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"It's Harder to Chase Pain Than It Is to Prevent It": Perinatal Individual and Care Professional Attitudes Towards Preventing Perinatal Mood and Anxiety Disorders in Obstetric Settings
No full textPurpose: Depression and anxiety disorders are prevalent in the perinatal period and disproportionately impact individuals who experience economic marginalization. <15% of at-risk individuals are referred for recommended preventative counseling interventions. Little is known about the attitudes of care professionals and perinatal individuals towards prevention. This study's objective was to elicit attitudes of perinatal care professionals and individuals with lived experience of perinatal depression and anxiety who have been marginalized due to their economic status towards prevention interventions for perinatal mood and anxiety disorders in routine perinatal care settings.
Methods: We conducted semi-structured qualitative interviews with economically marginalized individuals with lived experience of perinatal anxiety or depression (n = 12) and perinatal care professionals (n = 12). We used a thematic analysis approach for data analysis.
Results: Participants endorsed generally positive attitudes towards prevention. Both individuals and professionals identified gaps in current practices and expressed interest in prevention because they felt that it could improve outcomes. Both groups described skepticism that prevention is possible. Perinatal individuals also described concerns about professional capacity, stigma, and medical mistrust while professionals had concerns about potential for harm and resource limitations. Participants emphasized the importance of professional-patient relationships and multidisciplinary teams in effective delivery of prevention care.
Conclusions: Current approaches to prevention of mood and anxiety disorders in the perinatal period are lacking. Integration of prevention into routine obstetric care is of interest to perinatal individuals and professionals as a strategy to improve outcomes and reduce care inequities. Improving education and awareness of prevention interventions may reduce skepticism towards these interventions. Steps to build communication and trust between patients and professionals are needed to improve comfort and engagement with prevention interventions.No embarg
Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives
Get PDFIntroduction: Medically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the practitioners' perspective regarding the facilitators and barriers to reaching and enrolling patients in MTM programs.
Methods: We interviewed 19 staff across four ACOs that had implemented MTM interventions. Interviews were conducted from Feb to Aug 2023 and included staff who participated in patient screening, referral, or enrollment. The interview guide was informed by the Health Equity Implementation Framework. Interviews were recorded and transcribed and coded using NVivo software. We used directed qualitative content analyses. The study team identified and discussed common themes and presented them back to our ACO partners.
Results: Staff described facilitators of and barriers to reach and enrollment related to several domains of the Health Equity Implementation Framework. For program (innovation) factors, facilitators included perceived positive effects on patient health outcomes and a relative advantage over both the status quo and other nutrition assistance programs; outreach by care team members rather than other staff; the eligibility criteria, which were viewed as appropriate and evidence-based; and the simplicity of the program, which aided communication with patients. Patient-related facilitators included patients being more in need of the program due to more severe illness and being more motivated to change dietary behaviors. Patient-related barriers included lacking a working phone or stable housing and concern about meals meeting taste and cultural food preferences. Staff-related barriers included limited time and especially knowledge about the MTM program.
