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Early Prenatal Nitrate Exposure and Birth Outcomes: A Study of Iowa’s Public Drinking Water (1970-1988)
No full textBackground Despite the biological mechanisms linking prenatal nitrate exposure to birth outcomes, epidemiological research has been inconclusive. The evidence-base has been limited by where and how nitrate exposure was measured, and the spurious correlation between geotemporal nitrate heterogeneity and unmeasurable factors contributing to gestational age and birth weight. Objective We linked Iowa water quality data and birth records to estimate the independent association between early prenatal nitrate exposure and birth outcomes. Methods Accessing Community Water Supply Quality Data, we calculated the median nitrate (mg/L) level for each county-date. With birth certificate microdata from the National Center for Health Statistics, we linked every Iowa birth (1970-1988) to a county-level nitrate measure within thirty days of conception. The outcomes were gestational age (weeks), preterm birth (\u3c 37 weeks), birth weight (g), and low birth weight (\u3c 2500 g). Nitrate exposure was first measured as a “dose-response” continuous variable, then as four binary variables (\u3e10 mg/L, \u3e5 mg/L, \u3e 0.1 mg/L, \u3e 0.0 mg/L). We constructed linear regression models which controlled for maternal and paternal characteristics, and county-year and year-month fixed-effects to account for unobservable annual variation between counties and longitudinal variation within all counties. Results Among 357,741 births, mean nitrate exposure was 4.2 mg/L. Early prenatal exposure to \u3e0.1 mg/L nitrate was associated preterm birth (Est. = +0.66%-points; C.I. = 0.31, 1.01). Early prenatal exposure to 5 mg/L nitrate was associated with low birth weight (Est. = +0.33%-points; C.I. = 0.03, 0.63). The associations between elevated exposure to nitrate and any birth outcomes did not differ from lower levels of exposure. Discussion Prenatal exposure to nitrate below the \u3e10 mg/L standard may cause harm. Since establishing this standard in 1992, groundwater nitrate levels have risen. Our results warrant greater scholarly and policymaking attention to understand and combat the adverse effects of nitrate
Autumn in New York: The Case of Long-Term Care Facilities in the Safe Staffing Lawsuit With Less Staffing But Similar COVID-19 Outcomes
No full textBackground and Objectives: In 2022, 239 New York state long-term care facilities (LTCFs) challenged a Safe Staffing law in court. Our study compares LTCFs involved and not involved in the lawsuit, testing for differences in staffing measures and resident outcomes during the first year of the coronavirus disease 2019 (COVID-19) pandemic. Research Design and Methods: New York LTCF-level data were obtained from the Centers for Medicare and Medicaid Services 2019 organization and 2020 COVID-19 data files. These data were then linked to data from the Long-Term Care Community Coalition, which identified the LTCFs involved in the Safe Staffing lawsuit. We first tested for differences in reported 2019 staffing levels by lawsuit involvement. Second, we specified Doubly Robust regression models to test if lawsuit involvement was associated with differences in resident COVID-19 infections, COVID-19 deaths, and overall mortality. Results: LTCFs involved in the lawsuit reported lower staff ratings and fewer staffing hours compared to LTCFs not involved in the lawsuit. Despite finding higher rates of admissions with COVID-19 in LTCFs involved in the lawsuit, we did not find that COVID-19 infections, COVID-19 deaths, or overall mortality differed by lawsuit involvement. Discussion and Implications: LTCFs involved in the lawsuit were deemed by policymakers as reducing staff, earning excess profits, and placing residents at risk. While these LTCFs reported lower staffing levels, we observed no differences in resident outcomes during the first year of the COVID-19 pandemic. Researchers and policymakers should develop more nuanced perspectives concerning the relationship among LTCF staffing, outcomes, and organizational profitability
Explicit inference: A meta-replication of SEER cancer registry research evaluating the Affordable Care Act\u27s Medicaid expansion
