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Malinda R Schaefer,1 Jessica Holttum,1 Megan Olson,1 Danielle Westenberg,1 Nathan Rubin,2 Mark R Schleiss,3 Jessica Nyholm1 1Department of Obstetrics, Gynecology & Women’s Health, University of Minnesota Medical School, Minneapolis, MN 55455, USA; 2Biostatistics Core, Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN 55455, USA; 3Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis, MN 55455, USACorrespondence: Malinda R Schaefer Email schaefer.malinda@gmail.comPurpose: Congenital CMV infection can result in serious sequelae in the newborn. The goal of this study was to assess pregnant women’s knowledge and understanding of CMV infection during pregnancy and develop an educational tool about CMV infection to be utilized during prenatal care.Materials and Methods: This is a prospective intervention study that assessed pregnant women’s knowledge before and after receiving an educational handout about CMV infection in pregnancy and the perceived value of this education. Pre- and post-education questionnaires were utilized to assess knowledge. The pre-education questionnaire and CMV educational handout were given at the same clinic visit. The educational handout was given after the pre-education questionnaire had been completed. The post-education questionnaire was given at the next scheduled prenatal clinic appointment and included questions regarding the level of satisfaction with the education and the perceived value of the information. Pregnant women less than 34 weeks of gestation were eligible.Results: A total of 263 women were enrolled, 263 completed the pre-CMV educational questionnaire and 215 women completed both questionnaires. Some women only partially completed the questionnaires and those partial responses have been included. Prior to education, 33% (85/261) of participants had heard of CMV. This increased to 75% (160/214) after education. Participants scored each of the recommended hygiene practices between 1 and 5 (5 is the most acceptable) and each recommended hygiene practice received an average score between 3.8 and 5. 74% (134/180) of participants reported increasing their hygienic practices after education. 96% (180/188) of participants indicated they were satisifed to have received the education. 98% (187/190) thought more women should receive this education during prenatal care.Conclusion: Pregnant women viewed education about CMV favorably and increased the frequency of recommended hygiene practices. Introducing an educational handout to routine prenatal care may be beneficial in increasing awareness of CMV infection in pregnancy.Keywords: congenital CMV, CMV vaccine, CMV pregnancy, CMV education

A food assessment questionnaire was completed by Alutiiq and Eyak peoples of the Chugach Region of Alaska in 2016-2017. This questionnaire, conducted by the Chugach Regional Resource Commission, gathered 87 responses from adults residing in seven communities. The questions related to traditional food systems, food security, and food sovereignty and were organised into six sections: Community Food Resources, Diet and Health, Culture, Organisation and Governance, Food Resources, and Natural Resources and Environment. Nine questions directly addressed food sovereignty. Results revealed the importance of traditional food sources in the communities, foods that are not readily available or are difficult to access, resources that are useful to improve traditional food security, health problems that are perceived to be caused or exacerbated by the lack of traditional foods in the area, traditional foods commonly consumed, and barriers from accessing traditional foods. Additionally, recommendations for improving food systems and addressing barriers are provided.

Background: The most common degenerative condition in older adults is dementia, which can be predicted using a number of indicators and whose progression can be slowed down. One of the indicators of an increased risk of dementia is sleep disturbances. This study aims to examine if machine learning can predict dementia and which sleep disturbance factors impact dementia., Methods: This study uses five machine learning algorithms (gradient boosting, logistic regression, gaussian naive Bayes, random forest and support vector machine) and data on the older population (60+) in Sweden from the Swedish National Study on Ageing and Care - Blekinge (n=4175). Each algorithm uses 10-fold stratified cross-validation to obtain the results, which consist of the Brier score for checking accuracy and the feature importance for examining the factors which impact dementia. The algorithms use 16 features which are on personal and sleep disturbance factors., Results: Logistic regression found an association between dementia and sleep disturbances. However, it is slight for the features in the study. Gradient boosting was the most accurate algorithm with 92.9% accuracy, 0.926 f1-score, 0.974 ROC AUC and 0.056 Brier score. The significant factors were different in each machine learning algorithm. If the person sleeps more than two hours during the day, their sex, education level, age, waking up during the night and if the person snores are the variables that most consistently have the highest feature importance in all algorithms., Conclusion: There is an association between sleep disturbances and dementia, which machine learning algorithms can predict. Furthermore, the risk factors for dementia are different across the algorithms, but sleep disturbances can predict dementia., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In mass casualty incidents including hazardous chemical skin exposure, decontamination is the primary intervention to avoid systemic uptake of the toxic compound. The protocol needs to be both simple and efficient to enable a rapid response and avoid delay of patient management. In the present study, decontamination strategies included in the initial operational response were evaluated following human skin exposure in vitro to four different contaminants. Results demonstrated that the efficacy of selected decontamination procedures was highly dependent on the chemical contaminant used. Dry removal of the sulfur mustard simulant methyl salicylate prior to wet decontamination was found beneficial compared to wet decontamination alone. Rapidly initiated wet decontamination was more efficient compared to dry and wet removal of the industrial chemical 2-butoxyethanol and the nerve agent tabun. Following VX-exposure, all wet decontamination procedures resulted in increased agent penetration compared to the control. In conclusion, challenges in establishing simple and efficient decontamination procedures for a broad-spectrum of chemicals have been demonstrated. The impact of including a dry removal step during decontamination was evidently agent specific. Despite the variation in efficacy, immediately initiated dry removal may facilitate patient management until wet decontamination resources are available and to reduce the risk of secondary contamination., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lina Thors reports financial support was provided by Swedish Ministry of Defence., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Antenatal diagnosis of right heart enlargement has a wide spectrum of differential diagnosis from maternal, placental and fetal causes, and outcomes of all are not known. Coarctation of the aorta is in the differential diagnosis of right heart enlargement. In our study, we focused to measure multiple cardiac dimensions in fetuses with right heart enlargement to identify the fetus with coarctation of the aorta utilizing echocardiographic measurements. Ten cardiovascular dimensions were measured from fetal studies between 20- and 34-week gestation, and six were measured on postnatal echocardiograms. Z-scores for the cardiac dimensions were calculated, and each variable for fetuses and infants was tested using a two-sample t test between patients with and without coarctation. We excluded fetuses with TAPVR, Shone complex, interrupted aortic arch, Ebstein anomaly or HLHS. Of the 31 fetuses with in utero right heart enlargement, 11 had coarctation postnatally and 20 did not have coarctation. We compared the fetal and newborn cardiac dimensions between the groups. The mean fetal carotid-subclavian index (CS Index) was 0.7 mm with coarctation compared with 1.1 mm without coarctation (p < 0.0001). The mean difference in diameter z-scores for fetal aortic isthmus (p < 0.0001), mitral valve (<0.001) and aortic valve (p < 0.009) was also significantly different. Similar significant differences were noted postnatally in the diameters of the cardiac dimensions between the coarctation and no-coarctation group: CS index (p < 0.0001), aortic isthmus (p < 0.0002) and aortic valve annulus (p < 0.007). A spectrum of diagnoses was found postnatally in fetuses with right heart enlargement, including a normal heart. The likelihood of identifying fetuses with coarctation of the aorta and planning for postnatal management can be refined by noninvasive screening measurements. A smaller CS index and smaller diameters of the aortic isthmus, mitral valve and aortic valve were significantly associated prenatally (p < 0.05) with coarctation of the aorta versus without coarctation and might be useful in prenatally diagnosing coarctation of the aorta. Postnatally, these measurements are reproducible. This is the first study utilizing these specific measurements to diagnose coarctation prenatally.

