Illinois Department of Agriculture

To compare the effect of intervention on patients' postoperative preparedness to return to sexual activity after pelvic organ prolapse (POP) or urinary incontinence (UI) surgery compared with the usual counseling regarding the first sexual encounter. This multicenter randomized clinical trial recruited individuals who were planning to be sexually active after surgery for POP or UI; the patients who were randomized to intervention or usual counseling at 6 to 8 weeks postoperatively. The primary outcome was preparedness to return to sexual activity. Patients were considered prepared if they answered "strongly agree" or "agree" on a 6-point Likert scale to the statement, "Overall, I feel prepared for resuming sexual activity after my surgery." Participants were contacted at 1-month intervals up to 6 months postoperatively; when they reported return to sexual activity, they completed preparedness and pain scales and the PISQ-IR (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised). Of 186 patients, 170 (91.4%) completed follow-up and were included in the analyses. There was no difference in preparedness to return to sexual activity, at the time of returning to sexual activity within 6 months. However, there were differences noted 6 to 8 weeks after the intervention counseling. Patients randomized to intervention counseling reported higher preparedness to return to sexual activity (odds ratio [OR] 2.42, 95% CI, 1.03-5.65), lower likelihood of experiencing dyspareunia (OR 0.27, 95% CI, 0.09-0.86), and an earlier return to sexual activity (hazard ratio 1.46, 95% CI, 1.06-2.01). Before the intervention, 57 (33.5%) patients returned to sexual activity. In sensitivity analysis of the remaining 113 participants, intervention counseling remained associated with greater preparedness at 6-8 weeks postoperatively (81.0% vs 56.9%, adjusted OR 4.82, 95% CI, 1.66-13.99). Intervention counseling regarding return to sexual activity after surgeries for POP or UI was not associated with improved patient preparedness at the time of return to sexual activity but did improve preparedness and decrease dyspareunia at 6-8 weeks, compared with usual counseling. Despite counseling otherwise, nearly a third of participants returned to sexual activity before 6-8 weeks postoperatively. ClinicalTrials.gov, NCT05342090.

The healing power of therapeutic massage.

Injured older adults account for nearly 25% of trauma admissions nationwide with increased morbidity and mortality compared with younger adults. Endothelial dysfunction has been associated with poor outcomes in trauma patients. We hypothesized that posttraumatic endothelial changes in older versus younger adult trauma patients will be different with worse outcomes in older adults. This is a retrospective secondary analysis of the "Tranexamic Acid (TXA) in Traumatic Brain Injury" prehospital database (2015-2017). We studied patients with admission endothelial biomarkers: intercellular adhesion molecule 1, angiotensin 1, thrombomodulin, vascular cell adhesion molecule 1 (VCAM 1), angiotensin 2, syndecan-1, and thrombospondin. We divided patients into age quartiles and compared the oldest quartile (older age [OA] group) with the three youngest quartiles (younger age [YA] group). In-hospital, discharge, and mortality outcomes were compared. Significance was set at p < 0.05. A total of 436 patients were included. The mean age in OA group was 66 years (55-88 years, n = 108). The YA mean age was 30 years (15-54 years, n = 328). There was no difference between OA and YA in rates of blunt trauma (98.1% vs. 96.3%, p = 0.61), head abbreviated injury scale (mean, 2.83 vs. 2.93; p = 0.582), or Injury Severity Score (mean, 21 vs. 19; p = 0.29). Tranexamic acid dosing was not different between cohorts ( p = 0.571). Overall, the OA group had higher thrombomodulin (median, 693.3 vs. 592.9 pg/mL; p = 0.0008), VCAM 1 (median, 70,852 vs. 59,738 pg/mL; p = 0.0015), and angiotensin 2 (median, 165.3 vs. 134.2 pg/mL; p = 0.005). When comparing endothelial biomarkers of OA to each YA age quartile subsets, in the 2g TXA group OA patients had significantly higher syndecan-1 levels from a subset of YA (37 to 54-year-olds, p = 0.034). In the 2g TXA group OA patients had significantly lower plasma thrombomodulin, angiotensin 2, and VCAM 1 ( p = 0.00001, p = 0.0032, and p = 0.0002, respectively) than patients in the placebo group. None of the biomarkers were independent predictors of 28-day mortality. Despite similar injury patterns, OA presented with higher admission endothelial plasma biomarkers. The OA patients receiving 2 g of TXA had significantly different endothelial biomarker levels versus YA group. These differences suggest that OA patients have a different baseline endothelial function prior to injury and that TXA may have a more pronounced effect on injured OA versus YA endothelium. Therapeutic Care Management; Level IV.

