for practical application.