bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Rules of Interpretation
Authors: Gardiner Richard
Published: August 2024

In drawing up the draft articles which became the Vienna Convention’s rules on treaty interpretation, the International Law Commission (ILC) focused on isolating and codifying the comparatively few general principles which appear to constitute general rules for the interpretation of treaties. The Convention’s rules do not exclude other principles compatible with these general rules, leaving open to the interpreter’s discretion recourse to the wealth of material on treaty interpretation which preceded the Convention. This material can shed light on why the Vienna rules are as they are as well as prove a useful quarry from which to extract principles, arguments, and examples to buttress or supplement particular applications of the rules. This chapter provides an overview of that material and the accompanying literature.
The Concept of an International Crime
Authors: O’Keefe Roger
Published: August 2024

The chapter considers in detail what is meant by an ‘international crime’, proposing a definition, conceptual framework, and associated terminology. The concept of an international crime put forward is not unitary; rather, the genus ‘international crime’ is divided into species, with the nomenclature suggested extending to these taxonomic divisions. The chapter then analyses the history of the evolution of individual criminal responsibility under international law before examining the relationship between such responsibility and state responsibility (including the relationship between international crimes and jus cogens) and the theoretical source of the binding nature for individuals of penal rules of international law.
The Crimes
Authors: O’Keefe Roger
Published: August 2024

The chapter focuses on those crimes accepted as existing under customary international law, namely war crimes, crimes against humanity, the crime of genocide, and the crime of aggression, and asks whether further crimes, such as terrorism or torture, could be added to the list. After dealing with preliminary methodological and substantive matters such as the material sources for customary international crimes and the general conditions for criminal responsibility under customary international law, the chapter sketches the respective historical backgrounds to the four crimes in question, and outlines and analyses their respective material and mental elements, both settled and asserted. It concludes by inquiring into the existence of a hierarchy of gravity among these crimes.
Substantive Law, Jurisdiction, Prosecution, and Courts
Authors: O’Keefe Roger
Published: August 2024

The chapter first examines how, as a technical matter, states give effect in their respective bodies of municipal criminal law and criminal procedure to the substantive law of international crimes and to the jurisdiction over such crimes permitted or mandated by international law, and what international law may say about aspects of this. It then considers technical, principled, and pragmatic questions relating to, specifically, the prosecution of international crimes at the national level, focusing on controversy over the exercise of universal jurisdiction. It lastly surveys the types of criminal courts to which states entrust the municipal adjudication of international crimes, highlighting in the process a variety of special municipal criminal courts established by specific states.
The Special Court for Sierra Leone and Residual Special Court for Sierra Leone
Authors: O’Keefe Roger
Published: August 2024

The chapter focuses on the Special Court for Sierra Leone (SCSL) and the Residual Special Court for Sierra Leone (RSCSL), both of them established and empowered on an ad hoc basis under a bilateral treaty between Sierra Leone and the United Nations. The chapter starts by sketching the history and basic workings of the two courts before examining the international legality of their means of establishment. It next examines legal issues relating to the scope and exercise of the courts’ jurisdiction and the relationship of the courts to the courts of Sierra Leone. It lastly considers the obligation on Sierra Leone, and on Sierra Leone alone, to co-operate with the courts.
The International Criminal Court
Authors: O’Keefe Roger
Published: August 2024

The chapter focuses on the International Criminal Court (ICC), established and empowered under the Rome Statute, a multilateral treaty among states. It starts by sketching the history and basic workings, including the procedural essentials, of the Court, before considering a wide range of legal questions relating to the scope and exercise of its jurisdiction and to its applicable law. The chapter next examines the relationship between the Court’s jurisdiction and national jurisdictions, in particular the principle of ‘complementarity’. It concludes with an account and analysis of the many legal issues that arise in connection with the obligation on states parties to the Rome Statute to co-operate with the Court, especially by way of the surrender of suspects and the production of evidence.
Dispute Resolution Provisions
Authors: McLachlan Campbell , Shore Laurence , Weiniger Matthew
Published: August 2024

Chapter 3 Dispute Settlement looks in more detail at four fundamental issues in the settlement of investment disputes through arbitration. These are:
Parallel Proceedings
Authors: McLachlan Campbell , Shore Laurence , Weiniger Matthew
Published: August 2024

Chapter 4 is concerned with a complex set of problems which have arisen in determining the relationship between parallel claims in investment arbitration, and other forms of dispute resolution, notably proceedings in host State courts. These issues typically arise at the preliminary jurisdictional phase of investment arbitrations. The response of tribunals has been shaped by a combination of the specific treaty provisions dealing with conflicts of jurisdiction, and consideration of more general principles of lis pendens and res judicata. The chapter addresses four issues in particular:
Treatment of Investors
Authors: McLachlan Campbell , Shore Laurence , Weiniger Matthew
Published: August 2024

In general, investment treaties seek to protect investors by assuring them of two types of treatment. The standards of fair and equitable treatment and full protection and security have been described as ‘non–contingent’ in the sense that the protections which they extend are absolute. They are not dependent upon the extent of protection afforded to others. By contrast, the provisions for national treatment and MFN treatment and the guarantee of non–discrimination are contingent standards. The extent of the protection which they afford is dependent upon that which the host State metes out to others, who stand in the requisite legal relationship to the protect investor.

