Improving Emergency Department Care for Suicidality in Autism: Perspectives from Autistic Youth, Caregivers, and Clinicians.

ABSTRACT: Purpose: Emergency department (ED) visits for suicidal ideation and self-harm are more prevalent in autistic than non-autistic youth. However, providers are typically offered insufficient guidance for addressing suicide risk in autistic youth, likely impacting confidence and care. METHODS: In this pilot study, we conducted semi-structured interviews with 17 key members of the autism community (i.e., autistic youth with a history of suicidality, caregivers of autistic youth with a history of suicidality, autism specialist clinicians, ED clinicians) to inform the development of recommendations for modifying ED care for autistic patients, with a focus on suicide risk screening and management. RESULTS: Participants reported on challenges they encountered receiving or providing care and/or recommendations for improving care. Participant perspectives were aligned, and four main categories emerged: accounting for autism features, connection and youth engagement in care, caregiver and family involvement, and service system issues. CONCLUSION: As research continues in the development of autism-specific suicide risk assessment tools and management strategies, it is essential we better equip providers to address suicide risk in autistic patients, particularly in ED settings.

Body composition estimates using a 2D image analysis system across different environmental conditions: An agreement study.

PURPOSE: This study examined the agreement between %Fat measurements using a smartphone-based application (IMAGE) across different environmental conditions. METHODS: A single reference image was obtained using an 8 MP smartphone camera under Ambient Light in front of a white background. Additional photos were obtained using a 0.7 MP, 5 MP, and 12 MP smartphone cameras; low-, moderate-, and bright-lighting conditions; and various color backgrounds including black, green, orange, and gray. RESULTS: %Fat measured using the 0.7 MP camera (27.8 ± 6.2 %Fat) was higher than the reference (26.8 ± 6.1 %Fat) (p < 0.001). The black (32.0 ± 12.0 %Fat), green (27.5 ± 6.3 %Fat), and gray (27.8 ± 6.3 %Fat) backgrounds yielded higher %Fat than the white (p = 0.03, 0.01, and 0.001). All camera, lighting, and background conditions were strongly correlated with the reference (all intraclass correlation coefficient [ICC] >0.98, all standard error of the estimate [SEE] <1.5 %Fat, all p < 0.001), except the black background which yielded poorer agreement with the white background (ICC = 0.69, SEE = 4.5%, p < 0.001). CONCLUSION: %Fat from IMAGE were strongly correlated across various environmental conditions.

Impact of Statewide Statute Limiting Days' Supply to Opioid-Naive Patients.

INTRODUCTION: To address the ongoing opioid crisis, states use policy enactment to restrict prescribing by licensed healthcare providers and mandate the use of Prescription Drug Monitoring Programs. There have been mixed results regarding the effectiveness of such state policies. The purpose of this study is to evaluate the impact of Colorado Senate Bill 18-022, which limits opioid prescriptions to ≤7-day supply among patients without an opioid prescription in the previous year (i.e., are opioid naive). METHODS: This is a retrospective interrupted time-series analysis of opioid prescribing to evaluate the weekly percentage of opioid prescriptions consistent with statutory limits for ≤7-day supply among opioid-naive patients before and after enactment using Prescription Drug Monitoring Programs data from May 21, 2017 to May 25, 2019. Statistical analysis was performed in 2021-2022. RESULTS: The weekly percentage of opioid prescriptions ≤7-day supply increased by an average of 0.12% per week (p<0.0001) from 79.7% to 87.4% in the week before enactment. The week after enactment, the average increased by 0.2% (p=0.67). The year after enactment, the average weekly percentage change was 0.07% per week, a 0.05% decrease (p=0.01). CONCLUSIONS: Statutory limits on days' supply among opioid-naive patients had little impact on opioid prescribing in Colorado. Legislating limits on opioid prescribing should be evaluated using Prescription Drug Monitoring Program data and considered for deimplementation when not impactful.

Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis.

Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results. OBJECTIVE: Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA. METHODS: All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies. RESULTS: The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (ß = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (ß = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables. CONCLUSIONS: Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.

Creating an ignorance-base: Exploring known unknowns in the scientific literature.

