FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation-a retrospective cohort study.

Background: Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods: We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results: The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion: A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway.

Obesity and Native Tissue Repairs: A Secondary Analysis of the OPTIMAL Trial.

IMPORTANCE: The Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) Trial compared sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) surgical outcomes. Increasing body mass index (BMI) is associated with an increased risk of pelvic organ prolapse, and the prevalence of obesity is increasing worldwide. OBJECTIVE: The purpose of this study was to better understand the effect of obesity on the results of native tissue vaginal apical suspension procedures. STUDY DESIGN: This was a secondary analysis of the OPTIMAL Trial data set. Subgroup analysis was performed to compare surgical failure rates between SSLF and ULS across BMI subgroups after 2 years. RESULTS: There were 75, 120, 63, and 39 patients in the normal, overweight, class 1 obesity, and class 2 obesity or greater BMI subgroups, respectively. There were no statistically significant differences in surgical failure rates between SSLF and ULS within BMI subgroups; however, failure rates increased in the ULS group between the nonobese and obese groups (normal, 35.9% SSLF vs 30.6% ULS [P = 0.81]; overweight, 38.6% vs 30.2% [P = 0.44]; class 1 obesity, 38.7% vs 40.6% [P = 0.92]; class 2 obesity or greater, 21.1% vs 45% [P = 0.21]). CONCLUSIONS: The risk of surgical failure between SSLF and ULS was not significant across BMI subgroups. Additional investigation is required to further elucidate whether SSLF or ULS is a more reliable option for obese patients.

Genetic Risk for Alzheimer's Disease Alters Perceived Executive Dysfunction in Cognitively Healthy Middle-Aged and Older Adults.

Background: Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. However, findings comparing SCC and objective cognitive performance have varied, particularly in the memory domain. Even less well established is the relationship between subjective and objective complaints in non-amnestic domains, such as in executive functioning, despite evidence indicating very early changes in these domains. Moreover, particularly early changes in both amnestic and non-amnestic domains are apparent in those carrying the Apolipoprotein-E ɛ4 allele, a primary genetic risk for Alzheimer's disease (AD). Objective: This study investigated the role of the ɛ4 allele in the consistency between subjective and objective executive functioning in 54 healthy, cognitively intact, middle-aged and older adults. Methods: Participants (Mage = 64.07, SD = 9.27, range = 48-84; ɛ4+ = 18) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure subjective executive functioning (SEF) and multiple executive functioning tasks, which were condensed into a single factor. Results: After accounting for age, depression, and anxiety, objective executive functioning performance significantly predicted SEF. Importantly, ɛ4 moderated this effect. Specifically, those carrying the ɛ4 allele had significantly less accurate self-awareness of their executive functioning compared to ɛ4 non-carriers. Conclusions: Utilizing an approach that integrates self-evaluation of executive functioning with objective neurocognitive assessment may help identify the earliest signs of impending cognitive decline, particularly in those with genetic risk for AD. Such an approach could sensitively determine those most prone to future cognitive decline prior to symptom onset, when interventions could be most effective.

PedBotLab: A Novel Video Game-Based Robotic Ankle Platform Created for Therapeutic Exercise for Children With Neurological Impairments.

AIMS: Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance. METHODS: Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial. RESULTS: Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes. CONCLUSIONS: The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device.

Early prenatal sex steroids and sex-typed play behavior at 4 years of age.