There are no comprehensive management guidelines for pediatric blunt renal injury; therefore, we hypothesized that wide variation in care exists. We sought to describe contemporary management of pediatric blunt renal trauma and explore associations between clinical management strategies and adverse outcomes. We retrospectively evaluated blunt renal injury patients (younger than 18 years) treated at 11 pediatric level I trauma centers from 2020 to 2022. We categorized patients by the American Association for the Surgery of Trauma renal injury grade (low, grades 1-3; high, grades 4-5) and isolated renal injury versus polytrauma. Clinical management strategies included bedrest, urinary catheter use, antibiotic use, urology consult, intensive care unit (ICU) admission, and serial laboratory/imaging. We determined site-specific clinical management strategy frequencies and compared composite intervention outcomes (operations, interventional radiology procedures, blood transfusions) and composite adverse outcomes (mortality, infection, readmission, hypertension, deep venous thrombosis) between patients who did and did not undergo given clinical management strategies. We analyzed 276 patients stratified by low-grade isolated (15.2%), low-grade polytrauma (51.1%), high-grade isolated (12%), and high-grade polytrauma (21.7%). Compared with other clinical management strategies, antibiotic use, ICU admission, and urinary catheter placement were less universally implemented across sites. Composite adverse and intervention outcomes did not vary significantly based on use of bedrest, antibiotics, and postdischarge serial renal imaging (all p > 0.05). Composite adverse outcomes varied significantly among high-grade polytrauma patients with and without ICU admission (55.6% vs. 18.2%, p = 0.003) and among low-grade polytrauma patients with and without serial hemoglobin laboratories (20.8% vs. 0%, p = 0.04), serial renal laboratories (26.3% vs. 10.1%, p = 0.02), and serial inpatient renal imaging (28.6% vs. 13%, p = 0.04). Pediatric blunt renal injury management varied across institutions. Patients with isolated renal injuries had minimal differences in interventions or adverse outcomes despite variable clinical management. This population would benefit from a consensus-based algorithm to minimize clinical management strategy variation. Therapeutic/Care Management; Level IV.

The two terms of our title have long been destined for each other but, in the style of a Hollywood romantic comedy, have taken their sweet time to merge in an embrace. This special issue wants to be a setting for such a moment. We come into this with a double-pronged hypothesis: that “Beat time” is queer time, as it disrupts and rearranges the chronological patterns of straight society, and that recent critical work on queer temporality—the particular rhythms and tempos of queer minorities—c...

To evaluate the effect of an intensive nurse home visiting program on postpartum contraceptive use and birth spacing among individuals with a first pregnancy who were eligible for Medicaid insurance in South Carolina. We conducted a nonblinded, randomized controlled trial of the Nurse-Family Partnership (NFP), an established intensive home visiting program that provides prenatal and postpartum home visits through 2 years after childbirth. The trial included patients who were eligible for Medicaid insurance with a first pregnancy at less than 28 weeks of gestation between April 1, 2016, and March 17, 2020, who were followed up through 2 years after childbirth. Participants were randomized 2:1 to NFP compared with standard of care treatment. The primary outcome was a birth interval of less than 21 months between the index pregnancy and a subsequent birth. The secondary outcomes were birth intervals of less than 15 and 24 months, receipt of a contraceptive implant or intrauterine device (IUD) immediately postpartum, any contraceptive use and receipt of a family planning visit (at both 6 weeks and 1 year postpartum), and IUD receipt at 1 year postpartum. We assessed outcomes using linked birth certificate records and Medicaid claims data. A total of 4,932 trial participants (3,295 in the intervention group and 1,637 in the control group) were included in the study analysis. Within 21 months of the study index birth, 11.0% of individuals in the NFP group and 12.2% of the usual care group had a subsequent birth. The NFP did not have a statistically significant effect on birth intervals of less than 21 months (adjusted coefficient -1.1, 95% CI, -2.9 to 0.8). There were no statistically significant differences between the NFP and control groups for any of the study's eight secondary outcomes related to birth spacing and postpartum contraceptive use. Home visits with a registered nurse did not affect postpartum contraceptive use or birth spacing. ClinicalTrials.gov, NCT03360539.