BACKGROUND: Scientific discovery progresses by exploring new and uncharted territory. More specifically, it advances by a process of transforming unknown unknowns first into known unknowns, and then into knowns. Over the last few decades, researchers have developed many knowledge bases to capture and connect the knowns, which has enabled topic exploration and contextualization of experimental results. But recognizing the unknowns is also critical for finding the most pertinent questions and their answers. Prior work on known unknowns has sought to understand them, annotate them, and automate their identification. However, no knowledge-bases yet exist to capture these unknowns, and little work has focused on how scientists might use them to trace a given topic or experimental result in search of open questions and new avenues for exploration. We show here that a knowledge base of unknowns can be connected to ontologically grounded biomedical knowledge to accelerate research in the field of prenatal nutrition. RESULTS: We present the first ignorance-base, a knowledge-base created by combining classifiers to recognize ignorance statements (statements of missing or incomplete knowledge that imply a goal for knowledge) and biomedical concepts over the prenatal nutrition literature. This knowledge-base places biomedical concepts mentioned in the literature in context with the ignorance statements authors have made about them. Using our system, researchers interested in the topic of vitamin D and prenatal health were able to uncover three new avenues for exploration (immune system, respiratory system, and brain development) by searching for concepts enriched in ignorance statements. These were buried among the many standard enriched concepts. Additionally, we used the ignorance-base to enrich concepts connected to a gene list associated with vitamin D and spontaneous preterm birth and found an emerging topic of study (brain development) in an implied field (neuroscience). The researchers could look to the field of neuroscience for potential answers to the ignorance statements. CONCLUSION: Our goal is to help students, researchers, funders, and publishers better understand the state of our collective scientific ignorance (known unknowns) in order to help accelerate research through the continued illumination of and focus on the known unknowns and their respective goals for scientific knowledge.

Agreement between ultrasound protocols for the estimation of body fat percentage: Comparison to a four-compartment model.

The purpose of this study was to examine the agreement between body fat percentage (%Fat) estimates derived from a standardized ultrasound protocol (%FatIASMS ), a commonly used skinfold (SKF)-site-based ultrasound protocol (%FatJP ), and a criterion four-compartment (4C) model (%Fat4C ). For the ultrasound protocols, all measurement sites were marked, measured and analyzed by the same evaluator. Subcutaneous adipose tissue (SAT) thickness was measured manually at the region where the muscle fascia was parallel to the skin and the average value per measurement site was used to calculate body density and subsequently %Fat. A repeated-measures analysis of variance with a priori planned contrasts was used to compare %Fat values between the 4C criterion and both ultrasound methods. Small nonsignificant mean differences were observed between %FatIASMS (18.82 ± 14.21%Fat, effect size [ES] = 0.25, p = 0.178), %FatJP (18.23 ± 13.32%Fat, ES = 0.32, p = 0.050) and the %Fat4C criterion (21.70 ± 7.57%Fat); however, %FatIASMS did not yield a smaller mean difference than the %FatJP (p = 0.287). Additionally, %FatIASMS (r = 0.90, p < 0.001, standard error of the estimate [SEE] = 3.29%) and %FatJP (r = 0.88, p < 0.001, SEE = 3.60%) were strongly correlated with the 4C criterion, however, %FatIASMS did not yield better agreement than %FatJP (p = 0.257). Despite slightly underestimating %Fat, both ultrasound techniques demonstrated Good-Very Good agreement with the 4C criterion, with comparable mean differences, correlations, and SEE. The International Association of Sciences in Medicine and Sports (IASMS) standardized protocol using manual calculations of SAT was comparable to the SKF-site-based ultrasound protocol when compared to the 4C criterion. These results indicate that the IASMS (with manually measured SAT) and SKF-site-based ultrasound protocols may be of practical use to clinicians.

Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting.

Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.

The interdependent transport of yeast vacuole Ca2+ and H+ and the role of phosphatidylinositol 3,5-bisphosphate.