Non–contingent standards. The assurance of ‘fair and equitable treatment’ provides the most basic protection for foreign investment. Yet the expression has proved stubbornly resistant to precise definition. This section therefore puts the evolution of the standard in historical context, in order to provide a framework for analysis of its present application by arbitral tribunals in relation to:

As will be seen, in both contexts, the standard is concerned with the process of decision–making in the host State, rather than with the prescription of substantive outcomes. Analysis of arbitral awards enables a distillation of the factors which are likely to indicate that the standard has been breached, and to contrast them with those factors which have been successfully relied upon by host States to show that the standard has been met.

Contingent standards. The discussion of the contingent standards draws together with common threads of national treatment and most–favoured–nation treatment with the more general right of non–discrimination. It does so by examining the techniques for the identification of a difference in treatment, and then considering whether any such difference in fact breaches the standard.
The Competitive Significance of Big Data
Authors: Stucke Maurice E , Grunes Allen P
Published: August 2024

This chapter analyses six themes from business literature regarding the strategic implications of Big Data. It also addresses the rise of data-driven business models, examining why companies invest heavily to develop apps to access data as well as to maintain, index, and analyse the increasing volume of data. It then responds to two claims that downplay Big Data’s significance in competition policy. The first claim is that data is ubiquitous, low cost, and widely available; second is that data is non-rivalrous, and therefore collecting a particular piece of data does not prevent others from collecting the same data by similar or other means. This claim conflates two distinct concepts: it conflates data’s functionality with its value and it conflates non-rival, non-subtractable goods with non-excludable goods. To illustrate data’s competitive significance, the chapter reviews a lawsuit over the Twitter ‘firehose’.
Recognizing When Privacy and Competition Law Intersect
Authors: Stucke Maurice E , Grunes Allen P
Published: August 2024

This chapter describes how privacy can be viewed as a parameter of quality competition. It starts by discussing the emerging consensus of privacy protection as a parameter of non-price quality competition. As several European Commission officials have noted, if a website, post-merger, starts to require more personal data from users or supply such data to third parties as a condition for delivering its ‘free’ product, then this could be seen as either increasing its price or as degrading the quality of its product and violating competition law. The presence of competition over privacy is a useful indicator, not only of firms’ willingness to adapt to consumers’ desires, but also consumers’ understanding of the use of their data in that market, and the effectiveness of competition in the market in question. The chapter ends with a discussion on how antitrust can promote privacy interests generally by promoting citizens’ welfare (and well-being).
More Coordination among Competition, Privacy, and Consumer Protection Officials
Authors: Stucke Maurice E , Grunes Allen P
Published: August 2024

This chapter highlights the need for more coordination among competition, privacy, and consumer protection officials. It identifies two initial areas for greater coordination. The first is to move beyond the notice-and-consent paradigm. The consensus is that the current notice-and-consent regimen is inadequate to safeguard privacy. Individuals are generally unaware of who has access to their personal information, what data is being used, how the data is being used, when the data is used, and the privacy implications of the data’s use. The imbalance of power between consumers and data users is a significant concern. Competition, privacy, and consumer protection officials must coordinate to ensure that the other preconditions for an effective competitive process are in place. The second area is facilitating the preconditions necessary to spur privacy competition. These include the consumers having a viable choice, aside from forgoing the technology or service altogether and an alternative to the advertising-dependent revenue model.
Detection of terbinafine-resistant Trichophyton indotineae isolates within the Trichophyton mentagrophytes species complex isolated from patients in Hue City, Vietnam: A comprehensive analysis
Authors: Ngo Thi Minh Chau , Santona Antonella , Ton Nu Phuong Anh , Cao Le Chi , Tran Thi Giang , Do Thi Bich Thao , Ha Thi Ngoc Thuy , Vo Minh Tiep , Nguyen Phuoc Vinh , Ton That Dong Duong , Nguyen Thi Tra My , Bui Van Duc
Published: August 2024

The Trichophyton mentagrophytes complex comprises a group of dermatophyte fungi responsible for various dermatological infections. The increasing drug resistance of this species complex, especially terbinafine resistance of Trichophyton indotineae, is a major concern in dermatologist practice. This study provides a comprehensive analysis of T. mentagrophytes complex strains isolated from patients in Hue City, Vietnam, focusing on their phenotypic and genetic characteristics, antifungal susceptibility profiles, and molecular epidemiology. Keratinophilic fungi from dermatophytosis culture samples were identified morphologically and phenotypically, with species and genotypes confirmed by internal transcribed spacer sequencing and phylogenetic analysis. Antifungal susceptibility testing was carried out to evaluate their susceptibility to itraconazole, voriconazole, and terbinafine. The 24% (n = 27/114) of superficial mycoses were phenotypically attributed to T. mentagrophytes complex isolates. Trichophyton interdigitale, mainly genotype II*, was predominant (44.4%), followed by T. mentagrophytes genotype III* (22.2%), T. indotineae (14.8%), T. tonsurans (11.2%), and T. mentagrophytes (7.4%). While all isolates were susceptible to itraconazole and voriconazole, half of T. indotineae isolates exhibited resistance to terbinafine, linked to the Phe397Leu mutation in the SQLE protein. This study highlighted the presence of terbinafine-resistant T. indotineae isolates in Vietnam, emphasizing the need to investigate dermatophyte drug resistance and implement effective measures in clinical practice.
Radio U-Net: a convolutional neural network to detect diffuse radio sources in galaxy clusters and beyond
Authors: Stuardi C , Gheller C , Vazza F , Botteon A
Published: August 2024