During pregnancy, estrogens and testosterone influence brain development, resulting in sex-typical behavioral phenotypes. Prenatal testosterone exposure is associated with more male-typical behaviors in rodents, monkeys, and humans; however, few studies have examined the relationship between maternal sex hormones within the normal range and sex-dimorphic behaviors. In this study, we examined associations between prenatal estrogens and testosterone and sex-typical play in The Infant Development and the Environment Study (TIDES), a multicenter pregnancy cohort. We collected prenatal serum during the first trimester (mean=11.1 ± 2.6 weeks) and assessed child play behavior using the maternally completed Pre-School Activities Inventory (PSAI) at a mean age of 4.5 ± 0.3 years. This analysis includes mother-child pairs with complete data on hormones, play behavior, and covariates (n = 192 boys and 207 girls). No associations were seen between testosterone and PSAI scores in boys or girls or between estrogens and PSAI scores in boys. In girls, we observed an inverse relationship between feminine PSAI scores and both estradiol (E2) and estriol (E3) in multivariable linear regression analyses (E2: -0.11 [95% CI -0.20, -0.02]; E3: -0.44 [95% CI -0.83,-0.04]). Because the relationship between sex hormones and PSAI scores appeared nonlinear, we fit piecewise regression models to better fit the data and identify inflection points (point at which there is a significant change in slope). Piecewise regression analyses yielded inverse associations between masculine PSAI scores and estrone (E1) at values of E1 > 1340 pg/mL and E2 at values of E2 > 2870 pg/mL in girls. Further studies are needed to better understand the role of prenatal sex steroids on sexually dimorphic behavior.

Regional biogeography versus intra-annual dynamics of the root and soil microbiome.

BACKGROUND: Root and soil microbial communities constitute the below-ground plant microbiome, are drivers of nutrient cycling, and affect plant productivity. However, our understanding of their spatiotemporal patterns is confounded by exogenous factors that covary spatially, such as changes in host plant species, climate, and edaphic factors. These spatiotemporal patterns likely differ across microbiome domains (bacteria and fungi) and niches (root vs. soil). RESULTS: To capture spatial patterns at a regional scale, we sampled the below-ground microbiome of switchgrass monocultures of five sites spanning > 3 degrees of latitude within the Great Lakes region. To capture temporal patterns, we sampled the below-ground microbiome across the growing season within a single site. We compared the strength of spatiotemporal factors to nitrogen addition determining the major drivers in our perennial cropping system. All microbial communities were most strongly structured by sampling site, though collection date also had strong effects; in contrast, nitrogen addition had little to no effect on communities. Though all microbial communities were found to have significant spatiotemporal patterns, sampling site and collection date better explained bacterial than fungal community structure, which appeared more defined by stochastic processes. Root communities, especially bacterial, were more temporally structured than soil communities which were more spatially structured, both across and within sampling sites. Finally, we characterized a core set of taxa in the switchgrass microbiome that persists across space and time. These core taxa represented < 6% of total species richness but > 27% of relative abundance, with potential nitrogen fixing bacteria and fungal mutualists dominating the root community and saprotrophs dominating the soil community. CONCLUSIONS: Our results highlight the dynamic variability of plant microbiome composition and assembly across space and time, even within a single variety of a plant species. Root and soil fungal community compositions appeared spatiotemporally paired, while root and soil bacterial communities showed a temporal lag in compositional similarity suggesting active recruitment of soil bacteria into the root niche throughout the growing season. A better understanding of the drivers of these differential responses to space and time may improve our ability to predict microbial community structure and function under novel conditions.

Body image and psychosocial well-being among UK military personnel and veterans who sustained appearance-altering conflict injuries.

A modest but significant number of military personnel sustained injuries during deployments resulting in an altered-appearance (e.g., limb loss and/or scarring). Civilian research indicates that appearance-altering injuries can affect psychosocial wellbeing, yet little is known about the impact of such injuries among injured personnel. This study aimed to understand the psychosocial impact of appearance-altering injuries and possible support needs among UK military personnel and veterans. Semi-structured interviews with 23 military participants who sustained appearance-altering injuries during deployments or training since 1969 were conducted. The interviews were analyzed using reflexive thematic analysis, identifying six master themes. These themes indicate that in the context of broader recovery experiences, military personnel and veterans experience a variety of psychosocial difficulties related to their changed appearance. While some of these are consistent with evidence from civilians, military-related nuances in the challenges, protective experiences, coping approaches, and preferences for support are evident. Personnel and veterans with appearance-altering injuries may require specific support for adjusting to their changed appearance and related difficulties. However, barriers to acknowledging appearance concerns were identified. Implications for support provision and future research are discussed.