Yeast vacuoles are acidified by the v-type H+-ATPase (V-ATPase) that is comprised of the membrane embedded VO complex and the soluble cytoplasmic V1 complex. The assembly of the V1-VO holoenzyme on the vacuole is stabilized in part through interactions between the VO a-subunit ortholog Vph1 and the lipid phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2). PI(3,5)P2 also affects vacuolar Ca2+ release through the channel Yvc1 and uptake through the Ca2+ pump Pmc1. Here, we asked if H+ and Ca2+ transport activities were connected through PI(3,5)P2. We found that overproduction of PI(3,5)P2 by the hyperactive fab1T2250A mutant augmented vacuole acidification, whereas the kinase-inactive fab1EEE mutant attenuated the formation of a H+ gradient. Separately, we tested the effects of excess Ca2+ on vacuole acidification. Adding micromolar Ca2+ blocked vacuole acidification, whereas chelating Ca2+ accelerated acidification. The effect of adding Ca2+ on acidification was eliminated when the Ca2+/H+ antiporter Vcx1 was absent, indicating that the vacuolar H+ gradient can collapse during Ca2+ stress through Vcx1 activity. This, however, was independent of PI(3,5)P2, suggesting that PI(3,5)P2 plays a role in submicromolar Ca2+ flux but not under Ca2+ shock. To see if the link between Ca2+ and H+ transport was bidirectional, we examined Ca2+ transport when vacuole acidification was inhibited. We found that Ca2+ transport was inhibited by halting V-ATPase activity with Bafilomycin or neutralizing vacuolar pH with chloroquine. Together, these data show that Ca2+ transport and V-ATPase efficacy are connected but not necessarily through PI(3,5)P2.

Stress, eating and weight change in first year students: the moderating role of self-compassion.

OBJECTIVE: The current study sought to examine the drivers of weight change in first-year university students. The study examined the moderating role of self-compassion in the relationship between stress, eating and weight change. Specifically, we expected that students low in self-compassion would respond to stress with unhealthy eating resulting in weight gain. We expected students high in self-compassion to be buffered from the negative effects of stress (moderated mediation model). METHODS: First-year university students in New Zealand (N = 136) completed measures of healthy and unhealthy food intake and BMI at the beginning and end of the academic year. Self-compassion was measured at baseline only, and perceived stress was averaged over four time points across the year. RESULTS: Students gained a significant 1.45 kg (SD 3.67 kg) of body weight. Self-compassion moderated the relationship between stress and changes in: (a) unhealthy (but not healthy) food intake, and (b) body weight. For those with low self-compassion, perceived stress was significantly related to an increase in BMI and, unexpectedly, to a decrease in unhealthy food intake. Changes in food intake did not explain changes in BMI. CONCLUSION: Wellbeing interventions for university students to reduce negative effects of stress should incorporate concurrent training in self-compassion.

Multi-Resin Masked Stereolithography (MSLA) 3D Printing for Rapid and Inexpensive Prototyping of Microfluidic Chips with Integrated Functional Components.

Stereolithography based 3D printing of microfluidics for prototyping has gained a lot of attention due to several advantages such as fast production, cost-effectiveness, and versatility over traditional photolithography-based microfabrication techniques. However, existing consumer focused SLA 3D printers struggle to fabricate functional microfluidic devices due to several challenges associated with micron-scale 3D printing. Here, we explore the origins and mechanism of the associated failure modes followed by presenting guidelines to overcome these challenges. The prescribed method works completely with existing consumer class inexpensive SLA printers without any modifications to reliably print PDMS cast microfluidic channels with channel sizes as low as ~75 µm and embedded channels with channel sizes as low ~200 µm. We developed a custom multi-resin formulation by incorporating Polyethylene glycol diacrylate (PEGDA) and Ethylene glycol polyether acrylate (EGPEA) as the monomer units to achieve micron sized printed features with tunable mechanical and optical properties. By incorporating multiple resins with different mechanical properties, we were able to achieve spatial control over the stiffness of the cured resin enabling us to incorporate both flexible and rigid components within a single 3D printed microfluidic chip. We demonstrate the utility of this technique by 3D printing an integrated pressure-actuated pneumatic valve (with flexible cured resin) in an otherwise rigid and clear microfluidic device that can be fabricated in a one-step process from a single CAD file. We also demonstrate the utility of this technique by integrating a fully functional finger-actuated microfluidic pump. The versatility and accessibility of the demonstrated fabrication method have the potential to reduce our reliance on expensive and time-consuming photolithographic techniques for microfluidic chip fabrication and thus drastically lowering our barrier to entry in microfluidics research.

