Outcomes up to age 36 months after congenital Zika virus infection-U.S. states.

BACKGROUND: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Synthesis and Characterization of Cerium-Oxo Clusters Capped by Acetylacetonate.

Cerium-oxo clusters have applications in fields ranging from catalysis to electronics and also hold the potential to inform on aspects of actinide chemistry. Toward this end, a cerium-acetylacetonate (acac1-) monomeric molecule, Ce(acac)4 (Ce-1), and two acac1--decorated cerium-oxo clusters, [Ce10O8(acac)14(CH3O)6(CH3OH)2]·10.5MeOH (Ce-10) and [Ce12O12(OH)4(acac)16(CH3COO)2]·6(CH3CN) (Ce-12), were prepared and structurally characterized. The Ce(acac)4 monomer contains CeIV. Crystallographic data and bond valence summation values for the Ce-10 and Ce-12 clusters are consistent with both clusters having a mixture of CeIII and CeIV cations. Ce L3-edge X-ray absorption spectroscopy, performed on Ce-10, showed contributions from both CeIII and CeIV. The Ce-10 cluster is built from a hexameric cluster, with six CeIV sites, that is capped by two dimeric CeIII units. By comparison, Ce-12, which formed upon dissolution of Ce-10 in acetonitrile, consists of a central decamer built from edge sharing CeIV hexameric units, and two monomeric CeIII sites that are bound on the outer corners of the inner Ce10 core. Electrospray ionization mass spectrometry data for solutions prepared by dissolving Ce-10 in acetonitrile showed that the major ions could be attributed to Ce10 clusters that differed primarily in the number of acac1-, OH1-, MeO1-, and O2- ligands. Small angle X-ray scattering measurements for Ce-10 dissolved in acetonitrile showed structural units slightly larger than either Ce10 or Ce12 in solution, likely due to aggregation. Taken together, these results suggest that the acetylacetonate supported clusters can support diverse solution-phase speciation in organic solutions that could lead to stabilization of higher order cerium containing clusters, such as cluster sizes that are greater than the Ce10 and Ce12 reported herein.

Association of Provider Recommendation and Receipt of Influenza Vaccine Among Pregnant Women by Race and Ethnicity.

Background: All pregnant women and those who may become pregnant are recommended by the Advisory Committee on Immunization Practices to receive the flu vaccine to prevent severe illness in the woman and infant. Despite the increased risk for complications in this population, flu vaccine uptake in pregnant women was 68.1% in the 2020-2021 flu season, with disparities by race and ethnicity. We sought to describe associations between provider recommendation with flu vaccine uptake by race and ethnicity in Tennessee women with a recent live birth. Materials and Methods: Weighted analysis used data from the 2016 to 2020 Tennessee Pregnancy Risk Assessment Monitoring System complex survey analysis procedures. Uptake was measured as receipt of flu vaccine in the 12 months before the most recent live birth, and positive recall of receiving provider advice to get the shot was the independent variable; for both we estimated 5-year averages stratified by race/ethnicity. Differences were assessed using chi-square tests. We modeled receipt of flu vaccine and estimated marginal predicted prevalence ratios (PRs); stratified models by race/ethnicity were constructed to estimate unadjusted and adjusted PRs. Results: The 5-year average for vaccine uptake before or during pregnancy was 56.7% but varied by race and ethnicity. Stratified bivariate analyses yielded different magnitudes of association by race/ethnicity between provider recommendation and flu vaccine receipt. After adjustment for payment source at delivery, marital status, age group, urbanicity, and maternal education, receiving a provider recommendation was strongly associated with flu vaccine uptake for all stratified models of pregnant women included in the study. The effect size was of a larger magnitude among non-Hispanic Black women, a population with a lower vaccine uptake. Conclusions: Given the association between provider recommendation and vaccine uptake in all groups, attention should be focused on increasing rates of provider recommendation.

Efficient Europium Sensitization via Low-Level Doping in a 2-D Bismuth-Organic Coordination Polymer.

A new bismuth-organic compound containing 1,10-phenanthroline (phen) and 2,5-pyridinedicarboxylic acid (PDC) was synthesized and structurally characterized by single-crystal X-ray diffraction. The structure consists of 2-D {Bi(phen)(HPDC)(PDC)}n sheets wherein the PDC ligands bridge metal centers via three unique bonding modes. The 2-D sheets are further connected through strong hydrogen-bonding interactions to form a 3-D supramolecular network. The parent compound displayed yellow photoluminescence in the solid state at room temperature. Doping studies were undertaken to incorporate Eu3+ into the structure, statistically replacing Bi3+ in small quantities (1, 5, and 10 mol % Eu3+ relative to Bi3+). All three compounds displayed characteristic Eu3+ emission, with total quantum yields as high as 16.0% and sensitization efficiencies between 0.21 and 0.37 depending on the Eu3+ doping percentage.

Effects of neurotransmitter receptor antagonists on sea urchin righting behavior and tube foot motility.

Echinoderms, such as sea urchins, occupy an interesting position in animal phylogeny in that they are genetically closer to vertebrates than the vast majority of all other invertebrates but have a nervous system that lacks a brain or brain-like structure. Despite this, very little is known about the neurobiology of the adult sea urchin, and how the nervous system is utilized to produce behavior. Here, we investigated effects on the righting response of antagonists of ionotropic receptors for the neurotransmitters acetylcholine, GABA and glycine, and antagonists of metabotropic receptors for the amines dopamine and noradrenaline (norepinephrine). Antagonists slowed the righting response in a dose-dependent manner, with a rank order of potency of strychnine>haloperidol>propranolol>bicuculline>hexamethonium, with RT50 values (concentrations that slowed righting time by 50%) ranging from 4.3 µmol l-1 for strychnine to 7.8 mmol l-1 for hexamethonium. The results also showed that both glycine and adrenergic receptors are needed for actual tube foot movement, and this may explain the slowed righting seen when these receptors were inhibited. Conversely, inhibition of dopamine receptors slowed the righting response but had no effect on tube foot motility, indicating that these receptors play roles in the neural processing involved in the righting behavior, rather than the actual physical righting. Our results identify the first effects of inhibiting the glycinergic, dopaminergic and adrenergic neurotransmitter systems in adult sea urchins and distinguish between the ability of sea urchins to right themselves and their ability to move their tube feet.

