Faculty Bibliography

OBJECTIVES/OBJECTIVE:Retained placenta is a potential complication of second-trimester induction of labour. There is limited consensus regarding the use of adjunctive medications to manage the third stage following second-trimester vaginal delivery. This study aimed to evaluate the effects of oxytocin versus misoprostol on third-stage duration and the need for dilation and curettage (D&C) among patients with and without mifepristone pretreatment. STUDY DESIGN/METHODS:We conducted a retrospective cohort study of patients undergoing induction of labour between 14 + 0 and 23 + 6 weeks of gestation for any indication. Data on third-stage uterotonic use and mifepristone pre-treatment were collected. Primary outcomes were third-stage duration and the need for D&C for retained placenta among patients who received a third-stage uterotonic agent. Associations were assessed using adjusted linear and logistic regression models controlling for relevant clinical covariates. RESULTS:Among 181 patients, 85 (47.0%) received a third-stage uterotonic (oxytocin n = 55, 30.4%; misoprostol n = 45, 24.9%) and 101 (55.8%) received mifepristone (median 4.6 h prior to induction). Among patients receiving a third-stage uterotonic, oxytocin use was associated with a 2-hour reduction in placental delivery time and a 74% lower likelihood of D&C compared with misoprostol. Mifepristone pretreatment was not associated with third-stage duration (10 vs 24.5 min, p = 0.43) or D&C rates (12.9% vs 13.8%, p = 0.86). CONCLUSIONS:When third-stage uterotonic intervention is required following second-trimester induction of labour, oxytocin is associated with significantly shorter placental delivery time and lower likelihood of D&C when compared with misoprostol. Mifepristone pretreatment shortly before induction appears to have minimal impact on third-stage outcomes.

BACKGROUND/UNASSIGNED:Consumer wearable activity monitors are increasingly being used as end points in exercise-oncology trials and in clinical decision-making, yet their accuracy is unvalidated in lung cancer, where slow, fragmented gait may challenge step-counting algorithms. OBJECTIVE/UNASSIGNED:This study assessed the criterion validity of the Fitbit Charge 6 device against video-recorded direct observation in adults with lung cancer under controlled laboratory conditions. We aimed to describe step-count agreement across walking bout durations and gait speeds, and to compare its accuracy in classifying active vs sedentary minutes and detecting spurious steps across nonwalking activities. METHODS/UNASSIGNED:Fourteen adults diagnosed with stage I-IV lung cancer completed a cross-sectional, in-laboratory validation study at The Ohio State Wexner Medical Center. Participants wore the Fitbit Charge 6 device on their nondominant wrist while completing variable-duration walking trials (5, 15, and 30 seconds); self-selected gait speed trials across 8 progressively faster speeds; and standing, sitting, lying, and fidgeting tasks. All activities were video recorded and coded at a 1-second resolution. Step count agreement was evaluated using repeated-measures Bland-Altman analysis (mean bias and 95% limits of agreement), supported by mean absolute percentage error (MAPE) and intraclass correlation coefficients (ICCs). Minute-level activity intensity classification was assessed via a pooled confusion matrix using a majority-rule active-minute threshold of ≥30 seconds. Spurious step detection was descriptively analyzed across nonwalking minutes, stratified by fidgeting status. RESULTS/UNASSIGNED:Across 126 walking trials, the Fitbit device undercounted steps by only a small absolute margin, which was consistent across bout durations (bias of 1-3 steps), but relative agreement was poor and strongly duration dependent (MAPE 50.6% at 5 seconds vs 16.3%-18.7% at 15-30 seconds). The ICC was low (overall ICC[A,1]=0.21). Across 111 gait speed trials, undercounting was the greatest at gait speeds below 0.6 m/s (bias of approximately 13 steps; MAPE 56.6%) and was minimized near 1.0-1.2 m/s, with a quadratic mixed-effects model confirming a nonlinear speed-error relationship (P<.001). For activity intensity classification, sensitivity was high (0.91), but specificity was modest (0.63), and the positive predictive value was low (0.31), reflecting frequent misclassification of sedentary minutes as active. Among 267 nonwalking minutes, 33 (12.4%) contained at least one spurious step, with higher false-positive rates during fidgeting (24/167, 14.4%) than nonfidgeting (9/100, 9.0%) periods. CONCLUSIONS/UNASSIGNED:The Fitbit Charge 6 device provides improved step counts during sustained, moderate-speed walking but introduces a clinically meaningful error during short bouts and at slower gait speeds, which are frequently noted in adults with lung cancer. High sensitivity but low specificity for activity intensity classification suggests systematic overestimation of active minutes. These findings have implications for the design and interpretation of exercise-oncology interventions relying on consumer wearable-derived end points in this population.

