Jacobs Institute of Women's Health
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Evaluating Surgical Outcomes: A Comparative Analysis of Two Techniques for Sphincter Pharyngoplasty
No full textBACKGROUND: Sphincter pharyngoplasty (SP) is a well-established surgical strategy for correcting velopharyngeal insufficiency (VPI) after cleft palate repair. SP can be performed with flap inset in either an end-to-end (ETE) or overlapping (OL) pattern. In this study, we compare the relative efficacy of ETE versus OL inset in patients undergoing SP for VPI. METHODS: A retrospective review was conducted of VPI patients who underwent SP at a major children\u27s hospital between 2007 and 2023. Patient data collection included demographic characteristics, speech outcomes, and polysomnography results. Statistical analysis was performed using Mann-Whitney U and Chi-square tests. RESULTS: Ninety patients underwent SP, with 44 (49%) in the ETE group and 46 (51%) in the OL group. Patients with OL inset had better speech outcomes, with 56.5% achieving balanced resonance compared to 34.1% in the ETE group (p=0.033). ETE patients also had more compensatory speech errors (34.1% vs. 8.7%, p=0.003). OL inset patients had significantly higher rates of obstructive sleep apnea (OSA) and a higher apnea-hypopnea index (8.2 vs. 3.1, p=0.039). DISCUSSION: SP with OL inset is associated with improved speech outcomes but greater risk of OSA. The choice of inset pattern should be carefully considered to balance these considerations
Association of midlife air pollution and road proximity exposure with 29-year cognitive decline
No full textMidlife ambient air pollution exposures may be etiologically relevant to late-life cognition. We considered whether midlife air pollution and traffic exposures are associated with midlife to late-life cognitive change. Our sample included Atherosclerosis Risk in Communities (ARIC) cohort study participants with cognitive testing at Visit 2 (1990-1992, ages 48-67), which was repeated at Visit 4 (1996-1998), Visit 5 (2011-2013), Visit 6 (2016-2017), and Visit 7 (2018-2019). At participant addresses, we estimated: [i] 1990-1992 average ambient air pollutant concentrations for 18 pollutants using Community Multiscale Air Quality chemical transport model output fused with observed annual concentrations, and [ii] distance to major roads and road density within a 500-meter radius. We used meta-analysis of site-specific adjusted linear mixed-effects models to quantify associations between each exposure and 29-year cognitive change. Among 12,700 eligible participants, mean age was 57 years, 56 % were female, 24 % identified as Black, and 79 % had at least a high school education. There was no statistical support linking higher exposures to criteria air pollutants, most PM components, or roadway proximity in midlife and cognitive change. However, there was some suggestion that higher midlife exposures to nitrates, copper, iron, lead, and zinc may be associated with greater 29-year decline in executive function and that higher midlife exposures to copper and lead may be associated with greater declines in a global z-score. Our cohort study does not support a link between midlife exposures to most air pollutants and mid- to late-life-cognitive change. Confirmation or repudiation of suggestive findings in an independent dataset is warranted
Explaining Twitter\u27s inability to effectively moderate content during the COVID-19 pandemic
No full textSocial media platforms routinely face pressure to restrict harmful content while protecting free speech; however, prior theory suggests that platform design might undermine the efficacy of content moderation. During the COVID-19 pandemic, major social media platforms removed content that violated their medical misinformation policies. Although controversial, it is widely assumed that these interventions, such as deplatforming and content removal, are efficacious; however, this claim has not been evaluated based on evidence. We therefore evaluated the efficacy of Twitter\u27s attempts to curtail vaccine misinformation during the COVID-19 pandemic. We found that several clusters of vaccine skeptical accounts generated a larger share of tweets about vaccines, increased in virality, and continued to spread low-quality and likely misinformative content despite Twitter\u27s sustained removal of content and accounts - both when compared to prior trends and to corresponding clusters of pro-vaccine accounts. Several of these accounts were subject to a contemporaneous moderation action, in which Twitter removed 70,000 accounts on January 8, 2021. Although this action reduced activity among targeted accounts, virality increased and information quality decreased among both these accounts and those sharing similar political affiliations, calling into question the efficacy of these removals. Novel platforms that share Twitter\u27s architecture may therefore face similar moderation challenges
Comparative Analysis of ESBL Phenotypes and Antimicrobial Resistance in Escherichia coli Associated with Urinary Tract Infections and in Commensal Strains
