Evaluating a web-based training curriculum for disseminating best practices for the care of newborns with neonatal opioid withdrawal syndrome in a rural hospital, the NOWS-NM Program.

BACKGROUND: The incidence of neonatal opiate withdrawal syndrome (NOWS) in the US has grown dramatically over the past two decades. Many rural hospitals not equipped to manage these patients transfer them to hospitals in bigger cities. METHODS: We created a curriculum, the NOWS-NM Program, a web-based curriculum training in best practices. To evaluate the curriculum, we conducted pre- and post-surveys of NOWS knowledge, attitudes, and care practices, plus post-curriculum interviews and focus groups. RESULTS: Fourteen participants completed both pre- and post-curriculum surveys. They indicated an increase in knowledge and care practices. A small number of respondents expressed negative attitudes about parents of infants with NOWS at pre-test, the training curriculum appeared to have no impact on such attitudes at post-test. Sixteen participants participated in focus groups or interviews. Qualitative data reinforced the positive quantitative results and contradicted the negative survey results, respondents reported that the program did reduce stigma and improve provider/staff interactions with patients. CONCLUSIONS: This curriculum demonstrated positive impacts on NOWS knowledge and care practices. Incorporating focus on core concepts of trauma-informed care and self-regulation in future iterations of the curriculum may strengthen the opportunity to change attitudes and address the needs expressed by participants and improve care of families and babies with NOWS.

Implementation and early effects of medicaid policy interventions to promote racial equity in pregnancy and early childhood outcomes in Pennsylvania: protocol for a mixed methods study.

BACKGROUND: There are large racial inequities in pregnancy and early childhood health within state Medicaid programs in the United States. To date, few Medicaid policy interventions have explicitly focused on improving health in Black populations. Pennsylvania Medicaid has adopted two policy interventions to incentivize racial health equity in managed care (equity payment program) and obstetric service delivery (equity focused obstetric bundle). Our research team will conduct a mixed-methods study to investigate the implementation and early effects of these two policy interventions on pregnancy and infant health equity. METHODS: Qualitative interviews will be conducted with Medicaid managed care administrators and obstetric and pediatric providers, and focus groups will be conducted among Medicaid beneficiaries. Quantitative data on healthcare utilization, healthcare quality, and health outcomes among pregnant and parenting people will be extracted from administrative Medicaid healthcare data. Primary outcomes are stakeholder perspectives on policy intervention implementation (qualitative) and timely prenatal care, pregnancy and birth outcomes, and well-child visits (quantitative). Template analysis methods will be applied to qualitative data. Quantitative analyses will use an interrupted time series design to examine changes over time in outcomes among Black people, relative to people of other races, before and after adoption of the Pennsylvania Medicaid equity-focused policy interventions. DISCUSSION: Findings from this study are expected to advance knowledge about how Medicaid programs can best implement policy interventions to promote racial equity in pregnancy and early childhood health.

Mechanical indications for inflatable penile prosthesis revision: analysis and implications for revision surgery.

BACKGROUND: Despite technical advancements, inflatable penile prostheses (IPPs) are inherently at risk of mechanical failure given their nature as hydraulic devices. AIM: To characterize IPP component failure location at the time of device revision and stratify by manufacturer: American Medical Systems (Boston Scientific [BSCI]) and Coloplast (CP). METHODS: A retrospective review of penile prosthesis cases from July 2007 to May 2022 was conducted, identifying men who underwent revision surgery. Cases were excluded if documentation did not denote the cause of failure or the manufacturer. Mechanical indications for surgery were categorized by location (eg, tubing, cylinder, or reservoir leak; pump malfunction). Nonmechanical revisions were excluded (component herniation, erosion, or crossover). Categorical variables were assessed with Fisher exact or chi-square analysis; Student t-test and Mann-Whitney U test were used for continuous variables. OUTCOMES: Primary outcomes included specific location of IPP mechanical failure among BSCI and CP devices and time to mechanical failure. RESULTS: We identified 276 revision procedures, 68 of which met inclusion criteria (46 BSCI and 22 CP). Revised CP devices were longer than BSCI devices (median cylinder length, 20 vs 18 cm; P < .001). Log-rank analysis revealed a similar time to mechanical failure between brands (P = .096). CP devices failed most often due to tubing fracture (19/22, 83%). BSCI devices had no predominant site of failure. Between manufacturers, tubing failure was more common in CP devices (19/22 vs 15/46 for BSCI, P < .001), while cylinder failure was more common among BSCI devices (10/46 vs 0/22 for CP, P = .026). CLINICAL IMPLICATIONS: The distribution of mechanical failure is significantly different between BSCI and CP devices; this has implications regarding the approach to revision surgery. STRENGTHS AND LIMITATIONS: This is the first study to directly compare when and where mechanical failure occurs in IPPs and to compare the 2 main manufacturers head-to-head. This study would be strengthened by being repeated in a multi-institutional fashion to provide more robust and objective evaluation. CONCLUSION: CP devices commonly failed at the tubing and rarely elsewhere, while BSCI devices showed no predominant failure site; these findings may inform decision making regarding revision surgery.

