Janice Weinberg’s research while affiliated with Boston University and other places

Background Rhinoplasty patients are reported to have higher rates of psychological disorders. Psychosocial concerns may hinder positive outcomes after rhinoplasty. Objective The aim of the study was to assess the impact of psychosocial factors on outcomes after cosmetic and functional rhinoplasty. Methods A retrospective chart review was conducted on 554 rhinoplasty patients operated on by a single surgeon. Results 21.5% of rhinoplasty patients had a psychiatric comorbidity, with anxiety (11.3%) and depression (10.0%) being most prevalent. The mean follow-up duration was 363 days. 12.9% of patients requested revision, and 5.6% underwent revision surgery. Younger age, male sex, and functional indication for rhinoplasty were associated with earlier loss of patient follow-up. Cosmetic indication for surgery was associated with increased revision requests. Psychiatric comorbidities were not associated with differential rates of follow-up, revision request, or revision surgery. Conclusions Psychiatric comorbidities did not affect outcomes following rhinoplasty. Several patient factors associated with loss of follow-up and revision surgery were identified, including younger age, male sex, and indication for surgery.

Immune responses from prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccination mitigate disease severity, but they do not fully prevent subsequent infections, especially from genetically divergent strains. We examined the incidence of and immune differences against human endemic coronaviruses (eCoVs) as a proxy for response against future genetically heterologous coronaviruses (CoVs). We assessed differences in symptomatic eCoV and non-CoV respiratory disease incidence among those with known prior SARS-CoV-2 infection or previous COVID-19 vaccination but no documented SARS-CoV-2 infection or neither exposure. Retrospective cohort analyses suggest that prior SARS-CoV-2 infection, but not previous COVID-19 vaccination alone, associates with a lower incidence of subsequent symptomatic eCoV infection. There was no difference in non-CoV incidence, implying that the observed difference was eCoV specific. In a second cohort where both cellular and humoral immunity were measured, those with prior SARS-CoV-2 spike protein exposure had lower eCoV-directed neutralizing antibodies, suggesting that neutralization is not responsible for the observed decreased eCoV disease. The three groups had similar cellular responses against the eCoV spike protein and nucleocapsid antigens. However, CD8 ⁺ T cell responses to the nonstructural eCoV proteins nsp12 and nsp13 were higher in individuals with previous SARS-CoV-2 infection as compared with the other groups. This association between prior SARS-CoV-2 infection and decreased incidence of eCoV disease may therefore be due to a boost in CD8 ⁺ T cell responses against eCoV nsp12 and nsp13, suggesting that incorporation of nonstructural viral antigens in a future pan-CoV vaccine may improve vaccine efficacy.

Mindfulness-based interventions have shown promise in managing chronic pain conditions, including chronic low back pain (cLBP). Trait mindfulness, which refers to an individual’s characteristic disposition towards being mindful daily, can influence how individuals respond to mindfulness interventions. Here, we examine factors contributing to mindfulness traits among persons with cLBP in the OPTIMUM study - a multi-site pragmatic clinical trial randomized cLBP patients to a mindfulness clinical pain management program or usual care. At baseline, 451 participants completed assessments on pain, mindfulness traits, and psychological measures. Multiple regression and correlation analyses were conducted to explore the relationships between baseline characteristics and mindfulness traits. The majority (65%) of participants were female with a mean age of 52 years (SD 14.6), 45% (204) Non-Hispanic White, 31% (140) reported an income of less than $25,000, and 69% (312) of the sample endured more than five years of back pain. In the correlation analysis, trait mindfulness was negatively correlated with anxiety, depression, fatigue, and pain catastrophizing and positively correlated with age and the ability to participate in social activity. Notably, age (p = 0.0001) indicated a positive effect on mindfulness traits, whereas anxiety (p < 0.0001) and depression (p = 0.03) showed negative effects in the multiple regression model. Exploring factors associated with baseline mindfulness traits offers valuable insights to monitor changes in measure outcomes among cLBP patients after the interventions. Additionally, understanding these predictors allows for targeted interventions that cater to individual needs and maximize the efficacy of mindfulness interventions for persons with cLBP. Funded by NIH (UH3AT010621).

Venous thromboembolism (VTE) risk is increased in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A key question was whether increased intensity of anticoagulation would help prevent VTE and improve patient outcomes, including transfer to the intensive care unit (ICU) and mortality. At the start of the coronavirus disease-19 (COVID-19) pandemic, our institution, Boston Medical Center, instituted a VTE risk stratification protocol based on patients’ initial D-dimer levels, medical history, and presence of thrombosis to determine whether they should receive standard-dose prophylaxis, high-dose prophylaxis, or therapeutic anticoagulation. We performed a retrospective observational cohort study examining the association of degree of anticoagulation with outcomes in 915 hospitalized COVID-19 patients hospitalized initially on the general inpatient wards between March 1,, 2020, and June 1, 2020. Patients directly hospitalized in the ICU were excluded. Most, 813 patients (89%), in our cohort were on standard-dose prophylaxis; 32 patients (3.5%) received high-dose prophylaxis; 70 patients (7.7%), were treated with therapeutic anticoagulation. VTE occurred in 45 patients (4.9%), and the overall in-hospital mortality rate was 5.4% (49 deaths). On multivariable analysis of clinical outcomes in relation to type of anticoagulation, in the high-dose prophylaxis group, there was a trend towards increased in-hospital mortality (odds ratio 2.4 (0.8–7.5, 95% CI)) and increased ICU transfer (odds ratio 2.2 (0.9-5.7, 95% CI)). Our results suggest that patients receiving high-dose prophylaxis had more severe disease that was not mitigated by intermediate-dose anticoagulation.