Necrotic cardiac myocytes skew macrophage polarization towards a classically activated phenotype.

Necrotic and dying cells release damage-associated molecular patterns (DAMPs) that can initiate sterile inflammatory responses in the heart. Although macrophages are essential for myocardial repair and regeneration, the effect of DAMPs on macrophage activation remains unclear. To address this gap in knowledge we studied the effect of necrotic cardiac myocyte extracts on primary peritoneal macrophage (PPM) cultures in vitro. We first performed unbiased transcriptomic profiling with RNA-sequencing of PPMs cultured for up to 72 hours in the presence and absence of: 1) necrotic cell extracts (NCEs) from necrotic cardiac myocytes in order to mimic the release of DAMPs; 2) lipopolysaccharide (LPS), which is known to polarize macrophages towards a classically activated phenotype and 3) Interleukin-4 (IL-4), which is known to promote polarization of macrophages towards an alternatively activated phenotype. NCEs provoke changes in differential gene expression (DEGs) that had considerable overlap with LPS-induced changes, suggesting that NCEs promote macrophage polarization towards a classically activated phenotype. Treating NCEs with proteinase-K abolished the effects of NCEs on macrophage activation, whereas NCE treatment with DNase and RNase did not affect macrophage activation. Stimulation of macrophage cultures with NCEs and LPS resulted in a significant increase in macrophage phagocytosis and interleukin-1ß secretion, whereas treatment with IL-4 had no significant effect on phagocytosis and interleukin-1ß. Taken together, our findings suggest that proteins released from necrotic cardiac myocytes are sufficient to skew the polarization of macrophages towards a classically activated phenotype.

Study of Salmonella detection in laying hens using a Bayesian model.

As part of the measures to reduce the prevalence of Salmonella in poultry in the UK, National Control Programmes (NCPs) have been implemented. These involve regular statutory testing of poultry holdings to monitor and estimate the prevalence of Salmonella in the national flock population and to control Salmonella on holdings with positive flocks, especially those serovars most identified with human illness: Salmonella Enteritidis (SE) and S. Typhimurium (ST). It is very important to ensure that the level of testing is appropriate so that it is sufficiently effective to identify positive flocks and to monitor prevalence, but also efficient in the use of resources. The aim of this study was to estimate the sensitivity of both the Operator and Competent Authority (CA) Official sampling used to detect infected flocks, and to also estimate the true proportion of infected holdings of commercial laying flocks in GB each year of the NCP, along with the trend of any changes in prevalence for both SE/ST and non-SE/ST. A Bayesian model was developed to estimate the sensitivity of both Operator and CA Official sampling from the NCP data 2009-2018, and to estimate the true prevalence of infected holdings. The model estimate for the prevalence of infected holdings for the first complete year of the NCP was 3.9% (95% Credible Interval (CI) 2.8-6.2%) for non-SE/ST and 0.8% (95% CI: 0.4%-1.5%) for SE/ST. Prevalence had reduced to 1.6% (non-SE/ST) (95% CI 1.0%-2.5%) and 0.2% (SE/ST) (95% CI 0.1%-0.4%) in 2018. Results indicated a very low sensitivity of Operator sampling (~9%), but a much higher sensitivity of CA Official sampling (~44%). The true prevalence of Salmonella infected holdings in the UK had a mean average reduction of 10.6% (95% CI: 6.3%-15.1%) per annum (non-SE/ST) and 15.9% (95% CI: 6.0%-19.8%) annual reduction for SE/ST. This has shown the effectiveness of the NCP for Salmonella in commercial laying flocks, with reductions in Salmonella overall more or less equal to the target reduction for regulated serovars of 10% per annum. The true prevalence of SE/ST was estimated to be below the final target of less than 2% in every year and was below 0.5% at the end of the 10 year period.

In-Person Versus Video Preoperative Visit: A Randomized Clinical Trial.