Measuring and controlling medical record abstraction (MRA) error rates in an observational study.

BACKGROUND: Studies have shown that data collection by medical record abstraction (MRA) is a significant source of error in clinical research studies relying on secondary use data. Yet, the quality of data collected using MRA is seldom assessed. We employed a novel, theory-based framework for data quality assurance and quality control of MRA. The objective of this work is to determine the potential impact of formalized MRA training and continuous quality control (QC) processes on data quality over time. METHODS: We conducted a retrospective analysis of QC data collected during a cross-sectional medical record review of mother-infant dyads with Neonatal Opioid Withdrawal Syndrome. A confidence interval approach was used to calculate crude (Wald's method) and adjusted (generalized estimating equation) error rates over time. We calculated error rates using the number of errors divided by total fields ("all-field" error rate) and populated fields ("populated-field" error rate) as the denominators, to provide both an optimistic and a conservative measurement, respectively. RESULTS: On average, the ACT NOW CE Study maintained an error rate between 1% (optimistic) and 3% (conservative). Additionally, we observed a decrease of 0.51 percentage points with each additional QC Event conducted. CONCLUSIONS: Formalized MRA training and continuous QC resulted in lower error rates than have been found in previous literature and a decrease in error rates over time. This study newly demonstrates the importance of continuous process controls for MRA within the context of a multi-site clinical research study.

Long-term lower urinary tract sequelae following AUS cuff erosion.

AIMS: To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. METHODS: We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups. RESULTS: A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. CONCLUSIONS: Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.

Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020.

PURPOSE: The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. METHODS: Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. RESULTS: While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. CONCLUSION: This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.

Presenting signs and symptoms of artificial urinary sphincter cuff erosion.

PURPOSE: To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients. MATERIALS AND METHODS: We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 - 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for symptom comparison. Risk factors for cuff erosion - pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) - were recorded for each patient. Presenting signs and symptoms of cuff erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI). RESULTS: Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling. Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 ± 18 vs. obstructive symptoms 15 ± 16 vs. incontinence 37 ± 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 49%, p=0.02). CONCLUSION: AUS cuff erosion most commonly presents as SI symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.

Radiographic Assessment of Inflatable Penile Prosthesis Reservoir Location Variability in Contemporary Practice.