No full textObjectives: Among the provisions within the Affordable Care Act (ACA), expanding Medicaid was arguably the greatest contributor to increasing access to care. For over a decade, researchers have investigated how Medicaid expansion impacted cancer outcomes. Over this same decade, statistical theory illuminated how state-based policy research could be compromised by invalid inference. After reviewing the literature to identify the inference strategies of state-based cancer registry Medicaid expansion research, this study aimed to assess how inference decisions could change the interpretation of Medicaid expansion\u27s impact on staging, treatment, and mortality in cancer patients. Data sources: Cancer case data (2000–2019) was obtained from the Surveillance, Epidemiology, End Results (SEER) programme. Cases included all cancer sites combined, top 10 cancer sites combined, and three screening amenable cancers (colorectal, female breast, female cervical). Study design: A Difference-in-Differences design estimated the association between Medicaid expansion and four binary outcomes: distant stage, initiating treatment \u3e1 month after diagnosis, no surgery recommendation, and death. Three inference techniques were compared: (1) traditional, (2) cluster, and (3) Wild Cluster Bootstrap. Data collection: Data was accessed via SEER*Stat. Principal findings: Estimating standard errors via traditional inference would suggest that Medicaid expansion was associated with delayed treatment initiation and surgery recommendations. Traditional and clustered inference also suggested that Medicaid expansion reduced mortality. Inference using Wild Cluster Bootstrap techniques never rejected the null hypotheses. Conclusions: This study reiterates the importance of explicit inference. Future state-based, cancer policy research can be improved by incorporating emerging techniques. These findings warrant caution when interpreting prior SEER research reporting significant effects of Medicaid expansion on cancer outcomes, especially studies that did not explicitly define their inference strategy
Effectiveness of Cranial Remolding Orthosis in Treatment of Nonsynostotic Plagiocephaly
No full textIntroduction: The prevalence of cranial deformities, including nonsynostotic plagiocephaly, has been increasing, especially since the “Back to Sleep” campaign. Treatment of these deformities can use a cranial remolding orthosis or helmet. However, inconsistencies in results of studies of cranial remolding orthoses have made it increasingly more difficult for providers to accurately make recommendations for individuals with nonsynostotic plagiocephaly. Therefore, the purpose of this study was to assess the effectiveness of cranial remolding orthoses effective in treating nonsynostotic plagiocephaly by reducing cranial vault asymmetry (CVA) and to assess whether age and severity impact length and success of treatment. Materials and Methods: A retrospective analysis of patient files from September 2019–September 2020 was conducted. Paired samples of initial average and discharge average CVA measures and severity ratings were compared. Regression analyses were used to assess the relationship between all factors and severity rating at discharge. Results: A total of 106 infants (73 male, 33 female) were included in final analyses. Results indicated a significant difference between initial and discharge CVA and severity rating as a result of cranial remolding orthosis treatment. It was found that CVA at initial evaluation significantly predicted CVA at discharge (β = 0.73, P = 0.000) and severity at discharge (β = 0.52, P = 0.000), but all other variables were not significant predictors. Conclusions: The cranial remolding orthosis is an effective treatment in the correction of nonsynostotic plagiocephaly when used by a certified practitioner. In addition, this study found that treatment led to significant improvement regardless of age or initial severity. Clinical Relevance: After treatment, patients ages 0–18 months and with moderate or severe classifications demonstrated significant improvement. In order to prevent medical complications due to significant facial asymmetries, a cranial remolding orthosis should be recommended, with positive outcomes possible at all stages of diagnosis
Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by HPV-type and generosity of dental benefits
No full textBackground: Over a decade of evidence supports the claim that increased access to insurance through Medicaid expansions improves early detection of cancer. Yet, evidence linking Medicaid expansions to early detection of head and neck cancers (HNC) of the oral cavity and pharynx, specifically, may be limited by the lack of attention to Human Papillomavirus (HPV) etiology, generosity of dental coverage, and valid inference analyzing state cancer registry data. Aims: This study reexamined the effect of Medicaid expansion on early detection of HPV+/− HNC in states offering extensive dental benefits. Materials and Methods: Specialized data from the Surveillance, Epidemiology, and End Results (SEER) program was analyzed to account for, previously unmeasurable, differential detection patterns of HNCs associated with HPV. Then, to identify the effect of increasing Medicaid eligibility on staging patterns in states offering extensive benefits amidst potentially non-common trends between states, a “Triple Differences” design identifies