Prognostic Communication, Symptom Burden, Psychological Distress, and Quality of Life Among Patients With Decompensated Cirrhosis.

Background & Aims: Timely prognostic communication is a critical component of care for patients with decompensated cirrhosis (DC). However, few studies have examined the association of prognostic communication with symptoms, mood, and health-related quality of life (HRQOL) in this population.

Methods: In this cross-sectional study of 218 outpatients with DC, we assessed their self-reported health status (terminally ill vs not terminally ill), their prognostic communication with their hepatologists (Prognosis and Treatment Preferences Questionnaire), symptom burden (Revised Edmonton Symptom Assessment Scale), psychological distress (Hospital Anxiety and Depression Scale), and HRQOL (Short-Form Liver Disease Quality of Life scale).

Psychological Distress Is Prevalent and Interdependent Among Patients With Decompensated Cirrhosis and Their Caregivers.

Introduction: Little is known about the interdependence of psychological distress among patients with decompensated cirrhosis and their caregivers.

Methods: In this cross-sectional study, we examined the interdependence of psychological distress (Hospital Anxiety and Depression Scale) among 127 patient-caregiver dyads using Actor-Partner Interdependence Modeling.

Results: Among dyads, 26% had both partners reporting clinically significant anxiety and 18% reporting clinically significant depression.

Cohort profile: the Environmental Reproductive and Glucose Outcomes (ERGO) Study (Boston, Massachusetts, USA) - a prospective pregnancy cohort study of the impacts of environmental exposures on parental cardiometabolic health.

Purpose: Pregnancy and the postpartum period are increasingly recognised as sensitive windows for cardiometabolic disease risk. Growing evidence suggests environmental exposures, including endocrine-disrupting chemicals (EDCs), are associated with an increased risk of pregnancy complications that are associated with long-term cardiometabolic risk. However, the impact of perinatal EDC exposure on subsequent cardiometabolic risk post-pregnancy is less understood.

Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care.

Study Aim: This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach.

Background: Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described.

Methods: We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER.

Fractal approaches to scaling transformations to sustainability.

Responses to sustainability challenges are not delivering results at the scale and speed called for by science, international agreements, and concerned citizens. Yet there is a tendency to underestimate the large-scale impacts of small-scale, local, and contextualized actions, and particularly the role of individuals in scaling transformations. Here, we explore a fractal approach to scaling sustainability transformations based on "universal values.

Urinary phthalate metabolite concentrations and personal care product use during pregnancy - Results of a pilot study.

Introduction: Phthalates are reproductive toxicants commonly found in personal care products (PCPs). These endocrine disrupting chemicals are associated with pregnancy complications, including gestational diabetes. Yet, little is known about PCP use as a contributor to urinary phthalate metabolite concentrations in pregnancy.

Associations of insulin pump and continuous glucose monitoring use with pregnancy-related outcomes in women with type 1 diabetes.

Aims: To examine insulin pump and continuous glucose monitoring (CGM) use with pregnancy-related outcomes in women with type 1 diabetes.

Methods: We abstracted medical records of 646 pregnancies in 478 women with type 1 diabetes, with information on insulin pump versus multiple daily injection (MDI) use and CGM use. We analyzed the associations of pump vs.

Beyond "blah blah blah": exploring the "how" of transformation.

Calls for transformations are clear and multiple pathways and alternative visions for the future have been defined. Yet, there is very little shared understanding of how such transformations come about and how knowledge-action gaps will be filled. This Special Feature focuses on how we can go beyond talking about transformation-the "blah blah blah"-and moving toward action for results.

Risk-Factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy.

Objectives: Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied.

Getting to the heart of transformation.

Climate change, biodiversity loss, the COVID-19 pandemic, and growing inequity and poverty are some of the key global challenges facing us today. These multiple and interacting crises have elicited growing appeals to the need for transformation. Yet while the scholarly literature on transformations is expanding rapidly, the concept risks becoming an empty buzzword or an alibi for superficial interventions and business-as-usual responses within research, policy and practice communities.

Endocrine disrupting chemical-associated hair product use during pregnancy and gestational age at delivery: a pilot study.