BACKGROUND: Inflatable penile prosthesis (IPP) reservoirs are typically placed into the Space of Retzius (SOR) or alternative locations including the High Submuscular (HSM) space via transinguinal (TI) or counter incision (CI) techniques. A cadaver study showed variability in reservoir location after TI-HSM placement. AIM: To evaluate reservoir location using cross-sectional imaging following IPP insertion. METHODS: We retrospectively reviewed our institutional database and identified men who underwent virgin penoscrotal IPP insertion between 2007 and 2019. We then identified those men who subsequently underwent cross-sectional imaging prior to October 2019. Radiologists evaluated cross-sectional imaging in a blinded manner and categorized reservoir locations as follows: 1) submuscular; 2) posterior to the external oblique fascia and lateral to the rectus abdominis musculature; 3) preperitoneal; 4) retroperitoneal; 5) intraperitoneal; 6) inguinal canal; 7) subcutaneous. Patients were stratified by reservoir placement technique, transinguinal space of Retzius (TI-SOR), transinguinal high submuscular (TI-HSM), or counterincision high submuscular (CI-HSM). Clinical characteristics and outcomes were reviewed and compared. Statistical analysis was performed using Chi-squared and Fisher's exact tests. OUTCOMES: Variability exists in the TI placement of SOR and HSM reservoirs, CI-HSM reservoirs were associated with a low level of variability. RESULTS: Among 561 men who underwent virgin IPP insertion during the 12-year study period, 114 had postoperative cross-sectional imaging (29 TI-SOR, 80 TI-HSM, and 5 CI-HSM). Among the 114 patients imaged, TI-HSM reservoirs were more likely than TI-SOR to be located anterior to the transversalis fascia (48 vs 14%, P < .01) and were less likely to be located in the preperitoneal space (18 vs 62%, P < .01). Rates of intraperitoneal reservoir location were similar between the TI-HSM and TI-SOR groups (5 vs 7%, P = .66). Among imaged CI-HSM reservoirs, 4 (80%) were anterior to the transversalis fascia and 1 (20%) was within the inguinal canal. Among all 536 transinguinal cases (131 TI-SOR and 405 TI-HSM), rates of reservoir-related complications requiring operative intervention were similar between groups (5 vs 2%, P = .24). No complications were noted among the 25 patients in the CI-HSM cohort. CLINICAL IMPLICATIONS: The level of variability seen in this study did not seem to impact patient safety, complications were rare in all cohorts. STRENGTHS AND LIMITATIONS: This study is the first and largest of its kind in evaluating reservoir positioning in live patients with long-term follow-up. This study is limited in its retrospective and nonrandomized nature. CONCLUSIONS: Despite variability with both TI-HSM and TI-SOR techniques, reservoir related complications remain rare. Kavoussi M, Cook G, Nordeck S, et al. Radiographic Assessment of Inflatable Penile Prosthesis Reservoir Location Variability in Contemporary Practice. J Sex Med 2021;18:2039-2044.

Most men with artificial urinary sphincter cuff erosion have low serum testosterone levels.

AIMS: To evaluate the relationship between serum testosterone (T) levels and artificial urinary sphincter (AUS) cuff erosion in a population of incontinent men who underwent AUS placement. METHODS: A retrospective analysis of our single-surgeon AUS database was performed to identify men with T levels within 24 months of AUS placement. Men were stratified into two groups based on serum testosterone: low serum testosterone (LT) (<280 ng/dl) and normal serum testosterone (NT) (>280 ng/dl). Multivariable analysis was performed to control for risk factors. The outcome of interest was the incidence of and time to spontaneous urethral cuff erosion; other risk factors for cuff erosion were also evaluated. RESULTS: Among 161 AUS patients with serum testosterone levels, 84 (52.2%) had LT (mean: 136.8 ng/dl, SD: 150.4 ng/dl) and 77 (47.8%) had NT (mean: 455.8 ng/dl, SD: 197.3 ng/dl). Cuff erosion was identified in 42 men (26.1%) at a median of 7.1 months postoperatively (interquartile range: 3.6-13.4 months), most of whom (30/42, 71.4%) were testosterone deficient. LT levels were less common (54/119, 45.4%) in the non-erosion cohort (p = 0.004). Men with low T were nearly three times as likely to suffer AUS erosion than men with normal T (odds ratio = 2.519, p = 0.021). LT level was the only factor associated with AUS erosion on multivariable analysis. CONCLUSIONS: LT is an independent risk factor for AUS cuff erosion. Men with LT are more likely to present with cuff erosion, but there is no difference in time to erosion.

Male stress urinary incontinence is often underreported.