Objectives: The purpose of this study was to prospectively assess the rate of resolution of complete placenta previa diagnosed at second-trimester sonography in patients with and without previous cesarean delivery., Methods: This prospective study evaluated patients at 3 institutions with complete placenta previa diagnosed at second-trimester screening sonography. All patients were followed with sonography every 4 to 6 weeks until either resolution of the previa or delivery occurred. Patients with persistent/nonresolving complete placenta previa underwent cesarean delivery., Results: A total of 67 patients were enrolled in the study; 18 patients had a prior cesarean delivery. Resolution of placenta previa occurred in 11 of 18 patients (61%) with a prior cesarean delivery, whereas 44 of 49 patients (90%) without a prior cesarean delivery had resolution of placenta previa (P = .012, Fisher exact test). Placental location per se (anterior or posterior) was not associated with resolution of placenta previa (P = .22). Complete placenta previa persisted to delivery in 5 of 9 patients (56%) with a prior cesarean delivery and an anterior placental location., Conclusions: This prospective study indicates that patients with a prior cesarean delivery and complete placenta previa diagnosed at second-trimester sonography are less likely to have subsequent resolution of the previa when compared to those without a history of cesarean delivery.

The etiology of polyhydramnios may be attributed to either increased production of amniotic fluid (fetal polyuria or high-output cardiac failure) or decreased fetal swallowing (obstruction or neurological impairment). Although idiopathic polyhydramnios occurs in nearly half of all cases, it is often associated with fetal abnormalities. Fetal ductus arteriosus flow is normally from right to left. We report a case of antenatally detected bidirectional fetal ductus arteriosus flow diagnosed concomitantly with polyhydramnios. Amnioreduction was performed due to severe maternal symptoms, which resulted in correction of the fetal ductus arteriosus flow. Postnatal diagnosis of a Morgagni diaphragmatic hernia indicates that our sonographic findings collectively may have been a diagnostic clue., (© Thieme Medical Publishers.)

Background: Common genetic variants in the nitric oxide synthase 1 adaptor protein gene (NOS1AP) and in the HERG potassium channel gene (KCNH2) have been associated with cardiac repolarization in middle-aged and elderly subjects., Aim: We examined the relation between these variants and QT interval duration in a population of healthy young adults., Methods: We measured QT interval duration and genotyped rs10494366 T>G (NOS1AP gene, n=1,842) and rs1805123 A>C (KCNH2 gene, n=1,894) in subjects aged 24-39 years., Results: The NOS1AP variant was significantly related with heart rate-corrected QT interval duration (QTc). Additive regression model adjusting for age, sex, systolic blood pressure, body mass index, alcohol use, and smoking indicated that the G allele was associated with a 3.2 ms (95% confidence interval (CI) 1.7-4.6 ms, P<0.0001) increase in QTc interval duration for each additional copy. The KCNH2 variant was not significantly related with QTc interval duration in the study sample., Conclusion: These findings provide evidence from a population of healthy young adults that a common variation in the NOS1AP gene influences cardiac repolarization within the normal physiological range. Further studies are warranted to investigate the effects of this variant on sudden cardiac death and ventricular arrhythmias.