Noncanonical NF-κB factor p100/p52 regulates homologous recombination and modulates sensitivity to DNA-damaging therapy.

Homologous recombination (HR) serves multiple roles in DNA repair that are essential for maintaining genomic stability, including double-strand DNA break (DSB) repair. The central HR protein, RAD51, is frequently overexpressed in human malignancies, thereby elevating HR proficiency and promoting resistance to DNA-damaging therapies. Here, we find that the non-canonical NF-κB factors p100/52, but not RelB, control the expression of RAD51 in various human cancer subtypes. While p100/p52 depletion inhibits HR function in human tumor cells, it does not significantly influence the proficiency of non-homologous end joining, the other key mechanism of DSB repair. Clonogenic survival assays were performed using a pair DLD-1 cell lines that differ only in their expression of the key HR protein BRCA2. Targeted silencing of p100/p52 sensitizes the HR-competent cells to camptothecin, while sensitization is absent in HR-deficient control cells. These results suggest that p100/p52-dependent signaling specifically controls HR activity in cancer cells. Since non-canonical NF-κB signaling is known to be activated after various forms of genomic crisis, compensatory HR upregulation may represent a natural consequence of DNA damage. We propose that p100/p52-dependent signaling represents a promising oncologic target in combination with DNA-damaging treatments.

The Effects of COVID-19 Hospital Practices on Breastfeeding Initiation and Duration Postdischarge.

Background: Early in the COVID-19 pandemic, many birth hospitals separated SARS-CoV-2-positive mothers from their newborn infants and advised against breastfeeding to decrease postnatal SARS-CoV-2 transmission. Information on how these practices impacted breastfeeding postdischarge is limited. Objectives: In a statewide sample of SARS-CoV-2-positive mothers, we aimed to determine the extent to which (1) mother-infant separation and (2) a lack of breastfeeding initiation in-hospital were associated with breast milk feeding postdischarge. Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 187 women who tested positive for SARS-CoV-2 from 14 days before to 72 hours after delivery (March 1-July 31, 2020) and their newborn infants. We abstracted chart data from the delivery hospitalization on main exposure variables (mother-infant separation, in-hospital breast milk feeding [expressed milk feeding and/or direct breastfeeding]) and from outpatient visits until 30 days postdischarge. We evaluated associations of in-hospital practices with outcomes up to 30 days postdischarge, adjusting for confounders using multivariable logistic and linear regression. Results: Mother-infant separation in-hospital was associated with a shorter duration of any breast milk feeding (regression coefficient estimate -5.29 days, 95% confidence intervals [CI] [-8.89 to -1.69]). Direct breastfeeding in-hospital was associated with higher odds of any breast milk feeding (adjusted odds ratios [AOR] 5.68, 95% CI [1.65-23.63]) and direct breastfeeding (AOR 8.19, 95% CI [2.99-24.91]) postdischarge; results were similar for any breast milk feeding in-hospital. Conclusions: Perinatal hospital care practices implemented early in the COVID-19 pandemic, specifically mother-infant separation and prevention of breast milk feeding initiation, were associated with adverse effects on breast milk feeding outcomes assessed up to 1 month postdischarge.

The Reliability of CT Scan Measurements of Pelvic Incidence in the Evaluation of Adult Spondylolisthesis.