the differential effect of Medicaid Expansion (with dental coverage) on HPV-negative HNCs relative to the change in HPV-positive HNCs. For valid inference analyzing a small number of state clusters (12) in cancer registry data, each regression model applies a Wild Cluster Bootstrap. Results: Expanding Medicaid eligibility was found to be associated with a decrease in the proportion of distant-stage diagnoses of HPV(−) HNCs, but only among states which increased Medicaid dental generosity at the time of Medicaid expansion. Conclusions: These results suggest that adding extensive Medicaid dental benefits was the primary mechanism impacting HNC detection. This study highlights the potential positive spillover effects of policies which increase access to public dental coverage for low-income adults, while also showing the limitation of access to dental services for improving early detection of HPV+ HNCs
Comparing soft versus bony upper airway dimensions between populations of different climates
No full textAbstract
Differences in airway passages lead to a multitude of different impacts on the way humans breathe. Mainly, longer, narrower, and taller pathways lead to more air turbulence compared to their smaller counterparts. This results in humidification and heating of air prior to its arrival in the lungs. Our research looked at how human airway passages differ between populations that originate from different climates. I worked with 3DSlicer 5.2.2 to orient 3D imaging of subjects\u27 skulls (n = 41) into Frankfort Horizontal position and interpolate them with 2D images of the soft tissues. I then plotted 12 midline landmarks including bony and soft tissue portions of the nasal cavity, nasopharynx, and oropharynx. We ran linear regressions of nasal dimensions against the functional soft tissue nasal length (external nasal tip to posterior nasopharynx). Ultimately, we found females had smaller airways compared to males, as expected given their smaller builds on average. Compared to European females, African females tended to have longer nasal cavity and nasopharynx lengths (anterior nasal spine to C1) but shorter soft-tissue nasal lengths in the nose (nasal tip to anterior nasal spine) relative to their functional soft tissue nasal length. African vs European nasal dynamics in males could not be assessed due to small sample sizes. Future studies will need to utilize a larger sample size and imaging of the laryngopharynx
Group 6 - Anatomy Posters, 49-58
No full textThe sixth group of the presentation breakout consists of Anatomy Posters, 49-58
Involvement of APL-1 in Manganese-induced toxicity in Caenorhabditis elegans and possible mitigation using Iron Chelators
No full textAbstract
Manganese (Mn) is an essential element that participates in several biological processes. However, overexposure to Mn may induce neurotoxicity and contribute to the development of neurodegenerative diseases such as Alzheimer’s disease (AD). While the pathophysiology of AD is still unclear, aggregation of misfolded β-amyloid (Aβ) plaques in the brain due to changes in amyloid precursor protein (APP) processing has been postulated to contribute to development of AD. Environmental exposure to Mn have been implicated in the etiology of Alzheimer’s disease. Here, we used Caenorhabditis elegans (C. elegans) as a model to explore putative mechanisms of neurodegeneration secondary to exposure to Mn and mitigation using 3 iron chelators: deferoxamine mesylate (DFO), salicylaldehyde isonicotinoyl hydrazone (SIH) and deferoxamine-caffeine (DFCAF). Specifically, APL-1, the C. elegans orthologue of mammalian APP, was studied to evaluate its role in neurotoxicity. Studies were carried out in wild-type N2 and APL-1 (yn5) strains to assess sensitivity to reactive oxygen species (ROS) generation, as well as in BY200 worms, where dopaminergic neurons are labeled with green fluorescent protein (GFP) for the evaluation of neurodegeneration. The results showed that the APL-1 strain was more sensitive to Mn than wild-type worms. Moreover, we observed increased levels of ROS upon exposure to Mn (50 mM) in N2 and APL-1 worms compared to controls. Worms exposed to Mn showed increased dopaminergic neurodegeneration, which was rescued iron chelator treatments. Our results show that Mn causes APL-1-dependent increases in ROS levels and neurodegeneration and that treatment with iron chelators can mitigate the Mn-induced effects
Incidence and characteristics of concomitant bacterial infection in ED patients admitted to the hospital with a positive viral target on FilmArray Respiratory panel
No full textAbstract
Background: This study sought to determine the frequency and associated clinical variables of concomitant bacterial infection present in patients admitted to the hospital with a positive viral target on molecular testing in the Emergency Department.