INTRODUCTION Patient-reported pads per day use is a widely used metric in grading the severity of stress urinary incontinence and guiding surgical decision-making, particularly in mild-to-moderate cases. We sought to compare patient-reported stress urinary incontinence severity by pads per day with objective findings on standing cough test. We hypothesize that patient-reported pads per day often underestimates stress urinary incontinence severity. MATERIALS AND METHODS: We retrospectively reviewed our male stress urinary incontinence surgical database and identified 299 patients with self-reported mild-to-moderate stress urinary incontinence who were evaluated with standing cough test prior to surgical intervention between 2007 and 2019. Patients were evaluated with the Male Stress Incontinence Grading Scale for urinary leakage during a standing cough test. This test has been shown to reliably and accurately predict surgical success. Binary logistic regression analysis was used to identify parameters associated with stress urinary incontinence upgrading in a multivariable model. RESULTS: Among 299 patients with reported mild-to-moderate stress urinary incontinence, 101 (34%) were upgraded to severe stress urinary incontinence by standing cough test. Prior stress urinary incontinence surgery (OR 4.1, 95% CI 2.0-8.0, p < 0.0001) and radiation (OR 3.2, 95% CI 1.7-5.7, p < 0.0001) were significantly associated with Male Stress Incontinence Grading Scale upgrading in multivariable analysis. CONCLUSIONS: Roughly one-third of men who report mild-to-moderate stress urinary incontinence actually have severe incontinence observed on physical examination. All men being evaluated for stress urinary incontinence should undergo standing cough test to accurately grade incontinence severity and guide surgical management.

Ecological momentary assessment of stress, racism and other forms of discrimination during pregnancy using smartphone technology.

BACKGROUND: In the United States, there are considerable racial inequities in adverse perinatal outcomes. Exposure to racism, sexism, and other forms of oppression may help explain these inequities. OBJECTIVES: To describe the application of real-time data collection using ecological momentary assessment (EMA) and smartphone technology to assess exposure to stress, racism, sexism, microaggressions, and other forms of oppression. METHODS: The Postpartum Mothers Mobile Study (PMOMS) is an ongoing longitudinal cohort study that began recruitment in December 2017. Participants delivering at a hospital in Pittsburgh, PA are recruited by 29 weeks' gestation. Using smartphones and smart scales, participants complete daily surveys related to psychosocial, behavioural, and contextual factors and weigh themselves weekly for approximately 15 months. We provide a preliminary descriptive analysis of EMA self-reported measures of stress, racism, sexism, and microaggressions; and non-EMA measures of stress and major discrimination. RESULTS: The sample (n = 230) is 63.5% White, 24.8% Black/African American, and 7% Hispanic origin. The most commonly reported item from the Major Discrimination Scale is being unfairly fired (18.1% of the sample). Of those, 31.7% and 17.1% attribute unfair firing to their gender and race, respectively. From the random EMA measures, on average, participants report experiences of racism and sexism at least once daily, in an average 12-hour day over the 4-week period. Black participants indicate about two experiences per day of racism, and White participants indicate more than 1 per day of sexism. Mean stress levels from the EMA measures were similar to the stress measures collected at baseline. CONCLUSIONS: The methods applied in PMOMS provide real-time data regarding how participants' daily experiences of stress and discrimination influence their lives. Future work will include understanding if and how these EMA measures may relate to already established measures of racism, sexism, and stress; and ultimately understanding associations with perinatal inequities.

Rural-Urban Differences in Baseline Dietary Intake and Physical Activity Levels of Adolescents.

INTRODUCTION: Differences in dietary intake and physical activity may explain the higher prevalence of obesity among adolescents living in rural versus urban settings. The objective of this cross-sectional secondary analysis was to compare baseline dietary intake and physical activity of adolescents by rurality. METHODS: We analyzed data on 940 adolescents who participated in ACTION PAC (Adolescents Committed to Improvement of Nutrition and Physical Activity), an obesity prevention and management intervention trial conducted from 2014 through 2017 in 8 public high schools in the southwestern United States. Dietary intake was assessed with the Block Food Screener, and participants completed an exercise log and wore an accelerometer to provide data on physical activity. We compared data by rural-urban commuting area (RUCA) codes and log population density by using multilevel models, with students nested within zip code and repeated measures for accelerometer analysis. RESULTS: After adjusting for socioeconomic status and ethnicity, accelerometer data indicated that moderate-to-vigorous physical activity was 8.17 min/d (P = .02) higher and sedentary time was 20.42 min/d (P = .02) lower in moderately urban areas than in the urban reference area. Each 1-unit increase in log population density was associated with higher reported intake of whole grains (0.02 ounce equivalents, P = .03), potatoes (0.01 cup equivalents, P = .02), and added sugar (0.37 tsp, P = .02) after adjusting for socioeconomic status and ethnicity. CONCLUSION: Differences in reported dietary intake and physical activity level by measures of rurality were small and inconsistent in direction to explain the disparities observed in rural versus urban areas.