Gandhi, Rashmin A. FRCS (Edin); MacIntosh, Peter W. MD; Lee, Andrew G. MD; Van Stavern, Gregory P. MD Author Information

In non-impaired human locomotion, sagittal-plane slope adaptation of the foot-ankle complex is a volitional function driven by neuromotor control to support upright posture and forward ambulation. Loss of this adaptation due to transtibial amputation can lead to instability and compensatory motions as most commercially-available prosthetic feet do not permit automatic slope adjustments. A selection of slope-adaptive feet (SAF) have been developed to promote biomimetic ankle motion while ambulating over slopes. This review evaluated the current literature to assess the effects of SAF prostheses on sloped gait performance in unilateral transtibial prosthesis users. Four databases (PubMed, Embase, CINAHL, IEEE Xplore) were searched on April 28, 2022, for relevant articles. Search keywords covered the general terms "transtibial," "amputation," "slope," "adaptive," and "gait", and included articles comparing a SAF prosthesis to a non-SAF prosthesis condition. Data were extracted for analysis and results were grouped according to outcomes to identify trends and aid interpretation of slope adaptation effects on gait. Of the 672 articles screened, 24 met the selection criteria and were included in this review, published between 2009 and 2022. The non-SAF condition included dynamic response feet and SAF prostheses with the adaptability function inactive. Outcomes included biomechanical variables (joint dynamics, gait symmetry, toe clearance), clinical outcome measures, and energy expenditure. All SAF demonstrated some form of foot-ankle slope gradient adaptability, but effects on other joint dynamics were inconsistent. Minimum toe clearance during incline and decline walking was greater when using SAF compared to non-SAF in all reporting studies. Results generally suggest improvements in gait quality, comfort, and safety with use of SAF compared to non-SAF during slope walking. However, variations in tested SAF and walking gradients across studies highlight the need for research to elucidate walking condition effects and advantages of specific designs. Slope-adaptive prosthetic feet may improve user gait quality and comfort and enhance gait safety by increasing minimum toe clearance. Patients who encounter slopes regularly should be considered as potential users of SAF if indicated appropriately.

Code-mix is gaining popularity due to its widespread usage on social media platforms. Even bilingual users converse in code-mix in their day-to-day life due to the popularity of the English language mix with the user’s mother tongue. Codemix phenomena come under NLP(Natural Language Processing), again a subpart of Artificial Intelligence. Code-mix language means grammatically following one language but has used another language’s words. Identification of code-mix is challenging due to using two languages in one sentence. Our motive is to identify the code-mix language at the sentence level. Already machine learning algorithms have been applied to identify sentence-level code-mix languages. In this article, we have applied Deep learning and a transformer-based framework for the sentence-level language identification task. We have used BERT in the Gujarati code-mix data set and received 96.2%, which is a more accurate result than the machine learning and Deep learning algorithms have achieved.

Mycotoxin contamination of corn is a pervasive problem that negatively impacts human and animal health and causes economic losses to the agricultural industry worldwide. Historical aflatoxin (AFL) and fumonisin (FUM) mycotoxin contamination data of corn, daily weather data, satellite data, dynamic geospatial soil properties, and land usage parameters were modeled to identify factors significantly contributing to the outbreaks of mycotoxin contamination of corn grown in Illinois (IL), AFL >20 ppb, and FUM >5 ppm. Two methods were used: a gradient boosting machine (GBM) and a neural network (NN). Both the GBM and NN models were dynamic at a state-county geospatial level because they used GPS coordinates of the counties linked to soil properties. GBM identified temperature and precipitation prior to sowing as significant influential factors contributing to high AFL and FUM contamination. AFL-GBM showed that a higher aflatoxin risk index (ARI) in January, March, July, and November led to higher AFL contamination in the southern regions of IL. Higher values of corn-specific normalized difference vegetation index (NDVI) in July led to lower AFL contamination in Central and Southern IL, while higher wheat-specific NDVI values in February led to higher AFL. FUM-GBM showed that temperature in July and October, precipitation in February, and NDVI values in March are positively correlated with high contamination throughout IL. Furthermore, the dynamic geospatial models showed that soil characteristics were correlated with AFL and FUM contamination. Greater calcium carbonate content in soil was negatively correlated with AFL contamination, which was noticeable in Southern IL. Greater soil moisture and available water-holding capacity throughout Southern IL were positively correlated with high FUM contamination. The higher clay percentage in the northeastern areas of IL negatively correlated with FUM contamination. NN models showed high class-specific performance for 1-year predictive validation for AFL (73%) and FUM (85%), highlighting their accuracy for annual mycotoxin prediction. Our models revealed that soil, NDVI, year-specific weekly average precipitation, and temperature were the most important factors that correlated with mycotoxin contamination. These findings serve as reliable guidelines for future modeling efforts to identify novel data inputs for the prediction of AFL and FUM outbreaks and potential farm-level management practices.