The forthcoming generation of radio telescope arrays promises significant advancements in sensitivity and resolution, enabling the identification and characterization of many new faint and diffuse radio sources. Conventional manual cataloguing methodologies are anticipated to be insufficient to exploit the capabilities of new radio surveys. Radio interferometric images of diffuse sources present a challenge for image segmentation tasks due to noise, artifacts, and embedded radio sources. In response to these challenges, we introduce Radio U-Net, a fully convolutional neural network based on the U-Net architecture. Radio U-Net is designed to detect faint and extended sources in radio surveys, such as radio haloes, relics, and cosmic web filaments. Radio U-Net was trained on synthetic radio observations built upon cosmological simulations and then tested on a sample of galaxy clusters, where the detection of cluster diffuse radio sources relied on customized data reduction and visual inspection of Low-Frequency Array Two metre Sky Survey (LoTSS) data. The 83 per cent of clusters exhibiting diffuse radio emission were accurately identified, and the segmentation successfully recovered the morphology of the sources even in low-quality images. In a test sample comprising 246 galaxy clusters, we achieved a 73 per cent accuracy rate in distinguishing between clusters with and without diffuse radio emission. Our results establish the applicability of Radio U-Net to extensive radio survey data sets, probing its efficiency on cutting-edge high-performance computing systems. This approach represents an advancement in optimizing the exploitation of forthcoming large radio surveys for scientific exploration.
The evolution of protostellar outflow opening angles and the implications for the Growth of Protostars
Authors: Dunham Michael M , Stephens Ian W , Myers Philip C , Bourke Tyler L , Arce Héctor G , Pokhrel Riwaj , Pineda Jaime E , Vargas Joseph
Published: August 2024

We use $1-4$ arcsec ($300-1200$ au) resolution $^{12}$CO (2 − 1) data from the MASSES (Mass Assembly of Stellar Systems and their Evolution with the Submillimeter Array) project to measure the projected opening angles of 46 protostellar outflows in the Perseus Molecular Cloud, 37 of which are measured with sufficiently high confidence to use in further analysis. We find that there is a statistically significant difference in the distributions of outflow opening angles for Classes 0 and I outflows, with a distinct lack of both wide-angle Class 0 outflows and highly collimated Class I outflows. Synthesizing our results with several previous studies, we find that outflows widen with age through the Class 0 stage but do not continue to widen in the Class I stage. The maximum projected opening angle reached is approximately 90$^{\circ }$$\pm$ 20$^{\circ }$, with the transition between widening and remaining constant occurring near the boundary between the Classes 0 and I phases of evolution. While the volume fractions occupied by these outflows are no more than a few tens of per cent of the total core volume, at most, recent theoretical work suggests outflows may still be capable of playing a central role in setting the low star formation efficiencies of 25  per cent–50  per cent observed on core scales.
Insertions and Deletions: Computational Methods, Evolutionary Dynamics, and Biological Applications
Authors: Redelings Benjamin D , Holmes Ian , Lunter Gerton , Pupko Tal , Anisimova Maria
Published: August 2024

Insertions and deletions constitute the second most important source of natural genomic variation. Insertions and deletions make up to 25% of genomic variants in humans and are involved in complex evolutionary processes including genomic rearrangements, adaptation, and speciation. Recent advances in long-read sequencing technologies allow detailed inference of insertions and deletion variation in species and populations. Yet, despite their importance, evolutionary studies have traditionally ignored or mishandled insertions and deletions due to a lack of comprehensive methodologies and statistical models of insertions and deletion dynamics. Here, we discuss methods for describing insertions and deletion variation and modeling insertions and deletions over evolutionary time. We provide practical advice for tackling insertions and deletions in genomic sequences and illustrate our discussion with examples of insertions and deletion-induced effects in human and other natural populations and their contribution to evolutionary processes. We outline promising directions for future developments in statistical methodologies that would allow researchers to analyze insertions and deletion variation and their effects in large genomic data sets and to incorporate insertions and deletions in evolutionary inference.
Ultrasound-detected knee synovitis in patients with rheumatoid arthritis after total knee arthroplasty
Authors: Miyoshi Yuji , Takamasu Eisuke , Takada Ryosuke , Nagase Yuichi
Published: August 2024

Objectives

To evaluate the prevalence of ultrasound (US)-detected knee synovitis in patients with rheumatoid arthritis (RA) with a history of total knee arthroplasty (TKA) and to explore its association with RA disease activity and clinical outcomes.

Methods

The present, retrospective, cross-sectional study retrieved the data from electronic medical records of patients with RA who were followed up for TKA and had musculoskeletal ultrasound assessment at the study centre from 1 January 2021 through 31 December 2021.