Opioid Overdose Outbreak - West Virginia, August 2016.

On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington, West Virginia, notified the Cabell-Huntington Health Department (CHHD) of multiple calls regarding opioid overdose received by the emergency medical system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation and response conducted by the West Virginia Bureau for Public Health (BPH) and CHHD identified 20 opioid overdose cases within a 53-hour period in Cabell County; all cases included emergency department (ED) encounters. EMS personnel, other first responders, and ED providers administered the opioid antidote naloxone to 16 (80%) patients, six of whom were administered multiple doses, suggesting exposure to a highly potent opioid. No patients received referral for recovery support services. In addition to the public health investigation, a public safety investigation was conducted; comprehensive opioid toxicology testing of clinical specimens identified the synthetic opioid fentanyl* and novel fentanyl analogs, including carfentanil,† which had been used by patients who overdosed in Huntington. Results of these two investigations highlight the importance of collaboration between public health and public safety agencies to provide in-depth surveillance data from opioid overdose outbreaks that involve high-potency fentanyl analogs. These data facilitated a public health response through increased awareness of powerful opioid substances requiring multiple naloxone doses for reversal, and improved patient linkage to recovery support services and a harm reduction program from the ED after opioid overdose.

Effects of an Obesity Prevention Intervention on Physical Activity Among Preschool Children: The CHILE Study.

Background Limited research addresses interventions to increase physical activity among American Indian and Hispanic preschool-aged children living in rural areas. We examined the impact of a Head Start-based intervention (Child Health Initiative for Lifelong Eating and Exercise [CHILE]) on physical activity at home. Method Sixteen Head Start centers in predominantly Hispanic or American Indian communities were group randomized to the six-component intervention or a comparison group for 2 years. Structured surveys were administered at four assessment times to a convenience sample of caregivers of 655 children in the study. Multilevel modeling was used to assess the effects of the intervention on physical activity. Results The relative change in physical activity in the intervention group compared with the comparison group over the 2-year period was 1.56 (95% confidence interval [1.02, 2.38]; p = .04). Among specific promoted activities (ball playing, dancing, active games, jumping, and walking), dancing increased significantly in the intervention compared with the comparison group (2.9; 95% confidence interval [1.2, 7.1]; p = .02). Conclusions The CHILE intervention was effective at increasing physical activity at home in preschool children in priority populations. Future research should focus on increasing family involvement and strengthening messaging about physical activity in these populations.

Therapeutic Function of Liraglutide for Mitigation of Blast-Induced Hearing Damage: An Initial Investigation in Animal Model of Chinchilla.

INTRODUCTION: Auditory injuries induced by repeated exposures to blasts reduce the operational performance capability and the life quality of military personnel. The treatment for blast-induced progressive hearing damage is lacking. We have recently investigated the therapeutic function of liraglutide, a glucagon-like peptide-1 receptor agonist, to mitigate blast-induced hearing damage in the animal model of chinchilla, under different blast intensities, wearing earplugs (EPs) or not during blasts, and drug-treatment plan. The goal of this study was to investigate the therapeutical function of liraglutide by comparing the results obtained under different conditions. MATERIALS AND METHODS: Previous studies on chinchillas from two under-blast ear conditions (EP/open), two blast plans (G1: 6 blasts at 3-5 psi or G2:3 blasts at 15-25 psi), and three treatment plans (blast control, pre-blast drug treatment, and post-blast drug treatment) were summarized. The auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), and middle latency response (MLR) recorded within 14 days after the blasts were used. Statistical analysis was performed to evaluate the effect of liraglutide under different conditions. RESULTS: ABR threshold shifts indicated that the conditions of the EP and open ears were substantially different. Results from EP chinchillas indicated that the pre-blast treatment reduced the acute ABR threshold elevation on the day of blasts, and the significance of such an effect increased with the blast level. Liraglutide-treated open chinchillas showed lower ABR threshold shifts at the later stage of the experiment regardless of the blast levels. The DPOAE was less damaged after G2 blasts compared to G1 when pre-blast liraglutide was administrated. Lower post-blast MLR amplitudes were observed in the pre-blast treatment groups. CONCLUSIONS: This study indicated that the liraglutide mitigated the blast-induced auditory injuries. In EP ears, the pre-blast administration of liraglutide reduced the severity of blast-induced acute damage in ears with EP protection, especially under G2. In animals with open ears, the effect of liraglutide on the restoration of hearing increased with time. The liraglutide potentially benefits post-blast hearing through multiple approaches with different mechanics.