IMPORTANCE: This study further supports virtual visits for gynecologic preoperative care. OBJECTIVES: The objective of this study was to determine if preoperative video visits are noninferior to in-person visits in pelvic reconstructive surgery. Secondary objectives are as follows: patient satisfaction, convenience, visit duration, total perioperative visits, and patient travel time/distance. STUDY DESIGN: Noninferiority randomized-controlled trial of patients undergoing pelvic reconstructive surgery randomized to in-person or video counseling. The primary outcome was a composite score on the Preoperative Preparedness Questionnaire. RESULTS: Demographics were similar except for higher body mass index (BMI) in the video group (29.5 vs 26.3; P = 0.01), and fewer patients in the video group used text messaging for health care delivery (40.7% vs 59.3%, P = 0.04). Video visits were noninferior to in-person visits in Preoperative Preparedness Questionnaire scores (62.5 ± 4.6 vs 63.0 ± 3.6; difference = 0.5; 95% confidence interval, -0.8, □). There was no difference in "strongly agree" response to question 11, "Overall, I feel prepared for my upcoming surgery" (79.6% vs 88.9%, P = 0.19). Satisfaction was higher for video visits based on composite Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey scores (31.3 ± 1.5 vs 30.5 ± 2, P = 0.02). Video visits were more convenient (100% vs 85.2%, P < 0.01), of shorter duration for patients (39.3 ± 14.0 minutes vs 55.9 ± 18.9 minutes; P < 0.01), and similar length for health care providers (28.8 ± 9.6 minutes vs 28.2 ± 9.8 minutes; P = 0.77). The video visit group had fewer office visits (2.0 vs 3.0, P < 0.01) and traveled 66 minutes ( P < 0.01) and 28 miles ( P < 0.01) less. CONCLUSION: Preoperative video visits are noninferior to in-person visits for preparing patients for pelvic reconstructive surgery.

Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation.

OBJECTIVE: This study aimed to assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP). STUDY DESIGN: A retrospective case-control study of patients with HDP delivering at a single academic institution (2014-2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation. RESULTS: Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14-2.17), severe HDP (aOR: 1.94, 95% CI: 1.44-2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43-2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47-0.97), and public insurance (aOR: 0.65, 95% CI: 0.45-0.93) compared with private insurance. CONCLUSION: Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance. KEY POINTS: · A total of 57.9% of patients with HDP attended in person postpartum blood pressure check.. · Nulliparity, severe features of HDP, and cesarean birth were associated with higher rates of attendance.. · Non-Hispanic black race and ethnicity and public insurance were associated with lower attendance..

Introduction: Health, Well-Being, and Ability in Archaeology.

This thematic volume explores how health, well-being, and ability are constructed in the past and in the present. The volume's authors undo and question deeply ingrained assumptions about what constitutes a "normative" body. They do so by not only looking at how bodies have been medicalized and envisioned in the past, but also how our own profession and discipline discriminates against certain types of bodies in the present.

Early recognition of patients with leukodystrophies.

Leukodystrophies are defined as differences in normal myelin development and maintenance in the central nervous system. They typically present as white matter imaging abnormalities in young children with delayed developmental milestones. As the scientific community begins to better understand and research the mechanisms underlying leukodystrophies, clinical trials and approved therapies for specific disorders are becoming available. These interventions, ranging from repurposing of existing small molecules to recently approved gene therapies, are highly dependent on early diagnosis. It is essential for pediatricians to identify affected individuals promptly, but they face challenges including lack of awareness of the disorders and nonspecific symptom presentation (e.g., cognitive or motor developmental delay). This review provides five hypothetical clinical presentations and describes the disease mechanisms, typical symptoms, and treatments currently available for common leukodystrophies: Krabbe Disease, Aicardi Goutières Syndrome (AGS), Metachromatic leukodystrophy (MLD), Alexander Disease (AxD), Pelizaeus-Merzbacher Disease (PMD), and X-Linked Adrenoleukodystrophy (X-ALD.) This review educates pediatricians to recognize the presentation of leukodystrophies in affected children. These clinical vignettes can serve as a framework for pediatricians to identify potentially treatable rare disorders among their patients.

Development and validation of retrospective electronic frailty index using operational data of aged care homes.