Results

Forty-two patients with 67 post-TKA knee joints were enrolled in the present study. US-detected synovitis of the post-TKA knee was present in 15 knees (22.4%) and 12 patients (28.6%). There was no difference in disease activity scores or the pain domain of Knee Injury and Osteoarthritis Outcome Score between the patients with (n = 12) and without (n = 30) US-detected knee synovitis. The proportion of patients with the intensification of antirheumatic drugs after MSUS assessment was significantly higher in patients with US-detected synovitis compared to those without US-detected synovitis (41.7 versus 6.7%, P = .01).

Conclusions

US-detected synovitis of the knee was present at 22.4% of post-TKA knee joints. Patients with US-detected synovitis of post-TKA knees were likely to receive an intensification of antirheumatic drugs.
Psychological factors influencing healthcare utilization in breast cancer survivors with pain
Authors: Roose Eva , Cools Wilfried , Leysen Laurence , Van Wilgen Paul , Beckwée David , Timmermans Annick , Bults Rinske , Nijs Jo , Vanhoeij Marian , Fontaine Christel , Lahousse Astrid , Huysmans Eva
Published: August 2024

Introduction

Pain is a prevalent side effect seen in breast cancer survivors (BCS). Psychological factors are known role players in pain mechanisms. Both pain and psychological factors contribute to or interact with healthcare use (HCU). However, the association between psychological factors and HCU has never been investigated in BCS with pain, which is the aim of the present study.

Methods

Belgian BCS with pain (n = 122) were assessed via the Medical Consumption Questionnaire, the Injustice Experienced Questionnaire, the Pain Catastrophizing Scale, the Pain Vigilance and Awareness Questionnaire, the Brief Illness Perceptions Questionnaire, and the Depression, Anxiety, and Stress Scale. Associations were analyzed with logistic and Poisson regressions.

Results

Opioid use was related to more catastrophizing and less psychological distress. Psychotropic drug use was related to more psychological distress. Endocrine therapy was related to less vigilance and awareness. Psychological distress was related to all types of healthcare provider (HCP) visits, with psychological distress negatively related to physiotherapy, psychology, and other primary HCP visits, and positively related to visiting a general practitioner or secondary HCP. Catastrophizing was related to more visiting behavior to a primary HCP, except to a general practitioner. Perceived injustice was related to more general practitioner and other primary HCP visits but to fewer psychology visits. Illness perceptions were related only to visiting other primary HCPs. Vigilance and awareness were related to more psychologist and secondary HCP visits.

Conclusion

Our findings underscore the complex interplay between HCU and psychological factors in BCS with pain. Psychological distress was overall the most important psychological factor related to HCU, whether catastrophizing and perceived injustice were the most relevant related to HCP visits.
An engineered NKp46 antibody for construction of multi-specific NK cell engagers
Authors: Lee Robert B , Maddineni Sainiteesh , Landry Madeleine , Diaz Celeste , Tashfeen Aanya , Yamada-Hunter Sean A , Mackall Crystal L , Beinat Corinne , Sunwoo John B , Cochran Jennifer R
Published: August 2024

Recent developments in cancer immunotherapy have highlighted the potential of harnessing natural killer (NK) cells in the treatment of neoplastic malignancies. Of these, bispecific antibodies, and NK cell engager (NKCE) protein therapeutics in particular, have been of interest. Here, we used phage display and yeast surface display to engineer RLN131, a unique cross-reactive antibody that binds to human, mouse, and cynomolgus NKp46, an activating receptor found on NK cells. RLN131 induced proliferation and activation of primary NK cells, and was used to create bispecific NKCE constructs of varying configurations and valency. All NKCEs were able to promote greater NK cell cytotoxicity against tumor cells than an unmodified anti-CD20 monoclonal antibody, and activity was observed irrespective of whether the constructs contained a functional Fc domain. Competition binding and fine epitope mapping studies were used to demonstrate that RLN131 binds to a conserved epitope on NKp46, underlying its species cross-reactivity.
Evolution of the Cytomegalovirus RL11 gene family in Old World monkeys and Great Apes
Authors: Litvin Ulad , Wang Eddie C Y , Stanton Richard J , Fielding Ceri A , Hughes Joseph
Published: August 2024

Cytomegalovirus (CMV) is a genus of herpesviruses, members of which share a long history of coevolution with their primate hosts including New World monkeys, Old World monkeys (OWMs), and Great Apes (GAs). These viruses are ubiquitous within their host populations and establish lifelong infection in most individuals. Although asymptomatic in healthy individuals, infection poses a significant risk to individuals with a weakened or underdeveloped immune system. The genome of human CMV is the largest among human-infecting viruses and comprises at least 15 separate gene families, which may have arisen by gene duplication. Within human CMV, the RL11 gene family is the largest. RL11 genes are nonessential in vitro but have immune evasion roles that are likely critical to persistence in vivo. These genes demonstrate an extreme level of inter-species and intra-strain sequence diversity, which makes it challenging to deduce the evolutionary relationships within this gene family. Understanding the evolutionary relationships of these genes, especially accurate ortholog identification, is essential for reconstructing ancestral genomes, deciphering gene repertoire and order, and enabling reliable functional analyses across the CMV species, thereby offering insights into evolutionary processes, genetic diversity, and the functional significance of genes. In this work, we combined in silico genome screening with sequence-based and structure-guided phylogenetic analysis to reconstruct the evolutionary history of the RL11 gene family. We confirmed that RL11 genes are unique to OWM and GA CMVs, showing that this gene family was formed by multiple early duplication events and later lineage-specific losses. We identified four main clades of RL11 genes and showed that their expansions were mainly lineage specific and happened independently in CMVs of GAs, African OWMs, and Asian OWMs. We also identified groups of orthologous genes across the CMV tree, showing that some human CMV–specific RL11 genes emerged before the divergence of human and chimpanzee CMVs but were subsequently lost in the latter. The extensive and dynamic species–specific evolution of this gene family suggests that their functions target elements of host immunity that have similarly coevolved during speciation.
Public Perceptions of Abortion Complications
Authors: Chaiken SR , Darney BG , Schenck M , Han L
Published: August 2024