Improved respiratory motion tracking through a novel fiducial marker placement guidance system during electromagnetic navigational bronchoscopy (ENB).

BACKGROUND: Stereotactic ablative radiotherapy (SABR) is a treatment option for patients with early stage non-small cell lung cancer (NSCLC) and recurrent or oligometastatic disease who are not surgical candidates. Due to the continuous motion of tumors within the lungs, implementing a strategy to track the target lesion is crucial. One method is to place fiducial markers which the robotic SABR system is able to track during treatment. However, placing these markers in a manner that maximizes tracking efficacy can be challenging. Using a novel fiducial placement guidance system (FPGS) during fiducial deployment may offer a way to improve the quantity of fiducials tracked by the robotic SABR system. METHOD: This was an institutional, retrospective review identifying all patients who received robotic SABR for lung tumors from May 2015 until January 2017. The FPGS was instituted in May 2016. The median number of fiducials tracked and the rate of complication was compared between patients whose fiducials were placed using FPGS versus those that were not. RESULTS: A total of 128 patients with 147 treated lung lesions were identified. Of the lesions that utilized FPGS (n = 44), 28 had 2 tracked fiducials (63.6%), 14 had 3 (31.8%) and 2 had 4 (4.6%). Of the lesions treated without FPGS (n = 103), 5 had 1 tracked fiducial (4.9%), 91 had 2 (88.4%), 6 had 3 (5.8%), and 2 had 4 (1.9%). A significant improvement in the median number of fiducials tracked per fraction was observed for the lesions with fiducials placed using FPGS on Wilcoxon rank sum test (p < 0.001). The rate of complication was low and not statistically different between cohorts (p = 0.44). CONCLUSIONS: The FPGS can be used during the deployment of fiducial markers and may increase the number of fiducials tracked. TRIAL REGISTRATION: An exemption for this retrospective review was granted by the East Carolina University IRB under UMCIRB 15-001726.

Improving Safe Sleep Modeling in the Hospital through Policy Implementation.

Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.

Perioperative medical comorbidities in the orthopaedic patient.

Evaluation and management of medical comorbidities in the perioperative period can help improve surgical morbidity and mortality. Perioperative evaluation essentially is risk assessment and minimization. Patients undergoing orthopaedic treatment may benefit from temporizing measures to reduce systemic complications associated with some procedures. Patients at increased risk of cardiac ischemia should undergo risk stratification to determine possible perioperative interventions. Use of perioperative medications and/or consultation with specialists can help to address heart murmurs, bacterial endocarditis, prior stenting, heart failure, and hypertension. Patients with severe or unstable chronic obstructive pulmonary disease require the involvement of pulmonary care specialists. Renal failure can require nephrology consultation, particularly in cases of worsening renal function or urinary outflow obstruction. Hematologic considerations include bleeding and clotting. Prophylaxis should be used in patients with risk factors for peptic ulcer, as well as respiratory failure and hypotension. Nutritional status and liver disease also must be monitored and treated preoperatively. Orthopaedic diabetic patients should be placed on modified oral hypoglycemic or insulin regimens; recalcitrant cases merit consultation. Effective communication among all members of the patient's caregiving team is paramount.

Thymic carcinoma in a child with HIV infection.

HIV infection predisposes to cancer during childhood. In addition to the AIDS-defining non-Hodgkin lymphoma (NHL) and Kaposi sarcoma, a range of other lymphoid malignancies and solid tumors have been described. We report the first case of an HIV-positive child with thymic carcinoma in the setting of regressing thymic cysts. The tumor expressed CKIT but failed to respond to imatinab mesylate after a transient response to multiagent chemotherapy. This case extends the spectrum of pediatric malignancy in the setting of HIV and suggests that patients with presumed benign thymic cysts require ongoing surveillance.

Patients' willingness to allow residents to learn to practice medical procedures.

PURPOSE: Consent for teaching procedures has been the focus of ethical discussion recently. Patients may consent to a procedure but be unaware that the procedure is to be performed by a resident, perhaps for the first time. In such cases, patients have not specifically consented to the practice of teaching medical procedures. The authors studied patients' awareness of resident training and willingness to allow residents to perform procedures on them. METHOD: A survey was administered to a convenience sample of 202 Vanderbilt University Medical Center emergency department patients from February to April 2000. Three procedures (intubation, lumbar puncture, and sutures) were demonstrated. Patients were asked about their awareness of residents' training and willingness to allow a resident to perform the procedures for the first time versus the tenth time. RESULTS: In all, 60% of patients did not realize they could be the first person a resident performs a procedure on. Only 49% of the patients were completely comfortable being the first patient for sutures, 29% for intubation, and 15% for a lumbar puncture. Most patients felt they should be informed if it was the resident's first time performing procedures (66% for sutures, 69% for intubation, and 82% for lumbar puncture). CONCLUSION: Not only do the majority of patients not know that they might be the first patient on whom a resident performs a procedure, more than two thirds believed they should be told if they are the first patient. Particularly for intubation and lumbar puncture, patients indicated that they would be uncomfortable being the first patient on whom these procedures were performed. These data raise ethical questions regarding physicians' obligations to inform patients about resident-performed procedures.