Sisters of Mercy Health System

Prematurity may place young children at increased risk for severe respiratory syncytial virus (RSV) disease because of differences in lung development. We describe characteristics of children aged less than 2years hospitalized with RSV by prematurity and bronchopulmonary dysplasia (BPD) status and examine both as risk factors for severe in-hospital outcomes. During 2016-2023, population-based surveillance was conducted at 7 medical centers for hospitalizations with RSV-associated acute respiratory illness in children. Poisson regression with robust variance was used to estimate adjusted relative risks (aRRs) of prolonged hospitalization (≥3days), intensive care unit (ICU) admission, and assisted ventilation by age in children with prematurity without and with BPD compared with term children after adjustment for surveillance site and palivizumab receipt. Among 5844 children, 4626 (79.2%) were term and 1218 (20.8%) were premature, including 1138 (93.4%) without BPD and 80 (6.6%) with BPD. Compared with term children, all premature children had greater risks for prolonged hospitalization (aRR = 1.3; 95% CI, 1.2-1.5), ICU admission (aRR = 1.4; 95% CI, 1.2-1.6), and assisted ventilation (aRR = 2.0; 95% CI, 1.4-2.8) at chronological age less than 6months. Premature children with BPD also had greater risk for prolonged hospitalization at all ages through 23months. Premature children accounted for 1 in 5 hospitalizations among children aged less than 2years hospitalized with RSV. Compared with term children, all premature children had increased risk for severe in-hospital outcomes in early infancy, and those with BPD remained at increased risk of prolonged hospitalization through age 23months.

This pilot study was designed to assess pediatricians' bias about intellectual disability (ID); whether symptoms suggesting Down syndrome (DS), meconium aspiration syndrome (MAS), cerebral palsy (CP), and fetal alcohol effects (FAE) predict lower ratings of infant potential versus controls; and whether proposed advice to parents of a likely DS diagnosis versus another diagnosis (such as meconium aspiration syndrome) would be more negative. Pediatricians (N = 56) completed an implicit association test (IAT) for intellectual disability (ID) plus an experimental vignette survey about a few days' old infant with apparent DS, MAS, FAE, or CP in Qualtrics. Measured outcomes were bias about ID, ratings of expected development, and advice for parents. Data were assessed using d-score frequencies, ANOVAs, and Tukey's HSD plus Cohen's d, and narrative analysis. Pediatricians (93%; n = 52) had high negative bias about persons with ID (d-scores < = -0.36). For DS versus MAS, pediatricians expected ID to be higher (p < 0.001, d Cohen = 3.05) and childhood, adolescent, and adult daily living skills to be lower (p < 0.05, d Cohen = 1.64; p < 0.05, d Cohen = 2.47; p < 0.05, d Cohen = 1.70). For DS versus CP, pediatricians expected early developmental skills quality to be higher (p = 0.012, d Cohen = 1.14); later developmental skills quality did not differ between groups. Less reassuring advice was considered for parents of the infants with DS versus MAS. In this pilot study, pediatricians generally exhibited a negative bias for infants with ID, and their perceptions about the infant's ability, as well as their associated advice for parents, were related to the postnatal diagnosis. Future research can expand and more extensively explore the use of IAT for intellectual disabilities within obstetric and pediatric practices.

PurposeLiF thermoluminescent dosimeters (TLDs) are commonly used in radiation therapy to verify the delivered dose. Examples include dose verification for complicated treatment setups or cardiovascular implantable electronic devices (CIEDs). TLDs may be present for both the pre‐treatment imaging kilovoltage (kV) beam and the megavoltage (MV) treatment beams. For low energy x‐ray beams, where the photoelectric effect dominates, TLDs respond differently than tissue or water. An overresponse of up to 40% has been previously reported for lower‐energy (kV) x‐rays when calibrated to higher‐energy (MV) beams. In this work, the response of TLDs to various cone beam computed tomography (CBCT) protocols with calibrations in clinical therapy beams (MV) is quantified.MethodsThree Varian OBI (Head, Thorax, and Pelvis) and three Elekta XVI (Fast Head and Neck, Fast Chest, and Fast Pelvis) CBCT protocols were investigated. For each protocol, TLDs were positioned on a tissue equivalent phantom at various distances extending out from the center of the imaging field. The response was determined by calibrating TLDs to a 6 MV photon beam.ResultsThe maximum in‐field TLD response ranged from 0.82 to 4.80 and 0.06 to 2.69 cGy for Varian OBI and Elekta XVI protocols, respectively. The out‐of‐field CBCT response dropped exponentially from the field edge. Calculated uncertainties were generally less than 3% (k = 1), with exceptions along the edge of the CBCT field (6%) and at the most distal TLD positions (34%).ConclusionsUsing the measured TLD responses to CBCT protocols with an MV calibration, the therapeutic dose can be isolated. The therapeutic dose can then be compared to predictions from the treatment planning system (TPS), allowing for more accurate dose verification for complex treatment setups and patients with CIEDs. The CBCT response can change the reported therapeutic dose by up to 2.5%.

