McMaster University

Despite numerous studies linking prenatal vaping to adverse perinatal outcomes, a systematic assessment for critical comparison remains absent. To investigate these associations, we conducted a systematic search of studies assessing perinatal outcomes in mothers and/or neonates exposed to vaping during pregnancy compared to those in women without prenatal vaping exposure through MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, PROSPERO, and Google Scholar until July 5, 2024. We performed inverse-variance random-effects meta- analyses for maternal and neonatal outcomes of 23 studies with a total of 924,376 participants with 7552 reporting vaping-only use during pregnancy. Prenatal vaping was associated with 53% higher odds of an adverse maternal outcome (OR: 1.53; 95% CI: 1.27 to 1.85; I2 = 80%), particularly with decreased breastfeeding (OR: 0.53; 95% CI: 0.38 to 0.72; I2 = 45%) and reduced prevalence of adequate prenatal care (OR: 0.69; 95% CI: 0.56 to 0.86; I2 = 82%). Prenatal vaping was also associated with a similarly 53% higher odds of an adverse neonatal outcome (OR: 1.53; 95% CI: 1.34 to 1.76; I2 = 45%), such as low birth weight (OR: 1.56; 95% CI: 1.28 to 1.93; I2: 15%), preterm birth (OR: 1.49; 95% CI: 1.27 to 1.76; I2: 0%), and small for gestational age (OR: 1.48; 95% CI: 1.16 to 1.89; I2: 70%). This is the first comprehensive systematic review and meta-analysis demonstrating vaping during pregnancy as a risk factor for increased odds of both maternal and neonatal outcomes and underscores the urgency to address awareness and regulations of vaping and its potential harms to both humans and the environment.

Study Design: Prospective Randomized Controlled Trial. Objectives: To investigate the effect of combined motor control and isolated lumbar strengthening exercise (MC + ILEX) vs general exercise (GE) on upper lumbar paraspinal muscle volume and composition, strength and patient outcomes in individuals with chronic low back pain (LBP). Methods: 50 participants with nonspecific chronic LBP were randomly allocated (1:1) to each group (MC + ILEX or GE) and underwent a 12-week supervised intervention program 2 times per week. Magnetic resonance imaging was performed at baseline, 6-weeks and 12-weeks to examine the impact of each intervention on multifidus (MF) and erector spinae (ES) muscle volume (cm3) and fatty infiltration (%FI) at L1-L2, L2-L3 and L3-L4. Results: Our results revealed no significant between-groups findings for MF and ES %FI and volume, and patient-reported psychosocial measures. However, both groups had significant within-groups decreases in MF %FI at L1-L2, L2-L3 and L3-L4, with concomitant decreases in MF volume at L1-L2 and L2-L3, and at L3-L4 in the GE group. Each group displayed significant improvements in Kinesiophobia, while only MC + ILEX had significant improvements in pain catastrophizing, anxiety, depression and sleep. Lastly, significant correlations were found between change in Kinesiophobia and upper lumbar MF %FI, and between change in strength and lower lumbar MF and ES size. Conclusions: Both exercise interventions may help reduce upper lumbar MF %FI in individuals with chronic LBP, while MC + ILEX could significantly improve important patient outcomes. Our results support the idea that improvements in paraspinal muscle health associate with better patient outcomes. Further high-quality imaging studies are needed to explore these relationships.

This study investigated an anomalous frequency shift observed in collected spectra from an inline monitoring system based on guided ultrasonic waves, with the changing flow rate of an extrusion compounding process for fiber-reinforced thermoplastics. Three possible process parameters to explain the ultrasonic peak shifting, namely melt temperature, velocity, and fiber length were evaluated. The unlikely potential of a doppler moment due to melt velocity, was readily dismissed in the analysis since fluid flow through the die was too slow and while resonance frequency variation may be possible from the related fiber damage associated with increasing flow rates, there was insufficient physical evidence of this anticipated effect in this study. Melt temperature variation associated with viscous dissipation was concluded to be the dominant cause for the frequency shifting noted in the acoustic spectra. The changes in material temperature through which the sound travelled were varying the extent and frequency of the dispersion modes in the polymer melt. These findings are new guidance to processors on setting up a system using active ultrasonics for in-line monitoring in the polymer composites industry.

Background Contralateral donor autografts in anterior cruciate ligament (ACL) reconstruction (ACLR) may act as an alternative to conventional ipsilateral donor grafts but are rarely used clinically because of the lack of evidence on patient outcomes and concerns around additional morbidity. Purpose To investigate the effect of contralateral versus ipsilateral autograft use in ACLR on patient outcomes. Study Design Systematic review; Level of evidence, 4. Methods The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to October 2022 for comparative studies assessing the clinical or functional outcomes of ipsilateral versus contralateral autograft harvest in primary or revision ACLR. Given the heterogeneity of the included studies, data were summarized using descriptive statistics. Results Included were 11 studies representing 1638 patients with a mean follow-up of 49 months. The mean time to return to sport was shorter in patients treated with a contralateral bone–patellar tendon–bone (BPTB) autograft in 2 of 3 studies that evaluated this outcome after primary ACLR and in the only study that evaluated this outcome after revision ACLR. Some studies found improved strength recovery in the contralateral ACL-reconstructed knee. Otherwise, there was no significant difference between contralateral and ipsilateral ACLRs on subjective or objective postoperative clinical outcome scores. Most studies reported minimal donor site morbidity. Clinical adverse events including postoperative graft rerupture and infection were low in both contralateral and ipsilateral ACLRs and were not significantly different. Conclusion Contralateral ACL autograft harvest may lead to earlier return to sport when patients undergo BPTB ACLR. However, clinical outcomes, morbidity, risk of rerupture, and risk of donor knee injury were not significantly different in this review.