No full textEscherichia coli is a genetically versatile organism capable of thriving in diverse environments, acting as a commensal in the intestine or as a pathogen in the urinary tract. E. coli causing urinary tract infections has acquired genes that enable it to colonize the urinary tract, survive immune response, and resist antimicrobials. In this study, we investigated the association between the ESBL (Extended Spectrum Beta Lactamase) phenotype and other antimicrobial resistances in E. coli associated with urinary tract infections (UTI-E. coli; n = 1,139) and compared them with commensal E. coli strains (n = 405) isolated from human fecal samples in the same communities and during the same period. Among UTI-E. coli strains, 16.9% were ESBL producers compared to 7.6% in commensal strains, and resistance to other antimicrobials was also significantly higher in UTI-E. coli. These results suggest that many UTI-E. coli and commensal E. coli lineages have been subjected to distinct antimicrobial pressures over time
Perceptions and use intentions of flavored versus unflavored tobacco products among young adults in Georgia: A cross-sectional study
No full textINTRODUCTION: Tobacco product marketing uses flavors to influence consumer perceptions, especially among youth and young adults. In Georgia, where tobacco use is among the highest in the WHO European Region, flavored products are widely available and unregulated. Limited data exist on young adults\u27 perceptions of flavored versus unflavored products. METHODS: This study aimed to assess how young adults in Georgia perceive flavored versus unflavored tobacco products in terms of harm, addictiveness, and social acceptability, and how these perceptions relate to their use intentions. A cross-sectional online survey (April-June 2024) included 400 participants aged 18-25 years measured perceptions on a 1-7 scale for flavored and unflavored cigarettes, e-cigarettes, and heated tobacco products. Perceptions were categorized as less, equal, or more harmful/addictive/acceptable. Multivariable logistic regression examined associations between these perceptions and past-month use and use intentions. RESULTS: Most participants perceived flavored and unflavored products similarly, but perceptions varied across product types. Flavored e-cigarettes were most often rated as more acceptable (13%) and addictive (12.5%) compared to unflavored e-cigarettes - more frequently than flavored cigarettes (9.5% acceptable, 7.5% addictive) or flavored HTPs (7% acceptable, 9.8% addictive) when compared to their unflavored counterparts. Perceiving flavored products as more harmful to self was associated with lower past-month cigarette use (adjusted odds ratio, AOR=0.18; 95% CI: 0.08-0.40), while perceiving flavored products as more addictive was associated with higher e-cigarette use (AOR=2.78; 95% CI: 1.06-7.28). Among non-past-month users, higher perceived harm to others was associated with lower intention to use flavored cigarettes (AOR=0.040; 95% CI: 0.003-0.622). CONCLUSIONS: Although most participants perceived flavored and unflavored products similarly, small differences in some perceptions contributed to differences in certain use behaviors, supporting stronger regulation of flavored products in Georgia. However, as this is a cross-sectional study, further prospective research is needed to confirm these findings and guide policy
Credentialing and Privileging of Point-of-Care Ultrasonography Across Specialties-From Adoption to Accountability
No full textCourtship and distress ultrasonic vocalizations are altered in a mouse model of Angelman syndrome
No full textBACKGROUND: Angelman syndrome (AS) is a single-gene neurodevelopmental disorder caused by loss of function of the maternal copy of the UBE3A gene. Nearly all individuals with AS lack speech, resulting in major impacts on daily life for patients and caregivers. To evaluate new therapies for AS, it is crucial to have a mouse model that characterizes meaningful clinical features. Vocalizations are used in many contexts in mice, including pup retrieval, social interactions, courtship, and distress. Previous work in the Ube3a mouse model of AS found abnormalities in the number of ultrasonic vocalizations (USVs) mice produced during pup isolation and same-sex social interactions. Here, we evaluated Ube3a vocalizations during courtship and distress. Quantifying USVs in these contexts enables comparison of USVs in social (courtship) and non-social (distress) settings. In addition, we assessed the utility of incorporating USV testing into existing Ube3a mouse behavioral assessments used to evaluate potential AS treatments. METHODS: We used multiple behavioral paradigms to evaluate courtship vocalizations and tail suspension tests to evaluate distress vocalizations in adult wild-type (WT) and Ube3a littermates, and quantified USV properties using the program DeepSqueak. A subset of mice also performed an established Ube3a behavioral battery that included rotarod, open field, marble burying, and nest building. We used principal component analysis to evaluate the value of USV testing in this cohort in the context of other behaviors. RESULTS: In both social courtship and nonsocial distress behavioral paradigms, Ube3a mice made fewer USVs compared to WT mice. Spectral properties of USVs were abnormal in Ube3a mice on courtship tests but mostly typical on distress tests. Including USVs in the Ube3a mouse behavior battery increased the distance between Ube3a and WT clusters in principal component space. CONCLUSIONS: Ube3a mice have disrupted USV production in social and nonsocial contexts. Spectral properties of USVs are most impacted in the social courtship context. Adding USVs to the Ube3a behavior battery may improve sensitivity to detect group differences and changes in communication. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s11689-025-09648-y