BACKGROUND:  Pelvic incidence (PI) has been described as a parameter that may be a risk factor for lumbar spondylolisthesis (SPL). Studies have reported PI measurement is more precise in CT scans. Very limited studies have measured PI using CT scans to evaluate SPL. We analyzed the reliability of CT scans to measure PI to evaluate SPL and compared it to patients without SPL. METHODS:  A retrospective, cross-sectional study of PI in a consecutive cohort of patients' pelvic/abdominal CT scans from an emergency room visit at a Level 1 trauma center between 2013 and 2016. Inclusion criteria was >18 years and had no lumbar or pelvis fracture. A total of 361 patients met the criteria for our study. We documented age, average PI, and SPL (type, grading, and location). Sagittal CT scans were used to measure PI (between hip axis to an orthogonal line originating at the center of superior end plate axis of first sacral vertebra). Patients were categorized: with SPL (n=45) and without SPL (n=316). Subgroups were comprised based on the location of SPL (L4/L5 and L5/S1) and type of SPL. Analysis of variance (ANOVA) and chi-square tests used; p≤0.05 considered statistically significant. RESULTS:  Patients with SPL were significantly older versus patients without SPL, p=0.006. There were no statistical differences in PI between patients with and without SPL (p=0.29); between subgroups of patients with SPL at L4/L5 and without SPL (p=0.52); between subgroups with type of SPL at L4/L5 and without SPL (p=0.47); and between SPL patients at L5/S1 and without SPL (p=0.40). Patients with isthmic SPL at L5/S1 had nearly significant higher PIs (p=0.06) compared to those without SPL or with degenerative SPL at L5/S1. There was a trend towards higher PI in Grade 2 SPL patients at L5/S1, p=0.18. CONCLUSIONS: Patients with SPL were significantly older than patients without SPL. The two trends observed were that PI was higher in patients with isthmic SPL at L5/S1 and an increased PI with Grade 2 isthmic SPL at L5/S1. Our reported CT PI measurements correlated with reported PI measured using standard radiographs in patients with SPL. CT scans may be a reliable modality to evaluate adult SPL.

Validity of a 3-compartment body composition model using body volume derived from a novel 2-dimensional image analysis program.

BACKGROUND/OBJECTIVES: The purpose of this study was: (1) to compare body volume (BV) estimated from a 2-dimensional (2D) image analysis program (BVIMAGE), and a dual-energy x-ray absorptiometry (DXA) equation (BVDXA-Smith-Ryan) to an underwater weighing (UWW) criterion (BVUWW); (2) to compare relative adiposity (%Fat) derived from a 3-compartment (3C) model using BVIMAGE (%Fat3C-IMAGE), and a 4-compartment (4C) model using BVDXA-Smith-Ryan (%Fat4C-DXA-Smith-Ryan) to a 4C criterion model using BVUWW (%Fat4C-UWW). SUBJECT/METHODS: Forty-eight participants were included (60% male, 22.9 ± 5.0 years, 24.2 ± 2.6 kg/m2). BVIMAGE was derived using a single digital image of each participant taken from the rear/posterior view. DXA-derived BV was calculated according to Smith-Ryan et al. Bioimpedance spectroscopy and DXA were used to measure total body water and bone mineral content, respectively, in the 3C and 4C models. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation. RESULTS: Near-perfect correlation (r = 0.998, p < 0.001) and no mean differences (p = 0.267) were observed between BVIMAGE (69.6 ± 11.5 L) and BVUWW (69.5 ± 11.4 L). No mean differences were observed between %Fat4C-DXA-Smith-Ryan and the %Fat4C-UWW criterion (p = 0.988). Small mean differences were observed between %Fat3C-IMAGE and %Fat4C-UWW (ES = 0.2, p < 0.001). %Fat3C-IMAGE exhibited smaller SEE and TE, and tighter limits of agreement than %Fat4C-DXA-Smith-Ryan. CONCLUSIONS: The 2D image analysis program provided an accurate and non-invasive estimate of BV, and subsequently %Fat within a 3C model in generally healthy, young adults.

Agreement Between A 2-Dimensional Digital Image-Based 3-Compartment Body Composition Model and Dual Energy X-Ray Absorptiometry for The Estimation of Relative Adiposity.