Youth with developmental disabilities (DD) are often at increased suicide risk. However, clinician guidance on suicide prevention practices specific to the DD population is rarely available, which may result in care disparities. The current study examined whether rates of standard suicide risk screening in two pediatric emergency departments (ED) differed for youth with and without DD. Then, using data from a NIMH-funded initiative, we compared youth with and without DD on demographic, visit, and clinical characteristics to identify possible factors related to differences in screening rates. Disparities in the completion of suicide risk screening with youth with DD were identified in standard care but few differences were found across groups to suggest a rationale, holding important clinical and research implications.

OBJECTIVE:To assess the association between child protective services (CPS) involvement and the risk and timing of intramuscular (IM) medication or physical restraint use in pediatric patients presenting to the emergency department (ED) with behavioral health concerns. METHODS:An electronic health record dataset spanning January 2021 to October 2023 was retrospectively analyzed. Individual cumulative incidence plots and Cox regression models were created to model the risk and risk rate of receiving either IM medication or being physically restrained by different levels of CPS involvement. Cox regression models were adjusted for age, legal sex, and race and ethnicity. RESULTS:We analyzed 6257 behavioral health encounters. Children in CPS custody had the highest cumulative incidence of receiving IM medication or being physically restrained compared to children with a new CPS report filed or children without any CPS involvement after 72 hours (IM medication: 17%, 6%, 5% respectively, p < 0.001, physical restraints: 8%, 4%, 3% respectively, p < 0.001). Compared to children without CPS involvement, children in CPS custody had a significantly higher risk rate of receiving IM medications (adjusted hazard ratio (aHR) 1.79, 95% Confidence Interval (CI) 1.01-3.18, p = 0.046), and physical restraints (aHR 2.71, 95% CI 1.35-5.43 p = 0.005). CONCLUSION/CONCLUSIONS:Children in CPS custody had a higher risk of receiving IM medication and being physically restrained during behavioral health encounters in a pediatric ED. Further work should focus on understanding the causal mechanisms and designing interventions that maximize optimal health outcomes for vulnerable children experiencing behavioral health emergencies.

BACKGROUND:Parents frequently consult health care professionals because of infant regurgitation, crying and stool consistency. OBJECTIVE:) is an awareness tool for cow's milk allergy. We aimed to characterize the distribution of CoMiSS items in presumed healthy infants and developed centiles with these data. METHODS:Data from 2500 infants (median age 5.3 months [Q1-Q3: 2.6-8.8]) across 10 countries were analyzed by pooling individual-level data. RESULTS:Age distribution differed between countries (p < 0.001). Median (Q1; Q3) and mean (SD) total CoMiSS were 4 (2; 6) and 4 (2.6), respectively. Overall CoMiSS <10 was observed in 99%. Crying >3 hours/day occurred in 6.1% at 1-2 months, 4% between birth and 4 months, and <1.5% thereafter. Regurgitating > 5x/day occurred in 7-11% during the first 7 months (peak at 1-4 months: 16-17%) and decreased to <2-4% thereafter. Stool consistency accounted for 93.9% of the score. Atopic dermatitis and respiratory symptom scores are very low. CONCLUSIONS:CoMiSS is stable across age, with transiently higher crying and regurgitation scores below 4 months. CoMiSS ≥10 is uncommon in healthy infants. Age-specific CoMiSS centile charts provide a framework for interpreting common infant symptoms and identifying values warranting further evaluation. IMPACT/CONCLUSIONS:These data report on the prevalence of common manifestations in healthy infants and inform about normality according to age and different regions. Crying or distress and regurgitation scores are transiently more frequent during the first 4 months of life. Eczema and respiratory symptoms are seldom reported in presumed healthy infants. While caregivers and health care professionals consider regurgitation and crying or distress up to a certain limit as normal, atopic dermatitis and respiratory symptoms are not. These age-specific centile charts provide information on common infant symptoms and identify conditions that may warrant further evaluation.