Stimulants Concomitant with Other Psychotropic Classes: A Competing Risk Analysis in Medicaid-Insured Youth
No full textPharmacoepidemiologic research shows increasing use of polypharmacy to manage behavioral treatment of youth. Methods to increase precision, for example, competing risk analysis, to capture psychotropic patterns of concomitant stimulant treatment changes over time have not been explored. A retrospective cohort study was derived from Medicaid enrollment data, prescription drug, and clinician-reported diagnosis claims data from 2007 to 2014. Youths aged 2-17 years with 1-7.5 years of continuous enrollment who were new users of stimulants were followed. Major outcomes include detailed changes of concomitant use according to the number of psychotropic classes (NPC); competing risk assessment of patient factors according to NPC; and time factors related to changes in NPC. Among 30,294 new stimulant users, 75.5% remained on stimulant monotherapy and 24.5% had stimulant concomitant regimens. Among the latter, great flux was observed, revealing exposure to combinations changed substantially across time. As a proportion of all changes, retention of the maximum NPC was observed for 65.3% of 2 concomitant classes, 56.2% of 3 concomitant classes, and 57.1% and 56.2% of 4 and 5 concomitant classes, respectively. Median duration according to NPC showed a linear decrease in time from 223 days for 2 classes, 172 days for 3 classes, 141 days for 4 classes, and 113 days for 5 classes combinations. By contrast, the path to maximum NPC regimens took median times of 491-833 days as NPC increased from 2 to 4 concomitant classes. Competing risk analysis demonstrated significantly increased hazard ratios according to the number of concomitant classes for 12-17-year-olds, patients with foster care or disability coverage, and those with 3-4 years of continuous enrollment. Detailed NPC changes illustrate great flux in concomitant stimulant patterns among Medicaid-insured youth. Competing risk analysis brings more precise patient characteristics risk information to assess NPC changes compared with a binary model
Switching from Dupilumab to Abrocitinib in Patients With Moderate-to-Severe Atopic Dermatitis: A Post Hoc Analysis of Efficacy After Treatment With Dupilumab in JADE DARE
No full textINTRODUCTION: Primary results of the JADE DARE trial (NCT04345367) demonstrated that abrocitinib was superior to dupilumab in reducing the signs and symptoms of moderate-to-severe atopic dermatitis (AD). This post hoc analysis evaluated the efficacy and safety of abrocitinib in patients with moderate-to-severe AD who were responders or nonresponders to dupilumab using various definitions of response. METHODS: Data included dupilumab-treated patients from JADE DARE who switched to abrocitinib 200 mg when enrolled in the ongoing JADE EXTEND trial (NCT03422822). For this analysis, various response criteria at Week 26 of JADE DARE were defined post hoc based on Investigator\u27s Global Assessment (IGA), Eczema Area and Severity Index (EASI), Peak Pruritus Numerical Rating Scale (PP-NRS), and Dermatology Life Quality Index (DLQI) scores or responses. Efficacy was analyzed at Week 12 of JADE EXTEND based on patients\u27 fulfillment of the various response criteria at Week 26 of JADE DARE. EASI scores and percentage changes from baseline in EASI and PP-NRS at Week 26 in JADE DARE were compared with the corresponding scores and percentage changes at Week 12 in EXTEND. Safety was assessed. RESULTS: Of 365 dupilumab-treated patients in JADE DARE, 316 were enrolled in JADE EXTEND and 312 received abrocitinib 200 mg. Most dupilumab responders for IGA, EASI, PP-NRS, and DLQI at DARE Week 26 maintained their responses 12 weeks after switching to abrocitinib, while a considerable proportion of IGA, EASI, PP-NRS, or DLQI dupilumab nonresponders gained response after switching to abrocitinib. Lower EASI scores and greater percentage changes from baseline in EASI and PP-NRS scores were observed with abrocitinib at EXTEND Week 12 than with dupilumab at DARE Week 26. No new safety signals were observed. CONCLUSION: Abrocitinib 200 mg may be an effective treatment option for patients with moderate-to-severe AD who do not achieve an optimal response with dupilumab treatment. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT04345367 (JADE DARE) and NCT03422822 (JADE EXTEND)