Discussion: This study highlights the perspectives of front-line staff during the implementation of an MTM program in a state-wide 1,115 Demonstration. Staff may require multiple trainings to gain full knowledge about the program and increase self-efficacy in describing it with sensitivity. These new findings elevate voices from front-line healthcare staff in MTM delivery and can help inform strategies for effective, equitable implementation of MTM programs.No embarg
Activation of the ciliary kinase CDKL5 is mediated by the cyclin-dependent kinase CDK20/LF2 to control flagellar length
Get PDFVariants in the protein kinase CDKL5 cause CDKL5 Deficiency Disorder (CDD), a severe neurodevelopmental condition characterized by seizures, developmental delay, and intellectual disability. The Chlamydomonas homolog of CDKL5, LF5, is a flagellar protein whose loss leads to elongated flagella. Here, we combine live-cell imaging, immunofluorescence, and biochemical approaches including mass spectrometry to define how CDKL5 activity is regulated and how its loss alters ciliary function. We find that Chlamydomonas CDKL5 is activated by LF2, a cyclin-dependent kinase, through phosphorylation of its activation loop. This activation controls CDKL5 localization in steady-state cilia, down-regulates its IFT-mediated transport as flagella reach steady-state, controls ciliary abundance of IFT proteins, and controls phosphorylation of the tubulin-binding domain of IFT74, thereby influencing flagellar length. Mouse Cdkl5 shows similar properties: it localizes within cilia, its loss leads to ciliary elongation, and its localization depends on both its kinase activity and Cdk20, the mammalian ortholog of LF2. These results extend our understanding of ciliary length control, challenge the prevailing model that CDKL5 is activated by autophosphorylation, and suggest that CDD pathogenesis arises, at least in part, from disruption of this conserved ciliary regulatory pathway.No embarg
The Reporting and Methodological Recommendations for Observational Studies Estimating the Effects of Deprescribing Medications (REMROSE-D) ISPE-Endorsed Guidance
Get PDFPurpose: Pharmacoepidemiologic studies on deprescribing are challenging to implement, yet little guidance exists on methods to avoid bias and minimum reporting for replicability and appraisal. We developed consensus recommendations for the methods and reporting of observational studies that aim to examine the effects of deprescribing.
Methods: We formed candidate recommendations based on our prior systematic review that methodologically appraised observational studies on deprescribing. We then conducted a two-round modified Delphi process with researchers working in deprescribing pharmacoepidemiology to refine, select, and reach consensus on recommendations for a checklist based on > 70% agreement of their importance. We termed this list the REMROSE-D (Reporting and Methodological Recommendations for Observational Studies estimating the Effects of Deprescribing medications) guidance.
Results: Twenty-three candidate recommendations were presented to the Delphi panel. The round 1 survey was completed by 55 participants, and 18 of the 23 candidate recommendations were selected for inclusion. Five candidate recommendations without consensus plus two additional items suggested by participants were included in a round 2 survey of 25 deprescribing researchers. Five of these seven items garnered consensus for inclusion, and two were excluded. The final REMROSE-D guidance contains 23 recommendations for the methods and reporting of observational research on deprescribing.
Conclusion: To ensure rigor and reproducibility in observational studies of the effects of deprescribing, the REMROSE-D guidance provides recommendations for important reporting and methods considerations, including time zero, precise definitions of deprescribing, addressing confounding by indication, and careful consideration of follow-up to avoid immortal time bias.No embarg
Rapid disassembly and Piwi-independent reassembly of Drosophila piRNA cluster heterochromatin following acute heat shock
Get PDFEnvironmental stress activates transposons and is proposed to generate genetic diversity that facilitates adaptive evolution. piRNAs guide germline transposon silencing, but the impact of stress on the piRNA pathway is not well understood. In Drosophila, the Rhino-Deadlock-Cuff complex (RDC) drives transcription of clusters composed of nested transposon fragments, generating precursors that are processed into mature piRNAs in the cytoplasm. We show that acute heat shock triggers rapid, reversable loss of RDC localization and cluster transcript expression with coordinate changes in the cytoplasmic processing machinery. Maternal piRNAs bound to Piwi are proposed to guide Rhino localization to clusters during early embryogenesis. However, RDC re-localization after heat shock is accelerated in piwi mutants and delayed in thoc7 mutants, which disrupt piRNA precursor binding to THO complex, and we show that maternally deposited piRNAs are dispensable for RDC localization to the major 42AB cluster. Cluster specification is reconsidered in light of these findings.1 year2026/12/1