Methods: A retrospective observational study was conducted at three EDs in the greater Des Moines area between July and December 2022. Inclusion criteria included patients admitted to the hospital with a positive viral target on FilmArray Respiratory Panel (FARP). A multidisciplinary chart review classified patients as viral infection only or viral plus concomitant bacterial infection. Only infections deemed to be present on admission were reviewed.
Results: During the six-month period, 395 patients with positive FARP were admitted to the hospital. Among those hospitalized, 77% were categorized as viral only infections (Vi) and 22% categorized as a concomitant bacterial infection (ViCon). Bandemia \u3e10% was more common in ViCon group compared to (VI) group (15.00% vs 1.19%, p = 0.005). Procalcitonin values were higher in ViCon vs Vi group as well (10.6 vs 1.5, p = 0.012). Antibiotic days of therapy (DOT) for Vi patients was shorter than the ViCon group (4.41 DOT vs 8.22 DOT, p \u3c 0.0001). Finally, the PPV for concomitant bacterial infection with bandemia ≥5% and ≥10% were 0.81 and 0.692, respectively.
Conclusion: This study opens the door to develop parameters for bandemia and procalcitonin levels to aid in clinical decision making when considering the need for antibiotic treatment in patients being admitted to the hospital with a positive viral FARP and potential bacterial concomitant infection
A new look at the dynamic measurement of foot arch stiffness during gait
No full textAbstract
Foot arch stiffness is a modifiable, clinically relevant biomechanical metric. Static arch stiffness is insufficient in representing dynamic arch behavior, while dynamic arch stiffness has only been measured using surrogate variables or at an arbitrary timepoint (mid-stance). We proposed that dynamic arch stiffness instead be assessed using the medial longitudinal arch angle (MLAA) at the time of its maximal deformation, defining medial longitudinal arch stiffness (MLAS). We evaluated (1) the test-retest reliability of MLAS and (2) the effect of walking speed on MLAS.
Subjects (n=56) completed 3-5 walking trials each at a self-selected typical speed on a walkway equipped with force plates and a motion-capture system. Reflective markers were placed on the foot, with calcaneal, navicular, and first metatarsal head markers subsequently used for the MLAA calculation. A subset of the subject pool (n=21) also completed walking trials at self-selected slow and fast speeds, and eight (8) of these subjects returned at a later date for an identical retest.
On average, the timing of peak MLAA deformation (tMLAAmax) occurred at 71.0 ±8.8% of the stance phase, and the MLAS was 8.93 ±4.47deg/kN. The Pearson r showed high test-retest reliability for tMLAAmax (0.792, p=.019) and MLAS (0.768, p=.026). A significant increase in arch stiffness was found with increasing walking speed (F=10.686, p=.004).
The MLAS measurement proposed here was found to be highly reliable, and tMLAAmax was shown to occur well after mid-stance. The MLAS change corroborates existing evidence suggesting a stiffer arch as walking speed increases