MAP is highly associated with evidence of intraparenchymal placental hemorrhage villous changes of MVU, and a lymphoplasmacytic infiltrate at the implantation site. The contribution of this basal chronic inflammatory infiltrate to MAP requires further investigation.

Objective To examine the psychometric properties of three measures, the Perceived Stress Scale (PSS), Pregnancy Experience Scale (PES), and State Trait Anxiety Inventory (STAI), for assessing stress and anxiety during pregnancy among a large sample of nulliparous women. Methods The sample included 10,002 pregnant women participating in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nMoM2b). Internal consistency reliability was assessed with Cronbach’s alpha and factorial validity with confirmatory factor analyses. Intraclass correlations (ICCs) were calculated to determine stability of PSS scales over time. Psychometric properties were examined for the overall sample, as well as subgroups based on maternal age, race/ethnicity, and language. Results All three scales demonstrated good internal consistency reliability. Confirmatory factor analyses supported the factor structures of the PSS and the PES. However, a one-factor solution of the trait-anxiety subscale from the STAI did not fit well; a two-factor solution, splitting the items into factors based on direction of item wording (positive vs. negative) provided a better fit. Scores on the PSS were generally stable over time (ICC=0.60). Subgroup analyses revealed a few items that did not perform well on Spanish versions of the scales. Conclusion Overall, the scales performed well, suggesting they could be useful tools for identifying women experiencing high levels of stress and anxiety during pregnancy and allowing for the implementation of interventions to help reduce maternal stress and anxiety.

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As opioid overdose deaths in the United States continue to climb, medical students must be prepared to prevent and treat opioid use disorder and opioid overdose. The administration of naloxone is an evidence-based way to reverse overdoses and save lives. At our medical school, a coalition of medical students, emergency medicine educators, and administrators worked together to permanently integrate naloxone rescue training into the Basic Life Support (BLS) curriculum required of all first-year medical students. This article outlines an argument for the integration of naloxone rescue into BLS training and an introduction to emergency medical care for medical students. The authors then describe the steps that students took to transform this program from an original pilot to a formally integrated curriculum offered to all first-year medical students. The article highlights the role of medical student advocacy in curriculum design and its potential to align medical training with community health needs, such as the ongoing opioid epidemic.

Background Our primary objective was to determine the adjusted quantitative associations of clinical predictors with QT prolongation, a defining cause of Torsades de Pointes (TdP). Methods A retrospective cohort study was performed on consecutive emergency department patients identified by ECG acquisition date, and heart rate corrected QT (QTc) and QRS durations. QTc was modeled as a function of clinical predictors with multiple linear regression. Results 1,010 patients were included. The strongest predictors of QTc and their coefficients were: antidysrhythmic (26.1ms, 95% CI 15.6–36.6) and methadone (43.6ms, 95% CI 28.1–59.2) therapies, and genetic long QT syndrome diagnosis (32.6ms, 95% CI −4.7–70.0). The association of QTc with serum potassium was approximated by a two piecewise linear function that differed by sex. For potassium below 3.9 mmol/L, QTc increased by 43.0ms (95% CI 26.2–59.7) and 29.5ms (95% CI 19.1–40.0) for every 1 mmol/L decrease in potassium in women and men, respectively. TdP occurred in only 4/686 (0.6%) of patients with QTc>500 and QRS<120, but mortality during the visit including hospitalization was 8.0%. Conclusions QTc duration is highly sensitive to hypokalemia, particularly in women. Methadone prolongs QTc remarkably compared to other non-cardiologic medicines. QTc>500 with normal QRS often signifies profound illness and substantial mortality risk, though not necessarily imminent TdP.