(Am J Obstet Gynecol. 2023;229(4):421.e1–421.e8. doi: 10.1016/j.ajog.2023.07.024)

Although abortion rates are on the decline, around a quarter of women in the United States are expected to experience it in their lifetime. It is crucial to highlight the impact of misinformation in perpetuating the misconception that abortion poses significant health hazards, despite the well-established safety of medication and aspiration abortion methods. Previous studies have noted the prevalence of public misunderstandings regarding abortion risks, but there is still a lack of clarity on the specific complications that are commonly believed to be associated. Therefore, the present cross-sectional survey study aimed to illuminate the public’s perception of both short-term and long-term risks associated with abortion in the United States.
Development of Obstetric Anesthesia Core Competencies for US Residency Programs Through a Delphi Process
Authors: Lilaonitkul M , Cosden CW , Markley JC , Pian-Smith M , Lim G , Yeh P , Aleshi P , Boscardin C , Sullivan K , George RB
Published: August 2024

(Can J Anaesth. 2023;70(10):1611–1622. doi: 10.1007/s12630-023-02536-w)

Every year in the United States, around 1.15 million cesarean deliveries are performed, emphasizing the critical role of anesthesiologists in clinical practice and the importance of obstetric anesthesia knowledge and skill acquisition on the outcomes of pregnant people, especially given the rising rates of preventable deaths. However, the current framework for anesthesia residency training in the United States primarily follows the guidelines of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, which outlines minimal time requirements and case numbers rather than competency-based metrics in obstetric anesthesia. Using a modified Delphi expert consensus methodology, this study aimed to identify the essential competencies in obstetric anesthesiology for resident trainees and determine the training level at which these competencies should be achieved.
Perinatal Psychiatric Practitioner Consultation Program Delivers Rapid Response to OB/GYN Practitioners
Authors: Doering JJ , Wichman CL , Laszewski A , Kuehn S , Ke W
Published: August 2024

(Birth. 2023;50(4):764–772. doi: 10.1111/birt.12722)

The American College of Obstetrics and Gynecology (ACOG) strongly suggests that OB/GYN practitioners should be capable of identifying, managing, and appropriately referring patients with perinatal psychiatric conditions. To effectively manage the pregnant or postpartum patient with psychiatric illness, knowledge of psychiatric medications, and their safe administration is critical, especially given the significant morbidity and mortality associated with perinatal psychiatric disorders in the United States. Geographic limitations and practitioner shortages may impact access to specialized psychiatric services. This descriptive quality improvement study evaluated a statewide perinatal psychiatric consultation service, The Periscope Project (TPP), in Wisconsin for OB/GYN practitioners by analyzing the volume, responsivity, content, and outcomes of clinical inquiries, and OB/GYN professional satisfaction.
Efficacy of Early Intrauterine Balloon Tamponade for Immediate Postpartum Hemorrhage After Vaginal Delivery: A Randomized Clinical Trial
Authors: Rozenberg P , Sentilhes L , Goffinet F , Vayssiere C , Senat MV , Haddad B , Morel O , Garabedian C , Vivanti A , Perrotin F , Kayem G , Azria E , Raynal P , Verspyck E , Sananes N , Gallot D , Bretelle F , Seco A , Winer N , Deneux-Tharaux C ,   On behalf of the Groupe de Recherche en Obstétrique et Gynécologie
Published: August 2024

(Am J Obstet Gynecol. 2023;229(5):542.e1–542.e14. doi: 10.1016/j.ajog.2023.05.014)

As a primary cause of maternal mortality and significant illness, postpartum hemorrhage (PPH) remains a substantial concern worldwide with improved management strategies necessary to optimize preventable outcomes. Initial PPH treatment includes medical interventions like uterine massage and the administration of uterotonic agents such as oxytocin, ergometrine, and prostaglandins. If these treatments fail, other therapies like intrauterine balloon tamponade (IUBT), uterine compression sutures, and arterial embolization may be used, with hysterectomy reserved as a life-saving procedure. Compared with surgical interventions, IUBT is less invasive, avoids inherent surgical complications, limits delays in care, does not require specialized resources, is cost-effective, and has evidence of success. The optimal timing and usage of IUBT is undetermined, with evidence suggesting early utilization may be beneficial. This randomized controlled trial aims to compare the effectiveness IUBT (Belfort-Dildy balloon) in combination with second-line uterotonics versus IUBT (Belfort-Dildy balloon) placement after the failure of second-line uterotonic treatment in managing persistent severe PPH after vaginal delivery and first-line uterotonic administration.
Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-day Prospective Observational Cohort Study
Authors: Gerber C , Bishop DG , Dyer RA ,   on behalf of the African Surgical Outcomes Study (ASOS) Investigators
Published: August 2024