Mitigation of Hearing Damage With Liraglutide Treatment in Chinchillas After Repeated Blast Exposures at Mild-TBI.

INTRODUCTION: Although hearing protection devices (HPDs) have been widely used during training and combat, over one million veterans experience service-connected hearing loss. Hearing damage has been reported to be associated with blast-induced mild traumatic brain injury (mTBI) and there is a lack of understanding and treatment. Liraglutide is a glucagon-like peptide-1 receptor agonist and a potential treatment for TBI-induced memory deficits. This study aims to investigate the function of the liraglutide to prevent damage and facilitate hearing restoration in chinchillas exposed to multiple high-intensity, mTBI-level blasts. MATERIALS AND METHODS: Chinchillas were divided into three treatment groups: blast control, pre-blast drug treatment, and post-blast drug treatment. On day 1, the chinchilla ears were protected by HPDs and exposed to three blasts with peak pressure levels of 15-25 psi. The auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), and middle latency response (MLR) were recorded pre- and post-blast on day 1 and on days 4, 7, 14, and 28. RESULTS: Substantial acute damage was observed and progressively recovered in chinchillas after the blast exposures. The pre-blast treatment group exhibited the lowest elevation of the ABR threshold and reduction of the wave I amplitude on day 1 after blasts. The liraglutide treatment insignificantly facilitated the recovery of the DPOAE levels and ABR thresholds on days 14 and 28. The pre-blast treatment chinchillas showed reduced MLR amplitudes on days 4 and 7. CONCLUSIONS: This study indicated that the pre-blast liraglutide administration provided damage protection against blasts in addition to the HPDs. Current evidence suggests that the effect of liraglutide is more prominent in the early phase of the experiment.

Hearing protection and damage mitigation in Chinchillas exposed to repeated low-intensity blasts.

Repeated exposures to blast overpressure (BOP) introduce hearing complaints in military service members even with the use of hearing protection devices (HPDs). Although epidemiology and animal studies have been performed to investigate the damage formation mechanism of blast-induced hearing damage, there is still a lack of understanding and therapeutic solutions, especially for HPD-protected ears. Recent studies revealed the potential therapeutic function of liraglutide, a glucagon-like peptide-1 receptor agonist, to facilitate post-blast hearing restoration in chinchillas. This study is a continuation and summary of the previous studies performed by Jiang et al. (2021, 2022) to investigate the damage mitigation function of liraglutide treatment in chinchillas with open and protected ears after repeated low-intensity blast exposures within 28 days of observation. Chinchillas were divided into six experimental groups: pre-blast treatment, post-blast treatment, and blast control with ears open or protected by earplug (EP). All animals were exposed to six consecutive blasts at the level of 3-5 psi (21-35 kPa) on Day 1. Hearing function tests including auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), and middle latency response (MLR) were performed on Day 1 (pre- and post-blast) and Days 4, 7, 14, and 28 after blast exposure. Results indicated that the damage mitigation function of the liraglutide treatment in the open-ear chinchillas was reflected by the significantly lower ABR threshold shifts in the drug treatment groups than in the blast controls. In EP groups, the higher ABR wave I/V ratio and lower MLR amplitude observed in the drug-treated chinchillas suggested that the post-blast hyperactivities in the auditory system might be potentially ameliorated by the liraglutide treatment. The 28-day-long experiment showed the effect of liraglutide treatment increased with time in both open and EP groups. This study demonstrated that the use of HPDs prevented the blast-induced complications in the middle ear and reduced the damage caused in the central auditory system. The liraglutide treatment showed an effect increasing with time and different outcomes in open and EP chinchillas. This innovation in the animal model of chinchilla provides insights to investigate subtle changes in the higher-level structures of the auditory system.

Examining demographic and psychosocial factors related to self-weighing behavior during pregnancy and postpartum periods.