Artificial intelligence (AI) methods have significantly impacted various areas of technology, particularly in fields where large datasets are available. Screw designs are proprietary, and there is very limited information available in the open literature. In this study, we generated a dataset of 232 designs using computer simulation software for screw extrusion, involving solids transport, melting, and melt pumping. The parameters (features) and the outputs (targets) were introduced into four powerful machine learning (ML) algorithms. The capabilities of the four algorithms were assessed by comparing the predictions of each of the algorithms to the corresponding results of the simulations. Three of the algorithms demonstrated satisfactory performance, with the bestperforming one being further tested on an “unseen” dataset, which involved a screw of 75 mm and another of 127 mm in diameter. A machine-learning technique called Permutation Feature Importance (PFI) was used to identify the features (parameters) with the greatest impact on the predictions. It is suggested that the same ML methodologies could be applied to datasets of existing real screw designs.

We give a brief introduction to a divergence penalized Landau-de Gennes functional as a toy model for the study of nematic liquid crystal with colloid inclusion, in the case of unequal elastic constants. We assume that the nematic occupies the exterior of the unit ball, satisfies homeotropic anchoring at the surface of the colloid and approaches a uniform uniaxial state as $|x|\rightarrow \infty$. We study the “small particle” limit and obtain a representation formula for solutions to the associated Euler-Lagrange equations. We also present a numerical analysis of these equations based on a finite element approach and discuss the effect of the divergence penalization on the “Saturn ring” defects and on the properties of the Q-tensor.

Importance Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data. Objective To examine the impact of the COVID-19 pandemic on US kindergarteners’ developmental health. Design, Setting, and Participants This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024. Exposure Kindergarteners’ developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts. Main Outcomes and Measures Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed. Results In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, −0.45; 95% CI, −0.48 to −0.43), social competence (mean change, −0.03; 95% CI, −0.06 to −0.01), and communication and general knowledge (mean change, −0.18; 95% CI, −0.22 to −0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, −0.01 to 0.02). Conclusions and Relevance The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners’ development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.

Importance The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain. Objective To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers. Data Sources PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024. Study Selection Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included. Data Extraction and Synthesis Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported. Main Outcomes and Measures The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay. Results A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49). Conclusions and Relevance This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours/d) was associated with better outcomes.

Background and Aims Over 10% of patients with Crohn’s disease require permanent ileostomy. We aimed to summarize the existing data on diagnosis, definitions of recurrence, and management of Crohn’s disease patients with permanent ileostomy. Methods MEDLINE, Embase, and CENTRAL databases were searched from inception to February 6, 2024. Randomized controlled trials, cohort and cross-sectional studies, and case series of more than five patients reporting on postoperative recurrence or the need for surgery in patients with Crohn’s disease and permanent ileostomy were included. Search results were independently screened, and full text of all titles meeting eligibility criteria were obtained. Outcomes of interest included diagnostic techniques, recurrence definitions, and management approaches. We estimated pooled rates [with 95% confidence interval] of recurrence. Results Thirty cohort studies including 2,055 Crohn’s patients with permanent ileostomy were included (53% female, median age at time of ileostomy creation 32 years, most common reason for ileostomy was refractory disease). The postoperative recurrence rate was 27% (95% CI, 21.3-33.3, 26 studies, 451/1805 patients). Modalities for diagnosis of Crohn’s disease recurrence were symptoms (15 studies), endoscopy (4 studies), histology from endoscopic biopsies (2 studies), imaging (5 studies) and surgery (22 studies). The reported definitions of recurrence for each modality were heterogeneous. Conclusions There is a lack of standardized monitoring tools and criteria for diagnosing recurrence in patients with Crohn’s disease and permanent ileostomy. The results of this systematic review will form the basis of a global expert recommendation exercise focused on developing management standards and trial endpoints for this condition.

Background and objectives Research has identified that the number of older adults experiencing homelessness in middle to high income countries is growing. Coincidingly, in recognition that individuals with housing precarity often have experiences of trauma, there have been increasing calls for trauma-and-violence-informed care in practice and research. We conducted this review to consolidate existing literature that explores experiences of trauma among older adults who have experienced homelessness. Research design and Methods We conducted a systematic review of qualitative evidence and meta-aggregation following the Joanna Briggs Institute methodology, in adherence with PRISMA guidelines. Results Our search yielded 24 studies. Through a process of meta-aggregation, we generated five synthesized findings: 1) Being let down by society and systems; 2) The world is not a safe place; 3) Survivor not victim; 4) Living in the long shadow of trauma; and 5) Homelessness as a deeply personal trauma. Discussion and Implications Our findings underscore the reality that older adults without housing face multiple experiences of trauma, including the trauma of homelessness itself. Considering these findings, research, practice, and policies need to focus on ways to better support older adults, both in preventing trauma and assisting those who have already experienced trauma. Our findings indicate the necessity of: 1) implementing trauma-and-violence-informed care across all sectors who work with older adults; 2) supporting older adults to age in place in safe, deeply affordable, accessible housing; and 3) creating shelter environments more suitable for older adults, and especially those who have experienced trauma.