(Anesth Analg. 2024;138(6):1275-1284. doi: 10.1213/ANE.0000000000006750)

A key finding of the African Surgical Outcomes Study (ASOS) was that general anesthesia (GA) was linked to higher maternal and neonatal risk and that cesarean delivery (CD) in Africa was 50 times higher than in high-income countries. The ASOS recruited consecutive patients 18 years or older who had inpatient surgery in 183 hospitals in 22 African countries over a 7-day period between February 2016 and May 2016. This ASOS substudy of the obstetric cohort was designed primarily to estimate the association between preoperative risk factors and the outcome of the type of anesthesia administered. The secondary aim was to estimate the association between the method of anesthesia and maternal and neonatal outcomes.
Risks of Fetal Exposure to Topiramate
Authors: Meador KJ
Published: August 2024

(N Engl J Med. 390(12):1141–1142. doi: 10.1056/NEJMe2401164)

Antiseizure medications are frequently used in individuals of childbearing potential for a variety of conditions such as pain management, epilepsy, and psychiatric disorders. However, these medications pose potential risks to the developing fetus, including congenital malformations and cognitive or behavioral impairments. Although all antiseizure medications have teratogenic potential, the severity of these effects varies significantly across different medications.
Role of Cosyntropin in the Management of Postpartum Postdural Puncture Headache: A Two-center Retrospective Cohort Study
Authors: Pancaro C , Balonov K , Herbert K , Shah N , Segal S , Cassidy R , Engoren MC , Manica V , Habib AS
Published: August 2024

(Int J Obstet Anesth. 2023;56:103917. doi: 10.1016/j.ijoa.2023.103917)

Approximately half a million women in the UK and up to two million in the USA receive labor neuraxial analgesia annually, with 0.5% to 1.5% experiencing unintentional dural puncture (UDP), leading to postdural puncture headache (PDPH) in 70% of cases. An epidural blood patch (EBP) is often necessary when conservative measures fail. Research suggests that prophylactic and therapeutic use of an adrenocorticotropic hormone analog, cosyntropin, may reduce PDPH incidence with the theoretical basis for its efficacy lying in its modulation of pain pathways, resembling morphine-like properties, and potential influence on cerebrospinal fluid dynamics. However, studies in this area are limited and contradictory.
Fellowship for Academic Generalists in Obstetrics and Gynecology
Authors: Abbate Alexandra M. , Knittel Andrea K. , Haas David M. , Moore Simas Tiffany A. , Learman Lee A. , Bienstock Jessica L. , Famuyide Abimbola O. , Peipert Jeffrey F. , Borahay Mostafa A.
Published: August 2024

Academic specialists in general obstetrics and gynecology are clinicians practicing the full breadth of the specialty while also contributing to medical education and scientific discovery. Residency programs in obstetrics and gynecology provide exposure to research training that is variable but frequently limited. This creates challenges for junior faculty and in many cases limits their research productivity, typically measured by published original research articles and grant funding. This frequently disadvantages academic specialists in promotion compared with their subspecialty fellowship–trained colleagues. A few research fellowship programs were recently launched to address this issue. However, these programs are not uniform and encounter challenges such as sustainable funding. In this article, building on knowledge from current academic specialist fellowship programs, we discuss the needs, challenges, and proposed solutions. We also propose some details needing further discussion among the academic obstetrics and gynecology community. We discuss how such fellowships can integrate with current development and training opportunities such as the Women's Reproductive Health Research award, Building Interdisciplinary Research Careers in Women's Health award, other K and K-type career development programs, NIH T32 grants, and clinical research courses for obstetricians and gynecologists. Academic specialist fellowship programs can have synergy with other women's health fellowship programs offered by other specialties. They can additionally leverage institutional resources. We conclude by summarizing a proposed model for academic specialist research fellowship programs.
ADAPTIVE OPTICS AND MULTIMODAL IMAGING FOR INFLAMMATORY VITREORETINAL INTERFACE ABNORMALITIES
Authors: Satcho Emmanuelle , Snyder Valerie C. , Dansingani Kunal K. , Liasis Alki , Kedia Nikita , Gofas-Salas Elena , Chhablani Jay , Martel Joseph N. , Sahel José-Alain , Paques Michel , Rossi Ethan A. , Errera Marie-Helene
Published: August 2024

Purpose:

To investigate changes to the vitreoretinal interface in uveitis with multimodal imaging including adaptive optics.

Methods:

Four eyes (four patients) affected by fovea-attached (subtype 1A) or fovea-sparing epiretinal membranes (ERMs) on spectral-domain optical coherence tomography or visible internal limiting membrane (ILM) on infrared scanning laser ophthalmoscope (SLO) fundus imaging were recruited in this pilot study. The microstructure of the vitreoretinal interface was imaged using flood-illumination adaptive optics (FIAO), and the images were compared with the cross-sectional spectral-domain optical coherence tomography data.

