COVID-19 Vaccine Hesitancy in Rural Midwestern Infertility Patients: A Cross-Sectional Survey.

BACKGROUND: Pregnant patients with COVID-19 experience higher rates of maternal mortality, pregnancy loss, and other severe comorbidities. Despite these well-characterized risks, this group displayed a high level of vaccine hesitancy that contributed to their slow acceptance of the COVID-19 vaccinations and greater maternal mortality during the pandemic. The rural Midwest was no exception to this unfortunate trend, so here we sought to determine attitudes, beliefs, and perceptions in these women and their partners associated with vaccine hesitancy to better address uncertainties and improve vaccination rates. METHODS: We used a cross-sectional survey of rural Midwestern infertility patients. Study population included both women and men, ranging from 21 to 53 years old. We evaluated vaccination status, hesitancy or refusal for COVID-19 vaccination, sociodemographic factors, sources and types of medical information, employer vaccination requirements, and specific attitudes, beliefs, and perceptions towards vaccines using questions guided by the Health Belief Model. RESULTS: We surveyed 390 Midwestern patients with pre-existing clinic appointments who were being evaluated for infertility and/or trying to conceive. Vaccine-hesitant patients held significant concerns of rushed vaccine development, safety, and benefits not outweighing potential risks. Patients were significantly more likely to obtain the vaccine if it was recommended by their physician. They were also more likely to receive the vaccine if they were given written resources or if required by their employer. CONCLUSIONS: Survey results identified specific concerns and strategies that may be used to address vaccine hesitancy in this at-risk population. Addressing vaccine hesitancy may improve vaccination rates and in turn reduce maternal mortality and morbidity, particularly in rural populations.

Clinical shoulder measurements related to joint loads in collegiate pitchers.

Background: Pitchers are prone to upper extremity injury due to repetitive high joint loads. Clinical measures of shoulder strength and range of motion (ROM) have shown links to injury risk in pitchers, however, these factors have rarely been studied in relation to throwing joint loads. The purpose of this study was to identify which clinical ROM and isokinetic strength variables were related to peak shoulder and elbow joint torques in collegiate pitchers. Methods: Thirty-three healthy collegiate pitchers participated in this study. Fastball velocity, shoulder concentric and eccentric strength, and passive shoulder ROM variables were analyzed using a Lasso regression to determine what factors influenced shoulder internal rotation torque and elbow varus torque. Results: Fastball velocity was selected by the Lasso as indicator of increased shoulder and elbow torque. Passive shoulder external rotation ROM was also selected as an important factor in joint loading with increased shoulder external rotation ROM being related to lower joint loads. The bilateral ratio of shoulder internal rotator concentric strength was related to peak shoulder and elbow torques with an increase in the bilateral ratio of shoulder strength leading to reduced joint torques. Increases in the eccentric external rotator to concentric internal rotator strength (functional ratio) of the dominant arm and increases in dominant arm eccentric internal rotator strength were both related to increases in each joint torque. Conclusion: Results from the study indicate that pitch speed, passive shoulder external rotation ROM, and the isokinetic shoulder strength profile including internal rotator strength and functional strength ratio of pitchers are related to joint loading during the pitch and may be important to monitor in relation to injury risk and/or during rehabilitation. These results provide insight into the role that both shoulder ROM and rotator cuff strength play in the dynamic stabilization of the elbow and shoulder during pitching.

Improved outcomes for borderline resectable adenocarcinoma of the pancreas after neoadjuvant chemotherapy in a community cancer center.

BACKGROUND: Borderline resectable adenocarcinoma of the pancreas involves the major vascular structures adjacent to the pancreas and has traditionally led to poor resection rates and survival. Newer chemotherapy regimens have demonstrated improved response and resection rates. We performed a retrospective review of borderline resectable pancreatic cancers who presented to a community cancer program to determine the effect of neoadjuvant chemotherapy to improve resection rates and overall survival. METHODS: Records of all patients diagnosed with adenocarcinoma of the pancreas from January 1, 2015 to December 31, 2019 were reviewed to determine stage at presentation, resectablility status, treatment methods, surgical resection and survival. Borderline resectable status was determined by preoperative imaging in agreement with published criteria from the National Comprehensive Cancer Network (NCCN) Guidelines 2.2021. Data was collected and analyzed by standard t-test. This study was approved by the institution's IRB. RESULTS: During this time period 322 patients were diagnosed with ductal adenocarcinoma of the pancreas of which 151 (47%) were unresectable, 31 (10%) were locally advanced, 70 (22%) were borderline resectable, and 69 (21%) were resectable at the time of presentation. 36 (51%) of the borderline resectable patients underwent neoadjuvant chemotherapy at our institution with either FOLFIRINOX or gemcitibine/nab-Paclitaxel regimens and served as the basis for this analysis. After neoadjuvant chemotherapy 24 (68%) of the borderline-resectable patients were deemed suitable for surgical exploration. At exploration, 15 (64%) were resected with 9 (60%) achieving margin-free resection on final pathology. The overall survival of those that underwent resection was increased by 19.6 months compared to those that did not undergo surgery (35.4 versus 15.8 mos, p < 0.01). Overall morbidity after resection was 46% (33% class 1 or 2, 13% class 3) with 0% mortality at 90 days. CONCLUSIONS: Use of neoadjuvant chemotherapy for borderline resectable adenocarcinoma of the pancreas results in improved resection rates and overall survival in resected patients. This management strategy for ductal adenocarcinoma of the pancreas is safe and feasible in a community-based cancer program.

Author Correction: Characterization of a recurrent missense mutation in the forkhead DNA-binding domain of FOXP1.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Characterization of a recurrent missense mutation in the forkhead DNA-binding domain of FOXP1.

Haploinsufficiency of Forkhead box protein P1 (FOXP1), a highly conserved transcription factor, leads to developmental delay, intellectual disability, autism spectrum disorder, speech delay, and dysmorphic features. Most of the reported FOXP1 mutations occur on the C-terminus of the protein and cluster around to the forkhead domain. All reported FOXP1 pathogenic variants result in abnormal cellular localization and loss of transcriptional repression activity of the protein product. Here we present three patients with the same FOXP1 mutation, c.1574G>A (p.R525Q), that results in the characteristic loss of transcription repression activity. This mutation, however, represents the first reported FOXP1 mutation that does not result in cytoplasmic or nuclear aggregation of the protein but maintains normal nuclear localization.