BACKGROUND: Although elderly population is generally frail, it is important to closely monitor their health deterioration to improve the care and support in residential aged care homes (RACs). Currently, the best identification approach is through time-consuming regular geriatric assessments. This study aimed to develop and validate a retrospective electronic frailty index (reFI) to track the health status of people staying at RACs using the daily routine operational data records. METHODS: We have access to patient records from the Royal Freemasons Benevolent Institution RACs (Australia) over the age of 65, spanning 2010 to 2021. The reFI was developed using the cumulative deficit frailty model whose value was calculated as the ratio of number of present frailty deficits to the total possible frailty indicators (32). Frailty categories were defined using population quartiles. 1, 3 and 5-year mortality were used for validation. Survival analysis was performed using Kaplan-Meier estimate. Hazard ratios (HRs) were estimated using Cox regression analyses and the association was assessed using receiver operating characteristic (ROC) curves. RESULTS: Two thousand five hundred eighty-eight residents were assessed, with an average length of stay of 1.2 ± 2.2 years. The RAC cohort was generally frail with an average reFI of 0.21 ± 0.11. According to the Kaplan-Meier estimate, survival varied significantly across different frailty categories (p < 0.01). The estimated hazard ratios (HRs) were 1.12 (95% CI 1.09-1.15), 1.11 (95% CI 1.07-1.14), and 1.1 (95% CI 1.04-1.17) at 1, 3 and 5 years. The ROC analysis of the reFI for mortality outcome showed an area under the curve (AUC) of ≥0.60 for 1, 3 and 5-year mortality. CONCLUSION: A novel reFI was developed using the routine data recorded at RACs. reFI can identify changes in the frailty index over time for elderly people, that could potentially help in creating personalised care plans for addressing their health deterioration.

A Low-fidelity Model for Office-based Hysteroscopy with a Vaginoscopic Approach.

STUDY OBJECTIVE: Hysteroscopy is an established method for the diagnosis and treatment of intrauterine pathology. A vaginoscopic approach for office-based hysteroscopy confers less pain; however, trainees report lack of confidence with this procedure. We sought to create a low-fidelity simulation model for office-based hysteroscopy with a vaginoscopic approach and to evaluate the validity and reliability of this model. DESIGN: Prospective cohort study. SETTING: A single academic medical center. PARTICIPANTS: Eligible participants included obstetrics and gynecology residents and attendings who regularly perform hysteroscopy. INTERVENTIONS: The vaginoscopy model was created with an inanimate female pelvis simulator with an exam glove placed within the vagina. Following 2 instructional videos, participants performed a hysteroscopy simulation with a vaginoscopic approach. The primary outcome was total score on a modified Global Rating Scale and Objective Structured Assessment of Technical Skills. The Objective Structured Assessment of Technical Skills outlines a series of steps that must be performed and was created with assistance from experts in hysteroscopy for providing content-oriented evidence of validity. Time to complete each task and total time were tracked. Participants completed a postprocedure survey assessing the model and experience. MEASUREMENTS AND MAIN RESULTS: A total of 30 physicians participated, with 20 residents (9 junior and 11 senior) and 10 attendings. Attending physicians completed the simulation faster than junior residents (197.2 ± 30.9 vs 289.8 ± 107.4 seconds, p = .022). On the Global Rating Scale, both attending physicians and senior residents scored significantly higher than junior residents (26.1 ± 2.4 vs 22.5 ± 3.7, p = .01). Postsurvey data demonstrated that 93.3% of all participants were satisfied with simulation, 96.6% found it useful, 80% found it realistic, and 93% indicated that they may use this technique in the future. CONCLUSION: This study shows our low-fidelity model to be effective and useful and to improve confidence for vaginoscopic approach to hysteroscopy. Further studies are needed to assess ability to predict or improve clinical and surgical skills.

Prenatal bisphenol A exposure in relation to behavioral outcomes in girls aged 4-5 and modification by socio-demographic factors in The Infant Development and Environment Study (TIDES).