Employment Outcomes among People with Disabilities: Macro-Level Determinants
Get PDFA systematic scoping review of research published between 2000 and 2020 on employment of people with disabilities, that was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), was conducted by CeKTER researchers. All papers comparing people with disabilities to those without were excluded from the systematic scoping review. Among over 100 publications reviewed there was a wide and very disparate array of findings with numerous variables used and varying research questions. This result belies summative findings. There are numerous ways of organizing the disparate findings. This brief is part of a series of findings from CeKTER’s systematic scoping review. In this brief we report on findings about a range of macro-level determinants impacting the employment of people with disabilities, including community-related and system-level determinants. Please note that all comparisons are always about corresponding peers with disabilities.The contents of this product were funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant #90DPEM0004. NIDILRR is a Center within the Administration for Community Living (ACL). ACL is an agency in the Department of Health and Human Services (HHS). The contents of this product do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.No embarg
SUMMIT MAX: A randomized trial of the super large bore HiPoint Reperfusion System versus Vecta System for aspiration thrombectomy
Get PDFRapid and complete recanalization is a primary goal in the endovascular treatment of large vessel occlusion stroke. The effectiveness and safety of super large bore aspiration catheters (.088" inner diameter) for the treatment of large vessel occlusion stroke have not been demonstrated in a randomized trial. SUMMIT MAX was a prospective, randomized, controlled, open label clinical trial of patients with ICA and MCA M1 occlusions, comparing the super large bore HiPoint Reperfusion system (Route 92 Medical) to the Vecta Aspiration system (Stryker Neurovascular) (NCT05018650). We hypothesized that the effectiveness and safety of the HiPoint reperfusion system was non-inferior (12.5% non-inferiority margin) to the Vecta Aspiration system. The primary effectiveness endpoint was successful reperfusion, defined as mTICI ≥ 2b as adjudicated by an independent core lab, using only the assigned study device, with any use of a non-study device prior to or following use of study device defined as failure. The primary safety endpoint was symptomatic intracranial hemorrhage (sICH) within 24h (-8/+24) post-procedure. There were 250 patients enrolled of whom 166 met criteria for the modified intent-to-treat population: 89 in HiPoint and 77 in Vecta. The median age was 69; 54.2% were female. Successful reperfusion with any adjunctive therapy counted as a failure was 77.5% (69/89) in the HiPoint group versus 50.6% (39/77) in the Vecta group (p<0.0001 for non-inferiority). SICH within 24h (-8/+24h) post procedure was similar between groups (3.6% vs. 2.7%, respectively). At 90 days, good clinical outcome (mRS<2) was achieved in 50.6% in the HiPoint group and 53.3% in the Vecta group (absolute difference -2.8%, 95% CI -18.2%, 12.7%, p=0.75). In this randomized trial of patients with anterior large vessel occlusion, the super large bore HiPoint system was non-inferior to the Vecta system in achieving successful reperfusion, with a similar safety profile. This study supports the super large bore HiPoint system for mechanical thrombectomy. NCT05018650.No embarg
Quantification and Analysis of Laser Peripheral Iridotomies in the United States from 2000 to 2021
Get PDFAIM: To analyze the number of laser peripheral iridotomies (LPIs) performed from 2000 to 2021 in the United States.
MATERIALS AND METHODS: The Centers for Medicare and Medicaid Services Part B National Summary database was queried to obtain deidentified records of patients who underwent LPI between 2000 and 2021, and patients who underwent cataract surgery between 2011 and 2021. Annual total allowed services and charges were collected for CPT 66761 (LPI), and CPT 66982 and 66984 (cataract surgery). Annual inflation rates and population data were obtained from the US Bureau of Labor Statistics and the World Bank.
RESULTS: The number of LPIs performed increased 58.8% from 64,935 in 2000 to 1,03,113 in 2008, remained fairly constant between 2009 and 2015, and declined 35.4% from 96,495 in 2016 to 62,376 in 2021. Allowed services per 10,000 people increased 47.37% from 2.301 in 2000 to 3.391 in 2008 before declining 44.59% to 1.879 in 2021. The US population increased 17.6% over the time period. LPI average allowed charge was 376.77 in 2007, decreased to 275.47 in 2019 to $280.33 in 2021. The average allowed charge decreased 10.1%, while the rate of cumulative inflation was 53%. Total annual allowed charge decreased 13.6% from 2000 to 2021, unadjusted for inflation.
