Nonsteroidal Antiinflammatory Drug Administration and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy

OBJECTIVE: To evaluate whether postpartum nonsteroidal antiinflammatory drug (NSAID) administration is associated with increased blood pressure in women with hypertensive disorders of pregnancy and to estimate the association between NSAID administration and use of opioid medication. METHODS: We conducted a retrospective cohort study of women with hypertensive disorders of pregnancy. Patients were analyzed in two groups according to whether they received NSAIDs postpartum. Study participants were women delivered at a tertiary care center from 2008 to 2015. The primary outcome was change in mean arterial pressure during the postpartum period. Secondary outcomes were postpartum pain scores, cumulative postpartum opioid requirement, initiation or dose escalation of antihypertensive agents, and adverse postpartum outcomes including acute renal failure, change in hematocrit, and maternal readmission for hypertensive disorder. RESULTS: Two hundred seventy-six women with hypertensive disorders of pregnancy were included (129 NSAID-unexposed and 147 NSAID-exposed). Postpartum NSAID administration was not associated with a statistically significant change in mean arterial pressure compared with no NSAID administration (-0.7 vs -1.8; mean difference 1.10, 95% CI -1.44 to 3.64). Similarly, no difference was observed between the cohorts in terms of need for initiation or escalation in dose of antihypertensive agents or maternal readmission for hypertensive disorder. The study was underpowered to determine whether NSAID administration was associated with any difference in less frequent secondary outcomes (eg, incidence of acute renal insufficiency, need for postpartum transfusion) or cumulative opioid use. CONCLUSION: Nonsteroidal antiinflammatory drug administration to postpartum patients with hypertensive disorders of pregnancy is not associated with a change in blood pressure or requirement for antihypertensive medication

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Parental Leave, Lactation, and Childcare Policies at Top US Schools of Public Health.

OBJECTIVES:To describe policies related to parental leave, breastfeeding, and childcare for faculty and staff at top schools of public health in the United States. METHODS:We identified the top 25 schools of public health from the US News and World Report rankings. We reviewed each institutional Web site to identify publicly available policies as of July 2018. RESULTS:For birth mothers, 80% (20/25) of the schools provided paid childbearing leave to faculty (mean = 8.2 weeks), and 48% (12/25) provided paid childbearing leave for staff (mean = 5.0 weeks). For nonbirth parents, 68% (17/25) provided paid parental leave for faculty and 52% (13/25) for staff (range = 1-15 weeks). We found that 64% (16/25) of the schools had publicly available lactation policies, and 72% (18/25) of the schools had at least 1 university-run on-campus childcare center. CONCLUSIONS:The majority of top US schools of public health provide paid leave to faculty birth mothers. However, most schools fall short of the 14 weeks recommended by the American Public Health Association

Tracking Nonliteral Language Processing Using Audiovisual Scenarios

Recognizing sarcasm and jocularity during face-to-face communication requires the integration of verbal, paralinguistic, and nonverbal cues, yet most previous research on nonliteral language processing has been carried out using written or static stimuli. In the current study, we examined the processing of dynamic literal and nonliteral intentions using eye tracking. Participants (N = 37) viewed short, ecologically valid video vignettes and were asked to identify the speakers’ intention. Participants had greater difficulty identifying jocular statements as insincere in comparison to sarcastic statements and spent significantly more time looking at faces during nonliteral versus literal social interactions. Finally, participants took longer to shift their attention from one talker to the other talker during interactions that conveyed literal positive intentions compared with jocular and literal negative intentions. These findings currently support the Standard Pragmatic Model and the Parallel-Constraint-Satisfaction Model of nonliteral language processing

Mitigating Racial Bias in Machine Learning

When applied in the health sector, AI-based applications raise not only ethical but legal and safety concerns, where algorithms trained on data from majority populations can generate less accurate or reliable results for minorities and other disadvantaged groups