Bisphenol A (BPA) is a polymer used in the production of polycarbonate plastics and epoxy resins. An estrogen mimic, prenatal BPA exposure has been associated with several behavioral outcomes in children; however, the impact of maternal demographic and economic factors on associations between BPA and child behavioral outcomes have not been examined. The objective of this study was to examine associations between prenatal maternal urinary BPA and behavior in 4-5 year old girls, and to assess whether socio-demographic factors modify this relationship. Mothers enrolled in The Infant Development and Environment Study (TIDES) provided a single spot urine at enrollment (median gestational age 11 weeks) and completed the Behavior Assessment System for Children-2 (BASC-2) and Social Responsiveness Scale-2 (SRS-2) when their daughters were 4-5 years of age. Mother-daughter pairs with complete phthalate, BASC-2, SRS-2, and covariate data were included in this analysis (N = 244). BPA was detectable in 93 % of urine samples. We used multivariable linear regression analyses to estimate associations between maternal urinary log10-transformed BPA concentration and BASC-2 subscale and composite scores and SRS-2 Total Score. To examine the role of socioeconomic and demographic factors associated with study site, we stratified by TIDES center, comparing those enrolled at University of Rochester Medical Center (URMC), a predominately lower socioeconomic population, and those enrolled elsewhere: University of Washington, University of Minnesota, and University of California San Francisco, whose populations share similar higher socioeconomic demographic characteristics. Across all centers, no associations were seen between BPA and BASC-2 or SRS-2 scores. When stratifying by center, BPA was significantly associated with greater social impairment as measured by the SRS-2 Total Score (ß-coefficient [95 % confidence intervals]: 5.1 [1.0, 9.2]) in URMC participants (N = 61). In non-URMC participants (N = 183), BPA was significantly associated with lower BASC-2 Internalizing composite (-3.3 [-6.7, 0.0]) and Depression subscale scores (-3.4 [-6.7, 0.0]) while no associations were seen between BPA and SRS-2 scores. Our findings suggest that sociodemographic factors may modify the impacts of maternal prenatal BPA on developmental endpoints.

Pass or Fail? Postoperative Active Voiding Trials in an Enhanced Recovery Program.

IMPORTANCE: Pelvic reconstructive surgery is often associated with transient postoperative voiding dysfunction. OBJECTIVE: This study aimed to compare postoperative active voiding trial (AVT) outcomes before and after implementation of an enhanced recovery program (ERP) for women undergoing pelvic reconstructive surgery. In addition, risk factors for postoperative urinary retention were identified. STUDY DESIGN: We retrospectively identified patients undergoing inpatient vaginal or robotic pelvic reconstructive surgery before and after implementation of an ERP at our institution. Demographics, operative and postoperative details, and AVT outcomes were collected. Primary outcome was AVT failure. Variables associated with increased risk of AVT failure were identified using multivariate analysis. RESULTS: Three hundred seventeen patients were included-75 pre-ERP and 242 ERP. There was no difference in AVT failures between pre-ERP and ERP groups (21.3% vs 21.9%, P = 0.92). The AVT failures were highest among those with abnormal preoperative postvoid residual volume (PVR ≥100 mL, 25.9% vs 12.2%, P = 0.01) and those who underwent an incontinence procedure (midurethral sling or Kelly plication, 30.4% vs 16.9%, P = 0.01). Compared with a reference procedure (total vaginal hysterectomy [TVH]), the following procedures were associated with statistically significant higher odds ratios (ORs) of AVT failure: TVH with incontinence procedure (OR, 15.0; confidence interval [CI], 4.58-48.9; P < 0.001), TVH with anterior repair (OR, 4.98; CI, 1.93-12.9; P = 0.001), and robotic sacrocolpopexy (OR, 3.6; CI, 1.18-11.2; P = 0.02). CONCLUSIONS: Postoperative AVT failure incidence did not differ pre- and post-ERP intervention. Abnormal preoperative PVR was associated with failed postoperative voiding trial. Concomitant incontinence procedures and/or anterior colporrhaphy were associated with increased incidence of voiding trial failure regardless of ERP cohort.