CONCLUSION: From 2000 to 2021, the number of LPIs performed in the United States declined while population increased. Potential drivers include results of scientific studies that recommended early cataract surgery and observing patients with primary angle closure suspects (PACS), a shift in physician sentiment of the LPI risk-benefit ratio, and economic forces. Finally, the COVID-19 pandemic may have contributed to the decrease in LPIs in 2020 and 2021.
CLINICAL SIGNIFICANCE: The number of LPIs performed in the United States declined over the last 20 years, while the population has increased. Factors, such as influential studies recommending early cataract extraction and monitoring patients without LPI, shifting doctor sentiments, and economic factors may have affected LPI rates.
HOW TO CITE THIS ARTICLE: Maheshwari A, Sarrafpour S, Jayaram R, Quantification and Analysis of Laser Peripheral Iridotomies in the United States from 2000 to 2021. J Curr Glaucoma Pract 2025;19(4):208-215.No embarg
Barriers to Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children
No full textIntroduction: Half of individuals eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal nutrition program, are not enrolled. This dissertation examines associations between (1) national policy change, (2) neighborhood opportunity, and (3) experiences of racial discrimination on WIC participation, with a focus on children of Hispanic, non-Hispanic Black, and immigrant mothers.
Methods: The data for this study were drawn from the 2013-2024 iterations of Children’s HealthWatch, an annual cross-sectional study among mothers with children ages 0-4. Aim 1 is an interrupted time series analysis examining differences in WIC participation by maternal nativity after a federal policy (the public charge rule) was changed. Aim 2 is a cross-sectional study of the association between neighborhood opportunity, measured by the Child Opportunity Index, and WIC participation. Aim 3 is a cross-sectional study which describes the association between experiencing racial discrimination and dropping out of WIC.
Results: After the public charge rule changed, WIC participation decreased significantly faster among children of immigrant mothers with a shorter length of residence in the US, relative to children of US-born mothers. The prevalence of WIC participation was significantly higher among respondents from lower opportunity neighborhoods compared to higher opportunity ones. Lifetime experiences of racial discrimination were significantly associated with WIC drop-out.
Conclusions: All three factors evaluated were significantly associated with WIC participation, which can inform targeted outreach strategies. Further studies that employ community-engaged approaches are needed to understand and improve the WIC experience among all mothers and children to increase enrollment and participation.Biochemistry and Molecular Biotechnology1 year2026-09-1
Incidence and predictors of Woven EndoBridge (WEB) shape modification following treatment of intracranial aneurysms in a large multicenter study
Get PDFThe Woven EndoBridge (WEB) device is FDA-approved for the treatment of bifurcation aneurysms. Despite its wide popularity, it has been under scrutiny for its association with potential aneurysm recanalization and retreatment due to device shape modification. This study aims to analyze the shape modification rate of WEB devices and identify factors associated with this phenomenon, as well as its correlation with aneurysm retreatment. We conducted a retrospective review of the WorldWide WEB Consortium database, including adult patients treated for intracranial aneurysms with the WEB device. We assessed aneurysm occlusion using the WEB Occlusion Scale and defined WEB shape modification as a percentage reduction in the distance between two WEB markers. Logistic regression and Cox proportional hazards models were utilized to evaluate predictors of shape modification and retreatment. Kaplan-Meier curves were used to estimate the time-dependent probability of no or minor shape modification. A total of 405 patients were analyzed, with minor and major shape modification occurring in 31.4% and 10.1% of cases, respectively. Major shape modification was associated with lower rates of adequate occlusion (70.7%) compared to no or minor shape modification (86.6%) and a higher rate of retreatment (26.8% vs. 8.1%). Predictors of major shape modification included the presence of daughter sac, bifurcation aneurysms, absence of immediate flow stagnation, and a WEB width minus aneurysm width ratio ≤ 0.5. The probability of no or minor shape modification declined within the first 25 months and stabilized thereafter. WEB device shape modification is a significant predictor of aneurysm occlusion efficacy and retreatment. Recognizing the factors influencing shape modification can guide treatment decisions and follow-up protocols to improve patient outcomes.No embarg