The purpose of this study was to compare relative adiposity (%Fat) derived from a 2-dimensional image-based 3-component (3C) model (%Fat3C-IMAGE) and dual-energy X-ray absorptiometry (DXA) (%FatDXA) against a 5-component (5C) laboratory criterion (%Fat5C). 57 participants were included (63.2% male, 84.2% White/Caucasian, 22.5±4.7 yrs., 23.9±2.8 kg/m2). For each participant, body mass and standing height were measured to the nearest 0.1 kg and 0.1 cm, respectively. A digital image of each participant was taken using a 9.7 inch, 16g iPad Air 2 and analyzed using a commercially available application (version 1.1.2, made Health and Fitness, USA) for the estimation of body volume (BV) and inclusion in %Fat3C-IMAGE . %Fat3C-IMAGE and %Fat5C included measures of total body water derived from bioimpedance spectroscopy. The criterion %Fat5C included BV estimates derived from underwater weighing and bone mineral content measures via DXA. %FatDXA estimates were calculated from a whole-body DXA scan. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation. A strong correlation (r = 0.94, p <.001) and small mean difference (ES = 0.24, p <.001) was observed between %Fat3C-IMAGE (19.20±5.80) and %Fat5C (17.69±6.20) whereas a strong correlation (r = 0.87, p <.001) and moderate-large mean difference (ES = 0.70, p <.001) was observed between %FatDXA (22.01±6.81) and %Fat5C. Furthermore, %Fat3C-IMAGE (SEE = 2.20 %Fat, TE= 2.6) exhibited smaller SEE and TE than %FatDXA (SEE = 3.14 %Fat, TE = 5.5). The 3C image-based model performed slightly better in our sample of young adults than the DXA 3C model. Thus, the 2D image analysis program provides an accurate and non-invasive estimate of %Fat within a 3C model in young adults. Compared to DXA, the 3C image-based model allows for a more cost-effective and portable method of body composition assessment, potentially increasing accessibility to multi-component methods.

Leveraging the Massachusetts perinatal quality collaborative to address the COVID-19 pandemic among diverse populations.

OBJECTIVE: We leveraged the Massachusetts perinatal quality collaborative (PQC) to address the COVID-19 pandemic. Our goals were to: (1) implement perinatal practices thought to reduce mother-to-infant SARS-CoV-2 transmission while limiting disruption of health-promoting practices and (2) do so without inequities attributable to race/ethnicity, language status, and social vulnerability. METHODS: Main outcomes were cesarean and preterm delivery, rooming-in, and breastfeeding. We examined changes over time overall and according to race/ethnicity, language status, and social vulnerability from 03/20-07/20 at 11 hospitals. RESULTS: Of 255 mothers with SARS-CoV-2, 67% were black or Hispanic and 47% were non-English speaking. Cesarean decreased (49% to 35%), while rooming-in (55% to 86%) and breastfeeding (53% to 72%) increased. These changes did not differ by race/ethnicity, language, or social vulnerability. CONCLUSIONS: Leveraging the Massachusetts PQC led to rapid changes in perinatal care during the COVID-19 crisis in a short time, representing a novel use of statewide PQC structures.

A randomized clinical trial of plasticity-based cognitive training in mild traumatic brain injury.

Clinical practice guidelines support cognitive rehabilitation for people with a history of mild traumatic brain injury (mTBI) and cognitive impairment, but no class I randomized clinical trials have evaluated the efficacy of self-administered computerized cognitive training. The goal of this study was to evaluate the efficacy of a self-administered computerized plasticity-based cognitive training programmes in primarily military/veteran participants with a history of mTBI and cognitive impairment. A multisite randomized double-blind clinical trial of a behavioural intervention with an active control was conducted from September 2013 to February 2017 including assessments at baseline, post-training, and after a 3-month follow-up period. Participants self-administered cognitive training (experimental and active control) programmes at home, remotely supervised by a healthcare coach, with an intended training schedule of 5 days per week, 1 h per day, for 13 weeks. Participants (149 contacted, 83 intent-to-treat) were confirmed to have a history of mTBI (mean of 7.2 years post-injury) through medical history/clinician interview and persistent cognitive impairment through neuropsychological testing and/or quantitative participant reported measure. The experimental intervention was a brain plasticity-based computerized cognitive training programme targeting speed/accuracy of information processing, and the active control was composed of computer games. The primary cognitive function measure was a composite of nine standardized neuropsychological assessments, and the primary directly observed functional measure a timed instrumental activities of daily living assessment. Secondary outcome measures included participant-reported assessments of cognitive and mental health. The treatment group showed an improvement in the composite cognitive measure significantly larger than that of the active control group at both the post-training [+6.9 points, confidence interval (CI) +1.0 to +12.7, P = 0.025, d = 0.555] and the follow-up visit (+7.4 points, CI +0.6 to +14.3, P = 0.039, d = 0.591). Both large and small cognitive function improvements were seen twice as frequently in the treatment group than in the active control group. No significant between-group effects were seen on other measures, including the directly-observed functional and symptom measures. Statistically equivalent improvements in both groups were seen in depressive and cognitive symptoms.