Immune responses from prior SARS-CoV-2 infection and COVID-19 vaccination do not prevent re-infections and may not protect against future novel coronaviruses (CoVs). We examined the incidence of and immune differences against human endemic CoVs (eCoV) as a proxy for response against future emerging CoVs. Assessment was among those with known SARS-CoV-2 infection, COVID-19 vaccination but no documented SARS-CoV-2 infection, or neither exposure. Retrospective cohort analyses suggest that prior SARS-CoV-2 infection, but not COVID-19 vaccination alone, protects against subsequent symptomatic eCoV infection. CD8+ T cell responses to the non-structural eCoV proteins, nsp12 and nsp13, were significantly higher in individuals with previous SARS-CoV-2 infection as compared to the other groups. The three groups had similar cellular responses against the eCoV spike and nucleocapsid, and those with prior spike exposure had lower eCoV-directed neutralizing antibodies. Incorporation of non-structural viral antigens in a future pan-CoV vaccine may improve protection against future heterologous CoV infections.

Background Tamil Nadu state reported the second highest number of confirmed COVID-19 cases in India. In this study, we aimed to describe and determine the risk factors for early death among the first 10,000 COVID-19 deaths in the state. Methods We conducted a cross sectional analysis of state government administrative data to describe deaths, examine the differences between early deaths and non-early deaths, and calculate the risks of early death for several independent variables. All p -values < 0.05 were considered statistically significant. Results In total, 4147 early deaths (41.5%) were recorded; the median age of patients who suffered from early death was significantly lower [64 years; interquartile range (IQR): 55–72] when compared with patients who did not suffer from early death (65 years; IQR: 56–73). After adjusting for comorbidities, age, and the time elapsed from the onset of symptoms to hospitalization; we found that the risk of early death was significantly lower for males [adjusted odds ratio (aOR): 0.82; 95% confidence interval (CI): 0.72, 0.93; p = 0.002], among rich individuals (aOR: 0.76; 95% CI: 0.63, 0.92; p = 0.004), in the richest districts (aOR: 0.70; 95% CI: 0.59, 0.84; p < 0.001) and for those who received treatment in private facilities (aOR: 0.45; 95% CI: 0.40, 0.51; p < 0.001. Conclusions The risk of early deaths among the first 10,000 reported COVID deaths in the Tamil Nadu state of India was higher in patients treated in government hospitals especially in the poorest districts probably indicating a lack of infrastructure in government facilities or the overburdening of government facilities at least in the early phase of the pandemic.

Background Mindfulness research and clinical programs are widespread, and it is important that mindfulness-based interventions are delivered with fidelity, or as intended, across settings. The MBI:TAC is a comprehensive system for assessing teacher competence, yet it can be complex to implement. A standardized, simple fidelity/engagement tool to address treatment delivery is needed. Objective We describe the development, evaluation, and outcomes of a brief, practical tool for assessing fidelity and engagement in online mindfulness-based programs. The tool contains questions about session elements such as meditation guidance and group discussion, and questions about participant engagement and technology-based barriers to engagement. Methods The fidelity rating tool was developed and tested in OPTIMUM, Optimizing Pain Treatment in Medical settings Using Mindfulness. The OPTIMUM study is a 3-site pragmatic randomized trial of group medical visits and adapted mindfulness-based stress reduction for primary care patients with chronic low back pain, delivered online. Two trained study personnel independently rated 26 recorded OPTIMUM sessions to determine inter-rater reliability of the Concise Fidelity for Mindfulness-Based Interventions (CoFi-MBI) tool. Trained raters also completed the CoFi-MBI for 105 sessions. Raters provided qualitative data via optional open text fields within the tool. Results Inter-rater agreement was 77-100% for presence of key session components, and 69-88% for Likert ratings of participant engagement and challenges related to technology, with discrepancies only occurring within 2 categories: ‘very much’ and ‘quite a bit’. Key session components occurred as intended in 94-100% of the 105 sessions, and participant engagement was rated as ‘very much’ or ‘quite a bit’ in 95% of the sessions. Qualitative analysis of rater comments revealed themes related to engagement challenges and technology failures. Conclusion The CoFi-MBI provides a practical way to assess basic adherence to online delivery of mindfulness session elements, participant engagement, and extent of technology obstacles. Optional text can guide strategies to improve engagement and reduce technology barriers.

The systemic inflammatory response seen in patients with severe COVID-19 shares many similarities with the changes observed in hemophagocytic lymphohistiocytosis (HLH); a disease characterized by excessive immune activation. Many patients with severe COVID qualify for a diagnosis of HLH. Etoposide, an inhibitor of topoisomerase II is used to control inflammation in HLH. This randomized, open-label, single center phase II trial attempted to determine whether etoposide can be used to blunt the inflammatory response in severe COVID. This trial was closed early after eight patients were randomized. This underpowered trial did not meet its primary endpoint of improvement in pulmonary status by two categories on an 8 point ordinal scale of respiratory function. There were not significant differences in secondary outcomes including overall survival at 30 days, cumulative incidence of grade 2 through 4 adverse events during hospitalization, duration of hospitalization, duration of ventilation and improvement in oxygenation or paO2/FIO2 ratio or improvement in inflammatory markers associated with cytokine storm. A high rate of grade 3 myelosuppression was noted in this critically ill population despite dose reduction, a toxicity which will limit future attempts to explore the utility of etoposide for virally-driven cytokine storm or HLH.