Black childbearing individuals in the US experience a higher risk of postpartum weight retention (PPWR) compared to their White counterparts. Given that PPWR is related to adverse health outcomes, it is important to investigate predictors of weight-related health behaviors, such as self-weighing (i.e., using a scale at home). Regular self-weighing is an evidence-based weight management strategy, but there is minimal insight into sociodemographic factors related to frequency. The Postpartum Mothers Mobile Study (PMOMS) facilitated longitudinal ambulatory weight assessments to investigate racial inequities in PPWR. Our objective for the present study was to describe self-weighing behavior during and after pregnancy in the PMOMS cohort, as well as related demographic and psychosocial factors. Applying tree modeling and multiple regression, we examined self-weighing during and after pregnancy. Participants (N = 236) were 30.2 years old on average (SD = 4.7), with the majority being college-educated (53.8%, n = 127), earning at least $30,000 annually (61.4%, n = 145), and self-identifying as non-Hispanic White (NHW; 68.2%, n = 161). Adherence to regular self-weighing (at least once weekly) was highest among participants during pregnancy, with a considerable decline after giving birth. Low-income Black participants (earning < $30,000) were significantly less likely to reach a completion rate of ≥ 80% during pregnancy (AOR = 0.10) or the postpartum period (AOR = 0.16), compared to NHW participants earning at least $30,000 annually. Increases in perceived stress were associated with decreased odds of sustained self-weighing after delivery (AOR = 0.79). Future research should consider behavioral differences across demographic intersections, such as race and socioeconomic status, and the impact on efficacy of self-weighing.

Evaluating a Web-based Training Curriculum for Disseminating Best Practices for the Care of Newborns with Neonatal Opioid Withdrawal Syndrome in a Rural Hospital, the NOWS-NM Program.

Background: The incidence of neonatal opiate withdrawal syndrome (NOWS) in the US has grown dramatically over the past two decades. Many rural hospitals not equipped to manage these patients transfer them to hospitals in bigger cities. Methods: We created a curriculum, the NOWS-NM Program, a mobile/web-based curriculum training in best practices. To evaluate the curriculum, we conducted pre- and post-surveys of NOWS knowledge, attitudes, and care practices, plus post-curriculum interviews and focus groups. Results: Fourteen participants completed both pre- and post-curriculum surveys. They indicated an increase in knowledge and care practices. A small number of respondents expressed negative attitudes about parents of infants with NOWS at pre-test, the training curriculum appeared to have no impact on such attitudes at post-test. Sixteen participants participated in focus groups or interviews. Qualitative data reinforced the positive quantitative results and contradicted the negative survey results, respondents reported that the program did reduce stigma and improve provider/staff interactions with patients. Conclusions: This curriculum demonstrated positive impacts on NOWS knowledge and care practices. Incorporating focus on core concepts of trauma-informed care and self-regulation in future iterations of the curriculum may strengthen the opportunity to change attitudes and address the needs expressed by participants and improve care of families and babies with NOWS. Significance: This project evaluates a novel curriculum covering best practices in care of infants with neonatal opiate withdrawal syndrome (NOWS) and is oriented toward supporting care in rural NM hospitals. We evaluated the curriculum with both quantitative and qualitative methods. Results support the effectiveness of the curriculum to increase competence of rural providers in the care of patients with NOWS. The NOWS-NM Program is a novel and effective mobile training tool, especially for under-resourced, rural hospitals.

Tetrapodal textured Janus textiles for accessible menstrual health.

Menstruating individuals without access to adequate hygiene products often improvise with alternatives that pose health risks and limit their participation in society. We describe here a menstrual hygiene product based on low-cost materials, which are integrated onto fabrics to imbue unidirectional permeability. A body-facing "Janus" fabric top layer comprising ZnO tetrapods spray-coated onto polyester mosquito netting imparts hierarchical texturation, augmenting the micron-scale texturation derived from the weave of the underlying fabric. The asymmetric coating establishes a gradient in wettability, which underpins flash spreading and unidirectional permeability. The hygiene product accommodates a variety of absorptive media, which are sandwiched between the Janus layer and a second outward-facing coated densely woven fabric. An assembled prototype demonstrates outstanding ability to wick saline solutions and a menstrual fluid simulant while outperforming a variety of commercially alternatives. The results demonstrate a versatile menstrual health product that provides a combination of dryness, discretion, washability, and safety.