Background: Prenatal endocrine disrupting chemical (EDC) exposure has been associated with increased risk of preterm birth. Non-Hispanic Black women have higher incidence of preterm birth compared to other racial/ethnic groups and may be disproportionately exposed to EDCs through EDC-containing hair products. However, research on the use of EDC-associated hair products during pregnancy and risk of preterm birth is lacking.

Ambient PM gross β-activity and glucose levels during pregnancy.

Background: Exposure to ionizing radiation has been associated with insulin resistance and type 2 diabetes. In light of recent work showing an association between ambient particulate matter (PM) gross β-activity and gestational diabetes mellitus (GDM) among pregnant women, we examined pregnancy glucose levels in relation to PM gross β-activity to better understand this pathway.

Methods: Our study included 103 participants receiving prenatal care at Beth Israel Deaconess Medical Center in Boston, MA.

Teaching the "how" of transformation.

College and university students are eager to engage with transformative solutions to the climate crisis, but often struggle to see openings or possibilities where they can leverage their actions and really "make a difference." While climate change education often focuses on the physical dimensions of climate change and the evaluation of political, technological, and behavioral solutions, less attention has been directed to questions of how large-scale transformations to sustainability occur and how educators can help students to perceive an active role for themselves in these efforts. This paper describes an integrative learning process for teaching the "how" of transformation.

Reflecting on the Anthropocene: The Call for Deeper Transformations : This article belongs to Ambio's 50th Anniversary Collection. Theme: Anthropocene.

Research on global environmental change has transformed the way that we think about human-environment relationships and Earth system processes. The four Ambio articles highlighted in this 50th Anniversary Issue have influenced the cultural narrative on environmental change, highlighting concepts such as "resilience," "coupled human and natural systems", and the "Anthropocene." In this peer response, I argue that global change research is still paying insufficient attention to how to deliberately transform systems and cultures to avoid the risks that science itself has warned us about.

Plasma glial fibrillary acidic protein and neurofilament light chain, but not tau, are biomarkers of sports-related mild traumatic brain injury.

Mild traumatic brain injury is a relatively common event in contact sports and there is increasing interest in the long-term neurocognitive effects. The diagnosis largely relies on symptom reporting and there is a need for objective tools to aid diagnosis and prognosis. There are recent reports that blood biomarkers could potentially help triage patients with suspected injury and normal CT findings.

Lead exposure and association with angiogenic factors and hypertensive disorders of pregnancy.

Objectives: Lead exposure has been associated with hypertensive disorders of pregnancy. Angiogenic factors, including soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), are aberrant in preeclampsia, but have not been correlated with lead levels. We evaluated the association of lead exposure with angiogenic factors.

Bereaved College Students: Social Support, Coping Style, Continuing Bonds, and Social Media Use as Predictors of Complicated Grief and Posttraumatic Growth.

Many college students experience the death of someone close to them and could be at risk for complicated grieving. Their primary sources of support may be unavailable as family members may live far away and their peers may be unprepared to respond to their grief. In addition, college students are exposed to a variety of stressors that could result in maladaptive coping.

Time trends in pregnancy-related outcomes among women with type 1 diabetes mellitus, 2004-2017.

Objective: To examine time trends in US pregnant women with type 1 diabetes mellitus for maternal characteristics and pregnancy outcomes.

Study Design: We abstracted clinical data from the medical records of 700 pregnant women from 2004 to 2017. For each time period, means and percentages were calculated.

Growth in the High-Risk Newborn Infant Post-Discharge: Results from a Neonatal Intensive Care Unit Nutrition Follow-up Clinic.

Growth and nutrition in preterm infants have long-term implications for neurodevelopmental and cardiometabolic outcomes. Many infants are discharged from the neonatal intensive care unit (NICU) with growth restriction, but often without a specialized team to monitor postdischarge growth. At our institution, we addressed our ongoing concerns for the health and growth of these infants post-discharge by creating a Nutrition NICU Graduate Clinic.

Impact of Interprofessional Telehealth Case Activities on Students' Perceptions of Their Collaborative Care Abilities.

To describe the development, implementation, and assessment of simulated interprofessional education (IPE) telehealth case activities. Faculty from pharmacy and physician assistant schools developed interprofessional cases covering topics addressed in both curricula and designed for specific levels of learners. Using a telehealth format, pharmacy students were paired with physician assistant students and met at specified times in a virtual room.