Exposure to HPV vaccines was not associated with an increased risk of ADs within the time period studied. Results were robust to case definitions and time windows of exposure. Continued active surveillance is needed to confirm this finding for individual ADs.

Study-level design characteristics that inform the optimal design of obesity randomized controlled trials (RCTs) have been examined in few studies. A pre-randomization run-in period is one such design element that may influence weight loss. We examined 311 obesity RCTs published between January 1, 2007 and July 1, 2009 that examined weight loss or weight gain prevention as a primary or secondary endpoint. Variables included run-in period, pre-post intervention weight loss, study duration (time), intervention type, percent female, and degree of obesity. Linear regression was used to estimate weight loss as a function of 1) run-in (yes/no), and 2) run-in, time, percent female, body mass index, intervention type. Interaction terms were also examined. Approximately nineteen percent (18.6%) of the studies included a run-in period with pharmaceutical studies having the highest frequency. Although all intervention types were associated with weight loss (Mean = 2.80 kg, SD=3.52), the inclusion of a pre-randomization run-in was associated with less weight loss (p=0.0017) compared to studies that did not include a run-in period. However, this association was not consistent across intervention types. Our results imply that in trials primarily targeting weight loss in adults, run-in periods may not be beneficial for improving weight loss outcomes in interventions.

Learning Objectives: Introduction: Arterial air emboli as a result of venous air emboli (VAE) are a rare complication following centrally or peripherally inserted central catheters (PICC). Case Description: A 79yo female with history of CAD was admitted for a post-operative hip infection, and was undergoing PICC placement for long-term antibiotic use. Post-procedure the patient was unresponsive, hypoxic, and rigid, with clenched fists and left lateral conjugate gaze. Despite assisted respirations with bag ventilation mask, the patient required intubation. Once stabilized, a head CT was performed and demonstrated gas bubbles in both cerebral hemispheres. The patient remained poorly responsive and a STAT EEG was performed which demonstrated epileptiform activity. A head CT the next morning demonstrated resolution of gas bubbles. An echocardiogram, to evaluate for stroke symptoms, displayed a significant right to left shunt within the atria. An MRI demonstrated ischemic changes within the right frontal, parietal, and left temporal regions, which correlate directly with areas of prior gas visualization. The patient failed to recover neurologically and the family withdrew care. Discussion: The patient's clinical scenario and imaging support cerebral air emboli (CAE) resulting from venous air entering circulation during PICC insterion, and into aterial circulation via an atrial defect. The incidence of CAE is estimated to be 0.13% during insterion/removal of central venous catheters. CAE causes ischemia and inflammation, resulting in decreased cerebral perfusion and neurologic impairment. Morbidity and mortality of air emboli depend on the rate and volume of gas entering venous circulation and the organ affected. Catheterassociated VAE carry a mortality rate between 23-30%. As little as 20mL of cerebral air has been reported to cause clinical harm, but traditionally 5 mL/kg is required to cause mortality. Treatment of CAE is supportive, with maintenance of adequate oxygenation and hemodynamic stability. High-flow and hyperbaric oxygen are reported to improve resorption of air.

Objective: To assess mothers' attitudes and knowledge about breast feeding in Thi-Qar City, Iraq. Methodology: This cross-sectional study was conducted at Hospital in Nasiriyah from January to February 2023 and included 192 mothers. United Nations' Food and Agriculture Organization (FAO)-adapted questionnaire was used. Socio-demographic information was recorded. The mother's viewpoint and intellectual capacity regarding breast feeding were assessed and their general opinions toward breast feeding were evaluated. Results: Out of 192 mothers, 103 (53.6%) were between the ages of 18 and 20. Most 87 (45.31) had completed elementary school and had a higher education; 79.17 percent of the sample lived in an urban area; and around half of the mothers were unemployed. The mothers had good knowledge of breast feeding and their attitude towards breast feeding was good. Conclusion: This study concluded that early mothers' knowledge of and attitudes toward Breast feeding were generally excellent at AL Hussein Teaching Hospital in Nasiriya city, and that these factors were crucial in determining the health of the children.

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