Apicomplexan parasites, including Toxoplasma gondii and Plasmodium falciparum, reside within a specialized compartment known as the parasitophorous vacuole (PV) during their intracellular life cycle. The PV membrane (PVM), which derives from the host plasma membrane upon invasion, serves as a selective barrier that permits nutrient acquisition while shielding the parasite from host defense mechanisms. Although the protein composition of the PVM has been studied extensively, its lipid organization remains poorly understood. Using the quick-freeze, freeze-fracture replica labeling (QF-FRL) method, we quantitatively analyzed the transbilayer distribution of phosphatidylserine (PtdSer), phosphatidylethanolamine (PtdEtn), and GM3 ganglioside in the PVM of T. gondii and P. falciparum. Unlike host cell plasma membranes, where these lipids exhibit strict asymmetry-PtdSer and PtdEtn confined to the cytoplasmic leaflet and GM3 to the exoplasmic leaflet-we found that all three lipids were symmetrically distributed across both leaflets of the PVM. This striking loss of lipid asymmetry suggests that the PVM undergoes profound remodeling during infection. The presence of PtdSer and PtdEtn in the luminal leaflet may facilitate the binding of perforin-like proteins (PLP1s) during egress. These findings reveal a unique feature of the PVM that redefines our understanding of host-parasite membrane biology.

To address the deterioration of expansive soil in seasonally frozen regions subjected to freeze-thaw cycles, this study investigated the effects of fiber modification by incorporating polypropylene fiber (PP) and lignin fiber (LF) on the swelling behavior, mechanical properties, and freeze-thaw durability of expansive soil. Using expansive soil as the base material, the modification effects of individual fiber incorporation were evaluated through free swell ratio, no-load swell ratio, and direct shear tests. Freeze-thaw cycle tests were then conducted on the composite fiber-modified soils, and the microscopic mechanism was analyzed in combination with SEM observations. The main conclusions are as follows: (1) For single-fiber modification, lignin fiber (LF) at a dosage of 1.2% exhibited the best overall performance, producing the greatest reduction in free swell ratio and the largest increase in shear strength. The incorporation of polypropylene fiber (PP) also significantly improved these parameters, although its effect was weaker than that of lignin fiber (LF). (2) Based on the results of single-fiber modification, the addition of 1.2% polypropylene fiber (PP) on the basis of 1.2% lignin fiber (LF) further improved the mechanical properties of expansive soil, under which the shear strength and unconfined compressive strength of the modified expansive soil were both enhanced. (3) In terms of freeze-thaw durability, the composite fiber-modified soil subjected to freeze-thaw cycles showed significantly lower attenuation rates of shear strength and unconfined compressive strength than the untreated specimens. SEM results showed that local overlapping and bridging structures formed between the fibers and soil particles, which helped delay crack propagation and weaken freeze-thaw damage. Through physical restraint and reinforcement effects, lignin fiber (LF) and polypropylene fiber (PP) jointly improved the mechanical performance and frost resistance of expansive soil, thereby providing an experimental reference for research on fiber modification of expansive soils in seasonally frozen regions.

Synthetic cathinones are a chemically diverse class of novel stimulants that continue to emerge in the U.S. and globally. Trends in overall and specific synthetic cathinone availability in the U.S. (as indicated by seizures) remain poorly characterized. We analyzed annual counts of reports submitted from 2010-2024 to the U.S. Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS). We grouped reports into chemical subclasses of beta-keto methylenedioxyamphetamines ("-ylones"), pyrrolidinophenones ("pyrros"), and beta-keto amphetamines ("-drones"). Temporal trends in total reports and subclasses were modeled using negative binomial regression spline models. To further contextualize subclass trends, we descriptively examined the contribution of individual synthetic cathinones over time. Between 2010 and 2024, 178,892 synthetic cathinone reports were submitted to NFLIS, of which 73.3% were classified as -ylones, 19.9% as pyrros, 5.2% as -drones, and 1.6% as other. 68.7% of total reports were from the South, with 33.5% from Florida. Nationally, total reports increased sharply in 2010-2013, declined mid-period, rose again from 2019-2020, and then stabilized. Additional regional and temporal heterogeneity was noted across subclasses. We identified patterns of rapid emergence and replacement of individual compounds within subclasses, particularly within the -ylone subclass. Overall, we found substantial temporal, regional, and subclass-specific variation in synthetic cathinone reports to NFLIS from 2010-2024, largely driven by reports from the South and from successive cycles of replacement of -ylones. These findings emphasize the need to strengthen forensic and epidemiological surveillance of the evolving synthetic cathinone landscape in the U.S.