Results:

Adaptive optics images revealed multiple abnormalities of the vitreoretinal interface, such as deep linear striae in ERM, and hyperreflective microstructures at the location of ERMs and ILMs. The cone mosaic was imaged by FIAO and was found altered in the four eyes with ERMs or visible ILM. The same four eyes presented alteration of photopic 30 Hz flicker that was reduced in amplitude indicating cone inner retinal layer dysfunction.

Conclusion:

FIAO imaging can identify specific patterns associated with ERMs and ILMs. Correlating FIAO imaging of the vitreomacular interface with the structural alterations seen in FIAO at the level of the outer retinal structures can help understand the cause of significant macular dysfunction associated with ERM.
COMPREHENSIVE MOLECULAR PROFILING OF UVEAL MELANOMA EVALUATED WITH GENE EXPRESSION PROFILING, PREFERENTIALLY EXPRESSED ANTIGEN IN MELANOMA EXPRESSION, AND NEXT-GENERATION SEQUENCING
Authors: Alsoudi Amer F. , Skrehot Henry C. , Chévez-Barrios Patricia , Divatia Mukul , De La Garza Maria , Bretana Maria E. , Schefler Amy C.
Published: August 2024

Purpose:

To determine the association between gene-expression profiling (GEP), next-generation sequencing (NGS), preferentially expressed antigen in melanoma (PRAME) features, and metastatic risk in patients with uveal melanoma (UM).

Methods:

A retrospective analysis of patients with UM treated by brachytherapy or enucleation by a single ocular oncologist was conducted from November 2020 and July 2022. Clinicopathologic features, patient outcomes, GEP classification, NGS, and PRAME results were recorded.

Results:

Comprehensive GEP, PRAME, and NGS testing was performed on 135 UMs. The presence of eukaryotic translation initiation factor 1A, X-chromosomal and splicing factor 3B subunit 1 mutations was significantly associated with GEP class 1A and GEP class 1B, respectively. The presence of BRCA- associated protein-1 mutation was significantly associated with GEP class 2. The average largest basal diameter for tumors with eukaryotic translation initiation factor 1A, X-chromosomal mutations was significantly smaller than those with splicing factor 3B subunit 1 mutations and BRCA1-associated protein-1 mutations. Class 2 tumors metastasized sooner than GEP class 1 tumors. Tumors with splicing factor 3B subunit 1 and/or BRCA1-associated protein-1 mutations metastasized sooner compared with tumors that had either no driver mutation or no mutations at all. Tumors with splicing factor 3B subunit 1 did not have a significantly different time to metastasis compared with tumors with BRCA1-associated protein-1 (P value = 0.97). Forty tumors (30%) were PRAME positive, and the remaining 95 tumors (70%) were PRAME negative. Tumors with PRAME-positive status did not have a significantly different time to metastasis compared with tumors without PRAME-positive status (P value = 0.11).

Conclusion:

GEP, NGS, and PRAME expression analysis help determine different levels of metastatic risk in UM. Although other prognostic tests exist, the following study reports on the use of NGS for metastatic prognostication in UM. However, limitations of NGS exist, especially with small lesions that are technically difficult to biopsy.
SURGICAL OUTCOMES AND INTRAOPERATIVE PARAMETERS OF THREE-DIMENSIONAL VISUALIZATION SYSTEM VERSUS CONVENTIONAL MICROSCOPES FOR MACULAR SURGERY IN HIGHLY MYOPIC EYES
Authors: Tsui Mei-Chi , Hsieh Yi-Ting , Lai Tso-Ting , Lee Cheng-Yung , Hsia Yun , Wang Shih-Wen , Ma I-Hsin , Hung Kuo-Chi , Lin Chang-Pin , Yang Chang-Hao , Yang Chung-May , Ho Tzyy-Chang
Published: August 2024

Purpose:

To investigate the surgical outcomes and intraoperative parameters of 3D visualization system for macular diseases in highly myopic eyes.

Methods:

In this single-center, prospective, randomized, comparative interventional study, 40 highly myopic eyes (axial length > 26 mm) were randomly assigned to either a 3D visualization system or a conventional microscope group. Surgical outcomes and intraoperative parameters, including the number of indocyanine green injections, surgical time, and epiretinal membrane/internal limiting membrane peeling time, were compared.

Results:

The 3D group required significantly fewer indocyanine green injections (1.3 ± 0.5 vs. 2.3 ± 0.7, P < 0.001), had shorter epiretinal membrane/internal limiting membrane peeling times (522.8 ± 258.0 vs. 751.8 ± 320.2 seconds, P < 0.05), and experienced fewer intraoperative retinal hemorrhages (0 vs. 7 cases, P < 0.05) compared with the conventional microscope group. Anatomical and functional outcomes were comparable between the two groups.

Conclusion:

The 3D system exhibited a lower number of indocyanine green injections, shorter epiretinal membrane/internal limiting membrane peeling times, and a reduced incidence of intraoperative retinal hemorrhages, suggesting the 3D visualization system may offer advantages for macular surgery in highly myopic eyes.
Diagnostic Power and Reproducibility of Objective Perimetry in Glaucoma
Authors: Maddess Ted , Carle Corinne F. , Kolic Maria , Saraç Özge , Essex Rohan W. , Rohan Emilie M.F. , Sabeti Faran , van Kleef Josh P.
Published: August 2024

Précis:

An objective perimetry method provides four 30-2 style reports in 8 minutes. These comprise sensitivity and delay reports for both eyes. A combined report format shows comparable diagnostic power to 2 forms of automated perimetry.