Utilizing a Novel 2D Image Processing System for Relating Body Composition Metrics to Performance in Collegiate Female Rowers.

The purpose of this study was to determine if rowing performance was associated with fat mass (FM) or fat-free mass (FFM) measured using a novel 2D digital image analysis system. Nineteen female rowers (ages = 20.3 ± 1.0 years, weight = 73.8 ± 8.3 kg, height = 172.7 ± 4.7 cm) participated in this study. FM and FFM were estimated with a smartphone application that uses an automated 2D image analysis program. Rowing performance was measured using a 2 km (2k) timed trial on an indoor ergometer. The average speed of the timed trial was recorded in raw units (m·s-1) and adjusted for body weight (m·s-1·kg-1). FFM was significantly correlated to unadjusted 2k speed (r = 0.67, p < 0.05), but not for FM (r = 0.44, p > 0.05). When 2k speed was adjusted to account for body weight, significant correlations were found with FM (r = -0.56, p < 0.05), but not FFM (r = -0.34, p > 0.05). These data indicate that both FM and FFM are related to rowing performance in female athletes, but the significance of the relationships is dependent on overall body mass. In addition, the novel 2D imaging system appears to be a suitable field technique when relating body composition to rowing performance.

Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts.

Importance: The incidence of mother-to-newborn SARS-CoV-2 transmission appears low and may be associated with biological and social factors. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. Objective: To ascertain the percentage of neonates who were born to mothers with positive SARS-CoV-2 test results during the birth hospitalization, the clinical and sociodemographic factors associated with neonatal test result positivity, and the clinical and virological outcomes for newborns during hospitalization and 30 days after discharge. Design, Setting, and Participants: This multicenter cohort study included 11 academic or community hospitals in Massachusetts and mother-neonate dyads whose delivery and discharge occurred between March 1, 2020, and July 31, 2020. Eligible dyads were identified at each participating hospital through local COVID-19 surveillance and infection control systems. Neonates were born to mothers with positive SARS-CoV-2 test results within 14 days before to 72 hours after delivery, and neonates were followed up for 30 days after birth hospital discharge. Exposures: Hypothesized maternal risk factors in neonatal test result positivity included maternal COVID-19 symptoms, vaginal delivery, rooming-in practice, Black race or Hispanic ethnicity, and zip code-derived social vulnerability index. Delivery indicated by worsening maternal COVID-19 symptoms was hypothesized to increase the risk of adverse neonatal health outcomes. Main Outcomes and Measures: Primary outcomes for neonates were (1) positive SARS-CoV-2 test results, (2) indicators of adverse health, and (3) clinical signs and viral testing. Test result positivity was defined as at least 1 positive result on a specimen obtained by nasopharyngeal swab using a polymerase chain reaction-based method. Clinical and testing data were obtained from electronic medical records of nonroutine health care visits within 30 days after hospital discharge. Results: The cohort included 255 neonates (mean [SD] gestational age at birth, 37.9 [2.6] weeks; 62 [24.3%] with low birth weight or preterm delivery) with 250 mothers (mean [SD] age, 30.4 [6.3] years; 121 [48.4%] were of Hispanic ethnicity). Of the 255 neonates who were born to mothers with SARS-CoV-2 infection, 225 (88.2%) were tested for SARS-CoV-2 and 5 (2.2%) had positive results during the birth hospitalization. High maternal social vulnerability was associated with higher likelihood of neonatal test result positivity (adjusted odds ratio, 4.95; 95% CI, 1.53-16.01; P = .008), adjusted for maternal COVID-19 symptoms, delivery mode, and rooming-in practice. Adverse outcomes during hospitalization were associated with preterm delivery indicated by worsening maternal COVID-19 symptoms. Of the 151 newborns with follow-up data, 28 had nonroutine clinical visits, 7 underwent SARS-CoV-2 testing, and 1 had a positive result. Conclusions and Relevance: The findings emphasize the importance of both biological and social factors in perinatal SARS-CoV-2 infection outcomes. Newborns exposed to SARS-CoV-2 were at risk for both direct and indirect adverse health outcomes, supporting efforts of ongoing surveillance of the virus and long-term follow-up.