Pneumonia is amongst the leading causes of death in the United States. In 2020, pneumonia accounted for over 53,000 deaths and 2.6 million emergency department visits. Further research is needed to study the evolution of country-wide trends and disparities. The centers for disease control and prevention wide-ranging online data for epidemiologic research (CDC WONDER) was used to identify pneumonia-related deaths within the United States from 1999 to 2022. Data on demographic and regional groups were analyzed by calculating age-adjusted mortality rates (AAMRs) and annual percentage change (APC) in AAMRs, for sex, race/ethnicity, age, urban-rural classification, region, and states. Overall, the AAMR per 100,000 from pneumonia-related deaths declined by 52.1% from 35.9 to 17.2 between 1999 and 2022. Both males and females experienced a similar decrease (Average APC −3.24%), though males maintained higher AAMR throughout 1999–2022. African American and Black people experienced the highest mortality throughout the duration of the study, while American Indians and Native Alaskans had the greatest reduction in mortality, by −59.5%. Nursing home deaths decreased over time, and in turn, hospice deaths substantially rose. AAMR in age groups ≥ 70 declined but not for younger age groups. Several geographical differences were found between urban-rural groups, states, and census regions. Despite a decrease in pneumonia-related mortality in the United States between 1999 and 2022, significant differences in AAMR have been observed to have persisted, with male sex, African American race, and rural areas being disproportionately affected. Improving access to timely and adequate health care and reducing disparities between population groups appear to be the most promising ways of continuing the downward trend.

Janus kinase (JAK) inhibitors, such as tofacitinib, are potent anti-inflammatory agents used in the treatment of ulcerative colitis (UC). Current guidelines recommend avoiding their use during pregnancy due to safety concerns, as well as during breastfeeding due to the potential excretion into breast milk. This case report describes the impact of in utero exposure to tofacitinib during pregnancy and subsequent exposure via breastfeeding on the immune development of the exposed infant. A 37-year-old woman with UC, who was being treated with tofacitinib and vedolizumab, became pregnant and continued both medications, with the tofacitinib dosage reduced from 10 to 5mg BID at gestational week 28. The infant was born healthy, with normal growth and development, and received all scheduled non-live vaccinations. At 15 months, immune parameters-including response to vaccination-were evaluated. The results showed normal immunoglobulin levels and an adequate serologic response to vaccination, with no signs of immune dysfunction. This case suggests that prolonged prenatal and postnatal exposure to tofacitinib may not adversely affect infant immune development. However, caution is advised due to the limited number of documented cases. Further research is needed to fully understand the long-term implications of JAK inhibitor exposure during pregnancy and breastfeeding.

The burden of congenital gastrointestinal (GI) anomalies is poorly understood. The aim of this systematic review to assess the global prevalence of congenital gastrointestinal (GI) anomalies. We conducted a systematic review of global population-level birth prevalence of gastroschisis, omphalocele, intestinal atresia, esophageal atresia, congenital diaphragmatic hernia, Hirschsprung’s disease, and anorectal malformation. We identified 103 studies from high and middle-income countries. Gastroschisis was the most reported condition. Studies reported geographic heterogeneity in gastroschisis, omphalocele, esophageal atresia, Hirschsprung’s disease, congenital diaphragmatic hernia, and anorectal malformation prevalence. The prevalence of gastroschisis, omphalocele, and Hirschsprung’s disease prevalence was reported to have increased over recent decades. Mean prevalence per 10 000 live and total births ranged from 2.1 to 4.4 cases and 1.4 to 3.6 per 10 000 live or total births, respectively. There is limited surveillance for congenital GI anomalies in LICs and potential temporal and geographic trends that need to be further investigated.

BackgroundAbaloparatide and teriparatide are osteoanabolic treatments indicated for postmenopausal women and men with osteoporosis at high risk of fracture. In the Abaloparatide Comparator Trial In Vertebral Endpoints study, bone mineral density improvements were significantly greater with abaloparatide compared to teriparatide at the total hip and femoral neck. We conducted a retrospective claims study to examine the incidences of hip and nonvertebral fractures and cardiovascular events in women aged ≥50 years initiating abaloparatide or teriparatide therapy, expanding on a previous retrospective claims study. MethodsThis retrospective observational study used anonymized claims data from ICON’s Symphony Health, PatientSource for women aged ≥ 50 years with ≥ 1 prescription fill for abaloparatide or teriparatide. The index date was the date of the initial prescription dispensed. Times to first hip fracture, nonvertebral fracture, and serious cardiovascular event were compared between logistic regression-based propensity score–matched cohorts and in predefined subgroups by age, prior antiresorptive use, and prior fracture using Cox proportional hazards models. ResultsPatients (21 676 per cohort) were well matched on 73 baseline parameters. Over 18 months (+ 30 days follow-up), 245 (1.1%) and 296 (1.4%) women in the abaloparatide and teriparatide cohorts, respectively, had a hip fracture (HR [95% CI] 0.83 [0.70, 0.98]; P = .027); 947 (4.4%) and 1078 (5.0%) had a nonvertebral fracture (0.88 [0.80, 0.96]; P = .003). There were no significant treatment-subgroup interactions (P ≥ .2). Cardiovascular events were similar between groups. ConclusionsThere were significantly lower rates of hip and nonvertebral fractures with abaloparatide compared to teriparatide, which were consistent across subgroups. No differences in cardiovascular safety were noted between cohorts.