Purpose:

To compare objective perimetry with 2 forms of standard automated perimetry (SAP) in glaucoma.

Methods:

The study cohort contained 40 persons with glaucoma (PwG) and 94 normal control subjects. The PwG had both perimetric and preperimetric eyes. Multifocal pupillographic objective perimetry was performed with the objectiveField Analyser (OFA), which independently assesses the visual fields of both eyes concurrently. Its OFA30 test assessed the central ±30 degrees, and the OFA15 test assessed the central ±15 degrees, both providing 30-2 style reports. The OFA tests were repeated 2 weeks apart to assess test-retest variability (TRV). OFA was compared with Matrix and HFA-SITA fast 24-2 threshold testing. Diagnostic power was quantified as the area under the receiver operating characteristic curves (AUROC). Test durations, mean defects, and pattern standard deviations of the 4 tests were compared.

Results:

At a median of 4.09±0.02 minutes/eye the OFA tests were quicker than SAP (all P≤0.0001), 2 minutes/eye if OFA per-region sensitivities and delays are considered separately. The %AUROCs for OFA, Matrix, and HFA were not significantly different, averaging 93±3% (mean±SD) in perimetric eyes, and 73±6% in preperimetric eyes. For moderate to severe fields, OFA TRV was less than the published results for SAP. OFA30 mean defects were significantly correlated between repeats (r=0.91) and with OFA15 (r=0.93, both P<0.0001).

Conclusions:

OFA provides extra functional measures in the form of per-region delays and between-eye asymmetries. Both the OFA wide-field and macular tests provided comparable diagnostic power to SAP and better TRV in damaged eyes.
Ecthyma Gangrenosum Secondary to Multidrug-Resistant Gram-Negative Rod Infections in Leukemia Patients With Prolonged Neutropenia
Authors: Patel Raj H. , Velez Ana Paula , Greene John N.
Published: August 2024

Ecthyma gangrenosum is a cutaneous infection classically associated with Pseudomonas aeruginosa as the causative pathogen, but other gram-negative enteric flora can be found. This infection is typically seen in immunocompromised patients in the setting of fulminant bacteremia with lesional features of gangrenous ulceration surrounded by tender erythematous borders. In patients with hematological malignancies, prompt recognition of this entity through microbiological and clinical features is critical to ensuring successful treatment and resolution. As patients with refractory leukemia live longer with breakthroughs in therapy, infectious complications are becoming more common along with increasing resistant gram-negative pathogens. Herein, we present 9 cases of ecthyma gangrenosum caused by multidrug-resistant gram-negative bacteria in leukemia patients with prolonged neutropenia, which were successfully managed with combination antibiotic therapy.
Arcanobacterium haemolyticum Bacteremia and Possible Meningitis in a Previously Healthy 14-Year-Old Male Patient
Authors: Bozso Clare R. , Leibowitz Jill , Barton Michael , Ostovar Gholamabbas Amin , Rubin Lorry G.
Published: August 2024

Arcanobacterium haemolyticum is known to cause pharyngitis in adolescents. We report the case of a healthy 14-year-old male patient with A. haemolyticum bacteremia with possible associated meningitis. Arcanobacterium haemolyticum should be considered as a source of infection in young, immunocompetent patients with systemic illness in the setting of recent or active pharyngitis.
Retrospective Cohort Study of Financial Incentives for Sexually Transmitted Infection Testing and Treatment in an Outreach Population in Edmonton, Canada, 2018–2019
Authors: Krahn Jessica , Gratrix Jennifer , Khan MuhammadNaeem , Meyer Garret , Smyczek Petra , Singh Ameeta E.
Published: August 2024

Background

The incidence of sexually transmitted infections (STI) continues to increase worldwide. Patient incentives are one proposed intervention to increase STI testing and treatment.

Methods

We conducted a retrospective cohort study comparing incentivized versus routine care for STI outreach test and treat services between October 2018 and June 2019. Incentivized care included a $10 gift card for testing visits and an additional $10 gift card for results and/or treatment visits. Incentivized visits were offered to clients with a lack of housing, who were difficult to locate, or had a history of being lost to follow-up. All test and treatment visits included chlamydia, gonorrhea, syphilis, and HIV testing and/or treatment by Registered Nurses and outreach workers from an STI Clinic. Outreach visits were offered at subsidized housing locations, community-based organizations, and street outreach.

Results

From October 2018 to June 2019, 2384 outreach clients were reached: 453 (19.0%) received incentives and 1931 (81.0%) received routine care. There were no significant differences in case-finding rates for chlamydia (4.8%), gonorrhea (2.9%), and HIV (0.1%); however, there was for syphilis (3.8% for incentivized vs. 1.9% for routine visits; P = 0.02). All newly diagnosed infections identified in the incentivized group received treatment compared with routine visits (chlamydia 100% vs 79.1%, P = 0.008, gonorrhea 100% vs 59.7%, P = 0.002, and syphilis 100% vs. 86.7%, P = 0.08).

Conclusions

Incentives were associated with increased case-finding rates of syphilis and were associated with 100% treatment rates. Incentives are a promising approach to decreasing the burden of STI among outreach populations.